Attentional bias in injection phobia: Overt components, time course, and relation to behavior
Highlights
► We report the first eye tracking study of BII phobia. ► Injection phobia was characterized by robust attentional avoidance of threat. ► Attentional avoidance mediated group differences in behavioral avoidance. ► Implications for attention modification procedures are discussed.
Section snippets
Participants
Students in several large undergraduate classes (N = 931) completed the Injection Phobia Scale – Anxiety (IPS-anx; Öst, Hellstrom, & Kaver, 1992). Consistent with prior research (Olatunji, Smits, Connolly, Willems, & Lohr, 2007; Sawchuk, Lohr, Westendorf, Meunier, & Tolin, 2002), individuals were recruited for the high injection fear (HIF; n = 33; IPS-anx M = 44.06, SD = 10.15) group if their IPS-anx score was higher than or equal to the IPS-anx patient mean, and they endorsed fainting symptoms
Group characteristics
Seventy-three percent of individuals in the HIF group met full diagnostic criteria for BII phobia according to the specific phobia module of the ADIS–IV (DiNardo et al., 1994). There was not a significant difference, in terms of IPS-anx score, BAT performance, or other symptom measures, between HIF participants that met full diagnostic criteria for BII phobia and those that met partial criteria, ts (31) ≤ 2, ps > .05. Compared to the LIF group, the HIF group reported significantly higher levels
Discussion
The present study is the first, to our knowledge, to examine attentional biases related to BII phobia using eye tracking methodology. Although overt vigilance for threat has been observed in spider phobia (Pflugshaupt et al., 2005; Rinck & Becker, 2006), the present study did not find evidence of an injection-specific orienting bias in the HIF group. Within-subjects contrasts revealed that BII individuals showed a general emotionality bias in their initial orienting, a bias that has been
References (59)
- et al.
Attentional bias towards threat in contamination fear: overt components and behavioral correlates
Journal of Abnormal Psychology
(2012) - et al.
Threat-related attentional bias in anxious and non-anxious individuals: a meta-analytic study
Psychological Bulletin
(2007) - et al.
Eye gaze bias for emotion stimuli prospectively predicts PTSD and depression symptoms among soldiers deployed in Iraq
American Journal of Psychiatry
(2011) - et al.
The epidemiology of blood-injection-injury phobia
Psychological Medicine
(1998) - et al.
Covert and overt orienting of attention to emotion faces in anxiety
Cognition and Emotion
(2000) - et al.
Reliability of DSM-IV anxiety and mood disorders: implications for the classification of emotional disorders
Journal of Abnormal Psychology
(2001) - et al.
Electromagnetic indication of hypervigilant responses to emotional stimuli in blood-injection-injury fear
Neuroscience Letters
(2007) - et al.
Event-related potentials and visual avoidance in blood phobics: is there any attentional bias?
Depression and Anxiety
(2006) - et al.
The neural correlates of attentional bias in blood phobia as revealed by the N2pc
Social Cognitive Affective Neuroscience
(2010) - et al.
Attentional bias toward suicide-related stimuli predicts suicidal behavior
Journal of Abnormal Psychology
(2010)
Mechanisms of attentional biases towards threat in anxiety disorders: an integrative review
Clinical Psychology Review
Fear of needles and vasovagal reactions among phlebotomy patients
Journal of Anxiety Disorders
The late positive potential: a neurophysiological marker for emotion regulation in children
Journal of Child Psychology and Psychiatry
Anxiety disorders interview Schedule for DSM-IV: Lifetime version
Preconscious processing biases predict emotional reactivity to stress
Biological Psychiatry
Do threatening stimuli draw or hold visual attention in subclinical anxiety?
Journal of Experimental Psychology: General
The time-course of attention to emotional faces in social phobia
Journal of Behavior Therapy and Experimental Psychiatry
A meta-analysis of the effect of cognitive bias modification on anxiety and depression
Psychological Bulletin
Needle phobia: a neglected diagnosis
Journal of Family Practice
One versus five sessions of applied tension in the treatment of blood phobia
Behaviour Research and Therapy
Attention to phobic stimuli during exposure: the effect of distraction on anxiety reduction, self-efficacy and perceived control
Behaviour Research and Therapy
Specificity and psychosocial correlates of blood/injury fear and fainting
Behaviour Research and Therapy
Blood/injury fear, fainting and avoidance of medically-related situations: a family correspondence study
Behaviour Research and Therapy
Attentional retraining procedures: manipulating early or late components of attentional bias?
Emotion
Attentional bias and spider phobia: conceptual and clinical issues
Behaviour Research and Therapy
Attentional bias predicts heroin relapse following treatment
Addiction
A cognitive–motivational analysis of anxiety
Behaviour Research and Therapy
Time course of attentional bias for fear-relevant pictures in spider-fearful individuals
Behaviour Research and Therapy
Time course of attentional bias for threat scenes: testing the vigilance-avoidance hypothesis
Cognition and Emotion
Cited by (36)
Gaze and avoidant patterns of visual attention to aversive stimuli during fear habituation trial: A pilot eye tracking study
2023, Journal of Behavioral and Cognitive TherapyA novel probe of attentional bias for threat in specific phobia: Application of the “MouseView.js” approach
2023, Journal of Anxiety DisordersTrypanophobia among medical students - An overlooked concern
2023, Clinical Epidemiology and Global HealthVigilance: A novel conditioned fear response that resists extinction
2022, Biological PsychologyCitation Excerpt :Voluntary control of attention becomes stronger after initial orienting, and across the course of exposure, interesting patterns emerge. Specific phobias are characterized by a vigilant-avoidant pattern of gaze, as the initial orienting bias towards phobic stimuli (e.g., spiders, injections) is followed by increasing avoidance (Armstrong & Hemminger, 2013; Rinck & Becker, 2006). In contrast, PTSD is characterized by sustained monitoring of threat across the trial (Armstrong, Bilsky et al., 2013; Lazarov et al., 2019, 2021) These findings may suggest that voluntary gaze reflects the competing goals of harm avoidance (monitor urgent threat cues to prevent harm) and emotion regulation (avoid monitoring less urgent threat cues to reduce anxiety) (Armstrong & Olatunji, 2012).
Anxiety disorders and healthcare utilization: A systematic review
2020, Clinical Psychology ReviewEmotion regulation via visual avoidance: Insights from neurological patients
2019, NeuropsychologiaCitation Excerpt :Prior work lends support to this assumption. For example, visual avoidance has been found in specific phobias (i.e., blood-injection-injury phobia), but not in posttraumatic stress disorder, which is characterized by hypervigilence to threating stimuli in the environment (Armstrong et. al., 2013a, 2013b; Armstrong and Olatunji, 2012; Dalgleish et al., 2001). Alternatively, visual avoidance may be particularly effective in short-lived, high intensity emotional states.