What Drives Symptom Reduction in Attention Bias Modification Treatment? A Randomized Controlled Experiment in Clinically Anxious Youths

Attention-bias modification (ABM) is a novel treatment for anxiety disorders. We tested the contribution of two possible factors implicated in ABM’s efficacy: training of threat-related selective spatial attention and exposure to threat. We also measured general attention control to examine its potential role in treatment effects. A four-arm randomized controlled design was used, which dissociated spatial attention and threat exposure while equating treatment expectancies. One hundred clinically anxious youths were randomized and assessed at pretreatment, midtreatment, posttreatment, and 3-month follow-up. All four groups manifested large reductions in anxiety symptoms; there were no significant between-group differences. Level of change in anxiety symptoms significantly correlated with level of change in youths’ self-rated attention control. Findings did not support the role of either dissociated spatial attention or threat exposure as underlying mechanisms. Implications of the findings are discussed including possible roles of expectations and general attention control in ABM efficacy.