Attentional bias for threat: Crisis or opportunity?

doi:10.1016/j.cpr.2018.05.005

Clinical Psychology Review

Volume 69, April 2019, Pages 4-13

https://doi.org/10.1016/j.cpr.2018.05.005 Get rights and content

Highlights

•
Attention biases for threat (ABT) often characterize anxiety disorders.
•
Methods for measuring ABT have become increasingly precise.
•
Yet the reliability of these methods is very poor.

Abstract

Beginning in the 1980s, experimental psychopathologists increasingly adapted the concepts and paradigms of cognitive science to elucidate information-processing abnormalities that may figure in the etiology and maintenance of anxiety disorders. Assessment and modification of attentional biases for threat has been a major theme in this research program. The field has witnessed the development of progressively more sophisticated approaches for isolating attentional processes from other cognitive processes in the service of accurate assessment and treatment. Yet the field is now in crisis as foundational concerns about the reliability of basic measures of attentional bias for threat (ABT) have emerged. Moreover, recent research points to theoretical revisions deemphasizing ABT as a stable, near-universal feature of anxiety disorders, and stressing deficits in executive control as the primary attentional problem linked to anxiety.

Section snippets

Attentional bias for threat

Limitations in our capacity to process information compel us to attend to only a subset of the input impinging on us at any moment. Hence, a bias for selectively attending to threatening content should heighten one's proclivity to experience episodes of increased anxiety. People characterized by high trait anxiety, especially those with anxiety disorders, should therefore exhibit a bias for selectively attending to threat cues relative to positive or neutral ones.

In a comprehensive review of

Attentional bias modification

The importance of ABT arises from its possible causal role in the etiology and maintenance of anxiety disorders (Van Bockstaele et al., 2014). If ABT increases proneness to experience episodes of heightened anxiety, then reducing it would be a worthy clinical goal. If the causal pathway operates both ways – ABT increases anxiety, which, in turn, exacerbates ABT – then therapeutically reducing it would still be worthwhile. Yet if ABT is merely a correlate of anxiety, then targeting it

The reliability crisis

Cronbach (1957) observed that psychology comprises two disciplinary traditions, one experimental and the other correlational. Research on attentional bias is squarely in the first tradition. Issues that preoccupy the psychometricians who dominate the second tradition seldom trouble the sleep of the experimentalists. Accordingly, whether measures of attentional bias are reliable has rarely been addressed until recently. An early study of inpatient Vietnam veterans with PTSD revealed that the

Conceptual crisis or opportunity?

A fundamental assumption behind research on the assessment and reduction of ABT is that it is a stable feature of individuals – “trait-like” – at least in people who have not undergone training programs designed to abolish it. Perhaps this assumption is incorrect.

Indeed, one research team has reconceptualized the attentional abnormalities that presumably characterize people with anxiety disorders, and they have devised novel methods of analyzing dot probe RT data as a means of testing their

Clinical implications and future directions

Cognitive science has inspired the study of aberrant processes presumably implicated in the maintenance and perhaps the etiology of anxiety disorders (e.g., attentional bias for threat) as well as the development of procedures to correct them. Yet despite their methodological rigor these new interventions seem unlikely to surpass the therapeutic efficacy of traditional CBT. On the other hand, some studies suggest that they can abolish anxiety disorders in 50% of patients in far less time than

Conflict of interest

None.

Richard J. McNally is Professor and Director of Clinical Training in the Department of Psychology at Harvard University.

References (118)

N. Amir et al.
Combining computerized home-based treatments for generalized anxiety disorder: An attention modification program and cognitive behavioral therapy
Behavior Therapy
(2012)
T. Armstrong et al.
Eye tracking of attention in the affective disorders: A meta-analytic review and synthesis
Clinical Psychology Review
(2012)
G.J.G. Asmundson et al.
Selective attention toward physical threat in patients with panic disorder
Journal of Anxiety Disorders
(1992)
A. Bernstein et al.
Attention Feedback Awareness and Control Training (A-FACT): Experimental test of a novel intervention paradigm targeting attentional bias
Behaviour Research and Therapy
(2014)
N.T.M. Chen et al.
Attentional bias modification facilitates attentional control mechanisms: Evidence from eye tracking
Biological Psychology
(2015)
J.M. Cisler et al.
Components of attentional biases in contamination fear: Evidence for difficulty in disengagement
Behaviour Research and Therapy
(2010)
D.M. Clark
A cognitive approach to panic
Behaviour Research and Therapy
(1986)
E.L. De Voogd et al.
Visual search attentional bias modification reduced social phobia in adolescents
Journal of Behavior Therapy and Experimental Psychiatry
(2014)
M.W. Eysenck et al.
New perspectives in attentional control theory
Personality and Individual Differences
(2011)
A. Heeren et al.
Does attention bias modification improve attentional control? A double-blind randomized experiment with individuals with social anxiety disorder
Journal of Anxiety Disorders
(2015)

A. Heeren et al.

Attention bias modification for social anxiety: A systematic review and meta-analysis

Clinical Psychology Review

(2015)

A. Heeren et al.

Attention training toward and away from threat in social phobia: Effects on subjective, behavioral, and physiological measures of anxiety

Behaviour Research and Therapy

(2012)

E.H.W. Koster et al.

