Attentional biases in social anxiety: An investigation using the inattentional blindness paradigm
Introduction
Over the past two decades, there has been a dramatic increase in clinical research aimed at examining underlying mechanisms of social anxiety. One line of research has utilized research paradigms borrowed from cognitive psychology (e.g., Stroop Task) to assess biased information processing associated with social anxiety. Particularly, attentional biases (e.g., self-focused attention, biased attentional processing of external social cues) have been placed at the core of current cognitive–behavioral models of social anxiety (Clark, 2001; Clark & Wells, 1995; Rapee & Heimberg, 1997).
Investigations of biased attention in social anxiety have varied along several dimensions including: (a) the paradigm used for assessing attentional bias (e.g., emotional Stroop task vs. dot-probe paradigm); (b) the nature of socially threatening cues (e.g., words vs. faces); (c) subjects’ clinical status (i.e., meeting threshold diagnoses for SAD vs. displaying non-clinical social anxiety); and (d) inclusion of a social anxiety induction manipulation prior to the assessment of attentional biases.
The Emotional Stroop and the Dot-Probe tasks have been the most frequently used assessment paradigms for studying biased attention in social anxiety. As reviewed by Bögels and Mansell (2004), most studies using the Stroop paradigm have shown that individuals with heightened social anxiety or SAD display longer color-naming latencies in response to social threat words (e.g., Amir, Freshman, & Foa, 2002; Andersson, Westoo, & Johansson, 2006; Becker, Rinck, Margraf, & Roth, 2001; Hope, Rapee, Heimberg, & Dombeck, 1990; Lundh & Ost, 1996; Maidenberg, Chen, Craske, Bohn, & Bystritsky, 1996; Mattia, Heimberg, & Hope, 1993; McNeil et al., 1995; Spector, Pecknold, & Libman, 2003) with very few exceptions that have revealed no or shorter response latencies (e.g., Amir et al., 1996; Kindt, Bögels, & Morren, 2003). Despite the overall success of the emotional Stroop paradigm in demonstrating longer color-naming latencies linked to social anxiety, some methodological and interpretational problems weaken its status as an attentional bias measure for social anxiety. First, several authors have indicated that the Stroop effect is likely confounded with various non-attentional mental processes such as mental preoccupation, cognitive avoidance, or emotional reaction to threat words (Asmundson & Stein, 1994; Bögels & Mansell, 2004; Heinrichs & Hofmann, 2001; Williams, Mathews, & MacLeod, 1996). Second, it has been shown that the Stroop interference effect can be overridden by effortful control strategies (Amir, Freshman, & Foa (2002), Amir et al. (1996)). In sum, the emotional Stroop paradigm may tap other cognitive processes in addition to attentional biases.
The modified dot-probe paradigm has also been used extensively in social anxiety research. Bögels and Mansell (2004) have outlined several methodological advantages of the dot-probe paradigm over the Stroop. These include: (a) true selective attention can be examined via the simultaneous presentation of threat and distracter items, (b) the reliance on a meaningless detection cue (i.e., a dot) reduces the threat that reaction times are affected by mental preoccupation, and (c) both hypervigilance and avoidance can be indexed in the same paradigm. Studies using this paradigm in social anxiety have yielded mixed findings, suggesting hypervigilance (e.g., Amir, Elias, Klumpp, & Przeworski, 2003; Mogg & Bradley, 2002; Mogg, Philippot, & Bradley, 2004; Musa, Lepine, Clark, Mansell, & Ehlers, 2003; Sposari & Rapee, 2007), attentional avoidance (e.g., Chen, Ehlers, Clark, & Mansell, 2002; Mansell, Clark, Ehlers, & Chen, 1999), or no evidence of attentional bias to social threat cues (e.g., Horenstein & Segui, 1997; Mansell, Ehlers, Clark, & Chen, 2002).
