Attention training to reduce attention bias and social stressor reactivity: An attempt to replicate and extend previous findings

doi:10.1016/j.brat.2012.02.015

Behaviour Research and Therapy

Volume 50, Issue 5, May 2012, Pages 350-358

https://doi.org/10.1016/j.brat.2012.02.015 Get rights and content

Abstract

Cognitive theories suggest that social anxiety is maintained, in part, by an attentional bias toward threat. Recent research shows that a single-session of attention modification training (AMP) reduces attention bias and vulnerability to a social stressor (Amir, Weber, Beard, Bomyea, & Taylor, 2008). In addition, exercise may augment the effects of attention training by its direct effects on attentional control and inhibition, thereby allowing participants receiving the AMP to more effectively disengage attention from the threatening cues and shift attention to the neutral cues. We attempted to replicate and extend previous findings by randomizing participants (N = 112) to a single-session of: a) Exercise + attention training (EX + AMP); b) Rest + attention training (REST + AMP); c) Exercise + attention control condition (EX + ACC); or d) Rest + attention control condition (REST + ACC) prior to completing a public speaking challenge. We used identical assessment and training procedures to those employed by Amir et al. (2008). Results showed there was no effect of attention training on attention bias or anxiety reactivity to the speech challenge and no interactive effects of attention training and exercise on attention bias or anxiety reactivity to the speech challenge. The failure to replicate previous findings is discussed.

Highlights

► We attempted to replicate a previous study of attention training for social anxiety. ► We used a comparable sample and identical methods to the Amir et al. (2008) study. ► Attention training did not reduce attention bias or reactivity to social stressor. ► Aerobic exercise did not augment the effects of attention training. ► The findings emphasize the continued need for replication and guide future work.

Section snippets

Participants

Participants were 112 adults who scored in the elevated range of the Liebowitz Social Anxiety Scale-Self-Report (LSAS-SR; Baker, Heinrichs, Kim, & Hofmann, 2002), i.e., greater than a score of 26. This cut-off score for elevated social anxiety was selected in an effort to replicate the procedures implemented by Amir et al. (2008), who indicated that a score of 26 is greater than one standard deviation above the mean for individuals with no Axis-I disorders (M = 10.2, SD = 9.3; Fresco et al.,

Sample characteristics at baseline

Table 1 reports the sample characteristics at baseline by condition. Ages ranged from 18 to 48 years (M = 19.87; SD = 3.15), and the sample was 81.5% female. Thirty-two percent of the sample was diagnosed with a primary Axis-I disorder including: social anxiety disorder (10.7%); major depressive disorder (6.3%); specific phobia (3.6%); alcohol abuse (2.7%); generalized anxiety disorder or depressive disorder NOS (1.8%); or adjustment disorder, past binge eating disorder, past anorexia, or

Discussion

The purpose of the present study was to replicate and extend previous work suggesting that attention training can reduce attention bias and subsequent vulnerability to psychological stressors. To this end, we conducted an experiment with sufficient statistical power to detect small effects of attention training with or without exercise on attention bias and anxiety reactivity to a speech task in socially anxious adults. We used identical assessment and training procedures to those employed by

