The effects of trait and state anxiety on attention to emotional images: An eye-tracking study

Attentional biases for threatening stimuli have been implicated in the development of anxiety disorders. However, little is known about the relative influences of trait and state anxiety on attentional biases. This study examined the effects of trait and state anxiety on attention to emotional images. Low, mid, and high trait anxious participants completed two trial blocks of an eye-tracking task. Participants viewed image pairs consisting of one emotional (threatening or positive) and one neutral image while their eye movements were recorded. Between trial blocks, participants underwent an anxiety induction. Primary analyses examined the effects of trait and state anxiety on the proportion of viewing time on emotional versus neutral images. State anxiety was associated with increased attention to threatening images for participants, regardless of trait anxiety. Furthermore, when in a state of anxiety, relative to a baseline condition, durations of initial gaze and average fixation were longer on threat versus neutral images. These findings were specific to the threatening images; no anxiety-related differences in attention were found with the positive images. The implications of these results for future research, models of anxiety-related information processing, and clinical interventions for anxiety are discussed.     

Dynamic measures of anxiety-related threat bias: Links to stress reactivity

Exaggerated attention to threatening information, or the threat bias, has been implicated in the development and maintenance of anxiety disorders. Recent research has highlighted methodological limitations in threat bias measures, such as temporal insensitivity, leading to the development of novel metrics that capture change and variability in threat bias over time. These metrics, however, have rarely been examined in non-clinical samples. The present study aimed to explore the utility of these trial-level metrics in predicting anxiety-related stress reactivity (stress-induced negative mood state) in trait anxious adults (N?=?52). Following a stressor, participants completed the dot probe task to generate threat bias scores. Stress reactivity was measured via stress-induced changes in subjective mood state. More variability in trial-level bias scores (TL-BSs) and greater bias away from threat (both mean and peak negative TL-BSs) predicted increased stress reactivity. The temporal characteristics of threat bias and implications for clinically-relevant measurement are discussed.     

Effects of threat cues on attentional shifting, disengagement and response slowing in anxious individuals

According to cognitive models of anxiety, attentional biases for threat may cause or maintain anxiety states. Previous research using spatial cueing tasks has been interpreted in terms of difficulty in disengaging attention from threat in anxious individuals, as indicated by contrasts of response times (RTs) from threat cue versus neutral cue trials. However, on spatial cueing tasks, differences in RT between threat cue and neutral cue trials may stem from a slowing effect of threat on RT, as well as effects on allocation of visuospatial attention. The present study examined the effects of threat cues on both attentional cueing and response slowing. High and low anxious individuals completed a central cue task, which assessed threat-related response slowing, and a spatial cueing task, which assessed attentional biases for angry, happy and neutral faces. Results indicated that interpretation of the anxiety-related bias for threat depended on whether the effect of response slowing was taken into account. The study illustrates an important problem in using the modified spatial cueing task to assess components of threat-related attentional bias. As this experimental method may reflect both threat-related attentional cueing and response slowing effects, it cannot be assumed to provide pure measures of shift or disengagement components of attention bias.     

Contrasting two accounts of anxiety-linked attentional bias: selective attention to varying levels of stimulus threat intensity

Previous research has established that clinical anxiety patients and nonclinical populations with high levels of anxiety vulnerability characteristically orient attention toward moderately threatening stimuli. In contrast, populations with low levels of anxiety vulnerability typically orient attention away from such stimuli. The differing experimental predictions generated by 2 classes of hypothetical explanation for this anxiety-linked attentional discrepancy were tested, using attentional probe methodology to compare the attentional responses of high and low trait anxious individuals to facial stimuli of differing threat intensities. The results support the view that all individuals orient attention away from mildly threatening stimuli and toward strongly threatening stimuli, with differences in anxiety vulnerability reflecting the intensity of stimulus threat required to elicit the attentional vigilance response.     

Biased attention in childhood Anxiety disorders: A preliminary study

This study provides preliminary tests of two hypotheses: (1) Anxiety-disordered children show an attentional bias toward emotionally threatening stimuli, and (2) normal controls show an attentional bias away from emotionally threatening stimuli. Twelve children, 9 to 14 years of age, with primary diagnoses of anxiety disorder were compared with 12 normal controls matched for age, gender, vocabulary level, and reading ability. Subjects completed a reaction time task that measured visual attention toward threatening versus neutral words. The anxious group showed the predicted attentional bias toward threat words. However, controls did not show the predicted bias away from threat words. These results are the first showing that biased attentional processing occurs among clinically anxious children. The potential role of such an attentional bias in childhood anxiety disorders and future direction for research are discussed.This research was supported by a Seed Grant and a Small Grant to the first author from The Ohio State University. Portions of this paper were presented at the 27th Annual Convention of the Association for the Advancement of Behavior Therapy, Atlanta, November 1993. Thanks are extended to the participants and all those who helped with the project.     

