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Predictors of Treatment Outcomes in Anxious Children Receiving Group Cognitive-Behavioural Therapy: Pretreatment Attention Bias to Threat and Emotional Variability During Exposure Tasks

Published online by Cambridge University Press:  27 July 2015

Allison M. Waters ,
Alex Potter ,
Leah Jamesion ,
Brendan P. Bradley  and
Karin Mogg
Allison M. Waters*
Affiliation:
School of Applied Psychology and Griffith Health Institute, Griffith University, Brisbane, Queensland, Australia
Alex Potter
Affiliation:
School of Applied Psychology and Griffith Health Institute, Griffith University, Brisbane, Queensland, Australia
Leah Jamesion
Affiliation:
School of Applied Psychology and Griffith Health Institute, Griffith University, Brisbane, Queensland, Australia
Brendan P. Bradley
Affiliation:
Psychology, University of Southampton, Southampton, United Kingdom
Karin Mogg
Affiliation:
Psychology, University of Southampton, Southampton, United Kingdom
*
Address for correspondence: Dr Allison Waters, School of Applied Psychology, Mt Gravatt campus, Griffith University, 176 Messines Ridge Road, Mt Gravatt QLD 4122, Australia. Email: a.waters@griffith.edu.au
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Abstract

Background and objectives: Pretreatment attention bias towards threat stimuli has been shown to predict treatment outcomes following exposure-based treatments. The extent of emotional variability experienced during exposure therapy has also been found to predict better treatment outcomes in anxious adults. The present study examined whether pretreatment attention bias towards threat stimuli and greater emotional variability during exposure activities were associated with stronger treatment outcomes in anxious children receiving group-based cognitive-behavioural therapy (CBT). Methods: Twenty-six anxious children completed a visual probe task with emotional faces, followed by a 10-week CBT program in a group format. Children completed weekly within-session exposure activities during the last 5 weeks of group CBT. Results: Pretreatment attention bias towards threat stimuli, greater emotional variability and within-session habituation during exposure activities were significantly associated with reductions in clinician- and/or parent-rated anxiety symptoms after the 10-week CBT program. Treatment responders had significantly higher peak emotional distress ratings during exposure activities. However, threat attention bias and within-session exposure measures were not significantly related. Conclusions: Pre-existing individual differences in attention bias to threat cues and the degree of emotional reactivity experienced during exposure activities are both important independent predictors of treatment outcomes for anxious children receiving group-based CBT.

Keywords

anxietychildrenattention biasemotional variabilitycognitive behavioural therapy
Type
Standard Papers
Information
Behaviour Change , Volume 32 , Issue 3 , September 2015 , pp. 143 - 158
Copyright
Copyright © The Author(s) 2015 