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Attentional bias modification (ABM) has been used to modify the attentional bias (AB) towards smoking-related cues. Still, the effects of ABM are extensively controversial. The present study aimed to investigate the effects of ABM on AB and its two sub-processes named facilitated attention and difficulty in disengagement at two different stimulus durations, as well as test whether the effects of ABM could transfer to new measures of AB.
Forty-six male college smokers were allocated to either ABM group using a modified visual probe task (n = 24), or the corresponding placebo training (PT) group (n = 22). Participants performed three sessions of training in one week. The pre- and post-training AB and its sub-processes were measured using visual probe task. Cue-target task and pictorial Stroop task were used for testing the transfer effects of ABM.
The AB in ABM group was significantly decreased compared with the PT group. Specifically, the facilitated attention was significantly reduced at 200 ms stimulus duration, while the difficulty in disengagement was significantly decreased at 500 ms stimulus duration. The benefit of ABM training could transfer to the cue-target task, but not to the pictorial Stroop task. Meanwhile, no effects of ABM were observed on smoking craving and nicotine dependence.
These findings suggested that the stimulus duration is a crucial factor for the efficacy of ABM on the facilitated attention and the difficulty in disengagement in male college smokers and detected the transfer effects between different measures of AB to some extent. Future studies need to further explore the influence mechanism in distinct stimulus durations.
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Although several studies have shown that one acute bout of physical exercise can reduce state anxiety in healthy samples, studies that examine this effect in subclinical and clinical samples are still rare and have found mixed results. In the present study, we investigated the effect of a single session of acute exercise on state anxiety in a subclinical sample with moderate to high anxiety sensitivity. Potential mediators, including self-efficacy, self-esteem, mindfulness, subjective vitality, rumination and emotional competencies were explored. Participants (N = 88) with moderate to high anxiety sensitivity were assigned randomly to either an active group (n = 44) or a control group (n = 44). State anxiety and the mediator variables were assessed before and after the intervention. State anxiety was reduced from baseline to post-intervention, but no difference was found between groups. Exploratory analyses suggested that in the active intervention condition, a reduction in state anxiety was partly mediated by an increase in positive affect and mediated by an increase in subjective vitality. One acute bout of exercise might not be enough to decrease state anxiety in subclinical individuals with moderate to high anxiety sensitivity. However, the results of this study suggest that positive affect and subjective vitality could be two mechanisms that might explain the beneficial effect of exercise on anxiety. This should be further investigated in future studies.
Low working memory load facilitates attention bias modification training
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Implementations of attention bias modification training (ABMT) attempt to retrain attention away from rather than towards threat, thereby disrupting the anxiety-related attentional bias (AB). Yet, results of ABMT studies have been mixed due to limitations in knowledge of mechanisms underlying ABMT efficacy. Dual-process models of anxiety posit that ABMT works primarily through strengthening of the top-down cognitive control of attention to threat. If this is the case, introducing a working memory load (WML) during ABMT should reduce training efficacy. However, prior studies employing this method show mixed results (Booth, Mackintosh, Mobini, Oztop, & Nunn, 2014; Clarke et al., 2017) and fail to directly compare low and high WML with no WML or to account for individual differences in anxiety and working memory capacity (WMC). The present study (N = 306) assessed trait anxiety and WMC in neurotypical adults who were then randomly assigned to ABMT that trained attention toward or away from threat, with either no, low, or high WML, for a total of six training groups. Attentional bias was assessed before and after training. Results showed ABMT successfully trained attention under low WML, but not under high or no WML, suggesting that ABMT is facilitated by engaging but not overtaxing WML.
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Exposure therapy is highly effective for anxiety-related disorders, but there is a need for enhancement. Recent trials of adjunctive neuromodulation have shown promise, warranting evaluation of transcranial direct current stimulation (tDCS) as an augmentation. In a double-blind, placebo-controlled trial, contamination- and animal-phobic participants (N = 49) were randomized to active tDCS (1.7 mA, 20 min; n = 27), or sham tDCS (1.7 mA, 30 s; n = 22), followed by 30 min of in-vivo exposure. Active tDCS targeted excitation of the left mPFC and inhibition of the right dlPFC; polarity was counterbalanced for controls. We predicted tDCS would result in accelerated and better maintained gains, contingent on the subsequent in-session response, and baseline negative prognostic indicators. Consistent with predictions, tDCS promoted engagement and reductions in threat appraisals during exposure, and greater reductions in distress and threat appraisals through 1-month, although effects did not uniformly generalize. tDCS was most beneficial given high phobic severity, anxiety sensitivity, and a suboptimal early response. tDCS may promote engagement and response among individuals who are resistant or refractory to standard treatment. tDCS should be applied to more severe anxiety-related disorders, with parameters yoked to individual differences to improve outcomes in exposure-based interventions.
Attention and interpretation bias modification treatment for social anxiety disorder: A randomized clinical trial of efficacy and synergy
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Attention bias modification treatment (ABMT) and cognitive bias modification of interpretation (CBM-I) both have demonstrated efficacy in alleviating social anxiety, but how they compare with each other, their combination, and with a combined control condition has not been studied. We examined their relative and combined efficacy compared to control conditions in a randomized controlled trial (RCT).
Ninety-five adults diagnosed with social anxiety disorder (SAD), were randomly allocated to 4 groups: ABMT + CBM-I control (hereafter ABMT; n = 23), CBM-I + ABMT control (hereafter CBM-I; n = 24), combined ABMT + CBM-I (n = 23), and combined control (n = 25). Treatment included eight sessions over four weeks. Clinician-rated and self-reported measures of social anxiety symptoms, functional impairment, and threat-related attention and interpretive biases were evaluated at baseline, post-treatment, and 3-month follow-up.
ABMT yielded greater symptom reduction as measured by both clinician-ratings (Cohen's ds = 0.57-0.70) and self-reports (ds = 0.70-0.85) compared with the CBM-I, the combined ABMT + CBM-I, and the combined control conditions. Neither of the other conditions demonstrated superior symptom change compared to the control condition. No group differences were found for functioning or cognitive biases measures.
Limitations mainly include the mix of active and control treatments applied across the different groups. Therefore, the net effect of each of the treatments by itself could not be clearly tested.
Results suggest superiority of ABMT compared to CBM-I and their combination in terms of symptom reduction. Possible interpretations and methodological issues underlying the observed findings are discussed.
Exercise for the Management of Anxiety and Stress-Related Disorders
2018, Exercise-Based Interventions for Mental Illness: Physical Activity as Part of Clinical Treatment
Anxiety and stress-related symptoms and disorders are prevalent and burdensome public health problems for which successful treatment remains limited. Following an overview of what anxiety and anxiety and stress-related disorders are, how we believe they develop, and how best to measure anxiety, this chapter summarizes the available evidence of the effects of exercise training on anxiety among healthy adults, chronically ill adults, and individuals diagnosed with an anxiety or stress-related disorder. The chapter concludes with a brief discussion of proposed mechanisms which may underlie relations of exercise and anxiety. The available evidence of exercise effects on anxiety continues to grow and currently supports that exercise training reduces anxiety symptoms among healthy adults, chronically ill patients, and patients with panic disorder. Preliminary data support that exercise training improves symptoms among patients with social anxiety disorder, generalized anxiety disorder, obsessive–compulsive disorder, and posttraumatic stress disorder. Exercise-induced improvements appear to be comparable to empirically supported treatments for panic and generalized anxiety disorders. Larger trials should investigate the efficacy, generalizability, and biologically plausible mechanisms of exercise effects.