The dot-probe paradigm also has potential methodological limitations. First, several dot-probe studies using threat word stimuli demonstrated attentional biases only when threat cues appeared in the upper area of the screen, to which initial visual attention may be oriented (Asmundson & Stein, 1994; Horenstein & Segui, 1997). These findings may suggest that the relative cue detection speed indexed by the dot-probe paradigm could reflect the influence of individuals’ visual response pattern in addition to attentional competition between the paired items. Relatedly, Mogg et al. (2000) suggested that high trait anxious individuals may easily use strategies to counteract their vigilance towards threat words and that the dot-probe paradigm presents a relatively fragile index of attentional biases in normal samples. Second, this paradigm places social cues in competition with non-social or less threatening social cues in order to index attentional bias. This comparative context allows one to examine the relative attentional attraction/repulsion of socially threatening cues in comparison with other adjacent stimuli, but precludes the independent assessment of the attentional processing of the social cue itself. It remains unclear how the social cue itself was processed. The competition within the pair of stimuli may also pose some interpretative ambiguity with respect to underlying response mechanisms. For instance, the faster detection of a dot following a more threatening cue, relative to a less threatening or neutral cue, may arise from the inhibition of the less threatening cue, the facilitation of the more threatening cue, or both (see Cooper & Langton, 2006; Koster, Crombez, Verschuere, & De Houwer, 2004). Unlike previous studies, Cooper and Langton (2006) revealed that it was not the vigilance to the threat, but the inhibition of less threatening cues that accounted for the faster detection of the probe following threatening faces.
An intriguing perceptual phenomenon called inattentional blindness (IB) has been the focus of study by cognitive psychologists. In the typical IB experiment, subjects fail to notice a supra-threshold stimulus unexpectedly presented in front of their eyes while engaging in a perceptual discrimination task. Mack and Rock (1998) developed a static IB task, in which the subject is presented a cross on the screen for 200 ms followed by a circular pattern mask lasting for 500 ms. Subjects are first presented several regular discrimination trials in which they have to choose which of the two lines of the cross (horizontal vs. vertical) is longer. However, on the third or fourth trial, an extra object (i.e., critical item) unexpectedly appears for 200 ms at fixation along with the target cross (i.e., the inattentional trial). Following this critical trial, subjects are then asked whether they saw anything appear on the screen other than the target discrimination cross. Testing a number of simple geometric figures (e.g., a black or colored small square) as critical items during the IB trial, Mack and Rock (1998) found that approximately 75% of the subjects failed to detect the critical stimulus presented in the fovea. Interestingly, they discovered that certain stimuli had significantly higher rates of detection or conversely, markedly lower IB rates (80% detection rate=20% IB rate). More specifically, a smiling face icon was detected and identified better than a frowning face or a circle of the same size (detection rates−smiling face=85%, frowning face=40%, circle=15%; identification rates among the detectors−smiling face=88%, frowning face=63%, circle=15%). Via a number of follow-up experiments, Mack and Rock (1998) put forth the meaningfulness−signal hypothesis asserting that these exceptional objects are more easily noticed under the inattentional condition due to their meaningfulness. When these stimuli were slightly transformed to obliterate their meaning while maintaining the global sensory features (e.g., changed “Jack” to “Jeck”, turned the smiling face upside down), their unique capability to capture attention in the inattentional trial was significantly attenuated (Mack & Rock, 1998). Moreover, the authors repeatedly showed that the physical salience of the critical item had minimal influence on whether it was detected relative to the meaningfulness of the critical stimulus (Mack & Rock, 1998).
An alternative IB task using a more sustained stimulus presentation was developed by Most and colleagues (Most, Scholl, Clifford, & Simons, 2005; Most et al., 2001). In this sustained IB task, for example, two white squares, two white circles, two black squares, and two black circles appear on the computer display moving in haphazard paths occasionally bouncing off the edges of the display. The subject's task during this 15 s trial is to count the number of times a particular type of object (e.g., shape—all circles/color—all black objects) bounces off the edges of the display. This constitutes a regular judgment trial. On the third inattentional trial, an unexpected object enters the middle of the right side of the display and slowly moves and exits to the left side of the display over a period of 5 s.
