Anxiety-linked attentional bias and its modification: Illustrating the importance of distinguishing processes and procedures in experimental psychopathology research

doi:10.1016/j.brat.2016.07.005

Behaviour Research and Therapy

Volume 86, November 2016, Pages 68-86

https://doi.org/10.1016/j.brat.2016.07.005 Get rights and content

Highlights

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Reviews research on anxiety-linked attentional bias and its modification.
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Illustrates need to distinguish procedures/processes in assessment and intervention.
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Shows that evocation of attentional bias modification (ABM) process impacts anxiety.
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Shows that procedures intended to evoke ABM process do not consistently do so.
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Explains inconsistent emotional impact of procedures intended to evoke ABM process.

Abstract

In this review of research concerning anxiety-linked attentional bias, we seek to illustrate a general principle that we contend applies across the breadth of experimental psychopathology. Specifically, we highlight how maintenance of a clear distinction between process and procedure serves to enhance the advancement of knowledge and understanding, while failure to maintain this distinction can foster confusion and misconception. We show how such clear differentiation has permitted the continuous refinement of assessment procedures, in ways that have led to growing confidence in the existence of the putative attentional bias process of interest, and also increasing understanding of its nature. In contrast, we show how a failure to consistently differentiate between process and procedure has contributed to confusion concerning whether or not attentional bias modification reliably alters anxiety vulnerability and dysfunction. As we demonstrate, such confusion can be avoided by distinguishing the process of attentional bias modification from the procedures that have been employed with the intention of evoking this target process. Such an approach reveals that procedures adopted with the intention of eliciting the attentional bias modification process do not always do so, but that successful evocation of the attentional bias modification process quite reliably alters anxiety symptomatology. We consider some of the specific implications for future research concerning attentional bias modification, while also pointing to the broader implications for experimental psychopathology research in general.

Section snippets

The importance of distinguishing process from procedure in experimental psychopathology research

Experimental psychopathology researchers seek to understand and modify the processes that underpin psychopathology, and achieving these twin objectives requires that they must develop and deploy effective procedures. Processes must not be confused with procedures. Processes represent psychological operations, while procedures are sets of actions taken by the investigator, most often with the goal of measuring or manipulating processes. It is appropriate to distinguish two subsets of processes

The measurement of anxiety-linked attentional bias: maintaining clarity concerning the relationship between the putative pathological process and intended assessment procedures

Across all scientific disciplines, compelling theory plays a pivotal role in driving the advancement of knowledge and understanding. While theory can be simple or complex, it must always provide a plausible explanation for the phenomenon of interest. Within the discipline of clinical psychology, where phenomena of interest concern patterns of dysfunctional psychological symptomatology, theories describe candidate psychological processes that plausibly could give rise to this type of

Theoretical rationale motivating anxiety-linked attentional bias research

The origins of this field can be traced to the quite simple theoretical idea that elevated disposition to frequently experience intense and/or dysfunctional anxiety may potentially be explained by a tendency to selectively allocate attention to more threatening elements of the environment. This idea first gained traction in the 1980s, and quickly became incorporated into many influential models of anxiety vulnerability and dysfunction (e.g., Beck et al., 1985, Bower, 1981, Rapee and Heimberg,

Development of assessment procedures capable of detecting presence of anxiety-linked attentional bias

An early procedure employed with the intention of assessing anxiety-linked attentional bias presented threat-related and neutral words under degraded exposure conditions, that made their identification difficult, and required participants to explicitly identify these words. It was reasoned that an anxiety-linked attentional bias to threat should selectively enhance the identification of the threat-related items. Such an effect has indeed been observed. For example, Parkinson and Rachman (1981)

Refinement of assessment procedures to illuminate nature of anxiety-linked attentional bias

The progressive refinement of assessment procedures has permitted more than growing confidence in the veracity of the hypothesis that such a biased attentional process operates in anxious individuals. Additionally, the advancement of assessment procedures has enabled investigators to more precisely delineate the specific nature of this anxiety-linked process. Each step along this pathway to increasing precision has involved the identification of some theoretical distinction concerning the

The modification of anxiety-linked attentional bias: maintaining clarity concerning the relationship between the target change process and intended change evocation procedures

