Attentional bias to respiratory and anxiety related threat in children with asthma
Background: Attention and vigilance is highlighted as an adaptive function which facilitates a faster response to threat. It is also proposed as a maintenance factor in problems with anxiety, and more recently within physical health conditions. Researchers have hypothesised that due to the role of attention in anxiety, modifying this attention will result in a reduction of anxiety levels. In addition, research is now emerging in relation to the role of attention in paediatric health conditions. Due to the importance of early targeting in interventions for both anxiety and physical health conditions, further research is needed in this area. Aims: The research aims were twofold. The first aim was to review the literature and evidence related to the anxiolytic effect of Attention Bias Modification (ABM) in child and adolescent populations. The second aim was to investigate if children with asthma show an attentional bias to different threat related stimuli (asthma, anxiety or general negative emotion) and the relationship between this and other health related factors. Method: A systematic review of the current literature was carried out to address the first aim. This included 10 quantitative studies which all examined the effect of ABM on either child or adolescent anxiety levels. To address the second aim, 36 children aged nine to twelve participated in an empirical study. 18 of the participants had asthma, and 18 were asthma free and both groups were asked to complete a computer task designed to measure attentional bias to the different threat related stimuli. In addition, caregivers completed a questionnaire to measure their own anxiety levels, and the children with asthma completed measures focused on quality of life, coping strategies and inhaler use. Results: Research regarding the effectiveness of ABM for youth anxiety is in its early stages. However, preliminary conclusions can be drawn suggesting that it may be an effective intervention to reduce anxiety levels. Additional, rigorous research is required to standardise treatment protocols and answer further questions. Within the empirical study, repeated measures ANOVA revealed that children with asthma show an attentional bias to asthma cues whereas children without asthma do not. Furthermore, there was no selective attention to general negative words, suggesting that attentional bias was not due to general sensitivity to emotional stimuli. A Pearson’s correlation showed that vigilance to asthma cues was associated with parental anxiety. There was no attentional bias to anxiety symptom words and no significant correlations between bias scores and the measured health related factors. Conclusion: The results from the systematic review provide further evidence for the role of attention in paediatric anxiety problems. In addition, the outcome of the empirical study suggests an unconscious threat association in childhood asthma. Further research may yield a viable computerised treatment for paediatric anxiety. Regardless of this, it will be important to consider the role of attention in clinical practice, both in the treatment of anxiety and complex chronic health problems such as asthma.