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.     

A cognitive model of insomnia

Insomnia is one of the most prevalent psychological disorders, causing sufferers severe distress as well as social, interpersonal, and occupational impairment. Drawing on well-validated cognitive models of the anxiety disorders as well as on theoretical and empirical work highlighting the contribution of cognitive processes to insomnia, this paper presents a new cognitive model of the maintenance of insomnia. It is suggested that individuals who suffer from insomnia tend to be overly worried about their sleep and about the daytime consequences of not getting enough sleep. This excessive negatively toned cognitive activity triggers both autonomic arousal and emotional distress. It is proposed that this anxious state triggers selective attention towards and monitoring of internal and external sleep-related threat cues. Together, the anxious state and the attentional processes triggered by it tricks the individual into overestimating the extent of the perceived deficit in sleep and daytime performance. It is suggested that the excessive negatively toned cognitive activity will be fuelled if a sleep-related threat is detected or a deficit perceived. Counterproductive safety behaviours (including thought control, imagery control, emotional inhibition, and difficulty problem solving) and erroneous beliefs about sleep and the benefits of worry are highlighted as exacerbating factors. The unfortunate consequence of this sequence of events is that the excessive and escalating anxiety may culminate in a real deficit in sleep and daytime functioning. The literature providing preliminary support for the model is reviewed and the clinical implications and limitations discussed.     

Recruiting Anxious Older Adults for a Psychotherapy Outcome Study

Although anxiety is a serious problem among the elderly, very little research has been conducted with anxious older adults. One reason is that although anxiety disorders overall are more common than depression in older community samples, many specific anxiety disorders are relatively rare. Furthermore, anxious older adults often do not seek treatment or otherwise come to the attention of mental health researchers. This paper describes the first year of recruitment efforts for a treatment outcome study of psychotherapy for generalized anxiety disorder in adults at least 55 years old. Successful methods included collaborations with hospital-based health education programs and senior centers, as well as notices in local and senior newspapers. Less successful methods included radio public service announcements and mailings to residential facilities, churches and synagogues, and physicians. Recommendations for recruitment of anxious older adults into research projects are discussed.     

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.     

Framing COVID-19 as an existential threat predicts prejudice towards Chinese people via anxious arousal

We tested the hypothesis that perceived existential threat stemming from COVID-19 elicits anxious arousal, which can manifest in prejudice toward the perceived source of the threat (Chinese people). Americans (n = 474) were randomly assigned to a condition in which COVID-19 was framed as a high existential threat to the United States or to a condition in which COVID-19 was framed as a low existential threat to the United States. They then completed self-report measures of anxious arousal as well as subtle and blatant prejudice towards Chinese people. As expected, participants in the high threat (vs. low threat) condition reported greater anxious arousal which, in turn, predicted greater subtle and blatant prejudice. The high threat (vs. low threat) condition also indirectly predicted greater subtle and blatant prejudice via greater anxious arousal. Results advance knowledge on the reactions people had to perceiving COVID-19 as an existential threat during the early phase of the pandemic.     

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.     

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.     

焦虑性神经症的认知和躯体感觉研究

从Ｓｃｈａｃｈｔｅｒ的二因素理论和Ｂｅｃｋ的认知模式观点出发,采用信念量表、广场恐怖认知问卷、躯体感觉问卷、Ｈａｍｉｌｔｏｎ焦虑及抑郁量表,以抑郁患者和正常人两组作对照,调查了焦虑患者的焦虑、认知及躯体感觉的相互关系。初步结论是,“躯体损害性”自动想法和对躯体感觉的过分担心是临床焦虑的特征;“社会、行为后果性”想法似乎是焦虑和抑郁患者共有的。焦虑的认知内容是以“危险”为主题的,躯体感觉和认知错解在焦虑发生发展中起重要作用。“危险”的负性自动想法和焦虑关系密切,而由非理性信念所反映的特定的认知图式可能促使患者过度夸大危险性。这一结果在一定程度上支持了两因素理论和Ｂｅｃｋ的认知模式     

Autobiographical memory in angry and anxious individuals

Recent studies have found that angry individuals are characterized by more pronounced attentional and interpretation biases toward threat than anxious individuals. The present study examined anger-related, anxiety-related, and neutral autobiographical memories in 35 angry participants, 33 anxious participants, and 29 non-angry/non-anxious, or healthy participants. Objective indices of autobiographical memories (i.e., retrieval latency, coding of specificity and affective tone) suggested that groups retrieved memories with similar properties. However, both angry and anxious participants rated their memories as less pleasant than healthy participants. These results indicate that memory biases are not part of the cognitive sequelae associated with anger and anxiety, although aspects of the appraisal of these personal memories are distorted.     

