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.     

Attentional bias affects change detection

Thirty smokers and 30 nonsmokers participated in aflicker study in which the role of attentional bias in change detection was examined. The participants observed picture pairs of everyday objects flicker on a computer screen until they detected the one object that had changed. In half of the pictures, a smoking-related object (e.g., a lighter) was included among smoking-unrelated objects (e.g., a spoon). Half of the smokers and half of the nonsmokers were aware of the experiment’s focus, and the other half were not. The smokers exhibited shorter detection latencies than did the nonsmokers when a smoking object changed and longer detection latencies when a nonsmoking object changed while a smoking object was present, and they exhibited detection latencies similar to those of the nonsmokers when smoking objects were not present. Interestingly, the nonsmokers displayed the same attentional bias as the smokers when they were aware of the experiment’s smoking focus, but they did not display any attentional bias when they were unaware. Thus, these findings provide evidence for long-term context-independent, as well as for short-term context-dependent, attentional bias.     

Impaired positive inferential bias in social phobia

People with social phobia report anticipatory and retrospective judgments about social situations that appear consistent with a negative interpretative bias. However, it is not at all clear that biased interpretative inferences are made "on-line;" that is, at the time that ambiguous information is first encountered. In a previous study, volunteers who were anxious about interviews were found to lack the positive on-line inferential bias that was characteristic of nonanxious controls but also failed to show a bias favoring threatening inferences (C. R. Hirsch & A. Mathews, 1997). This finding was confirmed in the present study, in which social phobic patients showed no evidence of making on-line emotional inferences, in contrast with socially nonanxious controls who were again clearly biased in favor of positive inferences. The authors concluded that nonanxious individuals are characterized by a benign on-line inferential bias, but that this is impaired in people with social phobia.     

Attentional bias in euthymic bipolar I disorder

Little is known about the nature of the relation between information-processing biases and affective traits in bipolar disorder. The present study was designed to investigate whether attentional biases are evident in persons diagnosed with bipolar disorder when they are in a positive mood state, and whether biases are related to indices of emotion regulation and to prior history of mood episodes. Ninety adults diagnosed with bipolar I disorder and 81 controls with no lifetime mood disorder underwent a positive mood induction and then completed an emotion face dot-probe task; participants in the bipolar disorder group also completed a self-report measure of responses to positive affect. Attentional bias was not related to a diagnosis of bipolar disorder or to symptom severity. Consistent with hypotheses, analyses within the bipolar group indicated that greater dampening of positive affect related to significantly less attention paid to the positively valenced faces. Discussion focuses on the potential role of affective traits in shaping attentional bias in bipolar disorder.     

Attentional bias towards angry faces in trait-reappraisal

Emotion regulation (ER) strategies differ in when and how they influence emotion experience, expression, and concomitant cognition. However, no study to date has directly compared cognition in individuals who have a clear disposition for either cognitive or behavioural ER strategies. The present study compared selective attention to angry faces in groups of high trait-suppressors (people who are hiding emotional reactions in response to emotional challenge) and high trait-reappraisers (people who cognitively reinterpret emotional events). Since reappraisers are also low trait-anxious and suppressors are high trait-anxious, high and low anxious control groups, both being low in trait-ER, were also included. Attention to angry faces was assessed using an emotional dot-probe task. Trait-reappraisers and high-anxious individuals both showed attentional biases towards angry faces. Trait-reappraisers’ vigilance for angry faces was significantly more pronounced compared to both trait-suppressors and low anxious controls. We suggest that threat prioritization in high trait-reappraisal may allow deeper cognitive processing of threat information without being associated with psychological maladjustment.     

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.     

Attentional bias predicts outcome in smoking cessation.

Most attempts to quit smoking end in failure, with many quitters relapsing in the first few days. Responses to smoking-related cues may precipitate relapse. A modified emotional Stroop task-which measures the extent to which smoking-related words disrupt performance on a reaction time (RT) task-was used to index the distracting effects of smoking-related cues. Smokers (N = 158) randomized to a high-dose nicotine patch (35 mg) or placebo patch completed the Stroop task on the 1st day of a quit attempt. Smokers using an active patch exhibited less attentional bias, making fewer errors on smoking-related words. Smokers who showed greater attentional bias (slowed RT on the first block of smoking words) were significantly more likely to lapse in the short-term, even when controlling for self-reported urges at the test session. Attentional bias measures may tap an important component of dependence.     

