Attentional Bias For Threat Research Articles

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

At least 3 randomized, placebo-controlled, double-blind studies have supported the efficacy of computerized attention modification programs (AMPs) in reducing symptoms of anxiety in patients diagnosed with an anxiety disorder. In this study we examined patient characteristics that predicted response to AMP in a large sample of individuals diagnosed with generalized social phobia. The sample comprised 112 individuals seeking treatment for generalized social phobia who completed a randomized clinical trial comparing AMP (n = 55) with a placebo condition (i.e., attention control condition; n = 57). We examined the following domains of baseline predictors of treatment response: (a) demographic characteristics (gender, age, ethnicity, years of education); (b) clinical characteristics (Axis I comorbidity, trait anxiety, depression); and (c) cognitive disturbance factors (attentional bias for social threat, social interpretation bias). Results revealed that ethnicity predicted treatment response across both conditions: Participants who self-identified as non-Caucasian displayed better overall response than did Caucasians. The only prescriptive variable to emerge was attentional bias for social threat at preassessment. Participants in the AMP group who exhibited larger attentional bias scores displayed significantly greater reductions in clinician-rated social anxiety symptoms than did their counterparts in the attention control condition. These results suggest that AMP may be targeted to individuals most likely to benefit from these programs.

Serotonin transporter gene polymorphism and psychiatric disorders: Is there a link?

Though still in infancy, the field of psychiatric genetics holds great potential to contribute to the development of new diagnostic and therapeutic options to treat these disorders. Among a large number of existing neurotransmitter systems, the serotonin system dysfunction has been implicated in many psychiatric disorders and therapeutic efficacy of many drugs is also thought to be based on modulation of serotonin. Serotonin transporter gene polymorphism is one of the most extensively studied polymorphisms in psychiatric behavioral genetics. In this article, we review the status of evidence for association between the serotonin gene polymorphism and some common mental disorders like affective disorders, post-traumatic stress disorder, obsessive-compulsive disorder, suicide, autism, and other anxiety and personality disorders. Going beyond traditional association studies, gene-environment interaction, currently gaining momentum, is also discussed in the review. While the existing information of psychiatric genetics is inadequate for putting into practice genetic testing in the diagnostic work-up of the psychiatric patient, if consistent in future research attempts, such results can be of great help to improve the clinical care of a vast majority of patients suffering from such disorders.

ERP responses to facial affect in low-anxious, high-anxious, repressors and defensive high-anxious individuals

A range of ERP components responsive to facial stimuli and indexing the rapid attentional engagement (P1, N170), the increased (N400) and sustained (LPC) attention allocation and attentional control (N2) was investigated among low-anxious (LAs), high-anxious (HAs), repressors (REPs), and defensive high-anxious (DHAs) individuals. One week after questionnaire administration, EEG signals were recorded while Ss ( N = 102) were administrated the Emotional Go/NoGo task. They were instructed to respond to threatening, sad or friendly faces, respectively but not respond to any other facial expression. REPs presented enhanced responsivity to threatening and happy faces in several prefrontal areas, thus complementing the behavioral response data. Based on the behavioral and cortical indices the expected later attentional avoidance bias for threat in REPs and a difficulty in attention disengagement from threat in HAs were not confirmed. Moreover, REPs and HAs exhibited more bottom-up cortical regulation and more right-lateralized activation than DHAs in the processing of facial threat. In addition, there were non-significant results for DHAs on behavioral measures. However, they were cortically reactive to all facial expressions and not specifically to threat. Present results suggest that behavioral and brain levels of explanation should be carefully taken into account in further studies on anxiety.