Introduction to the special issue on Cognitive bias modification: Taking a step back to move forward?

Journal of Behavior Therapy and Experimental Psychiatry

(2015)

E.H.W. Koster et al.

Selective attention to threat in the dot probe paradigm: Differentiating vigilance and difficulty to disengage

Behaviour Research and Therapy

(2004)

E. Lavy et al.

Attentional bias and spider phobia

Behaviour Research and Therapy

(1993)

C. MacLeod et al.

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

Behaviour Research and Therapy

(2016)

A. Mathews et al.

Selective processing of threat cues in anxiety states

Behaviour Research and Therapy

(1985)

A. Mathews et al.

Effect of psychological treatment on cognitive bias in generalized anxiety disorder

Behaviour Research and Therapy

(1995)

J.L. Mattia et al.

The revised Stroop color-naming task in social phobics

Behaviour Research and Therapy

(1993)

R.J. McNally

On the scientific status of cognitive appraisal models of anxiety disorder

Behaviour Research and Therapy

(2001)

R.J. McNally

Mechanisms of exposure therapy: How neuroscience can improve psychological treatments for anxiety disorders

Clinical Psychology Review

(2007)

R.J. McNally

The legacy of Seligman's “Phobias and Preparedness” (1971)

Behavior Therapy

(2016)

R.J. McNally et al.

Attention bias modification for reducing speech anxiety

Behaviour Research and Therapy

(2013)

R.J. McNally et al.

Selective processing of emotional information in panic disorder

Behaviour Research and Therapy

(1992)

K. Mogg et al.

A cognitive-motivational analysis of anxiety

Behaviour Research and Therapy

(1998)

K. Mogg et al.

Time course of attentional bias for fear-relevant pictures in spider-fearful individuals

Behaviour Research and Therapy

(2006)

K. Mogg et al.

Anxiety and attention to threat: Cognitive mechanisms and treatment with attention bias modification

Behaviour Research and Therapy

(2016)

K. Mogg et al.

Anxiety and threat-related attention: Cognitive-motivational framework and treatment

Trends in Cognitive Sciences

(2018)

K. Mogg et al.

A follow-up study of cognitive bias in generalized anxiety disorder

Behaviour Research and Therapy

(1995)

K. Mogg et al.

Effects of threat cues on attentional shifting, disengagement and response slowing in anxious individuals

Behaviour Research and Therapy

(2008)

K.R. Paap et al.

The role of test-retest reliability in measuring individual and group differences in executive functioning

Journal of Neuroscience Methods

(2016)

T. Pflugshaupt et al.

Hypervigilance-avoidance pattern in spider phobia

Journal of Anxiety Disorders

(2005)

R.B. Price et al.

Pooled patient-level meta-analysis of children and adults completing a computer-based anxiety intervention targeting attentional bias

Clinical Psychology Review

(2016)

H.E. Reese et al.

Attention training for reducing spider fear in spider-fearful individuals

Journal of Anxiety Disorders

(2010)

S. Reiss et al.

Anxiety sensitivity, anxiety frequency and the prediction of fearfulness

Behaviour Research and Therapy

(1986)

D. Algom et al.

A rational look at the emotional Stroop phenomenon: A generic slowdown, not a Stroop effect

Journal of Experimental Psychology: General

(2004)

American Psychiatric Association

Diagnostic and statistical manual of mental disorders

(2013)

N. Amir et al.

Attention modification program in individuals with generalized anxiety disorder

Journal of Abnormal Psychology

(2009)

N. Amir et al.

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

Journal of Consulting and Clinical Psychology

(2009)

N. Amir et al.

Attentional bias to threat in social phobia: Facilitated processing of threat or difficulty disengaging attention from threat?

Behaviour Research and Therapy

(2003)

N. Amir et al.

Interpretation training in individuals with generalized social anxiety disorder: A randomized controlled trial

Journal of Consulting and Clinical Psychology

(2012)

N. Amir et al.

Predictors of response to an attention modification program in generalized social phobia

Journal of Consulting and Clinical Psychology

(2011)

Y. Bar-Heim et al.

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

Psychological Bulletin

(2007)

A.T. Beck et al.

