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Objective: Anxiety disorders of childhood are prevalent, debilitating conditions that do not always respond to existing treatments. Attentional biases towards threatening stimuli have been reported in anxious children and hypothesized to interfere with treatment response. Therefore, we examined such biases in children with anxiety disorders in relation to cognitive behavioral therapy CBT outcomes. Method: Thirty-eight children diagnosed with anxiety disorders in a specialized clinic 21 girls and 17 boys; age = 10.50 ± 1.11 years and 36 unaffected community controls 19 girls and 17 boys; age = 10.20 ± 1.07 years participated. Participants completed standardized questionnaire measures of anxiety and a probe position task PPT with facial cues. This task often reveals a response slowing effect related to threatening faces in vulnerable individuals. Children with anxiety disorders repeated these measures after completing CBT. Results: Groups did not differ in performance on the PPT, but angry-calm incongruent difference scores were significantly associated with self-reports of social anxiety and state anxiety. When controlling for pre-CBT anxiety levels, incongruent difference scores involving angry faces predicted post-CBT anxiety disorders index scores on the Multidimensional Anxiety Scale for Children. PPT scores did not change significantly with CBT. Conclusions: Attentional bias towards threat on the PPT task may predict response to CBT and appears linked to social anxiety. Interventions to ameliorate this bias merit further study, as they might improve treatment outcomes for anxious, especially socially anxious, children.


Anxiety Disorder; Children; Threat Perception; Emotion; Cognitive Behavioral Therapy

Cite this paper

Manassis, K. , Hum, K. , Lee, T. , Zhang, G. and Lewis, M. 2013 Threat perception predicts cognitive behavioral therapy outcomes in anxious children. Open Journal of Psychiatry, 3, 141-148. doi: 10.4236-ojpsych.2013.31A009.

Autor: Katharina Manassis, Kathryn M. Hum, Trevor Changgun Lee, Gloria Zhang, Marc D. Lewis



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