Attention Bias Modification for Anxiety in Childhood Cancer Survivors
Recruiting in Palo Alto (17 mi)
Age: < 65
Sex: Any
Travel: May Be Covered
Time Reimbursement: Varies
Trial Phase: Academic
Recruiting
Sponsor: Fred Hutchinson Cancer Center
Disqualifiers: Active cancer treatment, Cognitive impairment, No technology, others
No Placebo Group
Trial Summary
What is the purpose of this trial?This clinical trial studies how well attention bias modification (ABM) improves anxiety in adolescent and young adult (AYA) cancer survivors. Cancer-related anxiety is the most prevalent mental health problem affecting AYA cancer survivors. Cancer-related anxiety is associated with long-term negative outcomes such as poor quality of life, depression, distress, substance use, sleep problems, fatigue, and pain. ABM uses techniques to help patients change the way they react to environmental triggers that may cause a negative reaction. ABM uses brief self-guided smartphone applications. Patients complete repetitive association reaction-time tasks targeting automatic and unconscious negative attention biases to retrain attention away from perceived threat and towards a neutral or positive stimuli. Gratitude-finding and savoring activities are also provided to maintain and increase positive emotions. Using ABM plus gratitude-finding and savoring activities may improve anxiety in AYA cancer survivors.
Will I have to stop taking my current medications?
The trial information does not specify whether you need to stop taking your current medications. It is best to discuss this with the trial coordinators or your doctor.
What data supports the effectiveness of the treatment Attention Bias Modification for anxiety in childhood cancer survivors?
Research shows that Attention Bias Modification (ABM) can help reduce anxiety in children by training them to focus away from negative or threatening information. Studies have found that children who underwent ABM experienced significant decreases in anxiety symptoms, and many no longer met the criteria for anxiety disorders after treatment.
12345Is Attention Bias Modification (ABM) safe for children?
Research on Attention Bias Modification (ABM) in children with anxiety shows it is generally safe and well-tolerated. Studies found that children and their parents found the program acceptable, and no safety concerns were reported.
12367How is Attention Bias Modification (ABM) treatment different from other treatments for anxiety in childhood cancer survivors?
Attention Bias Modification (ABM) is unique because it focuses on training children to shift their attention away from threatening information and towards positive stimuli, using computer-based tasks. This approach is different from traditional therapies as it directly targets the underlying attention patterns associated with anxiety, rather than just addressing symptoms.
12348Eligibility Criteria
This trial is for adolescent and young adult cancer survivors who have experienced anxiety after battling childhood cancer, head and neck cancers, or leukemia. Participants should be comfortable using internet-based applications and willing to engage in interviews and questionnaires.Inclusion Criteria
I am between 15 and 29 years old.
I have been diagnosed with cancer.
I received cancer treatment aimed at curing me at a specified hospital.
+4 more
Exclusion Criteria
Patients who cannot understand/read/write English will be excluded from the research because the ABM intervention is currently only available in English
I am unable to take part in specific activities or answer surveys due to physical or cognitive reasons.
I am currently receiving treatment aimed at curing my cancer.
Trial Timeline
Screening
Participants are screened for eligibility to participate in the trial
2-4 weeks
Treatment
Participants engage in ABM or inert attention task sessions over 10 minutes twice a week and respond daily to text messaging prompts for 4 weeks
4 weeks
8 sessions (virtual), daily text prompts
Follow-up
Participants are monitored for safety and effectiveness after treatment
4 weeks
1 follow-up survey (virtual)
Open-label extension (optional)
Participants are given access to all components of ABM and texts on study after completion of the follow-up survey
Participant Groups
The study tests if attention bias modification (ABM) via smartphone apps can reduce anxiety by redirecting focus from negative triggers to neutral or positive stimuli. It includes gratitude exercises and aims to improve the mental health of young cancer survivors.
2Treatment groups
Experimental Treatment
Active Control
Group I: Arm I (ABM)Experimental Treatment4 Interventions
Patients engage in ABM over 10 minutes BIW and respond daily to text messaging prompts for 4 weeks.
Group II: Arm II (inert attention task)Active Control3 Interventions
Patients engage in inert attention task sessions over 10 minutes BIW for 4 weeks. Patients also receive and respond to text messaging prompts QD for 4 weeks. After completion of the 4 week follow up survey, patients are given access to all components of ABM and texts on study.
