Attentional Bias For Threat Research Articles

Impact of Anodal and Cathodal Transcranial Direct Current Stimulation over the Left Dorsolateral Prefrontal Cortex during Attention Bias Modification: An Eye-Tracking Study.

People with anxiety disorders show an attentional bias for threat (AB), and Attention Bias Modification (ABM) procedures have been found to reduce this bias. However, the underlying processes accounting for this effect remain poorly understood. One explanation suggests that ABM requires the modification of attention control, driven by the recruitment of the dorsolateral prefrontal cortex (DLPFC). In the present double-blind study, we examined whether modifying left DLPFC activation influences the effect of ABM on AB. We used transcranial direct current stimulation (tDCS) to directly modulate cortical excitability of the left DLPFC during an ABM procedure designed to reduce AB to threat. Anodal tDCS increases excitability, whereas cathodal tDCS decreases it. We randomly assigned highly trait-anxious individuals to one of three conditions: 1) ABM combined with cathodal tDCS, 2) ABM combined with anodal tDCS, or 3) ABM combined with sham tDCS. We assessed the effects of these manipulations on both reaction times and eye-movements on a task indexing AB. Results indicate that combining ABM and anodal tDCS over the left DLPFC reduces the total duration that participants’ gaze remains fixated on threat, as assessed using eye-tracking measurement. However, in contrast to previous studies, there were no changes in AB from baseline to post-training for participants that received ABM without tDCS. As the tendency to maintain attention to threat is known to play an important role in the maintenance of anxiety, the present findings suggest that anodal tDCS over the left DLPFC may be considered as a promising tool to reduce the maintenance of gaze to threat. Implications for future translational research combining ABM and tDCS are discussed.

(506) Does personality type influence attentional bias in individuals with chronic back pain?

Theories of attention and pain predict that individuals with chronic pain will display attentional biases towards pain related information. Eysenck, however, suggested that individuals differ in their attentional biases for threat (e.g. disability and pain) as an interactive function of trait anxiety and defensiveness. Weinberger et al. suggested four personality types1 based on measures of defensiveness and trait anxiety; repressors (low anxiety/high defensiveness), low-anxious (low anxiety/defensiveness), high-anxious (high anxiety/low defensiveness) and defensive high-anxious (high anxiety/defensiveness).

A Critical Review of Attentional Threat Bias and Its Role in the Treatment of Pediatric Anxiety Disorders.

Threat bias, or exaggerated selective attention to threat, is considered a key neurocognitive factor in the etiology and maintenance of pediatric anxiety disorders. However, upon closer examination of the literature, there is greater heterogeneity in threat-related attentional biases than typically acknowledged. This is likely impacting progress that can be made in terms of interventions focused on modifying this bias and reducing anxiety, namely attention bias modification training. We suggest that the field may need to "take a step back" from developing interventions and focus research efforts on improving the methodology of studying attention bias itself, particularly in a developmental context. We summarize a neurocognitive model that addresses the issue of heterogeneity by broadly incorporating biases toward and away from threat, linking this variation to key neurodevelopmental factors, and providing a basis for future research aimed at improving the utility of threat bias measures and interventions in clinical practice.

Anxiety and Attentional Bias in Preschool-Aged Children: An Eyetracking Study.

Extensive research has examined attentional bias for threat in anxious adults and school-aged children but it is unclear when this anxiety-related bias is first established. This study uses eyetracking technology to assess attentional bias in a sample of 83 children aged 3 or 4 years. Of these, 37 (19 female) met criteria for an anxiety disorder and 46 (30 female) did not. Gaze was recorded during a free-viewing task with angry-neutral face pairs presented for 1250 ms. There was no indication of between-group differences in threat bias, with both anxious and non-anxious groups showing vigilance for angry faces as well as longer dwell times to angry over neutral faces. Importantly, however, the anxious participants spent significantly less time looking at the faces overall, when compared to the non-anxious group. The results suggest that both anxious and non-anxious preschool-aged children preferentially attend to threat but that anxious children may be more avoidant of faces than non-anxious children.

