Selective processing of threat cues in anxiety states: a replication

A replication of Mathews and MacLeod's (Behav. Res. Ther. 23, 563-569, 1985) study, using a modified Stroop task, confirmed that threat words selectively interfere with the colour-naming performance of generally anxious patients, compared with normal controls. Clearer evidence was obtained of a highly specific interference effect of threat words that were congruent with the predominant worries reported by anxious patients. However, there was no evidence of a subsequent recognition memory bias for the threat words in anxious Ss. These results are discussed in relation to findings from other recent experiments investigating attentional and memory biases for threat-related information in anxiety states, and their implications for cognitive theories of anxiety are considered.     

Bias in interpretation of ambiguous sentences related to threat in anxiety

In the 1st of 2 experiments, currently clinically anxious, recovered clinically anxious, and normal control subjects were presented with a mixture of unambiguous and ambiguous sentences; both threatening and nonthreatening interpretations were possible for the latter. A subsequent recognition-memory test indicated that the currently anxious subjects were more likely than normal control and recovered anxious subjects to interpret the ambiguous sentences in a threatening fashion rather than in a nonthreatening fashion. This suggests that the biased interpretation of ambiguity found in currently anxious subjects reflected their anxious mood state. A 2nd experiment established that the difference in interpretative processes between currently anxious and control subjects was not due to response bias and that the interpretative bias was a reasonably general one.     

Terror mismanagement: evidence that mortality salience exacerbates attentional bias in social anxiety

Death anxiety is a basic fear underlying a range of psychological conditions, and has been found to increase avoidance in social anxiety. Given that attentional bias is a core feature of social anxiety, the aim of the present study was to examine the impact of mortality salience (MS) on attentional bias in social anxiety. Participants were 36 socially anxious and 37 non-socially anxious individuals, randomly allocated to a MS or control condition. An eye-tracking procedure assessed initial bias towards, and late-stage avoidance of, socially threatening facial expressions. As predicted, socially anxious participants in the MS condition demonstrated significantly more initial bias to social threat than non-socially anxious participants in the MS condition and socially anxious participants in the control condition. However, this effect was not found for late-stage avoidance of social threat. These findings suggest that reminders of death may heighten initial vigilance towards social threat.     

Selective Processing of Threat Cues in Subjects with Panic Attacks

Abstract

Previous research has demonstrated that patients with generalised anxiety disorder, phobias, and obsessive-compulsive disorder show an attentional bias towards threat cues related to their respective disorders. Two studies are presented that used a modified Stroop colour naming task to assess attentional bias in subjects with panic attacks. In Study 1, 24 panic disorder patients and 24 normal controls were presented three cards containing threat words related to physical harm, separation, or social embarrassment. Colour naming times were compared between these cards and control cards containing matched non-threat words. Reaction time differences in the two groups were in opposite directions, patients tending to be slower in colour naming threat words, and controls, faster. In Study 2, 18 non-clinical panickers and 18 controls were presented cards containing physical threat words, neutral control words, or colour words, respectively. Panickers showed greater interference than controls in colour naming threat words but not in colour naming colour words. The results are consistent with an attentional bias for threat-related material in subjects with panic attacks. Implications for psychophysiological models of 'spontaneous' panic attacks are discussed.     

Does anxiety lead to selective processing of threat-related information?

Four experiments investigating the detailed nature of the attentional bias in anxiety are reported. Previous research using the Stroop task has shown that, when compared with non-patient controls, anxious patients are relatively slower at colour naming threat-related words than non-threat words. Experiments One and Two investigated whether this apparent attentional bias is a function of anxiety per se and/or is related to patient/non-patient status. Experiment One compared colour-naming times for threat and non-threat words in low, medium and high trait anxiety normal subjects. High anxiety was not associated with slower colour-naming times for threat words. Experiment Two compared generalized anxiety disorder patients with equally anxious non-patients and found that the patients were significantly slower at colour-naming threat words. Read aloud and dwell tasks were also included in these experiments in order to identify the mechanism of Stroop interference. Experiments Three and Four investigated whether anxious patients' attentional bias is specific to threat-related material or also extends to certain positive, emotional material. In Experiment Three words used in previous Stroop studies were rated for emotionality. Threat words were more emotional, as well as more threatening, than control words, indicating that previous studies have confounded threat and emotionality. Experiment Four compared colour-naming times for threat words, equally emotional positive words, and neutral words. Consistent with the emotionality hypothesis, generalized anxiety disorder patients were slower than non-anxious controls at colour naming both threat words and positive words. The theoretical, methodological and clinical implications of these results are discussed.     