Find a Clinic Near You
Research Locations NearbySelect from list below to view details:
Fred Hutch/University of Washington/Seattle Children's Cancer ConsortiumSeattle, WA
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Who Is Running the Clinical Trial?
Fred Hutchinson Cancer CenterLead Sponsor
National Cancer Institute (NCI)Collaborator
References
A case series of attention modification in clinically anxious youths. [2021]Research in the last fifteen years suggests that anxious individuals selectively attend towards threatening information. Attention modification interventions for internalizing adults have been developed to target cognition at this basic level; these programs have demonstrated initial efficacy in attention bias and anxiety symptom reduction. To date, there have been no published studies of attention modification in youths with clinical levels of anxiety. The current case series examined the initial efficacy of a four-week (12 sessions) attention modification program (AMP) designed to train attention away from threat in 16 children and adolescents (ages 10 to 17) diagnosed with DSM-IV anxiety disorders. Overall, youths experienced a significant decrease in anxiety and depression symptoms, and 12 of 16 youths no longer met criteria for any anxiety diagnosis at post-treatment. AMP was feasible with youths, and all youths and parents deemed the program acceptable. These findings provide support for further research on the use of cognitive bias modification interventions with clinically anxious youths.
Look for good and never give up: A novel attention training treatment for childhood anxiety disorders. [2018]Attention bias modification training (ABMT) is a promising treatment for anxiety disorders. Recent evidence suggests that attention training towards positive stimuli, using visual-search based ABMT, has beneficial effects on anxiety and attention biases in children. The present study extends this prior research using distinctive techniques designed to increase participant learning, memory consolidation, and treatment engagement. Fifty-nine clinically anxious children were randomly assigned to the active treatment condition (ATC) (N = 31) or waitlist control condition (WLC) (N = 28). In the ATC, children completed 12 treatment sessions at home on computer in which they searched matrices for a pleasant or calm target amongst unpleasant background pictures, while also engaging in techniques designed to consolidate learning and memory for these search strategies. No contact was made with children in the WLC during the wait period. Diagnostic, parent- and child-reports of anxiety and depressive symptoms, externalising behaviour problems and attention biases were assessed pre- and post-condition and six-months after treatment. Children in the ATC showed greater improvements on multiple clinical measures compared to children in the WLC. Post-treatment gains improved six-months after treatment. Attention biases for angry and happy faces did not change significantly from pre-to post-condition. However, larger pre-treatment attention bias towards threat was associated with greater reduction in anxiety at post-treatment. Also, children who showed greater consolidation of learning and memory strategies during treatment achieved greater improvement in global functioning at post-treatment. Attention training towards positive stimuli using enhanced visual-search procedures appears to be a promising treatment for childhood anxiety disorders.
Training-associated changes and stability of attention bias in youth: Implications for Attention Bias Modification Treatment for pediatric anxiety. [2021]Attention Bias Modification Treatment (ABMT), an emerging treatment for anxiety disorders, is thought to modify underlying, stable patterns of attention. Therefore, ABMT research should take into account the impact of attention bias stability on attention training response, especially in pediatric populations. ABMT research typically relies on the dot-probe task, where individuals detect a probe following an emotional-neutral stimulus pair. The current research presents two dot-probe experiments relevant to ABMT and attention-bias stability. In Experiment 1, anxious youth receiving 8-weeks of cognitive-behavioral therapy (CBT) were randomly assigned to ABMT that trains attention towards happy faces (n=18) or placebo (n=18). Two additional comparison groups, anxious youth receiving only CBT (n=17) and healthy comparison youth (n=16), were studied. Active attention training towards happy faces did not augment clinician-rated response to CBT; however, individuals receiving training exhibited reductions on self-report measures of anxiety earlier than individuals receiving CBT only. In Experiment 2, healthy youth (n=12) completed a dot-probe task twice while undergoing functional magnetic resonance imaging. Intra-class correlation demonstrated stability of neural activation in response to attention bias in the ventrolateral prefrontal cortex and amygdala. Together, these two studies investigate the ways in which attention-bias stability may impact future work on ABMT.
