Introduction

A nxiety disorders, with a prevalence of about 5 to 25%, be considered the most common disorders in children and adolescents[2] which, if not treated, will have serious consequences throughout life. then it is necessary to understand the vulnerability factors to these disorders and design treatments to reduce them[4,5]. Cognitive and information processing models emphasize the role of biases in children's cognitive processing as factors related to vulnerability to anxiety. From the point of view of these models, one of these biases is selective attention[7].

On the other hand, cognitive models in the field of anxiety and attention processes usually distinguish between two types of automatic and strategic processes. Automatic processes are uncontrolled, involuntary and fast processes that usually happen outside of consciousness and at the level of the amygdala, and are also called bottom-up or stimulus-influenced processes. On the other hand, strategic processes refer to conscious, voluntary and controllable processes, which are also called top-down or goal-oriented processes and are among the functions of the frontal lobe[11].

While biasing attention towards threat is considered a bottom-up and automatic process, attentional control is considered as a top-down and strategic process, which means the ability to focus and sustain adaptive attention. It has been increasingly mentioned in the theoretical models of anxiety[12].

In the field of treatment, cognitive behavioral therapies have been used as effective treatments for the treatment of children's anxiety and their effectiveness has been proven[14].

Therefore, according to the mentioned issues, the current research aims to investigate whether school-based cognitive behavioral therapy has the ability to increase attentional control and reduce the bias of attention to threats in anxious children.

Materials and Methods: The present study was a Single-subject study with Multiple Baseline. The statistical sample of this study included all children aged 9 to 13 referred to the health centers of Qom city and according to the research literature in the field of single subject designs, 3 subjects were considered for the implementation of the treatment protocol.

To conduct the research, first, the attentional control questionnaire in children was translated into Farsi by an English language expert and the researcher of this study using the translation-back-translation method, and then translated into the original language by another English language expert, and at the end, the problems and The differences between the two translations were resolved.

Then, in order to be used in the present research, its psychometric properties were investigated in the students of schools in Qom city. At the same time, coordinations were made with the Deputy of Research and Technology of Qom University of Medical Sciences in order to obtain permission to implement the treatment protocol in children referring to the health centers of Qom city, and 3 anxious children were clinically interviewed and the treatment protocol was based on It was run on them.

Data was collected using the Kiddie schedule for Affective Disorder and Schizophrenia- Present and Lifetime Version (K-SADS-PL), Attentional Control Scale for Children and Dot Probe Task. The treatment protocol included 8 weekly individual sessions with children and 2 sessions with parents too. Data was analyzed using visual analysis, percentage of improvement and effect size (Cohen's d).

Results: The amount of change in attention control and attention bias of all three subjects is shown in graphs 1 and 2. The findings indicate that this treatment has slightly increased the amount of attention control in the first and third subjects, so that the first subject had an increase of 5 points and the third subject had an increase of 3 points in attention control. and the second subject has had a decreasing trend.

Attention bias has also started to decrease with the start of treatment in all three subjects, so that the reaction time of the first subject has changed from (44+) to (-41), which indicates a change of attention from stimuli related to threats. It is towards stimuli unrelated to the threat. The second and third subjects also showed this decrease in attention bias towards threat-related stimuli by changing the reaction time from (+27) to (-57) and (+59) to (-49).

Also, the results of Table 1 show that school-based cognitive behavioral therapy with the effect size (d=0.18) had little effectiveness in increasing attentional control.

Conclusion: The aim of the current study was to investigate the effectiveness of school-based cognitive behavioral therapy on improving attentional control and reducing attention bias towards threats in children. The results of this study, in line with previous studies [5.14.16.24], showed that this treatment is an effective treatment in increasing attentional control and especially reducing the bias of attention towards the threat and as a result reducing anxiety symptoms.

In explaining the effectiveness of school-based cognitive-behavioral therapy, it can be said that the use of a variety of coping and cognitive restructuring strategies, anxiety surfing and social skills training techniques to identify and change non-adaptive thought patterns that affect emotions and behavior and identify relationships Thinking and feeling as important factors of vulnerability to anxiety disorders are one of the reasons for the effectiveness of this treatment[14].

Keywords: School-Based Cognitive-Behavioral Therapy, Attention, Attentional Control, Attention Bias, Anxiety disorders

Research limitations: This research was also associated with limitations. First, the results confirm the initial applicability of this treatment in children, but due to the small sample size, the generalization of the results should be done with caution, and more research in clinical samples is necessary to confirm this effectiveness. Also, according to the findings of this research, it is recommended to use this treatment protocol in order to reduce the mechanisms of cognitive vulnerability in public and private counseling centers.

Ethical Considerations

Compliance with ethical guidelines

The ethical principles observed in the article, such as the informed consent of the participants, the confidentiality of information, the permission of the participants to cancel their participation in the research. Ethical approval was obtained from the Research Ethics Committee of the Qom University of Medical Sciences. (IR.MUQ.REC.1400.058).

Funding

This study was extracted from the Ph.D thesis of Corresponding Author and has no financial support.

Authors' contribution

Authors contributed equally in preparing this article.

Conflict of interest

The authors declared no conflict of interest.