Attentional bias for words and faces in social anxiety

Conflicting findings concerning the nature and presence of attentional bias in social anxiety and social phobia have been reported in the literature. This paper reports the findings of two studies comparing people with high and low social anxiety on dot probe tasks using words, faces photographed in front view, and faces photographed in profile as stimuli. In Study 1 those with high social anxiety displayed an attentional bias towards negative faces. The low social anxiety group showed an attentional bias towards positive faces. No significant effects were observed on the dot probe using words as stimuli. Study 2 used pairs of faces presented in profile as though looking at each other. One of the faces displayed either a positive, negative or neutral expression. The second face always had a neutral expression, and in half of the trials it was the subject's own face. The findings of this more ecologically valid procedure replicated those of Study 1. Facilitated attention to dots following emotional faces was specific to threatening facial stimuli. From these studies it appears that the facial dot probe task is a more sensitive index of attentional bias than the word task in a non-clinical sample with social anxiety.     

Limited generalisation of changes in attentional bias following attentional bias modification with the visual probe task

Although attentional bias modification (ABM) can change anxiety, recent studies failed to replicate such effects, possibly because the visual probe ABM failed to induce changes in attentional bias (AB). We investigated whether visual probe ABM generalised to different measures of AB besides the visual probe task (VPT), and thus whether ABM genuinely changes attentional processing. We trained participants (N?=?60) to either attend towards or away from angry facial expressions, and we examined training effects on the dot probe task, the exogenous cueing task, and the visual search task. We found a small change in AB in the VPT, but this effect did not transfer to the exogenous cueing task or the visual search task. Our study shows that ABM does not necessarily lead to generalised effects on AB. This finding can be explained by the poor psychometric properties of the AB measures.     

Attention allocation in social anxiety during a speech

Cognitive models assume that social anxiety is associated with and maintained by biased information processing, leading to change in attention allocation, which can be measured by examining eye movement. However, little is known about the distribution of attention among positive, neutral and negative stimuli during a social task and the relative importance of positive versus negative biases in social anxiety. In this study, eye movement, subjective state anxiety and psychophysiology of individuals with high trait social anxiety (HSA) and low trait social anxiety (LSA) were measured during a speech task with a pre-recorded audience. The HSA group showed longer total fixation on negative stimuli and shorter total fixation on positive stimuli compared to the LSA group. We observed that the LSA group shifted attention away from negative stimuli, whereas the HSA group showed no differential attention allocation. The total duration of fixation on negative stimuli predicted subjective anxiety ratings. These results point to a negative bias as well as a lack of a positive bias in HSA individuals during social threat.     

Money talks in attention bias modification: Reward in a dot-probe task affects attentional biases

Attention bias modification (ABM) aimed at correcting dysfunctional biases in anxiety patients has met with only mild success. Inspired by recent studies showing large effects of financial reward upon attention shifts, we contrasted effects of traditional dot-probe ABM and reward upon attention biases in a between-subject 2 × 2 design. Twenty-seven participants in group cognitive behavioural therapy (GCBT) for social anxiety disorder (SAD) were randomly assigned to undergo six sessions of a dot-probe task consisting of ABM or placebo ABM along with random or high reward following neutral stimuli. There was no influence of ABM on participants' attention bias over and above the influence of GCBT. Reward, however, had a strong influence on attention bias. Neither ABM nor reward reduced SAD symptoms over and above the effects of GCBT. The results add to the growing evidence that benefits of ABM through dot-probe training are unreliable but suggest on the other hand that rewarding attention may strongly influence dysfunctional attention biases.     

Autobiographical memory bias in social anxiety

In social anxiety the psychological self is closely related to the feared stimulus. Socially anxious individuals are, by definition, concerned about how the self is perceived and evaluated by others. As autobiographical memory is strongly related to views of the self it follows that biases in autobiographical memory play an important role in social anxiety. In the present study high (n = 19) and low (n = 29) socially anxious individuals were compared on autobiographical memory bias, current goals, and self-discrepancy. Individuals high in social anxiety showed a bias towards recalling more negative and more social anxiety-related autobiographical memories, reported more current goals related to overcoming social anxiety, and showed larger self-discrepancies. The pattern of results is largely in line with earlier research in individuals with PTSD and complicated grief. This suggests that the relation between autobiographical memory bias and the self is a potentially valuable trans-diagnostic factor.     