Anxiety disorders and phobias: A cognitive perspective

(1985)

J. Boettcher et al.

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

Cognitive Therapy and Research

(2012)

J. Boettcher et al.

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

PLoS ONE

(2013)

P. Carlbring et al.

Internet-delivered attention bias modification training in individuals with social anxiety disorder – A double blind randomized controlled trial

BMC Psychiatry

(2012)

I.A. Cristea et al.

Efficacy of cognitive bias modification interventions in anxiety and depression: Meta-analysis

British Journal of Psychiatry

(2015)

I.A. Cristea et al.

Invited commentary on… Confusing procedures with process in cognitive bias modification research

British Journal of Psychiatry

(2017)

L.J. Cronbach

The two disciplines of scientific psychology

American Psychologist

(1957)

Cited by (133)

Attention bias vs. attention control modification for social anxiety disorder: A randomized controlled trial
2024, Journal of Anxiety Disorders
Gaze-Contingent Music Reward Therapy (GC-MRT) is an eye-tracking-based attention bias modification protocol for social anxiety disorder (SAD) with established clinical efficacy. However, it remains unclear if improvement following GC-MRT hinges on modification of threat-related attention or on more general enhancement of attention control. Here, 50 patients with SAD were randomly allocated to GC-MRT using either threat faces or shapes. Results indicate comparable reductions in social anxiety and co-morbid depression symptoms in the two conditions. Patients in the shapes condition showed a significant increase in attention control and a reduction in attention to both the trained shapes and threat faces, whereas patients in the faces condition showed a reduction in attention to threat faces only. These findings suggest that enhancement of attention control, independent of valence-specific attention modification, may facilitate reduction in SAD symptoms. Alternative interpretations and clinical implications of the current findings are discussed.
The free-viewing matrix task: A reliable measure of attention allocation in psychopathology
2023, Journal of Anxiety Disorders
Aberrant attention allocation has been implicated in the etiology and maintenance of a range of psychopathologies. However, three decades of research, relying primarily on manual response-time tasks, have been challenged on the grounds of poor reliability of its attention bias indices. Here, in a large, multisite, international study we provide reliability information for a new eye-tracking-based measure of attention allocation and its relation to psychopathology and age. Data from 1567 participants, across a wide range of psychiatric diagnoses and ages, were aggregated from nine sites around the world. Of these, 213 participants also provided retest data. Acceptable overall internal consistency and test-retest reliability were observed among adult participants (Cronbach’s alpha = 0.86 and r(213) = 0.89, respectively), as well as across all examined psychopathologies. Youth demonstrated lower internal consistency scores (Cronbach’s alpha = 0.65). Finally, the percent dwell time index derived from the task statistically differentiated between healthy participants and participants diagnosed with social anxiety disorder, major depression, and post-traumatic stress disorder. These results potentially address a long-standing reliability crisis in this research field. Aberrant attention allocation patterns in a variety of psychiatric disorders may be targeted with the hope of affecting symptoms. The attention allocation index derived from the matrix task offers reliable means to measure such cognitive target engagement in clinical contexts.
How do mindfulness and compassion programs improve mental health and well-being? The role of attentional processing of emotional information
2023, Journal of Behavior Therapy and Experimental Psychiatry
Although the benefits of Meditation-Based Programs are well documented, the mechanisms underlying these benefits have not been fully elucidated. Therefore, we examined whether: (1) formal training in mindfulness and compassion meditation modifies the distribution of attentional resources towards emotional information; and (2) whether changes in attentional processing of emotional information after the meditation programs mediate the improvements in psychological distress, emotion regulation, and well-being.
A sample of 103 participants enrolled in the study: 36 in the mindfulness program (MBSR), 30 in the compassion program (CCT), and 37 in the no-intervention comparison group (CG). The assessment before and after the programs included the completion of an emotional Attentional Blink task (AB) together with self-report measures of psychological distress, emotion regulation, and well-being.
MBSR and CCT reduced similarly the AB deficit, whereas no changes occurred in the CG. This AB reduction was found for the different emotional and non-emotional stimuli (i.e., negative, positive, and neutral), showing a significant disengagement from first-target emotions and significant accessibility of second-target emotions to consciousness. The effects of both meditation programs on the psychological measures were mediated by changes in the AB and emotion regulation skills.
Due to our naturalistic design in a real-world community setting, random assignment of participants was not feasible.
Meditation may promote more flexible and balanced attention to emotional information, which may be a key transdiagnostic mechanism underlying its benefits on emotional distress and well-being.
Ecological anxiety and pro-environmental behaviour: The role of attention
2023, Journal of Anxiety Disorders
Climate change is a serious threat to human health and the awareness of this threat can elicit ecological anxiety (eco-anxiety), which could be considered a rational and potentially adaptive response. However, the experience of eco-anxiety does not always lead to adaptive behaviour. The present study investigated whether differential patterns of selective attention towards climate-related information, and variability in this attention, might explain this inconsistent relationship. Participants completed a dot-probe assessment of attentional bias to images of both climate change mitigation strategies and of climate change causes and consequences, and measures of eco-anxiety, climate change belief, environmental self-efficacy, and general psychological symptoms. Engagement in pro-environmental behaviours was measured using a daily behavioural diary. Eco-anxiety and attentional bias independently predicted behaviour, but did not interact. However, attentional bias variability moderated the relationship between eco-anxiety and behaviour, such that higher eco-anxiety predicted greater behavioural engagement, but only when attentional bias variability was low. This was the first known study to examine the potential moderating effect of attentional bias on the relationship between eco-anxiety and pro-environmental behaviours. This growing field of research can help in identifying how the rational response of eco-anxiety can be better harnessed to motivate an adaptive response to the climate crisis.
(A lack of) effects of acute social stress on attentional bias to threat
2023, Comprehensive Psychoneuroendocrinology
Attentional biases toward or away from emotionally evocative stimuli have been well documented and are known to be clinically relevant, making it important to understand how various factors contribute to them. Some work has suggested that acute stress modulates attentional biases, but this work has produced inconsistent results. For example, many studies have found that stress enhances attentional bias, others that stress decreases attentional bias, and others still that there is no effect of stress at all. Methodological differences may explain these inconsistencies. For example, discrepancies exist between studies in participant sex (e.g., mixed sample vs. all men) and in the type of attentional bias paradigm. We addressed these gaps by examining the effects of an acute social stressor (vs. control) on attentional bias assessed via facial dot probe, focusing on potential sex differences in these effects (N = 141). We found that, overall, participants were significantly biased towards threat, but biases did not differ by stress condition or sex. These findings help to clarify the existing discrepancy in the literature, as we found that stress exerts little if any effect on attentional bias assessed via a facial dot probe.
Blunted neurobiological reactivity and attentional bias to threat underlie stress-related disorders in women survivors of intimate partner violence
2023, Psychological Medicine