Attentional bias to threat in clinical anxiety states

Abstract

Attentional responses to threat stimuli were assessed in anxious patients, normal controls, and subjects who had recovered from a clinical anxiety state. The main aims of the study were: (1) to replicate MacLeod, Mathews, and Tata's (1986) finding of an attentional bias to threat in currently anxious patients compared with normal control subjects; (2) to assess whether the bias is related to the predominant worries of anxious patients; and (3) to investigate whether the bias is present in recovered anxious patients. The original finding of an anxiety-related attentional bias was replicated. The results indicated that the extent to which anxious patients selectively attended to social threat words was associated with the seventy of their social worries. The attentional responses of the recovered anxious group were not significantly differentiated from those of the currently anxious or normal control groups.     

Attentional bias in anxiety: a behavioral and ERP study

Accumulating evidence suggests the existence of a processing bias in favor of threat-related stimulation in anxious individuals. Using behavioral and ERP measures, the present study investigated the deployment of attention to face stimuli with different emotion expressions in high-anxious and low-anxious participants. An attention-shifting paradigm was used in which faces with neutral, angry, fearful, sad, or happy expressions were presented singly at fixation. Participants had to fixate on the face cue and then discriminate a target shape that appeared randomly above, below, to the left, or right of the fixated face. The behavioral data show that high-anxious participants were slower to respond to targets regardless of the emotion expressed by the face cue. In contrast, the ERP data indicate that threat-related faces elicited faster latencies and greater amplitudes of early ERP components in high-anxious than in low-anxious individuals. The between-group pattern in ERP waveforms suggests that the slower reaction times in high-anxious participants might reflect increased attentional dwelling on the face cues, rather than a general slowing of response enacting.     

Attentional bias and anxiety in individuals with coronary heart disease

This study examined whether in an emotional Stroop task, individuals with coronary heart disease (CHD) would show greater attention towards the threatening words related to their disease than healthy persons, and if such an attentional bias is associated with anxiety. An emotional Stroop task with threatening words related to CHD as well as positive, negative and neutral words was administered to 35 individuals with CHD and 35 healthy controls. Additionally, the original Stroop task, the Beck anxiety inventory and the state-trait anxiety inventory were administered. The results indicated an attentional bias towards threatening words related to CHD in the individuals with CHD. They experienced higher interference than healthy participants from threatening words related to CHD but not from positive or negative words. Moreover, the level of interference was associated with their level of anxiety, and a vicious circle may exist in this association. In addition, results indicated a possible deficit of executive functioning among individuals with CHD. Attentional bias, as well as its association with anxiety, and an indication of deficit in executive functioning among individuals with CHD might be the risk factors for these individuals’ quality of life and for further development of their disease.     

Attentional bias to direct gaze in a dot-probe paradigm

Previous research has suggested that a singly presented facial stimulus having a direct gaze holds spatial attention. This study examined whether facial stimulus having a direct gaze can also capture spatial attention in a relative dot-probe paradigm (facial stimulus having a direct gaze was presented concurrently with that having an averted gaze). The results showed that participants oriented their spatial attention to a facial stimulus having a direct gaze rather than to that with an averted gaze. This attentional bias depended on gaze-perception mechanisms as observed in the lack of attentional bias to a direct gaze from unnatural-looking eyes (i.e., white pupil/iris and black sclera). These findings raise the possibility that the attentional effect implicated in the perception of a direct gaze is induced regardless of the stimulus context.     

Attentional bias in anxiety: A defective inhibition hypothesis

Abstract

Three experiments are reported which examine attentional bias in high trait-anxious, low trait-anxious, and repressor subjects. Measures of interference did not provide consistent results. However, negative priming effects suggested that high trait-anxious subjects had difficulty inhibiting threat-related information, as well as nonthreat-related distracting information under conditions of attentional search. There was some evidence that individuals with a repressive coping style were particularly efficient in inhibiting threat-related information. It is suggested that defective inhibition of distracting information may be an important mechanism in understanding the cognitive basis of anxiety.     

Heterogeneity among specific phobia types in DSM-IV

Recently, it has been suggested that situational specific phobias (e.g., phobias of driving, flying, enclosed places) are more closely related to agorophobia than are other specific phobia types. The present study investigated this hypothesis by examining heterogeneity among the four main DSM-IV specific phobia types, particularly with respect to variables believed to be associated with agoraphobia. Using interviews and behavioral testing, 60 patients with specific phobias of animals, heights, blood/injections, or driving were compared with respect to etiology, age of onset, physiological response, predictability of panic attacks, and focus of apprehension. Fifteen patients suffering from panic disorder with agoraphobia served as a comparison group for some measures. Relative to the other specific phobias, driving phobias were most strongly associated with a later age of onset, similar to that of individuals with agoraphobia. Height phobias were also associated with a late age of onset as well as a more internal focus of apprehension, relative to other groups. Finally, individuals in the blood/injection phobia group reported a more internal focus of apprehension than those in other groups and were the only group to report a history of fainting in the phobic situation. Overall, the results did not support the hypothesis that situational phobias are a variant of agoraphobia. In fact, on several of the variables for which groups did differ, individuals with height phobias (a phobia from the natural environment type) showed a pattern most similar to individuals with agoraphobia. The implications of these results for the classification of specific phobias are discussed.     

