Gamified Attention Bias Modification Training to Augment Cognitive-Behavioral Therapy for Youth Anxiety Disorders: A Randomized Controlled Trial
Child And Adolescent Mental Health
Gamified Attention Bias Modification Training to Augment Cognitive-Behavioral Therapy for Youth Anxiety Disorders: A Randomized Controlled Trial
Child And Adolescent Mental Health

Gamified Attention Bias Modification Training to Augment Cognitive-Behavioral Therapy for Youth Anxiety Disorders: A Randomized Controlled Trial

J Am Acad Child Adolesc Psychiatry. 2025 Aug 22:S0890-8567(25)01428-5. doi: 10.1016/j.jaac.2025.08.010. Online ahead of print.

ABSTRACT

OBJECTIVE: Augmenting cognitive-behavioral therapy (CBT) with attention-bias modification training (ABMT) may maximize therapeutic benefit for anxiety through targeting different underlying processes. Yet, corresponding neural mechanisms are unclear. This pre-registered double-blind, randomized controlled trial assigned youth with anxiety disorders receiving CBT to active or sham gamified ABMT. Group differences in clinical efficacy, and associations between amygdala connectivity and treatment outcomes, were examined.

METHOD: Pediatric patients (N=121; 8-17y) with anxiety disorders were randomized to active or sham gamified ABMT alongside 12-weeks of manualized CBT. Primary outcomes were clinician-rated Pediatric Anxiety Rating Scale (PARS) and Clinical Global Impression-Improvement (CGI-I) Scale. Amygdala seed-based connectivity during an fMRI dot-probe attention-bias task was measured before and after treatment in patients, and across the same time-interval in healthy controls.

RESULTS: Over treatment, PARS decreased significantly in both groups (F(2, 214)=82.84; p<.001, ηp2=0.44). Contrary to hypotheses, active ABMT did not enhance symptom reductions (F(2, 214)=0.61; p=.54, ηp2<0.01). There was no difference in the proportion of CGI-I treatment responders vs. non-responders between active and sham (Χ2=0.76, p=.38). Amygdala connectivity is reported, but should be interpreted with caution due to poor observed test-retest reliability in healthy controls (ICC(3,1)<0.4). Lower post-treatment anxiety was associated with weaker left-amygdala connectivity with several cortical regions on threat-congruent trials.

CONCLUSION: Hypotheses that youth receiving active gamified ABMT+CBT would show greater improvement were not supported. Findings highlight the need to explore alternate attention-bias modification strategies for augmenting the clinical response to CBT for anxiety. Future research should continue to examine reliability of attention-bias tasks adapted for fMRI.

PMID:40850530 | DOI:10.1016/j.jaac.2025.08.010