Attention Training as a Low-Intensity Treatment for Concerning Anxiety in Clinic-Referred Youth. [2023]Although youth anxiety treatment research has focused largely on severe and impairing anxiety levels, even milder anxiety levels, including levels that do not meet full criteria for a diagnosis, can be impairing and cause for concern. There is a need to develop and test viable treatments for these concerning anxiety levels to improve functioning and reduce distress. We present findings from a randomized controlled efficacy trial of attention bias modification treatment (ABMT) and attention control training (ACT) for youths with concerning anxiety levels. Fifty-three clinic-referred youths (29 boys, M age = 9.3 years, SD age = 2.6) were randomized to either ABMT or ACT. ABMT and ACT consisted of attention-training trials in a dot-probe task presenting angry and neutral faces; probes appeared in the location of neutral faces in 100% of ABMT trials and 50% of ACT trials. Independent evaluators provided youth anxiety severity ratings; youths and parents provided youth anxiety severity and global impairment ratings; and youths completed measures of attention bias to threat and attention control at pretreatment, posttreatment, and 2-month follow-up. In both arms, anxiety severity and global impairment were significantly reduced at posttreatment and follow-up. At follow-up, anxiety severity and global impairment were significantly lower in ACT compared with ABMT. Attention control, but not attention bias to threat, was significantly improved at follow-up in both arms. Changes in attention control and attention focusing were significantly associated with changes in anxiety severity. Findings support the viability of attention training as a low-intensity treatment for youths with concerning anxiety levels, including levels that do not meet full criteria for a diagnosis. Superior anxiety reduction effects in ACT highlight the critical need for mechanistic research on attention training in this population.
Pooled patient-level meta-analysis of children and adults completing a computer-based anxiety intervention targeting attentional bias. [2018]Computer-based approaches, such as Attention Bias Modification (ABM), could help improve access to care for anxiety. Study-level meta-analyses of ABM have produced conflicting findings and leave critical questions unresolved regarding ABM's mechanisms of action and clinical potential. We pooled patient-level datasets from randomized controlled trials of children and adults with high-anxiety. Attentional bias (AB) towards threat, the target mechanism of ABM, was tested as an outcome and a mechanistic mediator and moderator of anxiety reduction. Diagnostic remission and Liebowitz Social Anxiety Scale (LSAS) were clinical outcomes available in enough studies to enable pooling. Per-patient data were obtained on at least one outcome from 13/16 eligible studies [86% of eligible participants; n=778]. Significant main effects of ABM on diagnostic remission (ABM-22.6%, control-10.8%; OR=2.57; p=0.006) and AB (β* (95%CI)=-0.63 (-0.83, -0.42); p
Visual attention in long-term survivors of leukemia receiving cranial radiation therapy. [2007]The effect of cranial radiation therapy (CRT) on visual attention was examined in long-term survivors of childhood acute lymphoblastic leukemia (ALL) compared to peers with no history of ALL (n = 24) using a cued orienting task and a global-local task. ALL participants treated with CRT (n = 13) demonstrated an increased cost in response time with invalid spatial orienting cues and inefficient shifts of attention across hierarchical levels. ALL participants treated only with chemotherapy (n = 8) showed performance similar to the non-ALL comparison group. Participants with exposure to CRT early in life appeared to largely account for the attention deficits, and showed particular difficulties with shifting attention from the local level of stimuli to the global level. The data are consistent with prior reports emphasizing attention deficits following CRT, and suggest that attention shifting may be particularly affected by CRT early in life.
The Generalization of Conscious Attentional Avoidance in Response to Threat Among Breast Cancer Women With Persistent Distress. [2022]A sample of women with persistent distress following breast cancer (BC) previously exhibited attentional bias (AB) away from supraliminally presented cancer-or threat-related information, responses consistent with avoidance coping, and showed negative interpretation bias. Here, we attempt to characterize the nature of supraliminal AB and interpretation bias in that sample of women by comparing against healthy controls.
Efficacy of Attention Bias Training for Child Anxiety Disorders: A Randomized Controlled Trial. [2020]A growing evidence base supports attention bias modification (ABM) as a novel intervention for anxiety. However, research has been largely conducted with adults and analogue samples, leaving the impact of ABM for child anxiety be fully elucidated. Thus, we conducted a double-blind, randomized controlled trial testing ABM efficacy versus an attention control condition (CC) in 31 children diagnosed with anxiety disorder. Youth were assigned to 4 weeks of ABM where attention was trained away from threat, or a sham CC in which no bias training occurred. Findings indicate that significantly more youth in the ABM versus CC group were considered treatment responders post training. The ABM versus CC group also demonstrated a greater decrease in anxiety severity, with this difference being marginally significant. Findings lend support for the potential of ABM in reducing youth anxiety. Further work regarding mechanisms of action is warranted to advance ABM research.