Attention Bias Modification for Anxiety in Childhood Cancer Survivors

Overseen By Nancy Lau, PhD

Age: < 65

Sex: Any

Trial Phase: Academic

Sponsor: Fred Hutchinson Cancer Center

Disqualifiers: Active cancer treatment, Cognitive impairment, No technology, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 9

Duration: 4 weeks

60 Participants Needed

Trial Summary

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It is best to discuss this with the trial coordinators or your doctor.

What data supports the effectiveness of the treatment Attention Bias Modification for anxiety in childhood cancer survivors?

Research shows that Attention Bias Modification (ABM) can help reduce anxiety in children by training them to focus away from negative or threatening information. Studies have found that children who underwent ABM experienced significant decreases in anxiety symptoms, and many no longer met the criteria for anxiety disorders after treatment. ^{1 2 3 4 5}

Is Attention Bias Modification (ABM) safe for children?

Research on Attention Bias Modification (ABM) in children with anxiety shows it is generally safe and well-tolerated. Studies found that children and their parents found the program acceptable, and no safety concerns were reported. ^{1 2 3 6 7}

How is Attention Bias Modification (ABM) treatment different from other treatments for anxiety in childhood cancer survivors?

Attention Bias Modification (ABM) is unique because it focuses on training children to shift their attention away from threatening information and towards positive stimuli, using computer-based tasks. This approach is different from traditional therapies as it directly targets the underlying attention patterns associated with anxiety, rather than just addressing symptoms. ^{1 2 3 4 8}

What is the purpose of this trial?

This clinical trial studies how well attention bias modification (ABM) improves anxiety in adolescent and young adult (AYA) cancer survivors. Cancer-related anxiety is the most prevalent mental health problem affecting AYA cancer survivors. Cancer-related anxiety is associated with long-term negative outcomes such as poor quality of life, depression, distress, substance use, sleep problems, fatigue, and pain. ABM uses techniques to help patients change the way they react to environmental triggers that may cause a negative reaction. ABM uses brief self-guided smartphone applications. Patients complete repetitive association reaction-time tasks targeting automatic and unconscious negative attention biases to retrain attention away from perceived threat and towards a neutral or positive stimuli. Gratitude-finding and savoring activities are also provided to maintain and increase positive emotions. Using ABM plus gratitude-finding and savoring activities may improve anxiety in AYA cancer survivors.

Research Team

Nancy Lau, PhD

Principal Investigator

Fred Hutch/University of Washington/Seattle Children's Cancer Consortium

Eligibility Criteria

This trial is for adolescent and young adult cancer survivors who have experienced anxiety after battling childhood cancer, head and neck cancers, or leukemia. Participants should be comfortable using internet-based applications and willing to engage in interviews and questionnaires.

Inclusion Criteria

I am between 15 and 29 years old.

I have been diagnosed with cancer.

I received cancer treatment aimed at curing me at a specified hospital.

Exclusion Criteria

Patients who cannot understand/read/write English will be excluded from the research because the ABM intervention is currently only available in English

I am unable to take part in specific activities or answer surveys due to physical or cognitive reasons.

I am currently receiving treatment aimed at curing my cancer.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants engage in ABM or inert attention task sessions over 10 minutes twice a week and respond daily to text messaging prompts for 4 weeks

4 weeks

8 sessions (virtual), daily text prompts

Follow-up

Participants are monitored for safety and effectiveness after treatment

4 weeks

1 follow-up survey (virtual)

Open-label extension (optional)

Participants are given access to all components of ABM and texts on study after completion of the follow-up survey

Treatment Details

Interventions

• Attention Bias Modification

Trial Overview The study tests if attention bias modification (ABM) via smartphone apps can reduce anxiety by redirecting focus from negative triggers to neutral or positive stimuli. It includes gratitude exercises and aims to improve the mental health of young cancer survivors.

Participant Groups

Group I: Arm I (ABM) Experimental Treatment 4 Interventions

Patients engage in ABM over 10 minutes BIW and respond daily to text messaging prompts for 4 weeks.

Group II: Arm II (inert attention task) Active Control 3 Interventions

Patients engage in inert attention task sessions over 10 minutes BIW for 4 weeks. Patients also receive and respond to text messaging prompts QD for 4 weeks. After completion of the 4 week follow up survey, patients are given access to all components of ABM and texts on study.

Who Is Running the Clinical Trial?

Fred Hutchinson Cancer Center

Lead Sponsor

Trials

583

Recruited

1,341,000+

National Cancer Institute (NCI)

Collaborator

Trials

14,080

Recruited

41,180,000+

Findings from Research

A four-week attention modification program (AMP) was tested on 16 children and adolescents (ages 10 to 17) with clinical anxiety, resulting in significant reductions in anxiety and depression symptoms, with 12 out of 16 participants no longer meeting criteria for any anxiety diagnosis after treatment.

The AMP was found to be feasible and acceptable for both youths and their parents, suggesting it could be a promising intervention for addressing anxiety in young people.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A case series of attention modification in clinically anxious youths. Rozenman, M., Weersing, VR., Amir, N.[2021]

In a study involving 59 clinically anxious children, those who underwent 12 sessions of attention bias modification training (ABMT) showed significant improvements in anxiety and depressive symptoms compared to a waitlist control group, with benefits lasting up to six months post-treatment.

