Anxiety-related Attentional Bias Research Articles

Effects of Heart Rate Variability Biofeedback Training on Anxiety Reduction and Brain Activity: a Randomized Active-Controlled Study Using EEG.

Heart rate variability biofeedback (HRVBF) is a promising anxiety-reducing intervention that increases vagally-mediated heart rate variability (vmHRV) through slow-paced breathing and feedback of heart rhythm. Several studies have reported the anxiety-reducing effects of HRVBF; however, some studies have reported such training as ineffective. Furthermore, the effects of training and underlying brain activity changes remain unclear. This study examined the anxiety-reducing effects of HRVBF training and related brain activity changes by randomly assigning participants, employing an active control group, and measuring anxiety-related attentional bias using the emotional Stroop task and electroencephalography (EEG). Fifty-five healthy students with anxiety were randomly assigned to the HRVBF or control groups, and 21 in the HRVBF group and 19 in the control group were included in the analysis. Both groups performed 10 training sessions of 20min each within 3 weeks. They were assessed using resting vmHRV, event-related potential (ERP), time-frequency EEG, attentional bias, and the State-Trait Anxiety Inventory-JYZ (STAI-JYZ) before and after training. The results demonstrated increased resting vmHRV in the HRVBF group compared to the control group after training. However, no differences were observed in ERP, time-frequency EEG, attentional bias, and STAI-JYZ. Participants with higher pre-training resting vmHRV achieved higher heart rhythm coherence in HRVBF training and had reduced attentional bias. This study suggests that individuals with higher resting vmHRV are more likely to be proficient in HRVBF training and benefit from its anxiety-reducing effects. The findings contribute to participant selection to benefit from HRVBF training and modification of the training protocols for non-responders.Clinical trial registrationOrganization: University Hospital Medical Information Network Clinical Trials Registry (UMIN-CTR), JapanRegistration number: UMIN000047096Registration date: March 6, 2022.

Eye-tracking to assess anxiety-related attentional biases among a large sample of preadolescent children

A considerable body of research in adults has demonstrated that anxiety disorders are characterised by attentional biases to threat. Findings in children have been inconsistent. The present study examined anxiety-related attention biases using eye tracking methodology in 463 preadolescents between 10 and 12 years of age, of whom 92 met criteria for a DSM-5 anxiety disorder and 371 did not. Preadolescent's gaze was recorded while they viewed adolescent face pairs depicting angry-neutral and happy-neutral expressions with each face pair presented for 5000 ms. No group differences were observed across any eye tracking indices including probability of first fixation direction, latency to first fixation, first fixation duration and dwell time. The sample overall showed faster initial attention towards threat cues, followed by a later broadening of attention away from threat. There is a need to identify the types of threats and the developmental period during which visual attention patterns of anxious and non-anxious youth diverge to inform more developmentally sensitive treatments.

Attentional bias to threat and gray matter volume morphology in high anxious individuals.

In a sample of highly anxious individuals, the relationship between gray matter volume brain morphology and attentional bias to threat was assessed. Participants performed a dot-probe task of attentional bias to threat and gray matter volume was acquired from whole brain structural T1-weighted magnetic resonance imaging scans. The results replicate previous findings in unselected samples that elevated attentional bias to threat is linked to greater gray matter volume in the middle frontal gyrus and superior frontal gyrus. In addition, we provide novel evidence that elevated attentional bias to threat is associated with greater gray matter volume in the inferior frontal gyrus, insula, cerebellum, and other distributed regions. Lastly, exploratory analyses provide initial evidence that distinct subregions of the right posterior parietal cortex may contribute to attentional bias in a sex-specific manner. Our results illuminate how differences in gray matter volume morphology relate to attentional bias to threat in anxious individuals. This knowledge could inform neurocognitive models of anxiety-related attentional bias to threat.

Transcranial Direct Current Stimulation (tDCS) Augments the Effects of Gamified, Mobile Attention Bias Modification.

