When spiders appear suddenly: spider-phobic patients are distracted by task-irrelevant spiders

Fear is thought to facilitate the detection of threatening stimuli. Few studies have examined the effects of task-irrelevant phobic cues in search tasks that do not involve semantic categorization. In a combined reaction time and eye-tracking experiment we investigated whether peripheral visual cues capture initial attention and distract from the execution of goal-directed eye movements. Twenty-one spider-phobic patients and 21 control participants were instructed to search for a color singleton while ignoring task-irrelevant abrupt-onset distractors which contained either a small picture of a spider (phobic), a flower (non-phobic, but similar to spiders in shape), a mushroom (non-phobic, and not similar to spiders in shape), or no picture. As expected, patients' reaction times were longer on trials with spider distractors. However, eye movements revealed that this was not due to attentional capture by spider distractors; patients more often fixated on all distractors with pictures, but their reaction times were delayed by longer fixation durations on spider distractors. These data do not support automatic capture of attention by phobic cues but suggest that phobic patients fail to disengage attention from spiders.     

Disgust sensitivity and contamination fears in spider and blood-injection-injury phobias

Disgust has been implicated in the onset and maintenance of blood-injection-injury (BII) and animal phobias. Research suggests that people with these phobias are characterized by an elevated sensitivity to disgust-evoking stimuli separate from their phobic concerns. The disgust response has been described as the rejection of potential contaminants. Disgust-motivated avoidance of phobic stimuli may therefore be related to fears of contamination or infection. The present study compared BII phobics, spider phobics and nonphobics on two measures of disgust sensitivity and two measures of contamination fears. Positive correlations were found between disgust sensitivity and contamination fear. Specific phobics scored higher than nonphobics on all scales and BII phobics scored higher than spider phobics on contamination fear measures. Furthermore, the contamination fear scales were correlated with the blood phobia measure, but not correlated with the spider phobia measure. The results suggest that while both phobias are characterized by elevated disgust sensitivity, contamination fear is more prominent in BII than spider phobia.     

Phobia-relevant illusory correlations: the role of phobic responsivity

The authors investigated the role of phobic responsivity in the generation of phobia-relevant illusory correlations. As a means of disentangling the contributions of prior fear and elicited fear responses, half of a group of phobic women received 1 mg alprazolam (n = 21), and half received a placebo (n = 22). A group of nonfearful women (n = 24) was included to control for prior fear per se. Participants were exposed to slides of spiders, weapons, and flowers that were randomly paired with a shock, a siren, or nothing. Postexperimental covariation estimates and on-line outcome expectancies were assessed. Irrespective of both prior and elicited fear, participants postexperimentally overassociated spiders and shock. Yet, only women with spider phobia displayed a persisting fear-confirming expectancy bias. This bias was similar for the placebo and alprazolam groups. Thus, the bias appeared to be due to preexisting phobogenic beliefs, whereas phobic responsivity played a negligible role.     

Rapid visuomotor processing of phobic images in spider- and snake-fearful participants

This study investigates enhanced visuomotor processing of phobic compared to fear-relevant and neutral stimuli. We used a response priming design to measure rapid, automatic motor activation by natural images (spiders, snakes, mushrooms, and flowers) in spider-fearful, snake-fearful, and control participants. We found strong priming effects in all tasks and conditions; however, results showed marked differences between groups. Most importantly, in the group of spider-fearful individuals, spider pictures had a strong and specific influence on even the fastest motor responses: Phobic primes entailed the largest priming effects, and phobic targets accelerated responses, both effects indicating speeded response activation by phobic images. In snake-fearful participants, this processing enhancement for phobic material was less pronounced and extended to both snake and spider images. We conclude that spider phobia leads to enhanced processing capacity for phobic images. We argue that this is enabled by long-term perceptual learning processes.     

What is so frightening about spiders? Self‐rated and self‐disclosed impact of different characteristics and associations with phobia symptoms

Spider phobia is a common and impairing mental disorder, yet little is known about what characteristics of spiders that spider phobic individuals find frightening. Using screening data from a clinical trial, we explored which characteristics that spider‐fearful individuals (n = 194) rated as having the greatest impact on fear, used factor analysis to group specific characteristics, and explored linear associations with self‐reported phobia symptoms. Second, a guided text‐mining approach was used to extract the most common words in free‐text responses to the question: “What is it about spiders that you find frightening?” Both analysis types suggested that movement‐related characteristics of spiders were the most important, followed by appearance characteristics. There were, however, no linear associations with degree of phobia symptoms. Our findings reveal the importance of targeting movement‐related fears in in‐vivo exposure therapy for spider phobia and using realistically animated spider stimuli in computer‐based experimental paradigms and clinical interventions such as Virtual Reality exposure therapy.     

