Attention biases in perfectionism: Biased disengagement of attention from emotionally negative stimuli
Introduction
Perfectionism is a multidimensional process defined by the setting of personally demanding high standards, and self-evaluation based on the attainment of those standards (Shafran, Cooper, & Fairburn, 2002). As a transdiagnostic process, perfectionism has been associated with the development and maintenance of multiple psychological disorders including anxiety, depression, eating disorders, and obsessive-compulsive disorder (OCD; Egan, Wade, & Shafran, 2011). Perfectionism may also impede treatment outcomes across psychological disorders, while treatment for perfectionism is associated with a reduction in the symptoms of associated disorders (Egan et al., 2011; Lloyd, Schmidt, Khondoker, & Tchanturia, 2015). Despite the clinical significance of perfectionism, the nature of cognitive features which may underpin perfectionism, is unclear.
Within the definition of perfectionism, two higher order constructs emerge which align with the cognitive behavioural definition of perfectionism; setting personally demanding standards, also known as perfectionistic strivings, and evaluating the self against these standards, known as perfectionistic concerns (Stoeber & Otto, 2006). There is ample evidence that perfectionistic concerns is associated with psychological disorders and symptoms of those disorders (Limburg, Watson, Hagger, & Egan, 2017), while the relationship between perfectionistic strivings and psychopathologies is less clear (Limburg et al., 2017). While it has been suggested that perfectionistic strivings are adaptive or associated with positive outcomes (Stoeber & Otto, 2006), the meta-analytic evidence suggests there is an association between perfectionistic strivings and negative outcomes particularly in the context of eating disorders and obsessive-compulsive disorders (Limburg et al., 2017). This suggests that both perfectionistic concerns and strivings are relevant to consider in the context of establishing how perfectionism is associated with psychopathologies.
Theoretical models of perfectionism suggest that there are underlying cognitive biases which may act to maintain perfectionism (Shafran et al., 2002). One such bias may be an attentional preference for threat-related stimuli over non-threatening information. Researchers have proposed that an attention bias to threat (e.g., stimuli that threaten perfection) can highlight failure, which may be an important maintaining factor in perfectionism (Frost, Marten, Lahart, & Rosenblate, 1990; Hewitt & Flett, 1991; Shafran et al., 2002). As has been observed in studies of attentional bias in anxiety or depression (e.g., Harvey, 2004), the pattern of attention bias may be highly specific to the class of stimulus relevant to an individual specific domain of concern. As such, for individuals with elevated perfectionism, perfectionism relevant threat may be more salient than stimuli that are perfectionism irrelevant. Perfectionism relevant threat is that which is related to meeting high standards, and can be positive in emotional tone (e.g., success) or negative in emotional tone (e.g., inadequate). According to models of perfectionism, these attention biases to perfectionism relevant information, relative to perfectionism irrelevant information, may give rise to other cognitive distortions often targeted in cognitive-behavioural therapy for perfectionism, such as overgeneralisation of failure or discounting of success (Lloyd et al., 2015; Shafran et al., 2002).
Within the literature examining the role of biased attention in various psychopathologies, a critical distinction is made between two sub-processes which can influence the overall manifestation of the bias. These processes are the tendency to attend more rapidly to certain stimuli (facilitated engagement) and difficulty withdrawing attention from stimuli (impaired disengagement; Cisler & Koster, 2010). Facilitated engagement may be related to increased sensitivity or heightened awareness, and associated with the initiation of anxiety (Koster, Crombez, Verschuere, Van Damme, & Wiersema, 2006). Conversely, impaired disengagement may be related to the continued processing of threat stimuli once observed, and the maintenance of anxiety (Koster et al., 2006). Given that the successful modification of biased attention for threat has been consistently linked to positive emotional effects for other types of psychological difficulties (Clarke, Notebaert, & MacLeod, 2014; MacLeod & Clarke, 2015; Price et al., 2016), discriminating the precise nature of attention biases which underpin perfectionism can inform our understanding of why some individuals are more likely to experience negative outcomes than others when they strive for perfection, and may also highlight potential target for direct intervention.
