Abstract
ObjectivesA sample of women with persistent distress following breast cancer (BC) previously exhibited attentional bias (AB) away from supraliminally presented cancer-or threat-related information, responses consistent with avoidance coping, and showed negative interpretation bias. Here, we attempt to characterize the nature of supraliminal AB and interpretation bias in that sample of women by comparing against healthy controls.MethodsExtending our previous work, we compared AB patterns for supraliminally presented negatively valenced words and cancer-related information (CRI) assessed by modified dot-probe tasks and negative interpretation bias assessed by an ambiguous cue task between 140 BC women previously identified as featuring low-stable or persistent high anxiety and 150 age-matched non-BC healthy controls having HADS-defined low or high anxiety (HADS-anxiety scores = 8).ResultsAttentional avoidance of non-cancer-related negatively valenced words was seen among the anxious BC group, while heightened attention toward such words was seen in anxious healthy controls, F(3, 282) = 3.97, p = 0.009. However, all anxious women in both BC and healthy groups directed attention away from CRI under supraliminal conditions. Interpretation bias scores were significantly higher in BC women with high anxiety vs. healthy controls with high anxiety, F(3, 282) = 13.26, p < 0.001.ConclusionWomen with high anxiety generalized conscious attentional avoidance responses to negatively valenced stimuli, indicating a likely hypersensitivity to potential threat in ambiguous cues and exaggerated threat perception. This may cause (or reflect) maladaptive emotional regulation. Attention focus training, reducing threat salience or modifying threat appraisal, may help women alleviate anxiety levels after BC.
Highlights
Though many women with breast cancer (BC) experience stable low or transient distress, a subset, ∼10–20%, remain distressed > 5 years after diagnosis, detrimentally impacting their quality of life (Helgeson et al, 2004; Burgess et al, 2005; Henselmans et al, 2010; Lam et al, 2010, 2012)
Such studies reported that individuals with anxiety often displayed facilitated preconscious attentional allocation toward threat-related stimuli under initial subliminal exposure, which was either maintained or reallocated away from such stimuli, depending on the emotional condition, under prolonged supraliminal exposures reflecting conscious control; in depression, attentional bias (AB) toward threat-related stimuli appeared to be confined to only supraliminal exposures, indicative of inability to disengage among depressed individuals (Mathews and MacLeod, 2005; Bar-Haim et al, 2007; Cisler and Koster, 2010)
In the only study found on subliminal AB, subliminal bias was uncorrelated with distress among BC survivors (Glinder et al, 2007)
Summary
Though many women with breast cancer (BC) experience stable low or transient distress, a subset, ∼10–20%, remain distressed > 5 years after diagnosis, detrimentally impacting their quality of life (Helgeson et al, 2004; Burgess et al, 2005; Henselmans et al, 2010; Lam et al, 2010, 2012). Prior findings in emotional disorders using experimental paradigms including dot-probe tasks better capture the time-course effect of attentional bias (AB) by manipulating stimuli exposure duration. Such studies reported that individuals with anxiety often displayed facilitated preconscious (automatic) attentional allocation (bias) toward threat-related stimuli under initial subliminal exposure, which was either maintained or reallocated away from such stimuli, depending on the emotional condition, under prolonged supraliminal exposures reflecting conscious control; in depression, AB toward threat-related stimuli appeared to be confined to only supraliminal exposures, indicative of inability to disengage among depressed individuals (Mathews and MacLeod, 2005; Bar-Haim et al, 2007; Cisler and Koster, 2010). Due to the use of cross-sectional study design, none have examined AB in distress with reliable distress chronicity assessment
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