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Attention Control and Attention to Emotional Stimuli in Anxious Children Before and After Cognitive Behavioral Therapy

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Abstract

This study investigated attention control and attentional bias for emotional stimuli in children with anxiety disorders, compared with disorder-free children. Furthermore, it examined the effect of individual cognitive behavioral therapy on these attentional variables in anxious children. Participants included 22 anxious and 20 control children (aged 7–12 years; 50 % female). Attention control was measured using a partial report-by-color task based on the theory of visual attention, which assesses ability to focus on task-relevant information and resist distraction by non-emotional task-irrelevant information. Attentional bias for emotional faces was assessed using a visual probe task with angry, happy, and neutral faces. Anxious and control children were assessed at baseline (pre-treatment) and, in addition, anxious children were re-assessed post-treatment and at 6 months following treatment. Before treatment, children with clinical anxiety showed poorer attention control and greater attentional bias for emotional faces in comparison to control children. Following treatment, anxious children showed a significant reduction in attentional bias for emotional faces, and a trend for improvement in attention control. There was no significant change in attentional bias or attention control between post-treatment and 6-months follow-up assessments. Findings contribute to prior research by showing that clinically anxious children exhibit both increased attention to emotional information and impaired attention control, and that following treatment their attentional bias and attention control are comparable with those of control children. Further research is required to clarify the extent to which changes in attentional functioning relate to the maintenance of anxiety disorders and responsiveness to treatment.

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Notes

  1. The present study was not designed to examine effects of both age and anxiety disorder on attentional measures (e.g., potential interaction effect of age and anxiety on attention bias, previously suggested by a non-clinical study, Reinholdt-Dunne et al. 2011), as this would have required a considerably larger sample of participants in each group. Instead, the clinically anxious and control groups were closely matched for age, t(40) = 0.66, p = .514, to ensure that the group difference in anxiety disorder status was not confounded by an age difference. However, we conducted additional unplanned exploratory correlations between the attention measures (attention control, attention bias for emotional faces) and age, gender and IQ in each group. There were no significant results when correcting the significance level for multiple tests (critical p = .05/6 = .008 for these additional tests when using Bonferroni correction). However, there was a suggestion of a negative relationship between age and attention bias for emotional faces in anxious children, r(20) = −.45, uncorrected p = .034, but not in control children, r(18) = −.25, uncorrected p = .296. This suggests a tendency for younger anxious children to show a greater attention bias for emotional faces than older anxious children. These supplementary analyses further highlight the need to investigate independent and interacting effects of anxiety disorder and age in larger samples of children.

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Acknowledgments

The study was supported by Grants to the Copenhagen Child Anxiety Project from the Egmont Foundation, Grant Number: 831-2205 and Sygekassernes Helse Foundation, Grant Number: 2011A613. We also wish to thank participating children and parents for partaking in the study as well as all staff and psychology students who have assisted in the process.

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  1. Department of Psychology, University of Copenhagen, Øster Farimagsgade 2A, 1353, Copenhagen K, Denmark

    Marie Louise Reinholdt-Dunne, Signe A. Vangkilde & Barbara Hoff Esbjørn

  2. Department of Psychology, University of Southampton, Southampton, UK

    Karin Mogg & Brendan P. Bradley

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  1. Marie Louise Reinholdt-Dunne
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  2. Karin Mogg
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  3. Signe A. Vangkilde
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Correspondence to Marie Louise Reinholdt-Dunne.

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M. L. Reinholdt-Dunne, K. Mogg, S. A.Vangkilde, B. P. Bradley, and B. H. Esbjørn declare that they have no conflict of interest.

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The present study complies with current ethical standards in assessment and treatment of the sample enrolled. Informed consent was obtained from all participants in the study.

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Reinholdt-Dunne, M.L., Mogg, K., Vangkilde, S.A. et al. Attention Control and Attention to Emotional Stimuli in Anxious Children Before and After Cognitive Behavioral Therapy. Cogn Ther Res 39, 785–796 (2015). https://doi.org/10.1007/s10608-015-9708-2

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