Experimental modification of interpretation bias in socially anxious children: Changes in interpretation, anticipated interpersonal anxiety, and social anxiety symptoms

We report on an experimental manipulation of interpretation bias in socially anxious youths. A non-clinical sample of 10–11-year-olds selected for high social anxiety was trained over three sessions to endorse benign rather than negative interpretations of potentially threatening social scenarios. This group was subsequently less likely to endorse negative interpretations of new ambiguous social situations than children in a test–retest condition. Children who received interpretation training also showed reduced trait social anxiety and reported significantly less anxiety about an anticipated interpersonal encounter, compared with the control group.     

Expectancy bias mediates the link between social anxiety and memory bias for social evaluation

Social anxiety (SA) involves a multitude of cognitive symptoms related to fear of evaluation, including expectancy and memory biases. We examined whether memory biases are influenced by expectancy biases for social feedback in SA. We hypothesised that, faced with a socially evaluative event, people with higher SA would show a negative expectancy bias for future feedback. Furthermore, we predicted that memory bias for feedback in SA would be mediated by expectancy bias. Ninety-four undergraduate students (55 women, mean age = 19.76 years) underwent a two-visit task that measured expectations about (Visit 1) and memory of (Visit 2) feedback from unknown peers. Results showed that higher levels of SA were associated with negative expectancy bias. An indirect relationship was found between SA and memory bias that was mediated by expectancy bias. The results suggest that expectancy biases are in the causal path from SA to negative memory biases for social evaluation.     

Working memory load moderates late attentional bias in social anxiety

The vigilance–avoidance hypothesis suggests that socially anxious individuals attempt to detect signs that they are being evaluated (vigilance) and subsequently direct attention away from such stimuli (avoidance). Although extensive evidence supports vigilance, data concerning subsequent avoidance is equivocal. Drawing from models of attention, the current study hypothesised that working memory load moderates late attentional bias in social anxiety such that avoidance occurs if working memory load is low, and difficulty disengaging attention occurs if working memory load is high. Forty-one undergraduates (19 socially anxious; 22 non-anxious controls) completed a dot-probe task with emotional (happy and disgust) and neutral facial expressions and a concurrent n-back task. Results supported the hypothesis such that socially anxious subjects demonstrated avoidance of disgust faces when working memory load was absent, but had difficulty disengaging attention during high working memory load. Theoretical implications and directions for future research are discussed.     

The effects of modifying interpretation bias on worry in generalized anxiety disorder

This study investigated whether facilitating a benign interpretive bias decreases negative thought intrusions in generalized anxiety disorder (GAD). Clients were randomly allocated to an interpretation modification condition in which they repeatedly accessed benign meanings of emotionally ambiguous homographs and scenarios, or to a control condition in which they accessed threat and benign meanings with equal frequency. Worry frequency was assessed using a breathing focus task that involved categorising the valence of thought intrusions before and after an instructed worry period. Interpretation bias was assessed during the modification tasks, and on a different measure of interpretation bias (sentence completion) following a period of worry. The experimental procedure modified interpretations made during training, and in the later sentence completion task. Furthermore, compared to the control group, the benign group showed fewer negative thought intrusions during breathing focus (as rated by both participants and an assessor). These findings show that it is possible to induce a more benign interpretive bias in GAD clients and that this reduces negative thought intrusions.     

The effect of attention modification with explicit vs. minimal instructions on worry

In this experiment we investigated the effect of different instructions on the modification of attentional biases, and subsequently on worry persistence. Participants without excessive worry completed a modified dot-probe task, designed to train attention either to threat or neutral words. Half of each group was given explicit instructions regarding the relationship between word valence and target location, and half were given the more usual minimal instructions. Impact on worry persistence was assessed by categorizing the valence of thought intrusions before and after a period of instructed worry. Response latencies to test items on the dot-probe task showed that attention had been successfully manipulated in the expected direction, and explicit instructions led to more effective attention modification. Moreover, participants in the attend-threat group who received explicit instructions reported significantly more negative thought intrusions following instructed worry, as rated by an assessor, whereas participants in the attend-neutral group did not. These findings suggest that an attentional bias towards threatening information plays a role in worry persistence, and that explicit instructions may be helpful in modifying this bias.     

A case series of attention modification in clinically anxious youths

Research in the last fifteen years suggests that anxious individuals selectively attend towards threatening information. Attention modification interventions for internalizing adults have been developed to target cognition at this basic level; these programs have demonstrated initial efficacy in attention bias and anxiety symptom reduction. To date, there have been no published studies of attention modification in youths with clinical levels of anxiety. The current case series examined the initial efficacy of a four-week (12 sessions) attention modification program (AMP) designed to train attention away from threat in 16 children and adolescents (ages 10 to 17) diagnosed with DSM-IV anxiety disorders. Overall, youths experienced a significant decrease in anxiety and depression symptoms, and 12 of 16 youths no longer met criteria for any anxiety diagnosis at post-treatment. AMP was feasible with youths, and all youths and parents deemed the program acceptable. These findings provide support for further research on the use of cognitive bias modification interventions with clinically anxious youths.     