Anxiety-related attention bias (AB) is the preferential processing of threat observed in clinical and sub-clinical anxiety. Attention bias modification training (ABMT) is a computerized cognitive training technique designed to systematically direct attention away from threat and ameliorate AB, but mixed and null findings have highlighted gaps in our understanding of mechanisms underlying ABMT and how to design the most effective delivery systems. One neuromodulation technique, transcranial direct current stimulation (tDCS) across the pre-frontal cortex (PFC) may augment the effects of ABMT by strengthening top-down cognitive control processes, but the evidence base is limited and has not been generalized to current approaches in digital therapeutics, such as mobile applications. The present study was a single-blind randomized sham-controlled design. We tested whether tDCS across the PFC, vs. sham stimulation, effectively augments the beneficial effects of a gamified ABMT mobile app. Thirty-eight adults (Mage = 23.92, SD = 4.75; 18 females) evidencing low-to-moderate anxiety symptoms were randomly assigned to active or sham tDCS for 30-min while receiving ABMT via a mobile app. Participants reported on potential moderators of ABMT, including life stress and trait anxiety. ECG was recorded during a subsequent stressor to generate respiratory sinus arrhythmia (RSA) suppression as a metric of stress resilience. ABMT delivered via the app combined with tDCS (compared to sham) reduced AB and boosted stress resilience measured via RSA suppression, particularly for those reporting low life stress. Our results integrating tDCS with ABMT provide insight into the mechanisms of AB modulation and support ongoing evaluations of enhanced ABMT reliability and effectiveness via tDCS.

Low working memory load facilitates attention bias modification training

Implementations of attention bias modification training (ABMT) attempt to retrain attention away from rather than towards threat, thereby disrupting the anxiety-related attentional bias (AB). Yet, results of ABMT studies have been mixed due to limitations in knowledge of mechanisms underlying ABMT efficacy. Dual-process models of anxiety posit that ABMT works primarily through strengthening of the top-down cognitive control of attention to threat. If this is the case, introducing a working memory load (WML) during ABMT should reduce training efficacy. However, prior studies employing this method show mixed results (Booth, Mackintosh, Mobini, Oztop, & Nunn, 2014; Clarke et al., 2017) and fail to directly compare low and high WML with no WML or to account for individual differences in anxiety and working memory capacity (WMC). The present study (N = 306) assessed trait anxiety and WMC in neurotypical adults who were then randomly assigned to ABMT that trained attention toward or away from threat, with either no, low, or high WML, for a total of six training groups. Attentional bias was assessed before and after training. Results showed ABMT successfully trained attention under low WML, but not under high or no WML, suggesting that ABMT is facilitated by engaging but not overtaxing WML.

Disgust face captures more attention in individuals with high social anxiety when cognitive resources are abundant: Evidence from N2pc

There is a debate about the relative contributions of top-down and bottom-up attention to the threat-related attentional bias. In this study we investigated the attentional bias in individuals with social anxiety under conditions of no, low and high visual working memory (WM) load. Event-related potential (ERP) and response time (RT) data were recorded while participants performed the dot-probe task and a concurrent change-detection task. The ERP results revealed that the maximum N2pc effect emerged in no visual WM load condition in individuals with social anxiety. The difference of N2pc effect between high socially anxious (HSA) and low socially anxious (LSA) groups was observed in no visual WM load condition, whereas this difference was eliminated under low and high load conditions. However, no significant main effects or interactions were observed in the behavioral index (reflected by Trial Level-Bias Score variability). Overall, the findings indicate the critical role of top-down attention on social anxiety-related attentional bias, which have important implication for attentional bias modification.

Anxiety-Related Attention Bias in Four- to Eight-Year-Olds: An Eye-Tracking Study.

(1) Background: There is evidence of an attention bias–anxiety relationship in children, but lack of appropriate methods has limited the number of studies with children younger than eight years old. This study used eye tracking as a measure of overt attention in young children. The aim of this study was to assess anxiety-related attention bias in children aged four to eight years. Age was considered a moderator, and the influence of effortful control was investigated. (2) Method: A community sample of 104 children was shown pairs of happy–neutral and angry–neutral faces. Growth curve analyses were used to examine patterns of gaze over time. (3) Results: Analyses revealed moderation by age and anxiety, with distinct patterns of anxiety-related biases seen in different age groups in the angry–neutral face trials. Effortful control did not account for age-related effects. (4) Conclusions: The results support a moderation model of the development of anxiety in children.

Social anxiety and attentional bias variability: electrophysiological evidence of attentional control deficits.