Attention training for reducing spider fear in spider-fearful individuals

Cognitive theorists propose that attentional biases for threatening information play an important role in the development and maintenance of anxiety disorders. If attentional biases for threat figure in the maintenance of anxiety, then the experimental reduction of the bias for threat (attention training) should reduce anxiety. We randomly assigned 41 spider-fearful individuals to receive either attention training ( n = 20) or control procedures ( n = 21). We used a modified dot-probe discrimination paradigm with photographs of spiders and cows to train attention. Training reduced attentional bias for spiders, but only temporarily. Although both groups declined in spider fear and avoidance, reduction in attentional bias did not produce significantly greater symptom reduction in the training group than in the control group. However, reduction in attentional bias predicted reduction in self-reported fear for the training group. The reduction in attentional bias for threat may have been insufficiently robust to produce symptom reduction greater than that produced by exposure to a live spider and spider photographs alone. Alternatively, attention training may be an unsuitable intervention for spider fear.

Diminished Neural and Cognitive Responses to Facial Expressions of Disgust in Patients with Psoriasis: A Functional Magnetic Resonance Imaging Study

Psoriasis produces significant psychosocial disability; however, little is understood about the neurocognitive mechanisms that mediate the adverse consequences of the social stigma associated with visible skin lesions, such as disgusted facial expressions of others. Both the feeling of disgust and the observation of disgust in others are known to activate the insula cortex. We investigated whether the social impact of psoriasis is associated with altered cognitive processing of disgust using (i) a covert recognition of faces task conducted using functional magnetic resonance imaging (fMRI) and (ii) the facial expression recognition task (FERT), a decision-making task, conducted outside the scanner to assess the ability to recognize overtly different intensities of disgust. Thirteen right-handed male patients with psoriasis and 13 age-matched male controls were included. In the fMRI study, psoriasis patients had significantly (P<0.005) smaller signal responses to disgusted faces in the bilateral insular cortex compared with healthy controls. These data were corroborated by FERT, in that patients were less able than controls to identify all intensities of disgust tested. We hypothesize that patients with psoriasis, in this case male patients, develop a coping mechanism to protect them from stressful emotional responses by blocking the processing of disgusted facial expressions.

Psychophysiological evidence for cortisol-induced reduction in early bias for implicit social threat in social phobia

The stress hormone cortisol is important for the regulation of social motivational processes. High cortisol levels have been associated with social fear and avoidance, which play an important role in social anxiety disorder (SAD), as does hypervigilant processing of social threat. However, causal effects of cortisol on threat processing in SAD remain unclear. In an event-related potential (ERP) study we investigated the effects of cortisol on task-irrelevant (implicit) processing of social threat in SAD, exploring the temporal dynamics as well as the role of symptom severity and stimulus awareness. Angry face processing was measured in participants with clinical SAD after double-blind, within-subject oral administration of cortisol (50mg) and placebo, using a masked and an unmasked emotional Stroop task. Both tasks showed significantly increased P2 midline ERP amplitudes for angry compared to neutral and happy faces in the placebo condition, reflecting an early attentional bias for social threat in SAD. Furthermore, cortisol administration significantly decreased P2 amplitudes for masked angry faces. This effect correlated with social anxiety, showing stronger decreases in patients with higher levels of social anxiety. These results indicate a highly specific effect of cortisol on early motivated attention to social threat and, together with previous findings, highlight the importance of motivational context (stimulus- or task-relevance) as well as symptom severity.

Components of attentional biases in contamination fear: Evidence for difficulty in disengagement

Attentional bias for threat has been implicated in the contamination fear (CF) subtype of obsessive-compulsive disorder, but the components of the bias (facilitated attention versus difficulty in disengagement) and the stage of processing during which the bias occurs (early versus late stage of processing) remains unclear. Further, it is unclear whether attentional biases in CF are towards fear or disgust-related stimuli. The present study examined attentional biases in a group of individuals selected to have elevated CF ( n = 23) and a control group ( n = 28) using the spatial cueing task. Stimuli were neutral, disgusting, or frightening pictures presented for either 100 or 500 ms. Results revealed evidence for delayed disengagement from both fear and disgust stimuli in the CF group, but not in the control group. The effect appeared to be greater at 500 ms stimulus presentation, but did not appear to differ between fear and disgust stimuli. The CF group was associated with delayed disengagement from threat even when controlling for generic response slowing. Theoretical and clinical implications are discussed.

