Project Summary This application proposes to collect preliminary data on Attention Bias Modification Training (ABMT) amongclinic referred children and adolescents who display subthreshold impairing anxiety (SubImpAnx; anxiety &related impairment that fails to meet DSM criteria for an anxiety disorder). Traditional approaches to mentalhealth service delivery cannot meet current demand. The inadequacies of traditional service delivery aremagnified when viewed through the lens of impaired but undiagnosed youth. It is an unaddressed empiricalquestion whether a least restrictive treatment can effectively reduce SubImpAnx in youth. Empirical efforts toaddress this issue are important because youths with SubImpAnx experience substantial impairment, are athigh risk of escalation to full syndrome anxiety disorder, and pose a burden on the health care system. ABMT is a novel translational treatment for anxiety based on experimental and neuroscience researchfindings on attention processes. Research demonstrates that ABMT leads to reductions in anxiety and itsdisorders. ABMT holds promise as a potential least restrictive treatment for SubImpAnx because (a) youth withSubImpAnx display an attention bias toward threatening stimuli, (b) ABMT is brief, inexpensive, and highlyportable, and (c) ABMT does not require skilled clinicians. This study will enroll 66 clinic referred children and adolescents (ages 8-16 years) who meet criteria forSubImpAnx. Participants will be randomly assigned to complete 8 sessions of either ABMT or a placebocontrol (PC) task over 4 weeks. Clinician ratings on youth anxiety severity and impairment will be evaluated asthe primary outcome. Youth self ratings and parent ratings on youth anxiety symptoms and impairment will beevaluated as secondary outcomes. All measures will be collected before condition assignment (pretreatment),at immediate posttreatment, and at an 8 week follow up. In addition, initial data will be collected to shed light onwhether it would be useful to pursue (a) attention bias to threat as a mediator of ABMT's anxiety reductioneffects and (b) dose-response issues related to ABMT's anxiety reduction effects in a subsequent, larger study. The specific aims are: Collect pilot data on the effects of ABMT and a PC task on levels of anxiety andimpairment at a post evaluation (Aim 1) and at a follow up (FU) evaluation 8 weeks after the post evaluation(Aim 2); Preliminarily examine whether ABMT leads to lower levels of attention bias toward threatening stimulias compared to a PC Task at post and 8 week FU (Aim 3); Describe the course of anxiety symptoms andimpairment during treatment among youth in the ABMT condition (Aim 4). This project will provide critically needed pilot data on ABMT for youth with SubImpAnx. With these data inhand, the field will be in a better position to determine whether ABMT may be used as a least restrictiveintervention among anxious youth who are 'impaired but undiagnosed.'