Attentional control has an important role in attentional bias in social anxiety. This study aimed to investigate whether attentional bias in social anxiety was caused by attentional control deficit. Event-related potentials and behavioural attentional bias index (trial-level attentional bias variability) were recorded as participants completed the dot-probe task. The behaviour result showed that compared with the low socially anxious individuals, the high socially anxious individuals had a marginally higher score of attentional bias variability. For event-related potentials results, target-locked frontocentral N2 amplitude was significantly larger under the incongruent condition than the congruent condition in the low socially anxious group, whereas there was no significant difference between these two conditions in the high socially anxious group. The low socially anxious group also exhibited reduced target-locked P2 amplitude from the congruent condition to the incongruent condition. Our findings provide electrophysiological evidence of attentional control dysregulation in socially anxious individuals, which contributes to modifying social anxiety-related attentional bias.

Heterogeneity of the Anxiety-Related Attention Bias: A Review and Working Model for Future Research.

The anxiety-related attention bias (AB) has been studied for several decades as a clinically-relevant output of the dynamic and complex threat detection-response system. Despite research enthusiasm for the construct of AB, current theories and measurement approaches cannot adequately account for the growing body of mixed, contradictory, and null findings. Drawing on clinical, neuroscience, and animal models, we argue that the apparent complexity and contradictions in the empirical literature can be attributed to the field's failure to clearly conceptualize AB heterogeneity and the dearth of studies in AB that consider additional cognitive mechanisms in anxiety, particularly disruptions in threat-safety discrimination and cognitive control. We review existing research and propose a working model of AB heterogeneity positing that AB may be best conceptualized as multiple subtypes of dysregulated processing of and attention to threat anchored in individual differences in threat-safety discrimination and cognitive control. We review evidence for this working model and discuss how it can be used to advance knowledge of AB mechanisms and inform personalized prevention and intervention approaches.

Furious snarling: Teeth-exposure and anxiety-related attentional bias towards angry faces.

Dot-probe studies consistently show that high trait anxious individuals have an attentional bias towards threatening faces. However, little is known about the influence of perceptual confounds of specific emotional expressions on this effect. Teeth-exposure was recently recognized as an important factor for the occurrence of attentional bias towards angry faces in a closely related paradigm (the face-in-the-crowd paradigm). Therefore, we investigated the effect of exposed teeth on attentional bias towards angry faces in the dot-probe task. Participants (N = 74) were asked to classify probe stimuli that were preceded by two simultaneously presented face cues, one angry and the other neutral. Half of the angry faces had exposed teeth, the other half had concealed teeth. Afterwards, participants completed the trait anxiety scale of the STAI. For angry faces with non-exposed teeth, we found the expected positive correlation (r = .441) of trait anxiety with the attentional bias score (reaction times for probes replacing the neutral face minus reaction times for probes replacing the angry face). However, we found no influence of trait anxiety on attentional bias towards angry faces with exposed teeth. These results suggest that natural low-level stimulus confounds of emotional faces like exposed teeth can affect the manifestation of anxiety-related attentional biases towards angry faces in the dot-probe task.

Brief time course of trait anxiety-related attentional bias to fear-conditioned stimuli: Evidence from the dual-RSVP task

Background and objectivesAttentional bias to threat is a much-studied feature of anxiety; it is typically assessed using response time (RT) tasks such as the dot probe. Findings regarding the time course of attentional bias have been inconsistent, possibly because RT tasks are sensitive to processes downstream of attention. MethodsAttentional bias was assessed using an accuracy-based task in which participants detected a single digit in two simultaneous rapid serial visual presentation (RSVP) streams of letters. Before the target, two coloured shapes were presented simultaneously, one in each RSVP stream; one shape had previously been associated with threat through Pavlovian fear conditioning. Attentional bias was indicated wherever participants identified targets in the threat’s RSVP stream more accurately than targets in the other RSVP stream. ResultsIn 87 unselected undergraduates, trait anxiety only predicted attentional bias when the target was presented immediately following the shapes, i.e. 160 ms later; by 320 ms the bias had disappeared. This suggests attentional bias in anxiety can be extremely brief and transitory. LimitationsThis initial study utilised an analogue sample, and was unable to physiologically verify the efficacy of the conditioning. The next steps will be to verify these results in a sample of diagnosed anxious patients, and to use alternative threat stimuli. ConclusionsThe results of studies using response time to assess the time course of attentional bias may partially reflect later processes such as decision making and response preparation. This may limit the efficacy of therapies aiming to retrain attentional biases using response time tasks.

