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.     

Biases in Visual Attention in Children and Adolescents With Clinical Anxiety and Mixed Anxiety-Depression

Recent research has indicated that anxious adult and child patients and high trait-anxious adults selectively shift attention toward threatening stimuli. The present study extends this research and investigates the content-specificity of the effects in clinically anxious and mixed anxious–depressed children and adolescents. Twenty four generally anxious patients, aged 9 to 18, 19 mixed anxious–depressed patients, and 24 normal controls were comparable with respect to age, sex, verbal IQ, and vocabulary level. The participants carried out an attentional deployment task in which probe detection latency data were used to determine the distribution of visual attention for threat-related and depression-related material. The results showed that clinically anxious children, relative to controls, selectively allocated processing resources toward threat stimuli. However, mixed anxious–depressed children, relative to controls, did not show any attentional bias towards either threat- or depression-related stimuli. Preliminary data on age and gender differences are also presented. The results of this study are discussed in the light of previous research.     

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.     

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.     

Attentional bias in high- and low-anxious individuals: evidence for threat-induced effects on engagement and disengagement

Attentional bias to threatening visual stimuli (words or pictures) is commonly present in anxious individuals, but not in non-anxious people. There is evidence to show that attentional bias to threat can be induced in all individuals when threat is imposed by threat not of symbolic nature, but by cues that predict aversive stimulation (loud noise or electric shock). However, it is not known whether attentional bias in such situations is still influenced by individual differences in anxiety. This question was addressed in two experiments using a spatial cuing task in which visual cues predicted the occurrence of an aversive event consisting of a loud human scream. Speeded attentional engagement to threat cues was positively correlated with trait anxiety in Experiment 1. Experiment 2 showed that speeded attentional engagement was present only in participants selected for high anxiety but not in low-anxious participants. In both experiments, slower disengagement from threat cues was found in all participants, irrespective of their trait anxiety levels.     

Attentional bias in high- and low-anxious individuals: Evidence for threat-induced effects on engagement and disengagement

Attentional bias to threatening visual stimuli (words or pictures) is commonly present in anxious individuals, but not in non-anxious people. There is evidence to show that attentional bias to threat can be induced in all individuals when threat is imposed by threat not of symbolic nature, but by cues that predict aversive stimulation (loud noise or electric shock). However, it is not known whether attentional bias in such situations is still influenced by individual differences in anxiety. This question was addressed in two experiments using a spatial cuing task in which visual cues predicted the occurrence of an aversive event consisting of a loud human scream. Speeded attentional engagement to threat cues was positively correlated with trait anxiety in Experiment 1. Experiment 2 showed that speeded attentional engagement was present only in participants selected for high anxiety but not in low-anxious participants. In both experiments, slower disengagement from threat cues was found in all participants, irrespective of their trait anxiety levels.     

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.     

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.     

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.     

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.     

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).     

Interpretation of homophones related to threat in anxiety states

In previous studies, we have established that anxiety states are characterized by an attentional bias that favors the processing of threatening stimuli. In the present study we extend this finding to ambiguous stimuli, specifically, homophones with spellings that correspond to either a threatening or a neutral meaning. As predicted, clinically anxious subjects used the threatening spellings relatively more than did controls, whereas recovered subjects were intermediate in this respect. Threatening words were associated with greater skin conductance responses than were neutral words, but the groups did not differ in their electrodermal reactions to homophones. We take these findings as evidence that, although the different meanings of ambiguous stimuli may be processed in parallel by all subjects, an interpretive bias operates such that anxiety-prone individuals tend to become preferentially aware of the more threatening meaning of such events.     

Attentional bias toward fear-related stimuli: an investigation with nonselected children and adults and children with anxiety disorders

Research investigating anxiety-related attentional bias for emotional information in anxious and nonanxious children has been equivocal with regard to whether a bias for fear-related stimuli is unique to anxious children or is common to children in general. Moreover, recent cognitive theories have proposed that an attentional bias for objectively threatening stimuli may be common to all individuals, with this effect enhanced in anxious individuals. The current study investigated whether an attentional bias toward fear-related pictures could be found in nonselected children (n=105) and adults (n=47) and whether a sample of clinically anxious children (n=23) displayed an attentional bias for fear-related pictures over and above that expected for nonselected children. Participants completed a dot-probe task that employed fear-related, neutral, and pleasant pictures. As expected, both adults and children showed a stronger attentional bias toward fear-related pictures than toward pleasant pictures. Consistent with some findings in the childhood domain, the extent of the attentional bias toward fear-related pictures did not differ significantly between anxious children and nonselected children. However, compared with nonselected children, anxious children showed a stronger attentional bias overall toward affective picture stimuli.     

Threat-based cognitive biases in anxious children: comparison with non-anxious children before and after cognitive behavioural treatment

Attention and interpretation biases for threat stimuli were assessed in 19 anxious (ANX) children before and after cognitive behavioural therapy (CBT), and compared with responses from 19 non-anxious (NA) control children collected over the same period. Attentional bias was assessed using a picture version of the visual probe task with threat, neutral and pleasant pictures. Threat interpretation bias was assessed using both a homographs task in which children used homograph words in a sentence and their neutral or threatening meaning was assessed, and a stories task in which children rated their negative emotion, danger judgments, and influencing ability in ambiguous situations. ANX children showed attention biases towards threat on the visual probe task and threat interpretation biases on the stories task but not the homographs task at pre-treatment in comparison with NA children. Following treatment, ANX children's threat interpretation biases as assessed on the stories task reduced significantly to within levels comparable to NA children. However, ANX children continued to show larger attentional biases towards threat than pleasant pictures on the visual probe task at post-treatment, whereas NA children did not show attentional biases. Moreover, a residual threat interpretation style on the stories task at post-treatment was associated with higher anxiety symptoms in both ANX and NA children.     

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.     

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).     

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.     

Anxiety and the allocation of attention to threat

Using a probe detection technique we have recently demonstrated that anxious subjects consistently deploy attention towards threat-related stimuli, whereas non-anxious controls tend to move attention away from such material (MacLeod, Mathews, & Tata, 1986).

The current study employed the same paradigm but attempted to distinguish the role of trait and state anxiety by testing high- and low-trait students when state anxiety was relatively low (12 weeks before a major examination) and again when it was relatively high (one week before this examination). High-trait subjects alone tended to shift attention towards generally threatening material on both test occasions. Results for examination-related stimuli were more complex. Increased proximity to the examination was associated with an increase in attentional bias towards such threat stimuli in high-trait subjects, but with increased attentional avoidance of such stimuli in low-trait subjects. It is suggested that the attentional response to currently relevant stress-related stimuli may be associated with neither trait nor state anxiety alone, but with an interactive function involving both these variables. These results are discussed in relation to existing models of emotion and cognition, and alternative interpretations of the findings are considered.     

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.     

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.