Attentional biases to internal and external sources of potential threat in social anxiety

D. M. Clark and A. Wells (1995) proposed that a shift of attention inward toward interoceptive information is a central feature of social phobia. However, few studies have examined attentional biases toward internal physiological cues in social phobia. The current experiment assessed whether socially anxious individuals exhibit an attentional bias (a) toward cues for an internal source of potential threat (heart-rate information), (b) toward cues for an external source of potential threat (threatening faces) or (c) both. Ninety-one participants who were selected to form extreme groups based on a social anxiety screening measure performed a dot-probe task to assess location of attention. Results showed that socially anxious participants exhibited an attentional bias toward cues of internal, but not external, sources of potential threat.     

Attention to Positive and Negative Social-Evaluative Words: Investigating the Effects of Social Anxiety,Trait Anxiety and Social Threat

The study investigated how attention to negative (threatening) and positive social-evaluative words is affected by social anxiety, trait anxiety and the expectation of social threat. High and low socially anxious individuals carried out a modified dot-probe task either while expecting to give a speech or under non-threatening conditions. High socially anxious individuals showed no significant attentional bias towards or away from social-evaluative words. This result significantly contrasted with an identical design that showed avoidance of emotional faces in high socially anxious participants drawn from the same population (Mansell et al ., 1999). Participants who expected to give a speech showed less attentional avoidance of negative and positive social-evaluative words. High trait anxiety was associated with selective attention to negative relative to positive social-evaluative words, consistent with earlier findings of attention to threat cues in high trait-anxious individuals. Implications for designing attention tasks and attentional bias across different dimensions of anxiety are discussed.     

Reaction time to threat stimuli in panic disorder and social phobia

Two studies assessed response time among clinically anxious subjects and normal controls when presented with threat, positive and neutral stimuli under perceptual (lexical decision) and semantic (category decision) task conditions. In Study 1, panic disorder subjects' (n = 14) performance was compared to that of matched normal controls (n = 14) while in Study 2 social phobic subjects (n = 24) were compared to matched normal controls (n = 24). Relative to matched normal controls, panic disorder subjects but not social phobics tended to show greater slowing in performance on the more cognitively complex (category) task. A second finding, consistent across both studies was that, compared to the normal control groups, both panic and social phobic groups showed significantly slowed responses to threat words in both the perceptual and semantic tasks. Such findings are directly counter to the predictions of a mood congruence hypothesis. This apparent contradiction is resolved by a review of the literature which indicates that mood-related facilitation effects are obtained only in tasks which tap awareness of threat information rather than speed of response. It is suggested that while anxiety may produce enhanced awareness of threat, it may inhibit responsiveness to it. The results of these studies are seen as consistent with ethological theories of inhibited motoric responses under certain threat conditions. Furthermore, the findings suggest that caution is indicated in interpreting slowed reaction time to threat stimuli in tasks such as the Stroop color naming task as purely the result of attentional processes.     

Effects of stress and anxiety on the processing of threat stimuli

Two experiments extended the work of MacLeod and Mathews (1988) and examined whether a cognitive bias for threat information is a function of state or trait anxiety. Color-naming and attention deployment tasks were used to assess the effects of a stress manipulation procedure on attentional responses in high and low trait anxious subjects. Subjects under high stress selectively allocated processing resources toward threat stimuli, irrespective of their trait anxiety level. There was no consistent evidence of a cognitive bias associated with trait anxiety, and the effect of the stress manipulation did not appear to be mediated by state anxiety. It was suggested that trait factors do not modify attentional biases associated with acute stress, but may influence such biases when stress is prolonged.     

Attentional bias to threat: Roles of trait anxiety, stressful events, and awareness

Attentional biases for threat stimuli were assessed in high and low trait anxious subjects (n = 66) using a probe detection task. To examine the effects of trait anxiety and situational stressors, each subject was tested three times: Under no stress, laboratory-induced stress, and examination-induced stress. To evaluate the role of awareness, half the word stimuli were presented very briefly (14 msec) and masked, and the other half were presented for 500 msec without a mask. Results showed that high trait anxious subjects under exam stress showed an attentional bias towards unmasked threat stimuli compared with low trait subjects. This effect was not found under lab-induced stress, suggesting that the attentional bias for unmasked threat in high trait subjects may be a function of a prolonged stressor, rather than a transient increase in state anxiety. The results from the masked exposure condition were not predicted; high trait anxious subjects shifted attention towards the spatial location of threat words despite lack of awareness of their lexical content, but this bias was only apparent in the no-stress condition. The results are discussed in relation to recent cognitive theories of anxiety.     