Subjectively rated physiological and cognitive symptoms in six different clinical phobias

The purpose of the present study was an attempt to describe clinical symptoms in terms of physiological reactions and negative cognitions experienced by phobic patients. A total of 267 clinical phobic patients divided among blood phobia, small animals phobia, dental phobia, claustrophobia, social phobia and agoraphobia, participated in the study. The patients within each phobic category were separated into a Conditioned and an Indirect Acquisition group, based on their answers to a set of specific questions concerning the etiology of the phobia. All patients rated (0–4) how intensively they experienced 11 specified physiological reactions and 10 negative cognitions when confronted with their phobic situation in vivo. A mean score was calculated for each item within each group, and an item rank-order hierarchy was set up for each group. Differences between items within each hierarchy were statistically evaluated by one-way ANOVAs and Turkey's HSD-tests. Results showed particular idiosyncratic patterns of responding for the blood phobic, agoraphobic and social phobic groups as well as several commonalities among all the groups concerning activation of specific physiological reactions and negative cognitions. A more fine-grained analysis of the data is best made by direct visual inspection of the figures in this paper.     

The role of modeling in prevention and extinction of phobic behaviour in cynomolgus monkeys (Macaca Fascicularis)

In previous studies surrogate reared cynomolgus monkeys have been shown to become phobic of an unprepared harmless object. In the present study an attempt was made to prevent the development of phobic behaviour in young monkeys and to extinguish avoidance behaviour in phobic monkeys. In the first experiment subjects were exposed to the object in company of their (surrogate) mothers which approached the object. In the second experiment phobic subjects were exposed to the object in company of non-phobic conspecifics which approached the object. The results of the first experiment show that modeling was unsuccessful in preventing the acquisition of phobia in the surrogate-reared monkeys but seemed successful in accelerating approach in the mother-reared subjects. The results of the second experiment show that during the modeling treatment the phobic subjects followed the model and approached the object. However, in post treatment tests all subjects but one relapsed into avoidance. The effect of modeling during treatment is interpreted in terms of coaclive facilitation.     

The role of modeling in prevention and extinction of phobic behaviour in cynomolgus monkeys (Macaca fascicularis)

In previous studies surrogate reared cynomolgus monkeys have been shown to become phobic of an unprepared harmless object. In the present study an attempt was made to prevent the development of phobic behaviour in young monkeys and to extinguish avoidance behaviour in phobic monkeys. In the first experiment subjects were exposed to the object in company of their (surrogate) mothers which approached the object. In the second experiment phobic subjects were exposed to the object in company of non-phobic conspecifics which approached the object. The results of the first experiment show that modeling was unsuccessful in preventing the acquisition of phobia in the surrogate-reared monkeys but seemed successful in accelerating approach in the mother-reared subjects. The results of the second experiment show that during the modeling treatment the phobic subjects followed the model and approached the object. However, in post treatment tests all subjects but one relapsed into avoidance. The effect of modeling during treatment is interpreted in terms of coaclive facilitation.     

I am going to gag: Disgust cognitions in spider and blood–injury–injection fears

There is mounting evidence that disgust plays an important role in certain anxiety disorders, yet little is known about disgust's cognitive component. The current study introduces a measure of cognitions associated with disgust and contamination to assess the role of disgust-specific primary and secondary appraisals in phobic responding. A multi-modal assessment of blood–injury–injection (BII) and spider phobia was conducted using BII (N=29) and spider (N=30) fearful groups, and a non-fearful control group (N=30). The Disgust Cognitions scale showed good reliability and validity, and distinguished among the groups. For example, relative to the other groups, the spider fear group reported higher disgust cognitions following presentation of a live spider, whereas the BII Fear group reported higher disgust cognitions following a surgery video. Moreover, the scale was associated with multiple phobic indicators (behavioural avoidance, subjective distress, symptom endorsement), suggesting cognitions may be critical to understanding how disgust contributes to anxiety disorders.     