Attentional bias for performance-related words in individuals with narcissism

In this study, dot probe tasks were employed to present performance-related or interpersonal-related words paired with neutral words, we examined the attentional bias of narcissists as well as its mechanism. Results showed that the narcissistic individuals demonstrated significant attentional bias for performance words. Specifically, they were highly vigilant to failure words and had difficulty disengaging from success words, and there was no such bias for the category of interpersonal ones. Non-narcissists, on the other hand, exhibited significant difficulty disengaging from negative words, including failure words and rejection words. From this data, it would appear that attentional bias may be a built-in cognitive attribute of narcissism. The limitations of the present study and future research directions are also discussed.     

Attentional bias to respiratory- and anxiety-related threat in children with asthma

This study investigated attentional biases in children with asthma. The study aimed at testing whether children with asthma are vigilant to asthma and/or anxiety cues. Thirty-six children (18 with asthma and 18 healthy controls) aged 9–12 completed a computerised dot probe task designed to measure attentional bias to three different categories of words: asthma, anxiety symptom and general negative emotion. Main caregiver anxiety was also assessed, as was frequency of inhaler use for those with asthma. Children with asthma showed an attentional bias towards asthma words but not anxiety or general negative emotion words. Children without asthma showed no significant attentional biases to any word categories. Caregiver anxiety was correlated with asthma word attentional bias in the asthma group. The findings indicate that attentional bias is present in children with asthma. Further research is required to ascertain if this exacerbates or maintains health-related problems.     

Mechanisms of visual threat detection in specific phobia

People with anxiety or stress-related disorders attend differently to threat-relevant compared with non-threat stimuli, yet the temporal mechanisms of differential allocation of attention are not well understood. We investigated two independent mechanisms of temporal processing of visual threat by comparing spider-phobic and non-fearful participants using a rapid serial visual presentation task. Consistent with prior literature, spider phobics, but not non-fearful controls, displayed threat-specific facilitated detection of spider stimuli relative to negative stimuli and neutral stimuli. Further, signal detection analyses revealed that facilitated threat detection in spider-phobic participants was driven by greater sensitivity to threat stimulus features and a trend towards a lower threshold for detecting spider stimuli. However, phobic participants did not display reliably slowed temporal disengagement from threat-relevant stimuli. These findings advance our understanding of threat feature processing that might contribute to the onset and maintenance of symptoms in specific phobia and disorders that involve visual threat information more generally.     

Attentional bias in post-traumatic stress disorder diminishes after symptom amelioration

Background

Avoidance and hypervigilance to reminders of a traumatic event are among the main characteristics of post-traumatic stress disorder (PTSD). Attentional bias toward aversive cues in PTSD has been hypothesized as being part of the dysfunction causing etiology and maintenance of PTSD. The aim of the present study was to investigate the cognitive strategy underlying attentional bias in PTSD and whether normal cognitive processing is restored after a treatment suppressing core PTSD symptoms.

Methods

Nineteen healthy controls were matched for age, sex and education to 19 PTSD patients. We used the emotional stroop and detection of target tasks, before and after an average of 4.1 sessions of eye movement desensitization and reprocessing (EMDR) therapy.

Results

We found that on both tasks, patients were slower than controls in responding in the presence of emotionally negative words compared to neutral ones. After symptoms removal, patients no longer had attentional bias, and responded similarly to controls.

Conclusion

These results support the existence of an attentional bias in PTSD patients due to a disengagement difficulty. There was also preliminary evidence that the disengagement was linked to PTSD symptomatology. It should be further explored whether attentional bias and PTSD involve common brain mechanisms.     

Attentional bias to violent images in survivors of dating violence

This study investigated the time-course characteristics of attentional bias, such as vigilance and maintenance, towards violent stimuli in dating violence (DV) survivors. DV survivors with PTSD symptoms (DV-PTSD group; n=14), DV survivors without PTSD symptoms (Trauma Control group; n=14), and individuals who were never exposed to dating violence (NDV group; n=15) viewed slides that presented four categories of images (violent, dysphoric, positive, and neutral) per slide, for ten seconds. Our results revealed that the DV-PTSD group spent more time on violent stimuli than did the Trauma Control or NDV groups. The DV survivors, both with and without PTSD symptoms, spent more time on dysphoric stimuli and less time on happy stimuli than did the NDV group. In addition to the effects of PTSD, researchers should also be considering the effects of simple traumatic exposure.