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References

Bandarian Balooch, S., Neumann, D., & Boschen, M.J. (2012). Extinction treatment in multiple contexts attenuates ABC renewal in humans. Behaviour Research and Therapy, 50, 604–609.CrossRefGoogle Scholar
Bittner, A., Egger, H.L., Erkanli, A., Costello, E., Foley, D.L., & Angold, A. (2007). What do childhood anxiety disorders predict? Journal of Child Psychology and Psychiatry, 48, 1174–1183.CrossRefGoogle ScholarPubMed
Bouton, M.E. (2002). Context, ambiguity, and unlearning: Sources of relapse after behavioral extinction. Biological Psychiatry, 52, 976–986.CrossRefGoogle ScholarPubMed
Clarke, P.J. F., Chen, N.T. M., & Guastella, A.J. (2012). Prepared for best: Readiness to modify attentional processing and reduction in anxiety vulnerability in response to therapy. Emotion, 12, 487–494.CrossRefGoogle ScholarPubMed
Craske, M.G., Kircanski, K., Zelikowsky, M., Mystkowski, J., Chowdhury, N., & Baker, A. (2008). Optimizing inhibitory learning during exposure therapy. Behaviour Research and Therapy, 46, 5–27.CrossRefGoogle ScholarPubMed
Craske, M.G., Treanor, M., Conway, C.C., Zbozinek, T., & Vervliet, B. (2014). Maximizing exposure therapy: An inhibitory learning approach, Behaviour Research and Therapy, 58, 10–23.CrossRefGoogle ScholarPubMed
Culver, N., Stoyanova, M.S., & Craske, M.G. (2012). Emotional variability and sustained arousal during exposure. Journal of Behavior Therapy and Experimental Psychiatry, 43, 787–793.CrossRefGoogle ScholarPubMed
Daniel, A.E. (1983). Power, privilege and prestige. Melbourne, Australia: Longman Cheshire.Google Scholar
Foa, E.B., & Kozak, M.J. (1986). Emotional processing of fear: Exposure to corrective information. Psychological Bulletin, 99, 20–35.CrossRefGoogle ScholarPubMed
Ginsburg, G.S., Becker, E.M., Keeton, C.P., Sakolsky, D., Piacentini, J., Albano, A.M., . . . Kendall, P.C. (2014). Naturalistic follow-up of youths treated for pediatric anxiety disorders. JAMA Psychiatry, 71, 310–318.CrossRefGoogle ScholarPubMed
James, A., Soler, A., & Weatherall, R. (2006). Cognitive behavioural therapy for anxiety disorders in children and adolescents. Cochrane Database Systemic Reviews, 2005 (4). Article No.: CD004690.Google Scholar
Kashani, J.H., & Orvaschel, H. (1990) A community study of anxiety in children and adolescents. American Journal of Psychiatry, 147, 313–318.Google ScholarPubMed
Kendall, P.C. (1994). Treating anxiety disorders in children: Results of a randomized clinical trial. Journal of Consulting and Clinical Psychology, 62, 100–110.CrossRefGoogle ScholarPubMed
Kendall, P.C., Robin, J.A., Hedtke, K.A., Suveg, C., Flannery-Schroeder, E., & Gosch, E.A. (2005). Considering CBT with anxious youth? Think exposure. Cognitive and Behavioral Practice, 12, 136–150.CrossRefGoogle Scholar
Kircanski, K., Mortazavi, A., Castriotta, N., Baker, A.S., Mystkowski, J.L., Yi, R., & Craske, M.G. (2012). Challenges to the traditional exposure paradigm: Variability in exposure therapy for contamination fears. Journal of Behavior Therapy and Experimental Psychiatry, 43, 745–751.CrossRefGoogle Scholar
Lang, A.J., & Craske, M.G. (2000). Manipulations of exposure-based therapy to reduce return of fear: A replication. Behaviour Research and Therapy, 38, 1–12.CrossRefGoogle ScholarPubMed
Legerstee, J.S., Tulen, J.H., Kallen, V.L., Dieleman, G.C., Treffers, P.D., Verhulst, F.C., & Utens, E.M.W.J. (2009). Threat-related selective attention predicts treatment success in childhood anxiety disorders. Journal of the American Academy of Child and Adolescent Psychiatry, 48, 196–205.CrossRefGoogle ScholarPubMed
Legerstee, J.S., Tulen, J.H., Dierckx, B., Treffers, P.D.A., Verhulst, F.C., & Utens, E. M.W.J. (2010). CBT for childhood anxiety disorders: Differential changes in selective attention between treatment responders and non-responders. Journal of Child Psychology and Psychiatry, 51, 162–172.CrossRefGoogle ScholarPubMed
Mackintosh, N.J. (1975). A theory of attention: Variations in the associability of stimuli with reinforcements. Psychological Review, 82, 276–298.CrossRefGoogle Scholar
Manassis, K., Mendlowitz, S.L., Scapillato, D., Avery, D., Fiksenbaum, L., Freire, M., . . . Owens, M.D. (2002). Group and individual cognitive-behavioral therapy for childhood anxiety disorders: A randomized trial. Journal of the American Academy of Child and Adolescent Psychiatry, 41, 1423–1430.CrossRefGoogle ScholarPubMed
MacLeod, C., Mathews, A., & Tata, P. (1986). Attentional bias in emotional disorders. Journal of Abnormal Psychology, 95, 15–20.CrossRefGoogle ScholarPubMed
Mitchell, C.J., De Houwer, J., Lovibond, P.F. (2009). The propositional nature of human associative learning, Behavioral and Brain Sciences, 32, 183–246.CrossRefGoogle ScholarPubMed
Muris, P., Schmidt, H., & Merckelbach, H. (2000). Correlations among two self-report questionnaires for measuring DSM-defined anxiety disorder symptoms in children: The Screen for Child Anxiety Related Emotional Disorders and the Spence Children's Anxiety Scale. Personality and Individual Differences, 28, 333–346.CrossRefGoogle Scholar
Nauta, M.H., Scholing, A., Rapee, R., Abbott, M., Spence, S.H., & Waters, A.M. (2004). Parent-report measure of children's anxiety: Psychometric properties and comparison with child-report in a clinical and normal sample. Behaviour Research & Therapy, 42, 413–439.CrossRefGoogle Scholar
