Effectiveness of attention bias modification treatment for children with social anxiety problem

Abstract

Social anxiety disorder is a common mental disorder frequently found in pediatric population. The prevalence has been reported to be around 7% in Western countries, and research in Hong Kong indicates a similar rate. The typical treatments for social anxiety disorder include cognitive-behavioral therapy (CBT) and medication. In addition, a novel treatment based on the attention bias model has emerged. Through attention bias modification (ABM) computerized program with re-direction of attention away from social threat stimuli toward more neutral stimuli, social anxiety symptoms could potentially be alleviated.

Research has suggested that children with social anxiety disorder show attention bias in processing social information, offering a promising foundation and rationale for the development of ABM treatment. However, while some research documented an attentional bias towards social threat, other studies suggested an avoidance. The present study examined a community sample of 220 school-age Chinese children in Hong Kong, yielding support of the latter. Children with social anxiety problem showed an attentional avoidance of angry and happy faces, whereas the non-anxious controls demonstrated no such bias. The socially anxious children were also found to have overall slower reaction time in response to faces expressing different emotions.

A randomized controlled trial (RCT) study was conducted to examine the treatment effects of ABM, and its effectiveness when compared to CBT. A group of 75 children diagnosed with social anxiety disorder in governmental clinics were randomly assigned into one of these four conditions: (1) CBT-only, (2) ABM-only, (3) combined CBT and ABM, and (4) wait-list control. As predicted, the ABM training was effective in alleviating social anxiety problems. Moreover, a combined form of treatment with CBT and ABM simultaneously yielded better treatment outcomes than single treatment. However, no significant difference was found between the ABM- and the CBT-only groups. The treatment effects were sustained at 6-month follow-up.

The present research documented an attention bias in Chinese children with social anxiety problem, and the ABM training was shown to be effective. The clinical significance of the findings and future research directions were discussed.