The study found that children who effectively consolidated learning and memory strategies during ABMT experienced greater improvements in their overall functioning, suggesting that enhancing these cognitive processes can boost the efficacy of anxiety treatments.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Look for good and never give up: A novel attention training treatment for childhood anxiety disorders. Waters, AM., Zimmer-Gembeck, MJ., Craske, MG., et al.[2018]

In a study involving anxious youth, adding Attention Bias Modification Treatment (ABMT) to 8 weeks of cognitive-behavioral therapy (CBT) did not enhance clinician-rated outcomes, but it did lead to earlier reductions in self-reported anxiety compared to CBT alone.

The research also showed that neural responses related to attention bias were stable in healthy youth, indicating that understanding these stable patterns could inform future ABMT strategies.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Training-associated changes and stability of attention bias in youth: Implications for Attention Bias Modification Treatment for pediatric anxiety. Britton, JC., Bar-Haim, Y., Clementi, MA., et al.[2021]

A randomized controlled trial involving 53 youths with concerning anxiety levels showed that both attention bias modification treatment (ABMT) and attention control training (ACT) significantly reduced anxiety severity and global impairment after treatment and at a 2-month follow-up.

ACT was found to be more effective than ABMT in reducing anxiety severity at follow-up, suggesting that attention control may play a crucial role in improving anxiety outcomes in youths, highlighting the need for further research on the mechanisms of attention training.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Attention Training as a Low-Intensity Treatment for Concerning Anxiety in Clinic-Referred Youth. Pettit, JW., Rey, Y., Marin, CE., et al.[2023]

Attention Bias Modification (ABM) significantly improved diagnostic remission in high-anxiety patients, with a 22.6% remission rate compared to 10.8% in control groups, based on a pooled analysis of data from 778 participants across 13 studies.

ABM effectively reduced attentional bias towards threats, indicating that it works through this mechanism to help reduce anxiety, particularly in younger patients and those trained in a lab setting.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Pooled patient-level meta-analysis of children and adults completing a computer-based anxiety intervention targeting attentional bias. Price, RB., Wallace, M., Kuckertz, JM., et al.[2018]

Long-term survivors of childhood acute lymphoblastic leukemia (ALL) who received cranial radiation therapy (CRT) showed significant attention deficits, particularly in shifting focus between local and global stimuli, compared to peers without a history of ALL.

Participants treated with only chemotherapy performed similarly to the non-ALL group, indicating that CRT is primarily responsible for the observed attention issues in survivors.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Visual attention in long-term survivors of leukemia receiving cranial radiation therapy. Schatz, J., Kramer, JH., Ablin, AR., et al.[2007]

Women with persistent anxiety after breast cancer showed attentional bias away from cancer-related information and negatively valenced words, indicating a tendency to avoid potential threats, unlike healthy controls who focused more on these stimuli.

The study found that women with high anxiety after breast cancer had a significantly greater negative interpretation bias compared to healthy controls, suggesting that they may misinterpret ambiguous situations as more threatening, which could hinder their emotional regulation.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The Generalization of Conscious Attentional Avoidance in Response to Threat Among Breast Cancer Women With Persistent Distress. Ng, DWL., Fielding, R., Lam, WWT.[2022]

In a double-blind, randomized controlled trial involving 31 children with anxiety disorders, attention bias modification (ABM) training significantly increased the number of treatment responders compared to a control condition.

The ABM group also showed a greater reduction in anxiety severity, suggesting that this intervention may be effective in helping children manage anxiety, although further research is needed to understand how it works.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Efficacy of Attention Bias Training for Child Anxiety Disorders: A Randomized Controlled Trial. Chang, SW., Kuckertz, JM., Bose, D., et al.[2020]

References

1. England pubmed.ncbi.nlm.nih.gov

A case series of attention modification in clinically anxious youths. [2021]

2. England pubmed.ncbi.nlm.nih.gov

Look for good and never give up: A novel attention training treatment for childhood anxiety disorders. [2018]

3. Netherlands pubmed.ncbi.nlm.nih.gov

Training-associated changes and stability of attention bias in youth: Implications for Attention Bias Modification Treatment for pediatric anxiety. [2021]

4. England pubmed.ncbi.nlm.nih.gov

Attention Training as a Low-Intensity Treatment for Concerning Anxiety in Clinic-Referred Youth. [2023]

5. United States pubmed.ncbi.nlm.nih.gov

Pooled patient-level meta-analysis of children and adults completing a computer-based anxiety intervention targeting attentional bias. [2018]

6. England pubmed.ncbi.nlm.nih.gov

Visual attention in long-term survivors of leukemia receiving cranial radiation therapy. [2007]

7. Switzerland pubmed.ncbi.nlm.nih.gov

The Generalization of Conscious Attentional Avoidance in Response to Threat Among Breast Cancer Women With Persistent Distress. [2022]

8. United States pubmed.ncbi.nlm.nih.gov

Efficacy of Attention Bias Training for Child Anxiety Disorders: A Randomized Controlled Trial. [2020]