Anxiety-related attentional biases and their regulation by attentional control

This study examined the role of self-reported attentional control in regulating attentional biases related to trait anxiety. Simple detection targets were preceded by cues labeling potential target locations as threatening (likely to result in negative feedback) or safe (likely to result in positive feedback). Trait anxious participants showed an early attentional bias favoring the threatening location 250 ms after the cue and a late bias favoring the safe location 500 ms after the cue. The anxiety-related threat bias was moderated by attentional control at the 500-ms delay: Anxious participants with poor attentional control still showed the threat bias, whereas those with good control were better able to shift from the threatening location. Thus, skilled control of voluntary attention may allow anxious persons to limit the impact of threatening information.     

Early attention processes and anxiety in children

It has been hypothesized that anxiety in children is associated with attentional bias in the early stages of information processing. Bias towards threat indicates the tendency of an individual to direct attention towards threatening information. The aim of the present study was to investigate whether high test-anxiety in a sample of nonreferred children is associated with attentional bias towards threat pictures, and if low test-anxiety is associated with attentional bias away from threat pictures. A probe-detection task was used with 44 10- to 13-yr.-old children. The overall analyses indicated the presence of an attentional bias away from threatening pictures in these nonreferred children. However, in relation to anxiety, the study did not confirm that high anxious children show an attentional bias towards threatening pictures or that low anxious children show an attentional bias away from threatening pictures. Yet, higher anxiety did seem to be associated with longer mean response times. These longer response times might originate from the interpretation of the nature of a stimulus as too threatening, compared to the actual threatening content, in the first stage of information processing. This finding could be useful to improve treatment methods aimed at anxiety symptoms during childhood.     

Fear of negative evaluation and attentional bias for facial expressions: An event-related study

Numerous studies have shown an exacerbation of attentional bias towards threat in anxiety states. However, the cognitive mechanisms responsible for these attentional biases remain largely unknown. Further, the authors outline the need to consider the nature of the attentional processes in operation (hypervigilance, avoidance, or disengagement). We adapted a dot-probe paradigm to record behavioral and electrophysiological responses in 26 participants reporting high or low fear of evaluation, a major component of social anxiety. Pairs of faces including a neutral and an emotional face (displaying anger, fear, disgust, or happiness) were presented during 200 ms and then replaced by a neutral target to discriminate. Results show that anxious participants were characterized by an increased P1 in response to pairs of faces, irrespective of the emotional expression included in the pair. They also showed an increased P2 in response to angry–neutral pairs selectively. Finally, in anxious participants, the P1 response to targets was enhanced when replacing emotional faces, whereas non-anxious subjects showed no difference between the two conditions. These results indicate an early hypervigilance to face stimuli in social anxiety, coupled with difficulty in disengaging from threat and sustained attention to emotional stimuli. They are discussed within the framework of current models of anxiety and psychopathology.     

Health anxiety,anxiety sensitivity,and attentional biases for pictorial and linguistic health‐threat cues

The study investigated attentional biases for pictorial and linguistic health‐threat stimuli in high and low health anxious individuals, who were selected from the upper and lower quartile ranges of a normal sample using a screening measure of health anxiety. Attentional bias was assessed using a visual probe task which presented health‐threat and neutral pictures and words at two exposure durations, 500 ms and 1250 ms. The prediction that the high health anxious group would show a greater attentional bias for health‐threat cues than the low health anxious group was not supported despite the groups being well‐differentiated on a general measure of health anxiety, the Illness Attitudes Scale (IAS). Instead, the results indicated that individuals with high levels of anxiety sensitivity showed a significantly greater initial attentional bias for threat pictures compared with those with low anxiety sensitivity, as assessed by the Anxiety Sensitivity Index (ASI).     

Processing efficiency in anxiety: Evidence from eye-movements during visual search

It is generally held that anxiety is characterized by an attentional bias for threatening information. In recent years there has been an important debate whether these biases reside at the level of attentional selection (threat detection) or attentional processing after threat detection (attentional disengagement). In a visual search task containing emotional facial expressions, eye-movements were examined before and after threat detection in high and low trait anxious individuals to further elucidate the temporal unfolding of attentional bias. Results indicated that high-anxious individuals neither showed facilitated orienting to threat nor impaired disengagement of visual attention from threat. Interestingly, the presence of threat in the visual search display was associated with increased decision times in high-anxious individuals. These results challenge some of the current views on attentional bias to threat but indicate that emotional information reduces processing efficiency in anxiety.     