View all citing articles on Scopus

View full text

Attention training to reduce attention bias and social stressor reactivity: An attempt to replicate and extend previous findings

Abstract

Highlights

Section snippets

Participants

Sample characteristics at baseline

Discussion

Behaviour Research and Therapy

Journal of Anxiety Disorders

Behaviour Research and Therapy

Biological Psychiatry

Science & Sports

American Journal of Preventive Medicine

Journal of Psychosomatic Research

Behaviour Research and Therapy

Behaviour Research and Therapy

Cognitive & Behavioral Practice

Behaviour Research and Therapy

Acta Psychologica

Attention training in individuals with generalized social phobia: a randomized controlled trial

Journal of Consulting and Clinical Psychology

The effect of a single-session attention modification program on response to a public-speaking challenge in socially anxious individuals

Journal of Abnormal Psychology

Reliability generalization of scores on the Spielberger State-Trait Anxiety Inventory

Educational and Psychological Measurement

Manual for Beck Depression Inventory-II

Difficulty disengaging from social threat in social anxiety

Cognitive Therapy and Research

Beta-adrenergic activation and memory for emotional events

Nature

A cognitive model of social phobia

Anxiety-related attentional biases and their regulation by attentional control

Journal of Abnormal Psychology

G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences

Behavior Research Methods

The effect of acute exercise on serum brain-derived neurotrophic factor levels and cognitive function

Medicine & Science in Sports & Exercise

Structured Clinical Interview for DSM-IV axis I Disorders (SCID-I/NP): Non-patient edition

The Liebowitz Social Anxiety Scale: a comparison of the psychometric properties of self-report and clinician-administered formats

Psychological Medicine

Attentional biases for facial expressions in social phobia: the face-in-the-crowd paradigm

Cognition & Emotion