A comparison between computer based Positive Search Training and Cognitive Behavioural Training in children with anxiety disorders an Australian Childhood Anxiety Treatment Study (A-CATS)

INTERVENTION: The project involves a two arm, nationwide randomised controlled non‐inferiority trial over five years comparing Positive Search training (PST) and computer‐delivered Cognitive Behavioural Therapy (CBT). BRAVE‐ONLINE will be used as the referent treatment in the CBT arm; a well‐established online CBT program for childhood anxiety disorders. Positive Search Training Families randomised to PST will be telephoned within a week of allocation to schedule initial set‐up procedures. They will be posted an information booklet containing information about PST, a rationale for the training given that PST is an explicit form of attention training, information on setting‐up PST on the family computer, and the USB drive. A 45‐min telephone call will be conducted between the research assistant and parents to cover material in the booklet and set‐up PST on their computer. Parents will open PST on the computer in a quiet room in the house and children will complete 4 x PST sessions (25 min per session) each week for 3 weeks. A 5‐min weekly scripted call from the research assistant will be conducted to check there are no technical or scheduling difficulties and no other treatments or service usage (e.g., CBT, medication). How it works: PST is programmed in Java, completed on a PC/laptop with headphones and a microphone (provided if necessary) and uses a wide variety of picture stimuli. PST contains 224 trials per session (divided into 9 blocks of different trial sizes) yielding 2688 trials over 12 sessions completed within 3 weeks. Children receive verbal and written instructions that they will learn to ‘look for good’, to ‘look for calm’, to ‘use both options’, and to ‘never give up’ using the positive search strategies. In each of the 9 blocks, children search arrays for ‘good’ (e.g., happy children; cute animals) or ‘calm’ (e.g., a vase; a book) targets or both types of targets among threat distractors in 3x3 and 4x4 arrays of varying size and spacing. They receive verb CONDITION: Anxiety disorders; ; Anxiety disorders Mental Health ‐ Anxiety PRIMARY OUTCOME: Clinically rated diagnostic anxiety severity; ; Outcome is assessed using the Anxiety Disorders Interview Schedule Parent and Child versions ‐ Clinician Severity Rating [Pre‐Treatment; Post Intervention commencement (3 weeks); 6 Months Post Intervention (Primary Timepoint) ; 12 Months Post‐Intervention] SECONDARY OUTCOME: An indicator of depressive symptoms will be assessed using the Short Mood and Feelings Questionnaire for children[Pre‐Treatment ; Post Intervention commencement (3 weeks) ; 6 Months Post Intervention ; 12 Months Post‐Intervention] Anxiety Symptoms will be assessed with the child and parent versions of the Spence Children's Anxiety Scale child and parent versions and the Children Anxiety Life Interference Scale child and parent version[Pre‐Treatment ; Post Intervention commencement (3 weeks) ; 6 Months Post Intervention ; 12 Months Post‐Intervention] Change in attention bias will be assessed with a visual search task developed by Prof Waters to assess the change in attention search for positive stimuli and inhibition of threat distractors using 3x3 and 4x4 arrays with emotional face stimuli[Pre‐Treatment ; Post Intervention commencement (3 weeks) ; 6 Months Post Intervention ; 12 Months Post‐Intervention] Change in attention control will be assessed using the Attention Control Scale: Child and parent Version[Pre‐Treatment ; Post Intervention commencement (3 weeks) ; 6 Months Post Intervention ; 12 Months Post‐Intervention] Change in Global functioning assessed with the clinician rated Children's Global Assessment Scale[Pre‐Treatment ; Post Intervention commencement (3 weeks) ; 6 Months Post Intervention ; 12 Months Post‐Intervention] Health outcomes will be assessed with the Child Health Utilities Index 9 Dimension and the EQ‐5D‐5L for parents. ; [Pre‐Treatment ; Post Intervention commencement (3 weeks) ; 6 Months Post Intervention ; 12 Months Post‐Intervention] Illness severity will be assessed with the Clinician Global Impression Scale[Pre‐Treatment ; Post Intervention commencement (3 weeks) ; 6 Months Post Intervention ; 12 Months Post‐Intervention] Treatment credibility will be assessed using the Credibility Scale for parents[Post PST Treatment (3 weeks)] Treatment satisfaction was assessed using the Treatment satisfaction scale[6 Months post treatment] INCLUSION CRITERIA: Inclusion: (a) child is 7 to 12 years of age; (b) meets criteria for a DSM‐5 anxiety disorder, (c) willingness to cease concurrent psychotherapy, (d) willingness to stabilise medication (if applicable) at the same dose for 12 weeks prior to diagnostic assessment. There is no specific inclusion criteria for parents