In shifting to consider experimental psychopathology research that has sought to evaluate the therapeutic impact of potentially beneficial change processes, through the use of procedures developed with the aim of evoking these change processes, we move onto the type of work represented by the right column of Fig. 1. A great deal of clinical psychology research is of this nature. Across the breadth of such work, the candidate change processes that clinical researchers may seek to evoke vary

Development of procedures capable of evoking the ABM process

Our own early efforts to develop procedures that may prove capable of evoking the ABM process began in the 1990s, and have been reviewed elsewhere by Mathews and MacLeod (2002). These intended change evocation procedures involved exposing participants to amended variants of tasks that had previously been employed to assess anxiety-linked attentional bias. The amended protocols involved introducing a contingency into the original task, that it was anticipated may drive the intended process of

Is anxiety vulnerability and dysfunction attenuated by procedures that demonstrably evoke the change process of attentional bias modification?

When intended change procedures evocation procedures successfully elicit the ABM process, then they also commonly impact on anxiety vulnerability. In two early studies, MacLeod, Rutherford, Campbell, Ebsworthy, and Holker (2002) delivered a word version of the probe-based protocol intended to elicit ABM, within a single session laboratory procedure, to students who were mid-range in trait anxiety. One subgroup received this procedure configured in the avoid-threat contingency condition, while

Is anxiety vulnerability and dysfunction attenuated by procedures that do NOT demonstrably evoke the change process of attentional bias modification?

Two case series studies, designed to examine the impact of procedures intended to evoke the ABM process, have included attentional bias assessment procedures but been unable to draw confident conclusions concerning whether or not ABM was elicited, due to power issues (Bechor et al., 2014, Rozenman et al., 2011). In both studies young participants were exposed to procedures involving the probe protocol, always configured in the avoid-threat contingency condition. Rozenman et al. (2011) gave 12

The need to distinguish process from procedure in ABM meta-analyses

Across the past 6 years, at least nine meta-analytic reviews of the ABM literature have been published (Bar-Haim, 2010, Beard et al., 2012, Cristea et al., 2015a, Cristea et al., 2015b, Hakamata et al., 2010, Hallion and Ruscio, 2011, Heeren et al., 2015, Linetzky et al., 2015, Mogoase et al., 2014). Meta-analysis can be an extremely powerful tool. Its major value comes from the statistical power it affords to determine both the significance, and the size, of effects obtained when combining

Closing comments

We have reviewed compelling evidence for the existence of an anxiety-linked processing bias involving heightened attentional vigilance for threat, and illustrated how the progressive refinement of assessment procedures has steadily advanced understanding of this process. We also have shown that efforts to reduce anxiety vulnerability and dysfunction, by directly modifying this attentional bias to threat, have produced mixed outcomes. Inconsistent findings are commonplace in experimental

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Attention bias (ABs) to threat is essential in the etiology and maintenance of test anxiety. However, little is known about the attention pattern of ABs in test anxiety. The stimulus duration affects the attention pattern in anxiety. Thus, the present research combined the dot-probe paradigm and event-related potentials (ERPs) and varied the stimulus duration (100 ms or 500 ms) to test the ABs in test anxiety. Consequently, both groups showed a threat N2pc in 100 ms and 500 ms duration, suggesting that both groups allocated attention to the test-related threat. However, in the 100 ms duration, the high test-anxious (HTA) group had smaller target-elicited P1 and greater target-elicited N2 in the threat-congruent condition than in the neutral condition. In the 500 ms duration, an earlier threat N2pc and a threat PD followed a greater target P1, and smaller target N2 were pronounced in the HTA group. The current results provided electrophysiological evidence that the HTA group kept a dynamic attention pattern that fluctuated shift between vigilance and avoidance in the 100 ms and 500 ms duration. The HTA group was more vigilant than the LTA group in the 500 ms duration when strategic attention was concerned, proposing that vigilance in test anxiety was not an automatic process.
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An important aim of basic research in Clinical Psychology is to improve clinical practice (e.g., by developing novel interventions or improving the efficacy of existing ones) based on an improved understanding of key mechanisms involved in psychopathology. In the first part of this article, we examine how frequently this translation has happened in the past by reviewing all 40 evidence-based psychological interventions recommended in current clinical guidelines for five important (groups of) mental disorders. Results show that only 23% of treatments showed a very strong link between basic research and the development of the intervention, and further 20% showed a strong link. These findings thus suggest that the route from basic research to clinical innovation may not be as strong historically as is commonly assumed. Important challenges for translational research in clinical psychology are reviewed, leading to the introduction of a new framework, and a discussion of possible solutions to overcome these challenges. Suggestions include increased attention to robust and replicable research findings, a stronger focus on experimental psychopathology research to establish causality of psychopathological mechanisms, a more systematic structural integration of basic and applied research in clinical psychology, a stronger emphasis on mechanisms of change and moderators of clinical interventions, increased attention to clinical subgroups, and emphasizing improvements to existing interventions over the development of novel interventions.
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^☆: This work was supported by Australian Research Council Grants DP140104448 and DP140103713, and by a grant from the Romanian National Authority for Scientific Research, CNCS–UEFISCDI, project number PNII-ID-PCCE-2011-2-0045.