There are only two known studies which have explored attention biases in perfectionism (Howell et al., 2016; Kobori & Tanno, 2012). Both studies present preliminary evidence that there may be a perfectionism-related attention bias, however there are methodological limitations that warrant further consideration. The earliest study aimed to compare attention biases in individuals high in perfectionism with those low in perfectionism in a Japanese population (Kobori & Tanno, 2012). In this research, participants with high and low scores in perfectionistic concerns completed a modified emotional Stroop task with either neutral or negatively valenced words associated with perfectionism (i.e., mistake). Kobori and Tanno (2012) demonstrated a slowed reaction for high-perfectionism participants for colour-naming negative, perfectionism relevant stimuli, consistent with an attention bias towards threat. While this finding is consistent with the presence of such a bias, slowing of responses in an emotional Stroop task may be also be attributed to non-attentional processes associated with differences in the emotional state of participants (Bar-Haim, Lamy, Pergamin, Bakermans-Kranenburg, & Van Ijzendoorn, 2007). Similarly, it was not clear from this study whether perfectionism is characterised by an attention bias towards all negative words, or just those that are perfectionism relevant. The study also evaluated perfectionistic concerns, but did not examine perfectionistic strivings. Finally, the modified Stroop task produces an overall index of attentional bias but does not differentiate between categories of bias type (e.g., engagement or disengagement). Understanding how this attention bias may be characterised contributes to our theoretical understanding of the processes underpinning perfectionism and may provide insight for treatment directions.
To address some of these limitations, Howell et al. (2016) conducted a study which compared participants high and low in perfectionistic concerns on attention biases using a modified-dot probe task. Following an initial fixation, two stimuli (one emotional and one neutral) are presented, followed by a target probe in the location of one of the words (Grafton & MacLeod, 2014; MacLeod, Mathews, & Tata, 1986). Participants are required to discriminate the identity of the probe, and the relative speed to identify probes appearing in the location of threatening as compared to neutral stimuli provides the critical index of attention bias.
The emotionally-relevant stimuli included words that were perfectionism relevant and perfectionism irrelevant, with an equal proportion of each that were positive and negative. Howell et al. (2016) found that participants who were higher in perfectionism showed an attention bias towards negative, perfectionism relevant, information over positive perfectionism relevant information. However, the study did not evaluate the nature of the attentional bias (e.g., engagement vs. disengagement).
Despite promising results, what still remains unclear is the component attentional processes that comprise the attentional bias towards threat in perfectionism and how the two higher-order constructs of perfectionism, perfectionistic concerns and perfectionistic strivings, may be commonly or differentially associated with biased attentional engagement and disengagement in attention bias scores. Understanding how strivings is characterised may be important considering the mixed findings around perfectionistic strivings association with psychopathology. It is possible that perfectionistic strivings (which in some research has been associated with more positive outcomes; Stoeber & Otto, 2006) may be specifically associated with biased attentional engagement/disengagement with positive perfectionism relevant stimuli.
Within the literature it is unclear if perfectionism is characterised by facilitated engagement with or impaired disengagement from threatening stimuli. Additionally, no study to date has considered the effect of an attention bias for perfectionistic strivings, despite the association between perfectionistic strivings and psychological distress (Limburg et al., 2017). The present study aims to determine whether perfectionistic strivings and perfectionistic concerns are characterised by different attentional bias types (engagement vs. disengagement) across different stimulus categories (perfectionism relevant vs. irrelevant, and negative emotional valence vs. positive emotional valence). As perfectionistic concerns and perfectionistic strivings are believed to be associated with different patterns of psychopathology, it is consequently hypothesised that both perfectionistic concerns and perfectionistic strivings will uniquely predict attention bias toward negative stimuli, when they are perfectionism relevant, after controlling for symptoms of depression, anxiety, and stress. A second aim of this study is to determine how the attention bias associated with perfectionistic concerns or perfectionistic strivings may be characterised by an engagement bias, a disengagement bias, or both. As no study to date provides evidence to suggest the nature of attention bias in perfectionism, a directional prediction cannot be made.
Section snippets
Participants
One hundred and eight participants were recruited through various recruitment methods, including advertising through and snowball sampling from the general community, networks at a local university, and the [removed for review] School of Psychology undergraduate participation pool. A-priori power analysis through G*Power (Faul, Erdfelder, Buchner, & Lang, 2009) indicated 108 participants were required to detect a moderate effect (ƒ2 = 0.2; power = 0.8, two-tailed alpha = .05). After data for
Preliminary analyses
Attention bias index scores were computed following the procedure described above. For further detail, see Clarke et al. (2013). Participants displayed a high level of accuracy on the probe task, averaging less than 6% errors. Only trials where the participant provided a correct response were included in subsequent analyses. Prior to computing the attentional preference indices, outlier probe discrimination latency scores (defined as those falling > 2.58 SD from each participant's mean probe
Discussion
The present study aimed firstly to replicate the finding that a bias in attention towards negative perfectionism relevant stimuli exists in individuals with higher perfectionistic concerns and perfectionistic strivings. The second aim of this study was to determine how this attention bias may be characterised by an engagement or disengagement bias. Findings indicate that there was an effect for attention bias, qualified by a three-way interaction with perfectionistic concerns, emotional
Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
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