Does attention bias modification improve attentional control? A double-blind randomized experiment with individuals with social anxiety disorder

People with anxiety disorders often exhibit an attentional bias for threat. Attention bias modification (ABM) procedure may reduce this bias, thereby diminishing anxiety symptoms. In ABM, participants respond to probes that reliably follow non-threatening stimuli (e.g., neutral faces) such that their attention is directed away from concurrently presented threatening stimuli (e.g., disgust faces). Early studies showed that ABM reduced anxiety more than control procedures lacking any contingency between valenced stimuli and probes. However, recent work suggests that no-contingency training and training toward threat cues can be as effective as ABM in reducing anxiety, implying that any training may increase executive control over attention, thereby helping people inhibit their anxious thoughts. Extending this work, we randomly assigned participants with DSM-IV diagnosed social anxiety disorder to either training toward non-threat (ABM), training toward threat, or no-contingency condition, and we used the attention network task (ANT) to assess all three components of attention. After two training sessions, subjects in all three conditions exhibited indistinguishably significant declines from baseline to post-training in self-report and behavioral measures of anxiety on an impromptu speech task. Moreover, all groups exhibited similarly significant improvements on the alerting and executive (but not orienting) components of attention. Implications for ABM research are discussed.

Impact of the temporal stability of preexistent attentional bias for threat on its alteration through attention bias modification

BackgroundAttention bias modification (ABM) aims to reduce attentional bias for threat (AB), thereby diminishing anxiety symptoms. However, recent meta-analyses indicated mixed effects. Recent works suggest that the presence of AB prior to ABM can be considered as a critical moderating factor that may account for these mixed results. MethodsWe assessed AB among highly trait-anxious individuals (n = 77) using both a face-version and a word-version of the dot-probe task at multiple time points: two weeks before ABM (t1), just prior to ABM (t2), and after ABM (t3). All participants were submitted to an ABM procedure including facial expressions. Analyses focused on 2 components of AB prior to ABM: a stable component, representing variance shared between the two baseline points (t1 and t2), and a dynamic component, representing variance that is specific to that point (t1 or t2). ResultsThe stable component of AB at baseline predicted the intensity of AB after ABM (t3) while the dynamic component did not. The dynamic component of AB at baseline positively predicts performance improvement during ABM procedure, while the stable component negatively predicted it. LimitationsThe findings depicted above only appear with the face-version of the dot-probe task. ConclusionsThe present results highlight the contribution of both the stable individual differences and dynamic components of preexistent AB. They also show the importance of moving the conceptualization of AB beyond the group-based analysis by integrating the notion and the assessment of within-person variability.

Measuring attentional biases for threat in children and adults.

Investigators have long been interested in the human propensity for the rapid detection of threatening stimuli. However, until recently, research in this domain has focused almost exclusively on adult participants, completely ignoring the topic of threat detection over the course of development. One of the biggest reasons for the lack of developmental work in this area is likely the absence of a reliable paradigm that can measure perceptual biases for threat in children. To address this issue, we recently designed a modified visual search paradigm similar to the standard adult paradigm that is appropriate for studying threat detection in preschool-aged participants. Here we describe this new procedure. In the general paradigm, we present participants with matrices of color photographs, and ask them to find and touch a target on the screen. Latency to touch the target is recorded. Using a touch-screen monitor makes the procedure simple and easy, allowing us to collect data in participants ranging from 3 years of age to adults. Thus far, the paradigm has consistently shown that both adults and children detect threatening stimuli (e.g., snakes, spiders, angry/fearful faces) more quickly than neutral stimuli (e.g., flowers, mushrooms, happy/neutral faces). Altogether, this procedure provides an important new tool for researchers interested in studying the development of attentional biases for threat.

Measuring Attentional Biases for Threat in Children and Adults

Investigators have long been interested in the human propensity for the rapid detection of threatening stimuli. However, until recently, research in this domain has focused almost exclusively on adult participants, completely ignoring the topic of threat detection over the course of development. One of the biggest reasons for the lack of developmental work in this area is likely the absence of a reliable paradigm that can measure perceptual biases for threat in children. To address this issue, we recently designed a modified visual search paradigm similar to the standard adult paradigm that is appropriate for studying threat detection in preschool-aged participants. Here we describe this new procedure. In the general paradigm, we present participants with matrices of color photographs, and ask them to find and touch a target on the screen. Latency to touch the target is recorded. Using a touch-screen monitor makes the procedure simple and easy, allowing us to collect data in participants ranging from 3 years of age to adults. Thus far, the paradigm has consistently shown that both adults and children detect threatening stimuli (e.g., snakes, spiders, angry/fearful faces) more quickly than neutral stimuli (e.g., flowers, mushrooms, happy/neutral faces). Altogether, this procedure provides an important new tool for researchers interested in studying the development of attentional biases for threat.