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.     

The Role of Anxiety Sensitivity and Mindful Attention in Anxiety and Worry About Bodily Sensations Among Adults Living With HIV/AIDS

The current study examined cognitive factors that may be relevant to understanding anxiety and worry about bodily sensations among an HIV/AIDS population. Specifically, this investigation tested the main and interactive effects of anxiety sensitivity and mindful attention on anxious arousal, bodily vigilance, interoceptive fear, and HIV symptom distress among 164 adults with HIV/AIDS. Results indicated that anxiety sensitivity was positively related to anxious arousal, bodily vigilance, and interoceptive fear, but not HIV symptom distress. Mindful attention was negatively related to anxious arousal, interoceptive fear, and HIV symptom distress, but not bodily vigilance. These main effects for anxiety sensitivity and mindful attention were evident after controlling for disease stage, years with HIV, and demographic variables. There were no interactive effects between anxiety sensitivity and mindful attention. Results are discussed in terms of the clinical implications for identifying and treating anxiety and worry about bodily sensations among adults with HIV/AIDS. Limitations of this study include the use of cross-sectional data and self-report assessments.     

Threat-related attentional bias in anxious and nonanxious individuals: a meta-analytic study

This meta-analysis of 172 studies (N = 2,263 anxious,N = 1,768 nonanxious) examined the boundary conditions of threat-related attentional biases in anxiety. Overall, the results show that the bias is reliably demonstrated with different experimental paradigms and under a variety of experimental conditions, but that it is only an effect size of d = 0.45. Although processes requiring conscious perception of threat contribute to the bias, a significant bias is also observed with stimuli outside awareness. The bias is of comparable magnitude across different types of anxious populations (individuals with different clinical disorders, high-anxious nonclinical individuals, anxious children and adults) and is not observed in nonanxious individuals. Empirical and clinical implications as well as future directions for research are discussed.     

Variability of attention bias in socially anxious adolescents: differences in fixation duration toward adult and adolescent face stimuli

Prior research on attention bias in anxious youth, often utilising a visual dot probe task, has yielded inconsistent findings, which may be due to how bias is assessed and/or variability in the phenomenon. The present study utilises eye gaze tracking to assess attention bias in socially anxious adolescents, and explores several methodological and within-subject factors that may contribute to variability in attention bias. Attention bias to threat was measured in forty-two treatment-seeking adolescents (age 12–16 years) diagnosed with Social Anxiety Disorder. Bias scores toward emotional stimuli (vigilant attention) and bias scores away from emotional stimuli (avoidant attention) were explored. Bias scores changed between vigilance and avoidance within individuals and over the course of stimulus presentation. These differences were not associated with participant characteristics nor with self-reported social anxiety symptoms. However, clinician rated severity of social anxiety, explained a significant proportion of variance in the bias scores for adult, but not the adolescent, stimuli. Variability in attention bias among socially anxious adolescents is common and varies as a function of stimulus duration and type. Results may inform stimulus selection for future research.     

Attention training and the threat bias: an ERP study

Anxiety is characterized by exaggerated attention to threat. Several studies suggest that this threat bias plays a causal role in the development and maintenance of anxiety disorders. Furthermore, although the threat bias can be reduced in anxious individuals and induced in non-anxious individual, the attentional mechanisms underlying these changes remain unclear. To address this issue, 49 non-anxious adults were randomly assigned to either attentional training toward or training away from threat using a modified version of the dot probe task. Behavioral measures of attentional biases were also generated pre- and post-training using the dot probe task. Event-related potentials (ERPs) were generated to threat and non-threat face pairs and probes during pre- and post-training assessments. Effects of training on behavioral measures of the threat bias were significant, but only for those participants showing pre-training biases. Attention training also influenced early spatial attention, as measured by post-training P1 amplitudes to cues. Results illustrate the importance of taking pre-training attention biases in non-anxious individuals into account when evaluating the effects of attention training and tracking physiological changes in attention following training.     

Anxiety and attention to threatening pictures

Previous research using attentional search tasks has revealed an anxiety-related bias favouring attention to threatening words when they are presented simultaneously with emotionally neutral words. In Experiment 1, using a similar task, a related effect was found here with emotionally threatening pictures. When pictures were used as location cues in a second experiment, high-trait anxious individuals were slower than less anxious controls when responding to targets requiring attentional disengagement from threat, and they were slower in general with pictures judged to be highly threatening. In a third experiment using the same task but with a longer cue exposure, a related disengagement difficulty occurred across both groups, although the more general slowing with severe threat was again confined to the anxious group. We conclude that attentional bias involves both a specific difficulty in disengaging attention from the location of any threat and a more general interference effect that is related to threat level.