Evidence from the eyes: Threatening postures hold attention.

Efficient detection of threat provides obvious survival advantages and has resulted in a fast and accurate threat-detection system. Although beneficial under normal circumstances, this system may become hypersensitive and cause threat-processing abnormalities. Past research has shown that anxious individuals have difficulty disengaging attention from threatening faces, but it is unknown whether other forms of threatening social stimuli also influence attentional orienting. Much like faces, human body postures are salient social stimuli, because they are informative of one's emotional state and next likely action. Additionally, postures can convey such information in situations in which another's facial expression is not easily visible. Here we investigated whether there is a threat-specific effect for high-anxious individuals, by measuring the time that it takes the eyes to leave the attended stimulus, a task-irrelevant body posture. The results showed that relative to nonthreating postures, threat-related postures hold attention in anxious individuals, providing further evidence of an anxiety-related attentional bias for threatening information. This is the first study to demonstrate that attentional disengagement from threatening postures is affected by emotional valence in those reporting anxiety.

Mechanisms of Selective Attention in Generalized Anxiety Disorder

A well-established literature has identified different selective attentional orienting mechanisms underlying anxiety-related attentional bias, such as engagement and disengagement of attention. These mechanisms are thought to contribute to the onset and maintenance of anxiety disorders. However, conclusions to date have relied heavily on experimental work from subclinical samples. We therefore investigated individuals with diagnosed generalized anxiety disorder (GAD), healthy volunteers, and individuals with high trait anxiety (but not meeting GAD diagnostic criteria). Across two experiments we found faster disengagement from negative (angry and fearful) faces in GAD groups, an effect opposite to that expected on the basis of the subclinical literature. Together these data challenge current assumptions that we can generalize, to those with GAD, the pattern of selective attentional orienting to threat found in subclinical groups. We suggest a decisive two-stage experiment identifying stimuli of primary salience in GAD, then using these to reexamine orienting mechanisms across groups.

Child temperamental reactivity and self-regulation effects on attentional biases.

This study examined the effects of individual differences in temperamental reactivity (fear) and self-regulation (attentional control) on attentional biases toward threat in a sample of school-aged children (age range was between 9 years 1 month and 13 years 10 months). Attentional biases were assessed with pictorial Dot-probe task, comparing attention allocation toward angry (threat-related) vs. neutral and happy faces. Children also completed self-report temperamental measures of fear and attentional control. We compared attentional bias scores in 4 groups of children: high/low fear and high/low attentional control. Results indicated that, in the case of children with high fear and low attentional control, attention was significantly biased toward angry faces compared with children who had low fear and low attentional control. Findings are discussed in terms of the moderating role of individual differences in attentional control in the context of threat, anxiety-related attentional biases in children.

Distinguishing the roles of trait and state anxiety on the nature of anxiety-related attentional biases to threat using a free viewing eye movement paradigm

Although attentional biases to threatening information are thought to contribute to the development and persistence of anxiety disorders, it is not clear whether an attentional bias to threat (ABT) is driven by trait anxiety, state anxiety or an interaction between the two. ABT may also be influenced by “top down” processes of motivation to attend or avoid threat. In the current study, participants high, mid and low in trait anxiety viewed high threat-neutral, mild threat-neutral and positive-neutral image pairs for 5 seconds in both calm and anxious mood states while their eye movements were recorded. State anxiety alone, but not trait anxiety, predicted greater maintenance of attention to high threat images (relative to neutral) following the first fixation (i.e., delayed disengagement) and over the time course. Motivation was associated with the time course of attention as would be expected, such that those motivated to look towards negative images showed the greatest ABT over time, and those highly motivated to look away from negative images showed the greatest avoidance. Interestingly, those ambivalent about where to direct their attention when viewing negative images showed the greatest ABT in the first 500 ms of viewing. Implications for theory and treatment of anxiety disorders, as well as areas for further study, are discussed.