Online attention modification for social anxiety disorder: replication of a randomized controlled trial

Social anxiety disorder (SAD) models posit vigilance for external social threat cues and exacerbated self-focused attention as key in disorder development and maintenance. Evidence indicates a modified dot-probe protocol may reduce symptoms of SAD; however, the efficacy when compared to a standard protocol and long-term maintenance of treatment gains remains unclear. Furthermore, the efficacy of such protocols on SAD-related constructs remains relatively unknown. The current investigation clarified these associations using a randomized control trial replicating and extending previous research. Participants with SAD (n = 113; 71% women) were randomized to complete a standard (i.e. control) or modified (i.e. active) dot-probe protocol consisting of 15-min sessions twice weekly for four weeks. Self-reported symptoms were measured at baseline, post-treatment, and 4-month and 8-month follow-ups. Hierarchical linear modeling indicated significant self-reported reductions in symptoms of social anxiety, fear of negative evaluation, trait anxiety, and depression, but no such reductions in fear of positive evaluation. Symptom changes did not differ based on condition and were maintained at 8-month follow-up. Attentional biases during the dot-probe task were not related to symptom change. Overall, our results replicate support for the efficacy of both protocols in reducing symptoms of SAD and specific related constructs, and suggest a role of exposure, expectancy, or practice effects, rather than attention modification, in effecting such reductions. The current results also support distinct relationships between fears of negative and positive evaluation and social anxiety. Further research focused on identifying the mechanisms of change in attention modification protocols appears warranted.     

Fewer intrusions after an attentional bias modification training for perceptual reminders of analogue trauma

The present experimental analogue study used computerised attention training to investigate the role of attention bias in the prediction of intrusive memories. After exposure to a trauma film, participants in a training group (n=22) were presented with a variant of the exogenic cueing task (ECT) in which visual film reminders (i.e., stills from the trauma film) were always presented during invalid and neutral control stimuli always during valid trials. The purpose of this cue–location contingency was reinforcing the direction of attention away from film reminders. Control participants (n=23) performed a similar training without such a contingency. Post-training processing bias was assessed with a single target Rapid Serial Visual Presentation (RSVP) task, in which trauma-film reminders served as task-irrelevant distracters appearing shortly before a neutral target. The frequency of film-related intrusions was recorded in a take-home diary and at a follow-up session three days after film viewing. Participants who underwent attention training reported fewer film-related intrusions and showed less interference by visual film distracters than controls. Implications for research on attention bias after real-life trauma are discussed.     

Attentional bias and emotional reactivity as predictors and moderators of behavioral treatment for social phobia

Cognitive behavioral therapy (CBT) is a well-established treatment for anxiety disorders, and evidence is accruing for the effectiveness of acceptance and commitment therapy (ACT). Little is known about factors that relate to treatment outcome overall (predictors), or who will thrive in each treatment (moderators). The goal of the current project was to test attentional bias and negative emotional reactivity as moderators and predictors of treatment outcome in a randomized controlled trial comparing CBT and ACT for social phobia. Forty-six patients received 12 sessions of CBT or ACT and were assessed for self-reported and clinician-rated symptoms at baseline, post treatment, 6, and 12 months. Attentional bias significantly moderated the relationship between treatment group and outcome with patients slow to disengage from threatening stimuli showing greater clinician-rated symptom reduction in CBT than in ACT. Negative emotional reactivity, but not positive emotional reactivity, was a significant overall predictor with patients high in negative emotional reactivity showing the greatest self-reported symptom reduction.     

Continual training of attentional bias in social anxiety

Using the dot-probe paradigm, it has been shown that high social anxiety is associated with an attentional bias toward negative information. In the present study, individuals with high social anxiety were divided into two groups randomly. One group was the attentional bias training group (Group T), and the other was the control group (Group C). For Group T, 7 days' continuous training of attentional bias was conducted using the dot-probe paradigm to make socially anxious individuals focus more on positive face pictures. The results showed that the training was effective in changing attentional bias in Group T. Scores of the Social Interaction Anxiety Scale (SIAS) in Group T were reduced compared to Group C, while the scores of Social Phobia Scale (SPS) and scores of Negative Evaluation Scale (FNE) showed no difference between the two groups, which suggested a limited reduction of social anxiety.     