A neurobehavioral account for individual differences in resilience to chronic military stress

Military training is a chronic stressful period that often induces stress-related psychopathology. Stress vulnerability and resilience depend on personality trait anxiety, attentional threat bias and prefrontal-limbic dysfunction. However, how these neurobehavioral elements interact with regard to the development of symptoms following stress remains unclear. Fifty-five healthy combat soldiers undergoing intensive military training completed functional magnetic resonance imaging (fMRI) testing while performing the dot-probe task (DPT) composed of angry (threat) and neutral faces. Participants were then stratified according to their bias tendency to avoidance (n = 25) or vigilance (n = 30) groups, categorized as high or low trait anxiety and assessed for post-stress symptom severity. Avoidance compared to vigilance tendency was associated with fewer post-trauma symptoms and increased hippocampal response to threat among high anxious but not low anxious individuals. Importantly, mediation analysis revealed that only among high anxious individuals did hippocampal activity lead to lower levels of symptoms through avoidance bias tendency. However, in the whole group, avoidance bias was modulated by the interplay between the hippocampus and the dorsal anterior cingulate cortex (dACC). Our results provide a neurobehavioral model to explain the resilience to post-trauma symptoms following chronic exposure. The model points to the importance of considering threat bias tendency in addition to personality traits when investigating the brain response and symptoms of trauma. Such a multi-parametric approach that accounts for individual behavioral sensitivities may also improve brain-driven treatments of anxiety, possibly by targeting the interplay between the hippocampus and the dACC.

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.

Reducing Anxiety: Training Attentional Disengagement from Threat Using a Modified Spatial Cueing Task

It is well established that trait anxious individuals have an attentional bias for threatening information and stimuli, as demonstrated through both the dot probe and cueing paradigms. In recent efforts to reduce attentional biases and minimize anxiety symptomatology, variations of the dot probe task have been used to train attention away from threat. However, under this paradigm, it is uncertain what the underlying mechanism for attentional bias is. Is anxiety being perpetuated by a shift in attention to threat or does it result from one’s inhibited ability to disengage from threat once it is attended to? The purpose of the present study was to train attention away from threat using a cueing task, thus isolating attentional biases to difficulties in disengaging from threat. The goal of this task was to train attention by manipulating the contingency between the location of a target and a threatening or affectively neutral pictorial cue. Eighty-nine trait anxious college students participated in this study. It was hypothesized that participants in training groups would be able to disengage from threat faster and subsequently show a greater decrease in state anxiety when compared to controls. However, the data failed to support the primary hypotheses of this study. Interestingly, none of the groups showed an attentional threat bias at pretest, which makes it difficult to evaluate the efficacy of the training task. Future research should continue to focus on developing alternative training techniques that can target the mechanism(s) responsible for attentional biases in anxious individuals.

The Causal Role of the Dorsolateral Prefrontal Cortex in the Modification of Attentional Bias: Evidence from Transcranial Direct Current Stimulation

A pattern of attentional bias for threatening information is thought to be involved in the etiology of anxiety. Consistent with this idea, cognitive training techniques directly targeting such patterns of biased attention have been shown to reduce symptoms of anxiety. Research seeking to establish the neurologic underpinnings of change in the attentional bias for threat have implicated, but not confirmed, the role of lateral prefrontal regions. The current study sought to confirm experimentally the causal role of lateral prefrontal areas in the modification of attentional bias by delivering targeted cortical stimulation during attention bias modification training to assess the consequent effects on attentional bias change. While completing either an "attend threat" or "avoid threat" attention bias modification task, 77 volunteers (17-22 per group) received either active transcranial direct current stimulation of the left dorsolateral prefrontal cortex or a sham stimulation control condition. Participants receiving active stimulation showed greater evidence of attentional bias acquisition in the targeted direction (toward or away from threat) compared with participants in the sham stimulation condition. Our findings provide the first experimental evidence that increasing activity in the dorsolateral prefrontal cortex leads to greater evidence of attention bias modification. This evidence confirms the role of these areas in facilitating change in the allocation of attention to threat. We believe this study provides a critical step in the translation of neuroimaging findings to novel neuromodulatory interventions capable of enhancing the treatment of emotional pathology.

