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

Research output: Contribution to journalArticlepeer-review

6 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)


Dive into the research topics of 'Group cognitive behavioral therapy and attention bias modification for childhood anxiety disorders: A factorial randomized trial of efficacy'. Together they form a unique fingerprint.

Cite this