Attentional bias for threat in older adults: Moderation of the positivity bias by trait anxiety and stimulus modality.

Socioemotional selectivity theory suggests that emotion regulation goals motivate older adults to preferentially allocate attention to positive stimuli and away from negative stimuli. This study examined whether anxiety moderates the effect of the positivity bias on attention for threat. The authors employed the dot probe task to compare subliminal and supraliminal attention for threat in 103 young and 44 older adults. Regardless of anxiety, older but not young adults demonstrated a vigilant-avoidant response to angry faces. Anxiety influenced older adults' attention such that anxious individuals demonstrated a vigilant-avoidant reaction to sad faces but an avoidant-vigilant reaction to negative words.

Traits, states, and attentional gates: Temperament and threat relevance as predictors of attentional bias to social threat

This study investigated the influence of situational and dispositional factors on attentional biases toward social threat, and the impact of these attentional biases on distress in a sample of adolescents. The results suggest greater biases for personally relevant threat cues, as individuals reporting high social stress were vigilant to subliminal social threat cues, but not physical threat cues, and those reporting low social stress showed no attentional biases. Individual differences in fearful temperament and attentional control interacted to influence attentional biases, with fearful temperament predicting biases to supraliminal social threat only for individuals with poor attentional control. Multivariate analyses exploring relations between attentional biases for social threat and symptoms of anxiety and depression revealed that attentional biases alone were rarely related to symptoms. However, biases did interact with social stress, fearful temperament, and attentional control to predict distress. The results are discussed in terms of automatic and effortful cognitive mechanisms underlying threat cue processing.

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

According to cognitive models of anxiety, attentional biases for threat may cause or maintain anxiety states. Previous research using spatial cueing tasks has been interpreted in terms of difficulty in disengaging attention from threat in anxious individuals, as indicated by contrasts of response times (RTs) from threat cue versus neutral cue trials. However, on spatial cueing tasks, differences in RT between threat cue and neutral cue trials may stem from a slowing effect of threat on RT, as well as effects on allocation of visuospatial attention. The present study examined the effects of threat cues on both attentional cueing and response slowing. High and low anxious individuals completed a central cue task, which assessed threat-related response slowing, and a spatial cueing task, which assessed attentional biases for angry, happy and neutral faces. Results indicated that interpretation of the anxiety-related bias for threat depended on whether the effect of response slowing was taken into account. The study illustrates an important problem in using the modified spatial cueing task to assess components of threat-related attentional bias. As this experimental method may reflect both threat-related attentional cueing and response slowing effects, it cannot be assumed to provide pure measures of shift or disengagement components of attention bias.

Trait anxiety modulates the electrophysiological indices of rapid spatial orienting towards angry faces

We investigated the electrophysiological markers of attentional bias for threat in anxiety. Low-anxiety and high-anxiety individuals performed a spatial-cueing task, in which an emotional facial expression (angry or happy) was presented alongside a neutral expression. Results revealed that angry expressions elicited an enhanced N2pc component, but that this was true only for those reporting high levels of trait anxiety. These results confirm the early capture of spatial attention by threat-related stimuli, and demonstrate that this early bias is modulated by trait anxiety. Enhanced P1 amplitudes to targets after presentations of angry expressions were also found; however, this effect was not modulated by trait anxiety levels. Our findings indicate that individual differences in temperament are an important determinant of the early neural response to threat.

An open trial of cognitive therapy for chronic insomnia

We describe the development of a cognitive therapy intervention for chronic insomnia. The therapy is based on a cognitive model which suggests that the processes that maintain insomnia include: (1) worry and rumination, (2) attentional bias and monitoring for sleep-related threat, (3) unhelpful beliefs about sleep, (4) misperception of sleep and daytime deficits and (5) the use of safety behaviors that maintain unhelpful beliefs. The aim of cognitive therapy for insomnia is to reverse all five maintaining processes during both the night and the day. In an open trial 19 patients meeting diagnostic criteria for primary insomnia were treated with cognitive therapy for insomnia. Assessments were completed pretreatment, posttreatment and at 3-, 6- and 12-month followup. The significant improvement in both nighttime and daytime impairment evident at the posttreatment assessment was retained up to the 12 month followup.