View full text

Anxiety-linked attentional bias and its modification: Illustrating the importance of distinguishing processes and procedures in experimental psychopathology research☆

Highlights

Abstract

Section snippets

The importance of distinguishing process from procedure in experimental psychopathology research

The measurement of anxiety-linked attentional bias: maintaining clarity concerning the relationship between the putative pathological process and intended assessment procedures

Theoretical rationale motivating anxiety-linked attentional bias research

Development of assessment procedures capable of detecting presence of anxiety-linked attentional bias

Refinement of assessment procedures to illuminate nature of anxiety-linked attentional bias

The modification of anxiety-linked attentional bias: maintaining clarity concerning the relationship between the target change process and intended change evocation procedures

Development of procedures capable of evoking the ABM process

Is anxiety vulnerability and dysfunction attenuated by procedures that demonstrably evoke the change process of attentional bias modification?

Is anxiety vulnerability and dysfunction attenuated by procedures that do NOT demonstrably evoke the change process of attentional bias modification?

The need to distinguish process from procedure in ABM meta-analyses

Closing comments

Behaviour Research and Therapy

Journal of Anxiety Disorders

Brain and Cognition

Behavior Therapy

Journal of Anxiety Disorders

Behaviour Research and Therapy

Behaviour Research and Therapy

Behaviour Research and Therapy

Developmental Cognitive Neuroscience

Behavior Therapy

Biological Psychiatry

Contemporary Educational Psychology

Journal of Behavior Therapy and Experimental Psychiatry

Clinical Psychology Review

Behaviour Research and Therapy

Behaviour Research and Therapy

Journal of Behavior Therapy and Experimental Psychiatry

Biological Psychiatry

Journal of Psychiatric Research

Clinical Psychology Review

Behaviour Research and Therapy

Behaviour Research and Therapy

Behaviour Research and Therapy

Behaviour Research and Therapy

Behavior Research and Therapy

Behaviour Research and Therapy

Behavior Research and Therapy

Behaviour Research and Therapy

Behaviour Research and Therapy

Behaviour Research and Therapy

Behaviour Research and Therapy

Behaviour Research and Therapy

Behaviour Research and Therapy

Behaviour Research and Therapy

Behaviour Research and Therapy

Behaviour research and therapy

Behaviour Research and Therapy

Behaviour Research and Therapy

Attention modification program in individuals with generalized anxiety disorder

Journal of Abnormal Psychology

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

Research review: Attention bias modification (ABM): A novel treatment for anxiety disorders

Journal of Child Psychology and Psychiatry

Threat-related attentional bias in anxious and nonanxious individuals: A meta-analytic study

Psychological Bulletin

Training anxious children to disengage attention from threat: A randomized controlled trial

Journal of Child Psychology and Psychiatry

Does anxiety-linked attentional bias to threatening information reflect bias in the setting of attentional goals, or bias in the execution of attentional goals?

Cognition and Emotion

Anxiety disorders and phobias: A cognitive perspective

Internet-based attention training for social anxiety: A randomized controlled trial

Cognitive Therapy and Research

Combining attention training with internet-based cognitive-behavioral self-help for social anxiety: A randomised controlled trial

Cognitive Behaviour Therapy

Internet-based attention bias modification for social anxiety: A randomised controlled comparison of training towards negative and training towards positive cues

PLoS ONE

Intelligence as the tests test it

New Republic