Expectancy biases in fear and anxiety and their link to biases in attention

doi:10.1016/j.cpr.2015.08.005

Clinical Psychology Review

Volume 42, December 2015, Pages 83-95

https://doi.org/10.1016/j.cpr.2015.08.005 Get rights and content

Highlights

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We summarize evidence for attention bias and expectancy bias in health and anxiety.
•
Possible causal relations between these processing biases were rarely investigated.
•
New research venues are proposed.
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This review aims at stimulating future research in order to provide effective therapy.

Abstract

Healthy individuals often exhibit prioritized processing of aversive information, as manifested in enhanced orientation of attention to threatening stimuli compared with neutral items. In contrast to this adaptive behavior, anxious, fearful, and phobic individuals show exaggerated attention biases to threat. In addition, they overestimate the likelihood of encountering their feared stimulus and the severity of the consequences; both are examples of expectancy biases. The co-occurrence of attention and expectancy biases in fear and anxiety raises the question about causal influences. Herein, we summarize findings related to expectancy biases in fear and anxiety, and their association with attention biases. We suggest that evidence calls for more comprehensive research strategies in the investigation of mutual influences between expectancy and attention biases, as well as their combined effects on fear and anxiety. Moreover, both types of bias need to be related to other types of distorted information processing commonly observed in fear and anxiety (e.g., memory and interpretation biases). Finally, we propose new research directions that may be worth considering in developing more effective treatments for anxiety disorders.

Section snippets

Expectancy bias

It is important to distinguish two types of biased expectations (Aue and Hoeppli, 2012, Foa and Kozak, 1986). Catastrophic thinking in exaggerated fear, phobia, and anxiety may result both from overestimating the likelihood of facing an anticipated threat source (encounter expectancy bias; referred to as probability by Foa & Kozak, 1986) and from overestimating the likelihood that such a confrontation with the threat source will have severe consequences (consequences expectancy bias; referred

Review of research on expectancy bias

Whether or not we anticipate the possibility of being confronted with a threatening situation in the near or far future should have a major impact on our experience of fear.⁵

Review of research on attention bias

In contrast to biased expectancies, attentional biases have been extensively studied and therefore are only partially reviewed here. Table 2 provides a summary of the evidence regarding different attention biases in healthy, anxious, fearful, and phobic individuals. Fig. 2 displays the most prominent paradigms used in examining attention biases in fear and anxiety.¹⁰

Research linking biases in expectancies and attention

To date, research on both healthy and pathological forms of fear has largely disregarded possible relations between expectancy and attention biases. We will start with some theoretical considerations about a link between diverse kinds of information-processing biases in fear and anxiety. We will then describe some first studies investigating associations between distortions in expectancy and attention and discuss their implications. We will conclude this section with an additional consideration

Extending the focus to underlying mechanisms and other information-processing biases

From the studies reviewed earlier, we postulate a link between attention and expectancy bias, with attention bias causally influencing expectancies. While our data are suggestive, we need more research in order to determine causality and to gain better insight into the concrete mechanisms underlying the presumed transfer of one bias into the other. One way toward this aim consists in the simultaneous consideration of other biases that have been observed in fear and anxiety (e.g., memory bias,

Some future directions

Future envisaged developments constitute an additional distinction between the different subtypes of the biases considered here (e.g., attention bias: early attention engagement, early attention disengagement, later attentional avoidance; expectancy bias: consequences, encounter; memory bias: encoding, consolidation, retrieval). As we outlined in the previous section, early attention biases in anxiety and phobia (e.g., facilitated initial engagement in threat) may conceivably have a causal

Conclusions and outlook

The evidence summarized in this article points to robust attention and expectancy biases among anxious, fearful, and phobic individuals. Recent studies revealed an association between these biases, emphasizing the need for future examination of their shared neurocognitive mechanisms. Such research efforts are crucial for a better understanding of processing biases in threatening situations and may have important theoretical and clinical implications. In future research, terminology—especially

Acknowledgments

This research was supported by the Swiss National Science Foundation grant PZ00P1_140060 awarded to T. Aue and by the Marie Curie Actions CIG grant 34206 and the National Institute for Psychobiology in Israel Young Investigator Research grant 145-14-15 awarded to H. Okon-Singer. We would like to thank Noga Cohen and Tomer Shechner for their helpful comments on a previous version of this manuscript.

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View full text

Expectancy biases in fear and anxiety and their link to biases in attention

Highlights

Abstract

Section snippets

Expectancy bias

Review of research on expectancy bias

Review of research on attention bias

Research linking biases in expectancies and attention

Extending the focus to underlying mechanisms and other information-processing biases

Some future directions

Conclusions and outlook

Acknowledgments

Journal of Anxiety Disorders

Journal of Anxiety Disorders

Journal of Anxiety Disorders

Journal of Behavior Therapy and Experimental Psychiatry

Pain

Behaviour Research and Therapy

Biological Psychiatry

Journal of Anxiety Disorders

Advances in Behaviour Research and Therapy

Clinical Psychology Review

Journal of Anxiety Disorders

Behaviour Research and Therapy

Behaviour Research and Therapy

Anxiety Disorders

Behaviour Research and Therapy

Clinical Psychology Review

Consciousness and Cognition

Clinical Psychology Review

Behaviour Research and Therapy

Personality and Individual Differences

Clinical Psychology Review

Behavior Therapy

Journal of Anxiety Disorders

Behavior Therapy

Trends in Cognitive Sciences

Behaviour Research and Therapy

Behaviour Research and Therapy

Behaviour Research and Therapy

Journal of Affective Disorders

Behaviour Research and Therapy

Behaviour Research and Therapy

Trends in Cognitive Sciences

Behaviour Research and Therapy

Behaviour Research and Therapy

Diagnostic and statistical manual of mental disorders

Dissociations between covariation bias and expectancy bias for fear-relevant stimuli

Cognition and Emotion

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

Journal of Consulting and Clinical Psychology

Automatic activation and strategic avoidance of threat-relevant information in social phobia

Journal of Abnormal Psychology

Dissociating emotion and attention functions in the pulvinar nucleus of the thalamus

Neuropsychology

Varying expectancies and the attention bias in phobic and non-phobic individuals

Frontiers in Human Neuroscience

Evidence for an encounter expectancy bias in fear of spiders

Cognition and Emotion

Brain systems underlying expectancy bias in spider phobia

Cognitive, Affective and Behavioral Neuroscience

Visual avoidance in phobia: Particularities in neural activity, autonomic responding, and cognitive risk evaluations

Frontiers in Human Neuroscience

Neural correlates of wishful thinking

Social Cognitive and Affective Neuroscience

Social learning theory

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

Journal of Child Psychology and Psychiatry

Cognitive bias modification for anxiety: Current evidence and future directions

Expert Review of Neurotherapeutics

Cognitive therapy and the emotional disorders

Anxiety disorders and phobias: A cognitive perspective