Is High Fear of Pain Associated With Attentional Biases for Pain-Related or General Threat? A Categorical Reanalysis

The purpose of this investigation was to clarify mixed findings reported in selective attention investigations. To accomplish this, recently published dot-probe data from 36 patients with chronic musculoskeletal pain and 29 healthy control participants were reanalyzed with consideration of fear of pain (FOP) as a categorical variable. FOP groups were identified by using a variety of strategies and represented differing conceptualizations of the FOP construct. Selective attention for sensory pain, affect pain, and health catastrophe words was assessed by using raw dot-probe detection latencies and the bias, congruency, and incongruency indices. Analysis of the raw detection latencies revealed no significant interactions that permit inferences regarding attentional shifts to or away from specific word types. Analyses of the attention indices revealed no evidence of pain-related selective attention as a function of FOP or the interaction between clinical status and FOP, regardless of the FOP categorization method used; however, for FOP groups derived by using the cluster method, participants with high FOP—all patients—exhibited hypervigilance for all word types on the dot-probe task when compared with those with low FOP. Implications for various categorical conceptualizations of FOP and future research directions are discussed. Perspective Fear of pain can be used to categorize people into groups more or less vulnerable to disabling effects of pain. When fear of pain groups are derived by using measures of general and pain-specific fearfulness, people with high fear of pain are likely to selectively attend all potentially threatening stimuli in their environment.

Observational fear conditioning in the acquisition and extinction of attentional bias for threat: An experimental evaluation.

Anxious persons show automatic and strategic attentional biases for threatening information. Yet, the mechanisms and processes that underlie such biases remain unclear. The central aim of the present study was to elucidate the relation between observational threat learning and the acquisition and extinction of biased threat processing by integrating emotional Stroop color naming tasks within an observational differential fear conditioning procedure. Forty-three healthy female participants underwent several consecutive observational fear conditioning phases. During acquisition, participants watched a confederate displaying mock panic attacks (UCS) paired with a verbal stimulus (CS+), but not with a second nonreinforced verbal stimulus (CS-). As expected, participants showed greater magnitude electrodermal and verbal-evaluative (e.g., distress, fear) conditioned responses to the CS+ over the CS- word. Participants also demonstrated slower color-naming latencies to CS+ compared to the CS- word following acquisition and showed attenuation of this preferential processing bias for threat following extinction. Findings are discussed broadly in the context of the interplay between fear learning and processing biases for threat as observed in persons suffering from anxiety disorders.

Identity state-dependent attentional bias for facial threat in dissociative identity disorder

Biased attention for threatening stimuli has been associated with many forms of psychopathology. Attention to threatening faces presented below perceptual thresholds was assessed in patients diagnosed with dissociative identity disorder using a pictorial emotional Stroop task. Patients were tested in two different identity states, in one of which they claimed strong awareness of trauma. Attentional bias for social threat proved state-dependent in the patients and deviated from the patterns observed in controls.

Selective processing of masked and unmasked verbal threat material in anxiety: Influence of an immediate acute stressor

Attentional biases for threat were investigated using a computerised version of the emotional Stroop task. The study examined the influence of state and trait anxiety by employing a student sample assigned to high trait anxious (HTA; n=32) or low trait anxious (LTA; n=32) groups on the basis of questionnaire scores, and state anxiety was manipulated within participants through the threat of electric shock. Threatening words that were either unrelated (e.g., cancer, danger) or related to the threat of shock (e.g., electrocute, shock) were presented to participants both within and outside of awareness. In the latter condition a backward masking procedure was used to prevent awareness and exposure thresholds between the target and mask were individually set for each participant. For unmasked trials the HTA group showed significant interference in colour naming for all threat words relative to control words when performing under the threat of shock, but not in the shock safe condition. For the masked trials, despite chance performance in being able to identify the lexical status of the items, HTA participants showed facilitated colour naming for all threat words relative to control items when performing under threat of shock, but this effect was not evident in the shock safe condition. Neither valence of the items nor the threat of shock influenced colour naming latencies in either exposure mode for the LTA group.

