OBJECTIVE Randomized clinical trials of augmentation strategies for youth with treatment-resistant anxiety disorders do not exist. This report presents findings from an efficacy trial of attention bias modification treatment (ABMT) as an augment for this population compared with attention control training (ACT). METHOD Sixty-four youths (34 boys; mean age 11.7 years) who continued to meet for anxiety diagnoses after completing cognitive-behavioral therapy were randomized to ABMT or ACT. ABMT and ACT consisted of dot-probe attention training trials presenting angry and neutral faces; probes appeared in the location of neutral faces on 100% of trials in ABMT and 50% of trials in ACT. Independent evaluators, youths, and parents completed ratings of youth anxiety severity, and youths completed measures of attention bias to threat and attention control at pretreatment, post-treatment, and 2-month follow-up. RESULTS The 2 arms showed significant decreases in anxiety severity, with no differences between arms. Specifically, across informants, anxiety severity was significantly decreased at post-treatment and decreases were maintained at follow-up. Primary anxiety disorder diagnostic recovery combined across arms was 50% at post-treatment and 58% at follow-up. Attention control, but not attention bias to threat, was significantly improved at post-treatment in the 2 arms. CONCLUSION This is the first study to show anxiety can be decreased in youth who did not respond to cognitive-behaviorial therapy, and that the anxiety-decreasing effect is found using these 2 attention training contingency schedules. These findings and increases in attention control in the 2 arms raise intriguing questions about mechanisms of decreasing anxiety in treatment-resistant youth with attention training that require further research. CLINICAL TRIAL REGISTRATION INFORMATION Attention Bias Modification Training for Child Anxiety CBT Nonresponders; https://clinicaltrials.gov/; NCT01819311.

中文翻译：

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青少年抗治疗性焦虑障碍的注意力偏倚调整治疗的随机对照试验。

目的不存在针对患有抗药性焦虑症的年轻人进行强化治疗的随机临床试验。本报告介绍了与注意控制训练（ACT）相比，注意偏倚修饰治疗（ABMT）增强该人群疗效的试验结果。方法将完成认知行为治疗后继续满足焦虑诊断的64名青年（34名男孩；平均年龄11.7岁）随机分配到ABMT或ACT。ABMT和ACT包括点探针注意力训练试验，这些试验表现出生气和中立的面孔；在ABMT中100％的试验和ACT中50％的试验中，探头出现在中性脸部位置。独立评估者，青少年和父母完成了对青少年焦虑严重程度的评估，年轻人在治疗前，治疗后和2个月的随访中完成了针对威胁和注意控制的注意偏见措施。结果2组手臂焦虑严重程度明显降低，两组之间无差异。具体而言，在各种信息提供者中，焦虑严重程度在治疗后显着降低，而随访后仍保持下降。治疗后原发性焦虑症的总体诊断恢复率为50％，随访时为58％。在两组的治疗后，注意力控制得到了显着改善，但注意力对威胁的偏见并未得到明显改善。结论这是第一项显示对未对认知行为疗法有反应的年轻人可以减少焦虑的研究，并且使用这两种注意力训练应变计划可以发现焦虑减轻​​的作用。这些发现和2组手臂注意力控制的提高提出了有趣的问题，即在需要培训的情况下，需要进一步研究的耐抗性降低的年轻人的焦虑减轻机制。临床试验注册信息儿童焦虑症CBT无反应者的注意偏倚调整培训；https://clinicaltrials.gov/; NCT01819311。