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Symposium

Anxiety Disorders

Enhancing Reward Processing to Improve Treatment Outcomes for Anxiety and Depression

1 - (SYM 7) Examining the Efficacy of Positive Search Training as a Treatment for Childhood Anxiety Disorders: A Nationwide, Non-inferiority Trial

Saturday, June 27, 2026
9:06 AM - 9:27 AM PDT
Location: Golden Gate C2, B2 Level
Keywords: Child Anxiety, Randomized Controlled Trial,
Abstract Body
Cognitive-behavioral therapy (CBT) is an efficacious treatment for anxious children. However, many anxious children cannot access CBT, and as many as 40% of anxious children who receive CBT do not respond in the short or long term. Research on the efficacy of alternative treatments for childhood anxiety disorders is urgently needed.

CBT primarily aims to reduce anxiety by targeting mechanisms and biases in threat sensitivity and negative valence systems. Treatments that activate positive valence and cognitive controls systems could provide effective alternatives to CBT. Positive search training (PST) is a 3 week, computer-delivered intervention designed to enhance anxious children’s attention to positive, goal-directed stimuli and to inhibit threat-related distractors. Based on evidence that PST is effective relative to waitlist and experimental control conditions, the aim of this study was to determine if PST is non-inferior to evidence-based CBT. It was predicted that computer-delivered PST would be more effective than computer-delivered CBT in reducing diagnostic severity at the post-PST end-point and non-inferior to CBT at the primary post-CBT end-point and the 12-month follow-up end-point. Child and parent evaluations of treatment acceptability, credibility and satisfaction were also assessed.
Clinically anxious children between 7 and 12 years of age (N=380) were randomly assigned to computer-delivered PST or best-practice, computer-delivered CBT after baseline diagnostic assessment. Diagnostic assessments were completed at the post-PST end-point, the six-month post-CBT primary end-point, and the 12-month follow-up end-point.
Results supported hypotheses in that PST produced greater declines in clinician-rated diagnostic severity compared to CBT at the post-PST end-point and was non-inferior to CBT at the primary and post-CBT end-point and 12-month follow-up time-point. CBT was rated as more acceptable and satisfying than PST by both children and parents, whereas children assigned to PST completed significantly more treatment sessions, were less likely to drop out of treatment and completed more assessment time-points than children assigned to CBT.
PST is a brief, intensive and efficacious alternative to CBT that can be completed at home with minimal therapist support. PST may be scalable and reach more anxious children in diverse settings.