Attentional bias in injection phobia: Overt components, time course, and relation to behavior

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Abstract

Blood-injection-injury (BII) phobia is an anxiety disorder that can cause serious health consequences by interfering with medical treatment. Although attentional bias for threat appears to be a core feature of many anxiety disorders and a potential target of treatment, very little is known about attentional bias in BII phobia. In the present study, eye movements were recorded in individuals high and low in injection fear (HIF, LIF) during 18-s exposures to stimulus arrays containing injection, attack, appetitive, and neutral images. Evidence for attentional vigilance was mixed, as HIF individuals oriented to injection images more often than LIF individuals, but did not orient to injection images more often than other emotional images. In contrast, evidence of attentional avoidance was highly robust. HIF individuals rapidly disengaged from injection images on initial viewing and viewed these images less overall compared to other image types, a pattern not observed in the LIF group. Furthermore, attentional avoidance of injection threat was found to uniquely predict behavioral avoidance on an injection behavioral avoidance task (BAT), and group differences on the BAT were mediated by group differences in attentional avoidance. The implications of these findings for further delineating the nature and function of attentional biases in BII phobia are discussed.

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

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