Using panicogenic inhalations of carbon dioxide enriched air to induce attentional bias for threat: Implications for the development of anxiety disorders

The tendency for anxious individuals to selectively attend to threatening information is believed to cause and exacerbate anxious emotional responding in a self-perpetuating cycle. The present study sought to examine the relation between differential interoceptive conditioning (IC) using carbon dioxide inhalation as a panicogenic unconditioned stimulus (US) and the development of Stroop colour-naming interference to various non-word conditioned stimuli (CSs). Healthy university students (N = 27) underwent the assessment of colour-naming interference to reinforced CS+ and non-reinforced CS− non-words prior to and following differential fear conditioning. Participants showed greater magnitude electrodermal and verbal-evaluative responses to the CS+ over the CS− non-word following IC, and demonstrated the expected slower colour-naming latencies to the CS+ compared to the CS− non-word from baseline to post-conditioning. We discuss the relation between fear learning and the emergence of attentional bias for threat to further understand the maintenance of anxiety disorders.

Attention processes in chronic fatigue syndrome: Attentional bias for health-related threat and the role of attentional control

Cognitive behavioural models of chronic fatigue syndrome (CFS) propose that attention processes, specifically, enhanced selective attention to health-threat related cues, may play an important role in symptom maintenance. The current study investigated attentional bias towards health-threat stimuli in CFS. It also examined whether individuals with CFS have impaired executive attention, and whether this was related to attentional bias. 27 participants with CFS and 35 healthy controls completed a Visual Probe Task measuring attentional bias, and an Attention Network Test measuring executive attention, alerting and orienting. Participants also completed self-report measures of CFS and mood symptoms. Compared to the control group, the CFS group showed greater attentional bias for health-threat words than pictures; and the CFS group was significantly impaired in executive attention. Furthermore, CFS individuals with poor executive attention showed greater attentional bias to health-threat related words, compared not only to controls but also to CFS individuals with good executive attention. Thus, this study revealed a significant relationship between attentional bias and executive attention in CFS: attentional bias to threat was primarily evident in those with impaired executive attention control. Taking account of individual differences in executive attention control in current intervention models may be beneficial for CFS.

Perturbed threat monitoring following a traumatic event predicts risk for post-traumatic stress disorder

Post-traumatic stress disorder (PTSD) is a chronic and difficult to treat psychiatric disorder. Objective, performance-based diagnostic markers that uniquely index risk for PTSD above and beyond subjective self-report markers could inform attempts to improve prevention and early intervention. We evaluated the predictive value of threat-related attention bias measured immediately after a potentially traumatic event, as a risk marker for PTSD at a 3-month follow-up. We measured the predictive contribution of attentional threat bias above and beyond that of the more established marker of risk for PTSD, self-reported psychological dissociation. Dissociation symptoms and threat-related attention bias were measured in 577 motor vehicle accident (MVA) survivors (mean age=35.02 years, 356 males) within 24h of admission to an emergency department (ED) of a large urban hospital. PTSD symptoms were assessed at a 3-month follow-up using the Clinician-Administered PTSD Scale (CAPS). Self-reported dissociation symptoms significantly accounted for 16% of the variance in PTSD at follow-up, and attention bias toward threat significantly accounted for an additional 4% of the variance in PTSD. Threat-related attention bias can be reliably measured in the context of a hospital ED and significantly predicts risk for later PTSD. Possible mechanisms underlying the association between threat bias following a potentially traumatic event and risk for PTSD are discussed. The potential application of an attention bias modification treatment (ABMT) tailored to reduce risk for PTSD is suggested.

