Group cognitive behavioral therapy and attention bias modification for childhood anxiety disorders: A factorial randomized trial of efficacy

Giovanni A. Salum*, Circe S. Petersen, Rafaela B. Jarros, Rudineia Toazza, Diogo Desousa, Lidiane Nunes Borba, Stela Castro, Julia Gallegos, Paula Barrett, Rany Abend, Yair Bar-Haim, Daniel S. Pine, Silvia H. Koller, Gisele G. Manfro

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

15 Citations (Scopus)


Background: The objective of this study is to assess group differences in symptom reduction between individuals receiving group cognitive behavioral therapy (G-CBT) and attention bias modification (ABM) compared to their respective control interventions, control therapy (CT), and attention control training (ACT), in a 2 × 2 factorial design. Methods: A total of 310 treatment-naive children (7-11 years of age) were assessed for eligibility and 79 children with generalized, separation or social anxiety disorder were randomized and received G-CBT (n = 42) or CT (n = 37). Within each psychotherapy group, participants were again randomized to ABM (n = 38) or ACT (n = 41) in a 2 × 2 factorial design resulting in four groups: G-CBT + ABM (n = 21), G-CBT + ACT (n = 21), CT + ABM (n = 17), and CT + ACT (n = 20). Primary outcomes were responder designation as defined by Clinical Global Impression-Improvement (CGI-I) scale (≤2) and change on the Pediatric Anxiety Rating Scale (PARS). Results: There were significant improvements of symptoms in all groups. No differences in response rates or mean differences in PARS scores were found among groups: G-CBT + ABM group (23.8% response; 3.9 points, 95% confidence interval [CI]-0.3 to 8.1), G-CBT + ACT (42.9% response; 5.6 points, 95% CI 2.2-9.0), CT + ABM (47.1% response; 4.8 points 95% CI 1.08-8.57), and CT + ACT (30% response; 0.8 points, 95% CI-3.0 to 4.7). No evidence or synergic or antagonistic effects were found, but the combination of G-CBT and ABM was found to increase dropout rate. Conclusions: We found no effect of G-CBT or ABM beyond the effects of comparison groups. Results reveal no benefit from combining G-CBT and ABM for anxiety disorders in children and suggest potential deleterious effects of the combination on treatment acceptability.

Original languageEnglish
Pages (from-to)620-630
Number of pages11
JournalJournal of Child and Adolescent Psychopharmacology
Issue number9
Publication statusPublished - 1 Nov 2018

Bibliographical note

Funding Information:
Funding: Brazilian government institutions—Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Fundo de Incentivo à Pesquisa do Hospital de Clínicas de Porto Alegre (FIPE-HCPA), Coordenac¸ão de Aperfeic¸oamento de Pessoal de Nível Superior (CAPES) and Fundac¸ão de Apoio à Pesquisa do Estado do Rio Grande do Sul (FAPERGS). Funding sources have no role in conducting, analyzing, or interpreting the trial results.

Publisher Copyright:
© 2018 Mary Ann Liebert, Inc. publishers.

Copyright 2018 Elsevier B.V., All rights reserved.

All Science Journal Classification (ASJC) codes

  • Pediatrics, Perinatology, and Child Health
  • Psychiatry and Mental health
  • Pharmacology (medical)


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