I am going to gag: Disgust cognitions in spider and blood-injury-injection fears

There is mounting evidence that disgust plays an important role in certain anxiety disorders, yet little is known about disgust's cognitive component. The current study introduces a measure of cognitions associated with disgust and contamination to assess the role of disgust-specific primary and secondary appraisals in phobic responding. A multi-modal assessment of blood-injury-injection (BII) and spider phobia was conducted using BII (N=29) and spider (N=30) fearful groups, and a non-fearful control group (N=30). The Disgust Cognitions scale showed good reliability and validity, and distinguished among the groups. For example, relative to the other groups, the spider fear group reported higher disgust cognitions following presentation of a live spider, whereas the BII Fear group reported higher disgust cognitions following a surgery video. Moreover, the scale was associated with multiple phobic indicators (behavioral avoidance, subjective distress, symptom endorsement), suggesting cognitions may be critical to understanding how disgust contributes to anxiety disorders.     

Danger expectancies, self-efficacy and insight in spider phobia

In the current edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; American Psychiatric Association, (1994) Diagnostic and statistical manual of mental disorders (4th ed.) Washington, DC: author) phobic adults and adolescents are said to "recognize that the phobia is excessive or unreasonable" given the actual danger posed by the feared situation. The present study examined perceptions of danger in 15 spider phobic subjects and a matched set of controls before, during and after a spider-avoidance test. When detached from the phobic stimulus, phobic subjects: (1) gave higher estimates of the probability of being bitten than controls did; (2) gave higher estimates of the injuries that would result from being bitten and (3) in line with these first two findings, believed their high levels of anticipated anxiety were more reasonable and appropriate to the demands of the situation than controls did. These findings are inconsistent with the prevailing notion that when detached from the phobic situation patients can accurately evaluate the danger of potential phobic encounters. Instead, the findings suggest that phobic individuals, whether detached or in the presence of the feared object, have relatively limited insight into the irrationality of their fears. In examining the mediation of phobic phenomena, both self-efficacy and danger estimates remained significantly related to the anxiety and avoidance experienced in the spider-avoidance task. Further research designed to experimentally establish the likely causal roles of these two constructs is warranted.     

Cognitive Bias in Spider-Phobic Children: Comparison of a Pictorial and a Linguistic Spider Stroop

The relation between spider fear in children and cognitive processing bias toward threatening information was examined. It was investigated whether spider fear in children is related to a cognitive bias for threatening pictures and words. Pictorial and linguistic Stroop stimuli were administered to 28 spider phobic and 30 control children aged 8–12. Spider-phobic children showed a moderate bias for threatening words. Surprisingly, no bias was found for spider pictures, while the spider-phobic children judged the pictures as more aversive. Moreover, in a recent similar study in adults (Kindt & Brosschot, 1997), a strong relation between spider phobia and bias toward threat words and pictures was found. Several explanations are given to account for this divergence.     

Internet‐Based Self‐Help Versus One‐Session Exposure in the Treatment of Spider Phobia: A Randomized Controlled Trial

The authors compared guided Internet‐delivered self‐help with one session of live‐exposure treatment in a sample of spider‐phobic patients. A total of 30 patients were included following screening on the Internet and a structured clinical interview. The Internet treatment consisted of five weekly text modules, which were presented on a web page, a video in which exposure was modelled, and support provided via Internet. The live‐exposure treatment was delivered in a 3‐hr session following a brief orientation session. The main outcome measure was the behavioural approach test (BAT), and as secondary measures the authors used questionnaires measuring anxiety symptoms and depression. Results showed that the groups did not differ at posttreatment or follow‐up, with the exception of the proportion showing clinically significant change on the BAT. At posttreatment 46.2% of the Internet group and 85.7% in the live‐exposure group achieved this change. At follow‐up the corresponding figures were 66.7% for the Internet group and 72.7% for the live treatment. Within‐group effect sizes for the spider phobia questionnaire were large (d = 1.84 and 2.58 for the Internet and live‐exposure groups, respectively, at posttreatment). The authors conclude that guided Internet‐delivered exposure treatment is a promising new approach in the treatment of spider phobia.     

Emotional responding to fearful and disgusting stimuli in specific phobics

Individuals with small animal and blood-injection-injury (BII) phobias respond to phobia-relevant stimuli with both fear and disgust. However, recent studies suggest that fear is the dominant emotional response in animal phobics whereas disgust is the primary emotional response in BII phobics. The present study examined emotional responding toward pictures of spiders, surgical procedures, and two categories of general disgust elicitors (rotting food and body products) among analogue spider phobics, BII phobics, and nonphobics. Dominant emotional responses to phobia-relevant stimuli clearly differentiated the groups. as spider phobics were more likely to be classified as primarily fearful when rating pictures of spiders (74%), whereas BII phobics were more likely to be classified as primarily disgusted when rating pictures of surgical procedures (78%). Discriminant function analyses revealed that disgust ratings, but not fear ratings, of the phobic pictures were significant predictors of phobic group membership. Both phobic groups were characterized by elevated disgust sensitivity toward video and pictorial general disgust elicitors. Implications and suggestions for continued research examining fearful and disgusting stimuli in specific phobia are outlined.     