Threat-Related Attention Bias in the Early Stages of Cognitive-Behavior Therapy Action for Panic Disorder

Cognitive theories of anxiety propose that informationprocessing biases play a pivotal role in the etiology and maintenance of anxiety disorders (1). Along with the application of conditioning principles derived from learning theories, such cognitive models inspired the development of cognitive-behavioral therapy (CBT), now considered the first-line treatment for anxiety disorders (2,3). But although extensive evidence indicates that automatic attention is biased toward threatening information in anxious individuals (4), such threatrelated attention biases were typically thought to be outside the realm of the direct therapeutic effects of CBT, which focuses primarily on the modification of thoughts, interpretations, and beliefs (3). Although CBT is highly effective in reducing anxiety symptoms, the exact processes and dynamics underlying its therapeutic effect are still not fully understood. In particular, it is not clear whether low-level, automatic processes are indeed not directly engaged by CBT. Complex interactions between different levels of cognitive processing impose further difficulties on outlining the mechanisms of CBT action. For example, it has been shown that training individuals to attend toward threat led to increased interpretation of ambiguous information as threatening (5). Conversely, another study (6) demonstrated that inducing change in the interpretation of ambiguous information affected attentional threat bias. Taken together, such findings suggest that anxiety symptoms may potentially be reduced via different and interacting cognitive processes and pathways. Mapping the interplay between the different mechanisms mediating symptom reduction has substantial implications for the understanding of CBT as well as for the development and refinement of novel treatment approaches. In the current issue of Biological Psychiatry, Reinecke et al. (7) examine the role of threat-related attention bias in the early stages of CBT action, testing the possibility that CBT rapidly affects automatic emotional information processing, before later symptom reduction is reported. Twenty-eight panic disorder patients participated in the study, which took place on 2 consecutive days and a follow-up 4 weeks later. On each of the study days, patients completed self-report questionnaires of panic-related cognitions assessing explicit catastrophic beliefs, fear of physical symptoms, and severity of agoraphobic beliefs. On each day, patients also reported stress reactivity to a 5-minute, panic-inducing situation tailored to each participant’s individual panic trigger (stress test). At the end of the first day, patients were randomized to receive either a single-session CBT intervention (treatment group) or no intervention (control group). The intervention included a brief explanation of the cognitive mechanisms associated with panic disorder and its treatment and a 15-minute exposure to a panic-inducing situation while dropping safety behavior. Attention bias to emotion faces (happy and fearful) was measured once on the day following the intervention. Results indicated that the treatment and control groups did not differ in self-reported panic cognitions at baseline (first day, prior to intervention). On the following day, after half of the patients received the CBT session, the two groups still did not differ in panic cognitions, and a significant attentional bias toward masked fearful faces was found in the control group. At the 4-week follow-up, the treatment group reported lower fear of physical symptoms and lower severity of agoraphobic beliefs relative to controls. Finally, in the treatment group, fear bias correlated with a reduction in agoraphobic beliefs from baseline to follow-up. The present results provide potentially important insights into the therapeutic effect of CBT and the role that threatrelated attention bias plays in it. Because group differences in threat bias were evident one day following the intervention and

Attentional interference by threat and post-traumatic stress disorder: The role of thought control strategies

Attentional interference by threat is associated with PTSD, but the mechanisms of this relationship remain unclear. Attentional interference might be related to increased use of maladaptive thought control strategies, such as suppressing unwanted thoughts (thought suppression) or replacing threatening thoughts with everyday concerns (worry), which increase PTSD risk. Conversely, attentional interference might be associated with reduced use of adaptive strategies, such as talking about threatening thoughts (social control), which decrease PTSD risk. This study tested if thought control strategies mediate the relationship between attentional interference and PTSD. Sixty-one male Vietnam-era veterans completed measures of PTSD symptoms and thought control strategies. Participants also completed a Visual Search Task measuring attentional interference, which required participants to identify a target letter string among a group of threat or neutral words. Attentional interference by threat was related to PTSD symptoms, and mediation analyses revealed significant indirect effects of attentional interference through thought suppression and worry. Attentional interference was related to re-experiencing and avoidance, but not hyperarousal, symptom clusters. Thought suppression was a unique mediator for re-experiencing, whereas thought suppression and worry both mediated the relationship with avoidance. These results offer evidence for maladaptive thought control strategies as a mechanism linking attentional biases for threat to PTSD.