防御性自尊大学生注意偏向对记忆偏向的影响

摘 要 为考查防御性自尊大学生注意偏向对记忆偏向的影响,本研究将被试分为训练组和控制组,训练组接受注意偏向训练,之后完成记忆任务。记忆任务中呈现中性和攻击性词汇,要求被试对词汇进行自由回忆。结果发现,控制组对攻击性信息存在着记忆偏向,而训练组对攻击性信息的记忆偏向消失。注意偏向训练可以即时性地改变防御性自尊大学生对攻击性信息的注意偏向,注意偏向可能是特质一致性记忆的原因之一。     

Memory bias for threatening information related to anxiety: an updated meta-analytic review

The evidence for an anxiety-related memory bias is contradictory. We compiled 171 articles published until October 2016 including a group with clinical or subclinical anxiety and a control group in tasks involving implicit or explicit memory using threatening stimuli. There was an anxiety-related memory bias in free recall tasks, but it was not observed in another memory task. The between-groups differences showed that the anxious group recalled more threatening stimuli than the control group (d?=?0.321). When we compared the group differences (anxious vs. control participants) in the within-groups effect (threatening vs. neutral stimuli), a moderate effect size emerged (d_bw?=?0.714). This anxiety-related memory bias was observed with shallow processing, that is consistent with attentional biases related to anxiety. There was also evidence that high-anxious persons recall fewer positive stimuli. Future research is needed to investigate whether this result is a memory or encoding bias and explore other moderator variables.     

Early information processing biases in social anxiety

Considerable controversy persists regarding the nature of threat-related attention biases in social anxiety. Previous studies have not considered how variations in the temporal and energetic dimensions of affective stimulus delivery interact with anxiety-related individual differences to predict biased attention. We administered a visual dot-probe task, using faces that varied in affective intensity (mild, moderate, strong) and presentation rate (100, 500, 1,250 ms) to a selected sample. The high, compared to the low, socially anxious group showed vigilance towards angry faces and emotionally ambiguous faces more generally during rapid (100 ms) presentations. By 1,250 ms, there was only a non-specific motor slowing associated with angry faces in the high socially anxious group. Findings suggest the importance of considering both chronometric and energetic dimensions of affective stimuli when examining anxiety-related attention biases. Future studies should consider using designs that more closely replicate aspects of real-world interaction to study processing biases in socially anxious populations.     

Fear-relevant selective associations and social anxiety: absence of a positive bias

An illusory correlation paradigm was used to compare high and low socially anxious individuals' initial, on-line and a posteriori covariation estimates between emotional faces and aversive, pleasant and neutral outcomes. Overall, participants demonstrated an initial expectancy bias for aversive outcomes following angry faces, and pleasant outcomes following happy faces. On-line expectancy biases indicated that initial biases were extinguished during the task, with the exception of low socially anxious individuals who continued to over-associate positive social cues with pleasant outcomes. In addition to lacking this protective positive on-line bias, the high social anxiety group reported retrospectively more negative social cues than the low socially anxious group. Findings are discussed in relation to similar evidence from recent interpretive and memory paradigms.     

Comorbid interpretation and expectancy bias in social anxiety and alcohol use

Background: In two studies, the present research examined whether being high in both social anxiety and alcohol use disorder symptoms is associated with a comorbid interpretation and expectancy bias that reflects their bidirectional relationship.

Design: Cross-sectional, quantitative surveys.

Methods: Measures of social anxiety and alcohol use disorder symptoms, as well as an interpretation and expectancy bias task assessing biases for social anxiety, drinking, and comorbid social anxiety and drinking.

Results: In Study 1 (N?=?447), individuals high (vs. low) in social anxiety had stronger social threat bias and individuals high (vs. low) in alcohol use disorder symptoms had stronger drinking bias. Those high in both social anxiety and alcohol use disorder symptoms endorsed interpretations and expectancies linking social interaction with alcohol use. Comorbid bias predicted membership into the high social anxiety/drinking group, even after taking into account single-disorder biases. In Study 2 (N?=?325), alcohol use disorder symptoms predicted drinking bias and social anxiety symptoms predicted social anxiety bias. Alcohol use disorder symptoms, social anxiety symptoms, and their interaction predicted comorbid interpretation and expectancy bias.

Conclusion: Results indicate unique cognitive vulnerability markers for persons with comorbid social anxiety and alcohol use disorder symptoms, which may improve detection and treatment of this serious comorbidity.