Spider fear and covariation bias in children and adolescents

Covariation bias can be defined as phobic people's tendency to overestimate the association between fear-relevant stimuli and negative outcomes. The current article presents two studies that examined this type of cognitive bias in children and adolescents aged 8-16 years. Study 1 was concerned with a thought experiment during which youths (N=150) were asked to imagine that they participated in an experiment during which they had to view a series of pictures showing spiders, guns, and flowers, that were occasionally followed by a negative outcome (i.e., a mild electric shock). Participants were asked to estimate the relation between each type of picture and the negative outcome. The results indicated that youths with higher levels of spider fear displayed a specific tendency to relate spider pictures to a negative outcome. In Study 2, youths (N=220) actually participated in a computer game during which they were confronted with pictures of spiders, guns, and flowers, each of which was equally often followed by a negative (i.e., losing candy), positive (i.e., winning candy), or neutral outcome. After the game, participants had to estimate the relation between each type of picture and various outcomes. It was found that youths with higher levels of spider fear estimated more negative and less positive outcomes in relation to spider pictures. Taken together, these findings provide support for a fear-related covariation bias in youths. Further developmental analyses indicated that this type of cognitive bias seems to be more consistently present among adolescents than among children.     

Sensitivity and response bias in fear of spiders

According to cognitive theories of anxiety, phobic patients are searching the environment for threatening stimuli, and detecting them rapidly. However, previous studies failed to find a lowered perceptual threshold for threatening stimuli in specific phobias. Therefore, two experiments applying a signal detection paradigm were conducted. Highly spider fearful and nonfearful participants were asked to decide whether a picture of a spider, beetle, or butterfly was presented. In both experiments, spider fearfuls were not better at detecting spiders, or any other animal, than healthy controls. Instead, spider fearfuls were more liberal in assuming that they had seen a spider or a beetle. In accord with earlier studies, these results suggest that spider phobics may exhibit an interpretation bias rather than improved detection of threat.     

Spider fearful individuals attend to threat, then quickly avoid it: evidence from eye movements

According to cognitive models of anxiety, anxiety patients exhibit an early reflexive attentional bias toward threat stimuli, which may be followed by intentional avoidance of these stimuli. To determine the time course of attentional vigilance and avoidance, the authors conducted an eye-tracking study in which 22 highly spider fearful participants (SFs) and 23 nonanxious control participants (NACs) studied groups of 4 pictures (spider, butterfly, dog, and cat). The authors found that the very first fixation was on a spider picture more often in SFs than in NACs. However, SFs quickly moved their eyes away from the spider they had fixated first, yielding shorter gaze durations than NACs. Afterward, SFs exhibited shorter gaze durations on spiders than NACs for the rest of the 1-min presentation time. This early reflexive attentional bias toward threat followed by avoidance of threat may explain earlier failures to find attentional biases in anxiety.     

Recurrent images and early memories in social phobia

A recent model [Clark, D. M. & Wells, A. (1995). A cognitive model of social phobia. In R. Heimberg, M. Liebowitz, D. A. Hope & F. R. Schneier (Eds.), Social phobia: diagnosis, assessment and treatment (pp. 69-93). New York: Guildford Press] suggests that a distorted image of one's public self lies at the heart of social phobia. A previous study of spontaneous imagery [Hackmann, A., Surawy, C. & Clark, D. M. (1998) Seeing yourself through others' eyes: a study of spontaneously occurring images in social phobia. Behavioural and Cognitive Psychotherapy, 26, 3-12] confirmed that patients with social phobia frequently report experiencing negative, distorted, observer-perspective images when in anxiety provoking social situations. In the present study, 22 patients with social phobia were given a semistructured interview which aimed to further explore the nature of social phobic imagery. All participants were able to identify negative spontaneous images that were recurrent in the sense that their content appeared to be relatively stable over time and across different feared social situations. Most recurrent images involved several sensory modalities. Most recurrent images were linked to memories of adverse social events that clustered in time around the onset of the disorder. Taken together, the results suggest that in patients with social phobia, early unpleasant experiences may lead to the development of excessively negative images of their social selves that are repeatedly activated in subsequent social situations and fail to update in the light of subsequent, more favourable experiences. Implications of the findings for the understanding and treatment of social phobia are discussed.     

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.