Anxiety and speaking in people who stutter: An investigation using the emotional Stroop task

People with anxiety disorders show an attentional bias towards threat or negative emotion words. This exploratory study examined whether people who stutter (PWS), who can be anxious when speaking, show similar bias and whether reactions to threat words also influence speech motor planning and execution. Comparisons were made between 31 PWS and 31 fluent controls in a modified emotional Stroop task where, depending on a visual cue, participants named the colour of threat and neutral words at either a normal or fast articulation rate. In a manual version of the same task participants pressed the corresponding colour button with either a long or short duration. PWS but not controls were slower to respond to threat words than neutral words, however, this emotionality effect was only evident for verbal responding. Emotionality did not interact with speech rate, but the size of the emotionality effect among PWS did correlate with frequency of stuttering. Results suggest PWS show an attentional bias to threat words similar to that found in people with anxiety disorder. In addition, this bias appears to be contingent on engaging the speech production system as a response modality. No evidence was found to indicate that emotional reactivity during the Stroop task constrains or destabilises, perhaps via arousal mechanisms, speech motor adjustment or execution for PWS.Educational objectives: The reader will be able to: (1) explain the importance of cognitive aspects of anxiety, such as attentional biases, in the possible cause and/or maintenance of anxiety in people who stutter, (2) explain how the emotional Stroop task can be used as a measure of attentional bias to threat information, and (3) evaluate the findings with respect to the relationship between attentional bias to threat information and speech production in people who stutter.     

Attentional bias towards angry faces is moderated by the activation of a social processing mode in the general population

ABSTRACT

Dot-probe studies usually find an attentional bias towards threatening stimuli only in anxious participants, but not in non-anxious participants. In the present study, we conducted two experiments to investigate whether attentional bias towards angry faces in unselected samples is moderated by the extent to which the current task requires social processing. In Experiment 1, participants performed a dot-probe task involving classification of either socially meaningful targets (schematic faces) or meaningless targets (scrambled schematic faces). Targets were preceded by two photographic face cues, one angry and one neutral. Angry face cues only produced significant cueing scores (i.e. faster target responses if the target replaced the angry face compared to the neutral face) with socially meaningful targets, not with meaningless targets. In Experiment 2, participants classified only meaningful targets, which were either socially meaningful (schematic faces) or not (schematic houses). Again, mean cueing scores were significantly moderated by the social character of the targets. However, cueing scores in this experiment were non-significant in the social target condition and significantly negative in the non-social target condition. These results suggest that attentional bias towards angry faces in the dot-probe task is moderated by the activation of a social processing mode in unselected samples.     

Attentional bias in anxiety: selective search or defective filtering?

Two experimental tasks were used to investigate the nature of a previously documented bias in attention associated with anxiety. Results from the first task failed to reveal any differences between anxious and nonanxious subjects, either in attention focusing or selective search for letters. The second task, with words as targets and distractors, suggested that selective search was less efficient in anxious subjects when distractors were present. Currently anxious subjects were slower than controls when required to search for the target among distractors of any type, whereas both currently anxious and recovered subjects were slower when the distractors were threatening words. It was therefore suggested that a bias favoring threat cues during perceptual search is an enduring feature of individuals vulnerable to anxiety, rather than a transient consequence of current mood state alone.     

Anxiety and Attention: Is There an Attentional Bias for Positive Emotional Stimuli?

Empirical research has shown that anxiety is associated with a systematic bias in the cognitive system. Anxious individuals (clinically anxious patients and normal individuals with high-trait anxiety) are characterized by a pattern of selective processing that favors the encoding of threatening information. Is this attentional bias specific to threat-related information, or does it operate for positive emotional stimuli? The research directly connected with the existence of an attentional bias for threat in anxiety was examined.     

Direction of threat attention bias predicts treatment outcome in anxious children receiving cognitive-behavioural therapy

BackgroundA bias to selectively direct attention to threat stimuli is a cognitive characteristic of anxiety disorders. Recent studies indicate that individual differences in pre-treatment threat attention bias predict treatment outcomes from cognitive-behavioural therapy (CBT) in anxious individuals. However, there have been inconsistent findings regarding whether attention bias towards threat predicts better or poorer treatment outcome.MethodThis longitudinal study examined treatment outcomes in 35 clinically-anxious children following a 10-week, group-based CBT program, as a function of whether children showed a pre-treatment attention bias towards or away from threat stimuli. The effect of CBT on attention bias was also assessed.ResultsBoth groups showed significant improvement after receiving CBT. However, anxious children with a pre-treatment attention bias towards threat showed greater reductions not only in anxiety symptom severity, but also in the likelihood of meeting diagnostic criteria for anxiety disorders at post-treatment assessment, in comparison with anxious children who showed a pre-treatment attention bias away from threat. Children who had a pre-treatment bias away from threat showed a reduction in this bias over the course of CBT.ConclusionsFindings suggest that pre-existing differences in the direction of attention towards versus away from threat could have important implications for the treatment of anxious children.