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CBT plus ABMT provides clinical benefits in paediatric anxiety disorder

15 Aug 2017

Young patients receiving active attention bias modification therapy (ABMT) exhibit improved clinical benefits, a recent study has shown. In addition, ABMT appears to be most effective for patients with abnormal amygdala-insula connectivity.

To assess potential complementary features of ABMT and cognitive-behavioural therapy (CBT) in paediatric anxiety disorders, researchers used amygdala-based connectivity during a threat-attention task and a randomized controlled design.

“In the treatment of anxiety disorders, ABMT and CBT may have complementary effects by targeting different aspects of perturbed threat responses and behaviours,” researchers said. “ABMT may target rapid, implicit threat reactions, whereas CBT may target slowly deployed threat responses.”

Young patients (aged 8 to 17 years) with anxiety disorders (n=54) and healthy comparison youths (n=51) performed a threat-attention task during functional magnetic resonance imaging (MRI) acquisition before the treatment. Their task-related amygdala-based functional connectivity was then evaluated.

Those with and without imaging data (n=85) were randomized to receive CBT matched with either active or placebo ABMT. Researchers then evaluated clinical response and compared pretreatment amygdala-based connectivity profiles among patients with varying levels of clinical response.

The CBT plus active ABMT group showed less severe anxiety after treatment compared with the CBT plus placebo ABMT group.

A difference was observed in amygdala-insula connectivity between patient and healthy comparison groups during the threat-attention task. The poorest treatment response was observed among patients whose connectivity profiles were most different from those of the healthy comparison group, particularly those who received CBT plus placebo ABMT.

“ABMT may target specific threat processes associated with dysfunctional amygdala-insula connectivity that are not targeted by CBT alone,” researchers said. “This may explain the observation of enhanced clinical response to CBT plus active ABMT.”

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