View all citing articles on Scopus

Richard J. McNally is Professor and Director of Clinical Training in the Department of Psychology at Harvard University.

^☆: I thank Bethany A. Teachman and two anonymous reviewers for their helpful and excellent comments, and Karin Mogg, Thomas L. Rodebaugh, and Stephanie Waechter for their insights conveyed in e-mail correspondence.

View full text

ReviewAttentional bias for threat: Crisis or opportunity?☆

Highlights

Abstract

Section snippets

Attentional bias for threat

Attentional bias modification

The reliability crisis

Conceptual crisis or opportunity?

Clinical implications and future directions

Conflict of interest

Behavior Therapy

Clinical Psychology Review

Journal of Anxiety Disorders

Behaviour Research and Therapy

Biological Psychology

Behaviour Research and Therapy

Behaviour Research and Therapy

Journal of Behavior Therapy and Experimental Psychiatry

Personality and Individual Differences

Journal of Anxiety Disorders

Clinical Psychology Review

Behaviour Research and Therapy

Journal of Behavior Therapy and Experimental Psychiatry

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

Clinical Psychology Review

Behavior Therapy

Behaviour Research and Therapy

Behaviour Research and Therapy

Behaviour Research and Therapy

Behaviour Research and Therapy

Behaviour Research and Therapy

Trends in Cognitive Sciences

Behaviour Research and Therapy

Behaviour Research and Therapy

Journal of Neuroscience Methods

Journal of Anxiety Disorders

Clinical Psychology Review

Journal of Anxiety Disorders

Behaviour Research and Therapy

A rational look at the emotional Stroop phenomenon: A generic slowdown, not a Stroop effect

Journal of Experimental Psychology: General

Diagnostic and statistical manual of mental disorders

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

Attentional bias to threat in social phobia: Facilitated processing of threat or difficulty disengaging attention from threat?

Behaviour Research and Therapy

Interpretation training in individuals with generalized social anxiety disorder: A randomized controlled trial

Journal of Consulting and Clinical Psychology

Predictors of response to an attention modification program in generalized social phobia

Journal of Consulting and Clinical Psychology

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

Psychological Bulletin

Anxiety disorders and phobias: A cognitive perspective

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

Cognitive Therapy and Research

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

PLoS ONE

Internet-delivered attention bias modification training in individuals with social anxiety disorder – A double blind randomized controlled trial

BMC Psychiatry

Efficacy of cognitive bias modification interventions in anxiety and depression: Meta-analysis

British Journal of Psychiatry

Invited commentary on… Confusing procedures with process in cognitive bias modification research

British Journal of Psychiatry

The two disciplines of scientific psychology

American Psychologist

Review
Attentional bias for threat: Crisis or opportunity?☆