Attentional biases and memory for emotional stimuli in men and male rhesus monkeys

We examined attentional biases for social and non-social emotional stimuli in young adult men and compared the results to those of male rhesus monkeys (Macaca mulatta) previously tested in a similar dot-probe task (King et al. in Psychoneuroendocrinology 37(3):396-409, 2012). Recognition memory for these stimuli was also analyzed in each species, using a recognition memory task in humans and a delayed non-matching-to-sample task in monkeys. We found that both humans and monkeys displayed a similar pattern of attentional biases toward threatening facial expressions of conspecifics. The bias was significant in monkeys and of marginal significance in humans. In addition, humans, but not monkeys, exhibited an attentional bias away from negative non-social images. Attentional biases for social and non-social threat differed significantly, with both species showing a pattern of vigilance toward negative social images and avoidance of negative non-social images. Positive stimuli did not elicit significant attentional biases for either species. In humans, emotional content facilitated the recognition of non-social images, but no effect of emotion was found for the recognition of social images. Recognition accuracy was not affected by emotion in monkeys, but response times were faster for negative relative to positive images. Altogether, these results suggest shared mechanisms of social attention in humans and monkeys, with both species showing a pattern of selective attention toward threatening faces of conspecifics. These data are consistent with the view that selective vigilance to social threat is the result of evolutionary constraints. Yet, selective attention to threat was weaker in humans than in monkeys, suggesting that regulatory mechanisms enable non-anxious humans to reduce sensitivity to social threat in this paradigm, likely through enhanced prefrontal control and reduced amygdala activation. In addition, the findings emphasize important differences in attentional biases to social versus non-social threat in both species. Differences in the impact of emotional stimuli on recognition memory between monkeys and humans will require further study, as methodological differences in the recognition tasks may have affected the results.

Attentional bias in injection phobia: Overt components, time course, and relation to behavior

Blood-injection-injury (BII) phobia is an anxiety disorder that can cause serious health consequences by interfering with medical treatment. Although attentional bias for threat appears to be a core feature of many anxiety disorders and a potential target of treatment, very little is known about attentional bias in BII phobia. In the present study, eye movements were recorded in individuals high and low in injection fear (HIF, LIF) during 18-s exposures to stimulus arrays containing injection, attack, appetitive, and neutral images. Evidence for attentional vigilance was mixed, as HIF individuals oriented to injection images more often than LIF individuals, but did not orient to injection images more often than other emotional images. In contrast, evidence of attentional avoidance was highly robust. HIF individuals rapidly disengaged from injection images on initial viewing and viewed these images less overall compared to other image types, a pattern not observed in the LIF group. Furthermore, attentional avoidance of injection threat was found to uniquely predict behavioral avoidance on an injection behavioral avoidance task (BAT), and group differences on the BAT were mediated by group differences in attentional avoidance. The implications of these findings for further delineating the nature and function of attentional biases in BII phobia are discussed.

A Bayesian Case-Controls Exploration of the Malleability of Attentional Bias for Threat in Social Phobia

Recent studies have demonstrated that training individuals with a social phobia to attend to non-threat is related to short-term (Amir et al., 2008) as well as long-term decrease in anxiety (e.g., Schmidt et al., 2009). However, to date, no study has examined the adaptation of this attention bias modification procedure into a single-case design for social phobia. Using an attention training procedure based on a modified dot-probe task, the present single-case study examined whether such procedure enabled a client with a social phobia to reduce attentional biases and to transfer this rehabilitation on anxiety response to a speech performance, social anxiety symptoms severity, and diagnosis of social phobia. Using a Bayesian probabilistic approach, case’s performances were compared to a normative sample before, after the treatment, at a two-month follow-up, at a six-month follow-up, as well as one year after the treatment. The results suggested the efficacy of the rehabilitation program on the attentional bias for threat cues and the generalization of these beneficial effects to decrease in anxiety symptoms during the two- and six-month follow-up period. A significant decrease in both subjective and behavioral anxiety during speech performance was also observed. However, a set back of the attentional bias for threat as well as symptoms of social anxiety was observed at the one-year follow up.