Attentional control, attentional network functioning, and emotion regulation styles

Attentional network functioning in emotionally neutral conditions and self-reported attentional control (AC) were analysed as predictors of the tendency to engage in dysfunctional emotion regulation strategies. Diminished attentional orienting predicted an increased tendency to engage in brooding rumination, and enhanced alertness predicted a greater chance of suppression, beyond trait anxiety and self-reported AC, which were not predictive of either rumination or suppression. This is the first study to show that some forms of dysfunctional emotion regulation are related to the attentional network functioning in emotionally neutral conditions. Results are discussed in relation to regulatory temperament and anxiety-related attentional biases literature.

Attentional threat avoidance and familial risk are independently associated with childhood anxiety disorders

Twin studies in children reveal that familial aggregation of anxiety disorders is due to both genetic and environmental factors. Cognitive biases for threat information are considered a robust characteristic of childhood anxiety. However, little is known regarding the underlying aetiology of such biases and their role in anxiety disorders. A face version of the dot-probe task measuring attentional biases for negative (anger, fear, sad, disgust) and positive (happy) facial expressions was completed by 600, 8-year-old twins; the largest study of its kind. Twin correlations for attentional bias scores were compared to estimate genetic and environmental effects. Parent-report diagnostic interviews identified children with an anxiety disorder. Indices of inferred genetic and familial risk for anxiety disorders were created for each child. Data were analysed using a series of logistic regressions. Anxious children showed greater attentional avoidance of negative faces than nonanxious children; t (548) = 2.55, p < .05. Attentional avoidance was not under genetic or shared environmental influence. Risk for anxiety disorders was predicted by familial factors. Both attentional avoidance and inferred familial risk were significant but independent predictors of anxiety disorders (ORs = .65 and 3.64, respectively). Anxiety-related attentional biases and familial risk play important but independent roles in childhood anxiety disorders. If replicated, these findings indicate that links between genetic risk and anxiety disorders lie outside the domain of attentional processes.

The time course of attentional bias for emotional faces in anxious children

The present study investigated the time course of attentional bias for angry and happy faces in 50 primary school children (9 to 12 years). That is, the study examined the degree to which an anxiety-related attentional bias was moderated by the duration of threat exposure. Using a visual-probe task, children were shown angry and happy faces paired with neutral ones over two exposure durations: 500 and 1250 ms. Results revealed that higher levels of anxiety were associated with an attentional bias towards angry faces across the 500 ms and 1250 ms exposure durations. There were no effects of children's anxiety or stimulus exposure duration on attentional bias for happy faces. Results are discussed in relation to threat-monitoring versus vigilance-avoidance patterns of attentional bias, and developmental considerations, including comparison with findings from studies of anxiety-related attentional biases in adults.

Temporal dynamics of selective attention in non-clinical anxiety

For the first time, anxiety-related attentional bias was examined by considering separately its time–course and the influence of processing time. High- and low-trait-anxious undergraduates performed a color-identification task: Emotional–neutral word pairs were presented for 14 or 500 ms; color appeared at word onset or after 514 ms, at emotional word position or at the other position. Word duration (processing time) and color onset time (moment at which bias was ‘tapped’) were manipulated independently. Relatively fast responses when emotional word and color spatially correspond reflect attentional bias for that word. High-trait-anxious, compared to low-trait-anxious, undergraduates showed biases for physical-threat words and positive words (second half of the task). These group differences did not significantly vary as a function of duration or SOA. The findings suggest a content-specific bias for threat in non-clinical trait-anxiety, very quickly upon stimulus onset, even when only little time is available for stimulus processing. This bias does not vary over a period of 500 ms, also not when further stimulus processing is possible. It is recommended to further investigate the precise temporal characteristics of anxiety-related attentional biases.

Goal-directed attentional deployment to emotional faces and individual differences in emotional regulation

This study investigated whether goal-directed attentional deployment to emotional faces serves as an effective mechanism for emotion regulation and whether individual differences in this ability predicts more effective emotion regulation. Undergraduate participants ( N = 109) performed the dot-probe task under stress and were given either a goal to focus their attention on happy faces and avoid angry faces or no attentional goal. Participants given this goal reported nearly three times less frustration in reaction to a stressful anagram task compared to those not given this goal. In addition, those with a greater ability to focus on happy faces and avoid angry faces persisted significantly longer on a stressful anagram task. Trait anxiety did not moderate these effects. These findings have important implications for theories of emotion regulation and anxiety-related attentional biases. Training goal-directed attentional deployment holds considerable promise for future research on developing effective emotion regulation techniques.