Niles, A.N., Mesri, B., Burklund, L.J., Lieberman, M.D., & Craske, M.G. (2013). Attentional bias and emotional reactivity as predictors and moderators of behavioral treatment for social phobia. Behaviour Research and Therapy, 51, 669–679.CrossRefGoogle ScholarPubMed
Pearce, J.M., & Hall, G. (1980). A model for Pavlovian learning: Variations in the effectiveness of conditioned but not of unconditioned stimuli, Psychological Review, 87, 532–552.CrossRefGoogle Scholar
Pine, D.S., Cohen, P., Gurley, D., Brook, J., & Ma, Y. (1998). The risk for early-adulthood anxiety and depressive disorders in adolescents with anxiety and depressive disorders. Archives of General Psychiatry, 55, 56–64.CrossRefGoogle ScholarPubMed
Podina, I.R., Koster, E.H., Philippot, P., Dethiuer, V., & David, D.O. (2013). Optimal attentional focus during exposure in specific phobia: A meta-analysis. Clinical Psychology Review, 33, 1172–1183.CrossRefGoogle ScholarPubMed
Price, M., Tone, E.B., & Anderson, P.L. (2011). Vigilant and avoidant attention biases as predictors of response to cognitive behavioural therapy for social phobia. Depression and Anxiety, 0, 1–5.Google Scholar
Rapee, R.M., Schniering, C., & Hudson, J.L. (2009). Anxiety disorders during childhood and adolescents: Origins and treatment. Annual Review of Clinical Psychology, 5, 311–341.CrossRefGoogle ScholarPubMed
Rauch, S., & Foa, E. (2006). Emotional processing theory (EPT) and exposure therapy for PTSD. Journal of Contemporary Psychotherapy, 36, 61–65.CrossRefGoogle Scholar
Rescorla, R.A., & Wagner, A.R. (1972). A theory of Pavlovian conditioning: variations in the effectiveness of reinforcement and non-reinforcement. In Prokasy, A.H. (Ed.), Classical conditioning II: Current research and theory (pp. 64–99). New York: Appleton-Century-Croft.Google Scholar
Rowe, M.K., & Craske, M.G. (1998). Effects of varied-stimulus exposure training on fear reduction and return of fear. Behaviour Research and Therapy, 36, 719–734.CrossRefGoogle ScholarPubMed
Roy, A.K., Vasa, R.A., Bruck, M., Mogg, K., Bradley, B.P., Sweeney, M., . . . Pine, D.S. (2008). Attention bias toward threat in paediatric anxiety disorders. Journal of the American Academy of Child and Adolescent Psychiatry, 47, 1189–1196.CrossRefGoogle Scholar
Silverman, W.K., & Albano, A.M. (1996). Anxiety Disorders Interview Schedule for DSM-IV: Child and Parent Versions. San Antonio, TX: Psychological Corporation.Google Scholar
Silverman, W.K., Kurtines, W.M., Ginsburg, G.S., Weems, C.F., Lumpkin, P.W., & Hicks-Carmichael, D. (1999). Treating anxiety disorders in children with group cognitive-behavioral therapy: A randomized clinical trial. Journal of Consulting and Clinical Psychology, 67, 995–1003.CrossRefGoogle ScholarPubMed
Spence, S.H. (1998). A measure of anxiety symptoms among children. Behaviour Research & Therapy, 36, 545–566.CrossRefGoogle ScholarPubMed
Spence, S.H., Donovan, C., & Brechman-Toussaint, M. (2000). The treatment of childhood social phobia: The effectiveness of a social skills training-based cognitive-behavioural intervention, with and without parental involvement. Journal of Child Psychology & Psychiatry & Allied Disciplines, 41, 713–726.CrossRefGoogle ScholarPubMed
Verduin, T.L., & Kendall, P. (2007). Peer perceptions and liking of children with anxiety disorders. Journal of Abnormal Child Psychology, 36, 459–469.CrossRefGoogle ScholarPubMed
Waters, A.M., Bradley, B.P., & Mogg, K. (2014). Biased attention to threat in paediatric anxiety disorders (generalized anxiety disorder, social phobia, specific phobia, separation anxiety disorder) as a function of ‘distress’ versus ‘fear’ disorder categorization. Psychological Medicine, 44, 607–616.CrossRefGoogle ScholarPubMed
Waters, A.M., Ford, L.A., Wharton, T.A., & Cobham, V.E. (2009). Cognitive behavioural therapy for young children with anxiety disorders: Comparison of group-based child + parent versus parent only focused treatment. Behaviour Research & Therapy, 47, 654–662.CrossRefGoogle Scholar
Waters, A.M., & Kershaw, R. (2015). Direction of threat attention bias is related to fear acquisition and extinction in anxious children. Behaviour Research & Therapy, 64, 56–65.CrossRefGoogle ScholarPubMed
Waters, A.M., Mogg, K., & Bradley, B.P. (2012). The direction of threat attention bias predicts treatment outcome from cognitive behavioural therapy in anxious children. Behaviour Research & Therapy, 50, 428–434.CrossRefGoogle ScholarPubMed
Waters, A.M., Mogg, K., Bradley, B.P., & Pine, D.S. (2008). Attentional bias for emotional faces in children with generalised anxiety disorder. Journal of the American Academy of Child and Adolescent Psychiatry. 47, 435–442.CrossRefGoogle Scholar
Waters, A.M., Wharton, T.A., Zimmer-Gembeck, M.J., & Craske, M.G. (2008). Threat-based cognitive biases in anxious children: Comparison with non-anxious children before and after cognitive behavioural treatment. Behaviour Research & Therapy, 46, 358–406.CrossRefGoogle ScholarPubMed
Woods, A.M., & Bouton, M.E. (2008). Immediate extinction causes a less durable loss of performance than delayed extinction following either fear or appetitive conditioning. Learning & Memory, 15, 909–920.CrossRefGoogle ScholarPubMed