Cognitive model of patient aggression towards health care staff: The patient's perspective

Aggression towards health care staff has become the focus for research as well as for government intervention. Negative effects upon staff and organizations have been established, yet few detailed explanations are offered for this aggression, and none represents the patient's perspective. This paper presents a model from the patient's perspective that takes account of situational variables, while also focusing upon patient cognitions. It also considers physiological responses related to arousal that might underpin aggression in an anxiety-provoking situation. In a previous study the frequency with which aggression was preceded by some anxiety-provoking event and the extent to which assailants displayed diminished cognitive processing were established; these were incorporated into the model. Increased anxiety commonly experienced by patients can have a negative effect upon cognitive processing. Anxiety generates a hyper-vigilance for threatening stimuli, induces selective attentional bias for threat, and causes a narrowing of attention, thus reducing cues and information upon which to make accurate appraisals and attributions. With such impairments, patients may make negative rather than positive attributions regarding actions of staff, which are frequently anxiety provoking. Thus, patients perceive staff behaviour as threatening rather than benign, and in the absence of positive attributions it will invoke an aggressive response. What health care staff perceive as aggression may be seen by patients as a defence against perceived attack. Changes in policy that take this into account may reduce future aggressive incidents.

Anxiety and attentional bias for threat: an event-related potential study

We investigated the attentional bias for threat in selected high and low trait-anxious participants using an event-related potential technique. A modified cue-target paradigm was adopted with threatening and nonthreatening pictures as uninformative location cues. In high anxious individuals, reactions were speeded up and the occipitoparietal P1 amplitude was enhanced when targets appeared at the same location as threatening pictures relative to nonthreatening ones, whereas in low anxious individuals, the P1 amplitude tended to be enhanced when the targets appeared at the opposite location to threatening pictures. These results suggest that the attentional bias caused by peripheral threatening stimuli is able to modulate the visual inputs in early processing stages, and this mechanism is markedly influenced by an individual's anxiety level.

Vigilance for threat: effects of anxiety and defensiveness

Eysenck’s (1997) theory that attentional biases for threat vary as an interactive function of trait anxiety and defensiveness was tested using a visual probe task. Two stimulus exposure conditions were used to explore a secondary issue concerning attentional allocation over time. Results indicated that, among high trait anxious participants, only those with low levels of defensiveness showed vigilance for threatening faces presented for 500 ms. They also showed an attentional preference for neutral faces, relative to happy faces, irrespective of exposure condition. This pattern was reversed in high trait anxious participants with high levels of defensiveness, who showed an attentional bias towards happy faces (relative to neutral faces) under both exposure conditions. The findings are discussed in relation to their implications for (a) the significance of measures of defensiveness for the conceptualization of high trait anxious individuals, and (b) the status of anxiety-related biases at different stages of information processing.

Attentional bias for psoriasis-specific and psychosocial threat in patients with psoriasis.

Information processing biases relate to the manner in which people attend to particular types of information more readily than others. This bias, which is central to cognitive models of disorder, has not been explored in patients with psoriasis. The purpose of this study was to examine whether patients with psoriasis show an automatic attentional bias to classes of information relative to controls. Sixty patients and 60 age- and sex-matched controls completed a computer-based attentional interference task (the modified Stroop task). Patients with psoriasis showed significant interference for disease-specific, self-referent, and others' behavior stimuli relative to controls. In terms of information processing biases, the relationship between subject status (psoriasis patient vs. control) and color-naming interference was significantly stronger than that between anxiety, depression and worry, and interference. Recall bias was limited to disease-specific stimuli only. The observed bias to threat is more appropriately accounted for by participant's status (i.e., psoriasis patient or control) than by psychological distress.