Most and colleagues have demonstrated that the sustained IB task can effectively generate IB and that this is strongly influenced by the viewer's attentional set (Most, Scholl, Clifford, & Simons (2005), Most et al. (2001)). For example, in one experiment using the above-mentioned eight distracters with a black circle as the critical item, most subjects who were instructed to attend to either the black shapes or the circles detected the critical item (88% and 81%, respectively). In contrast, almost none of those who were instructed to attend to either the white shapes or the squares detected the black circle (0% and 6%, respectively). Another experiment using the same set of distracters with a gray circle as the critical item again revealed the predominant role of attentional set despite the increased salience of the critical item. Of those instructed to attend to the circles, 86% detected the gray circle; whereas those instructed to attend to the squares, only 7% detected it (Most et al., 2005). Overall, these data support the central role of the viewer's mindset to attend to certain properties of the critical item in detecting its unexpected emergence in the sustained IB task.
The IB paradigm has several potential methodological strengths for assessing attentional biases associated with psychopathology in general and social anxiety in particular. The unexpected presentation of the critical stimulus in the IB paradigm reduces the chance that individuals will engage in effortful or strategic reactions during the attentional task. Moreover, the IB paradigm may provide a more direct measure of hypervigilance to the social threat cue itself, relative to the emotional Stroop or dot-probe paradigms in which attentional biases are inferred indirectly through either slower (Stroop) or faster (dot-probe) processing of non-social stimuli (i.e., color of words or location of dots).
The principal goal of the present study was to examine the utility of the IB paradigm for investigating attentional bias in social anxiety. To this end, two independent experiments were conducted using the IB paradigm. We employed an analog approach, which makes it possible to pilot a new experimental task in an efficient fashion and to use a complex experimental design requiring a large number of subjects (Stopa & Clark, 2001). In both Experiments 1 and 2, college students who displayed high levels of social anxiety (HSAs) or those who displayed low levels of social anxiety (LSAs) as indexed by the Fear of Negative Evaluation Scale (FNES; Watson & Friend, 1969) were randomly assigned to one of three critical item conditions (i.e., positive face, negative face, or neutral item) in the presence or absence of a bogus-speech threat manipulation.
Section snippets
Experiment 1
Given the first attempt to apply the static IB task to a psychopathology context, we sought to replicate the original experimental parameters of the Mack and Rock (1998) study that had used the schematic facial icons (i.e., smiling face, frowning face, and circle) as critical items. In the context of social anxiety, negative facial expressions are likely to carry a more meaningful signal portending negative social evaluation for HSAs relative to LSAs. Thus, we hypothesized that in the
Experiment 2
Although Experiment 1 provided encouraging support for the potential utility of the IB paradigm in attentional bias investigation, several limitations prompted us to conduct another experiment. For example, despite its success in helping to identify stimulus properties that attract attention, the short stimulus presentation inherent in the static IB task has raised concerns, For instance, Wolfe (1999) has put forward the possibility that IB may not reflect a perceptual failure caused by a lack
General discussion
The cost of failing to see an unexpected object can be quite consequential at times. As noted by Most et al. (2005), many traffic accidents seem to be caused by drivers’ obvious failure to detect obstacles placed in front of their eyes. Conversely, some clinical conditions such as anxiety disorders are characterized by enhanced detection of potentially threatening cues. This seems particularly true in the case of social anxiety disorder, in which hypervigilance is suspected to play a central
Limitations
Some limitations of the present study should be noted. First, the generalizability of our findings to a clinical sample cannot be assumed. Replication with clinical samples of patients with social phobia is needed. Particularly, it would help establish the specificity of current findings to pursue clinical replication including different diagnostic groups of anxiety disorders or depression. Second, some discrepancies in findings from Experiments 1 and 2 (e.g., the impact of dispositional social
Conclusions
Understanding the nature of biased attentional processing is likely to advance our models for the maintenance of social anxiety, which in turn may help guide the development of more potent treatment strategies. The present study demonstrated the potential utility of the IB paradigm. Its sensitivity in capturing attentional vigilance while reducing strategic or effortful responses makes the IB paradigm a useful addition to existing paradigms for assessing biased attention in social anxiety and
Acknowledgment
This research was in partial fulfillment of the Doctorate of Philosophy in Clinical Psychology for the first author (HJL) under the supervision of the senior author (MJT).
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