Trial Protocol Tests Music-Reinforced Gaze Training With Pediatric CBT

A preregistered, double-blind randomized controlled trial will test whether Gaze-Contingent Music Reward Therapy (GCMRT) can improve outcomes when added to cognitive behavioral therapy (CBT) for children and adolescents with anxiety disorders. The protocol plans to enroll 120 patients aged 8–17 who meet DSM-5-TR criteria for an anxiety disorder and will compare active GCMRT with a control form of GCMRT. Both groups will receive CBT, with the difference between groups in clinician-rated anxiety reduction from before to after treatment serving as a primary measure of effectiveness.

Because this is a study protocol rather than a completed trial, it reports no findings showing that GCMRT is safe, effective or superior to the control intervention. GCMRT is an eye-tracking-based treatment intended to modify threat-related attention bias. During the computer-based exercise, participants view matrices of faces with negative and non-negative valence while a system monitors their eye movements.

In the active condition, participant-selected music plays only when the participant looks at non-negative faces, creating a positive-reinforcement training regimen that links the reward to gaze direction. In the control condition, the same type of participant-selected music plays continuously rather than in response to gaze. The researchers describe recent studies as promising for GCMRT as an augmentative treatment for CBT, but note that this approach has not yet been robustly tested in pediatric samples with anxiety disorders.

The trial will assess changes in behavioral and neural indices of threat-related attention bias alongside anxiety outcomes. Behaviorally, the investigators will calculate prolonged eye-gaze dwell time on negative-valence faces relative to non-negative faces, using the change in that measure across treatment to indicate a shift in attention bias. Before and after treatment, participants will also undergo functional magnetic resonance imaging, or fMRI, while resting and while completing a dot-probe task with threatening face cues.

The protocol specifies a neural-efficiency approach for assessing brain-based implicit threat responses. Healthy youth will serve as a baseline comparison for the patients’ brain-based threat response, allowing the analysis to distinguish treatment-linked changes from patterns observed in a nonclinical comparison group. Linear mixed-effects models will be used to compare trajectories between groups in behavioral attention bias, neural threat-response indices and anxiety symptoms over the course of treatment.

The protocol identifies two broad objectives: determining whether GCMRT is an efficacious adjunct to CBT for pediatric anxiety disorders and advancing understanding of the neural mechanisms that may underlie its effects. The trial is registered as NCT06595953, with registration dated September 19, 2024; the source reports that data acquisition began on December 4, 2024. Until the trial is completed and analyzed, the evidence supports a planned test of GCMRT as an addition to CBT, not a conclusion that the intervention improves pediatric anxiety.

Subject of Research: A randomized trial protocol testing gaze-contingent music reward therapy as an adjunct to cognitive behavioral therapy for pediatric anxiety.

Article Title: Active versus control Gaze-Contingent Music Reward Therapy (GCMRT) augmentation of cognitive behavioral therapy in the treatment of pediatric anxiety: protocol for a double-blind randomized controlled trial

Article References: Byrne, M. E., Korom, M., Haller, S. P., Massac, L. A., Chen, E., Ross, A., Lewis, K. M., Berman, E., Silverman, W. K., Lazarov, A., Bar-Haim, Y., & Pine, D. S. (2026). Active versus control Gaze-Contingent Music Reward Therapy (GCMRT) augmentation of cognitive behavioral therapy in the treatment of pediatric anxiety: protocol for a double-blind randomized controlled trial. BMC Psychiatry. https://doi.org/10.1186/s12888-026-08631-8

Image Credits: AI Generated

DOI: 10.1186/s12888-026-08631-8

Keywords: pediatric anxiety, gaze-contingent therapy, music reward, eye tracking, cognitive behavioral therapy, randomized trial, attention bias, functional MRI, threat processing, clinical research, Active, versus