Attentional Control Mechanisms Research Articles

Aging impairs reactive attentional control but not proactive distractor inhibition.

Older adults tend to be more prone to distraction compared with young adults, and this age-related deficit has been attributed to a deficiency in inhibitory processing. However, recent findings challenge the notion that aging leads to global impairments in inhibition. To reconcile these mixed findings, we investigated how aging modulates multiple mechanisms of attentional control by tracking the timing and direction of eye movements. When engaged in feature-search mode and proactive distractor suppression, older adults made fewer first fixations to the target but inhibited the task-irrelevant salient distractor as effectively as did young adults. However, when engaged in singleton-search mode and required to reactively disengage from the distractor, older adults made significantly more first saccades toward the task-irrelevant salient distractor and showed increased fixation times in orienting to the target, longer dwell times on incorrect saccades, and increased saccadic reaction times compared with young adults. Our findings reveal that aging differently impairs attentional control depending on whether visual search requires proactive distractor suppression or reactive distractor disengagement. Furthermore, our oculomotor measures reveal both age-related deficits and age equivalence in various mechanisms of attention, including goal-directed orienting, selection history, disengagement, and distractor inhibition. These findings help explain why conclusions of age-related declines or age equivalence in mechanisms of attentional control are task specific and reveal that older adults do not exhibit global impairments in mechanisms of inhibition. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Aberrant Functional Connectivity of the Salience Network in Adult Patients with Tic Disorders: A Resting-State fMRI Study.

Tic disorders (TD) are characterized by the presence of motor and/or vocal tics. Common neurophysiological frameworks suggest dysregulations of the cortico-striatal-thalamo-cortical (CSTC) brain circuit that controls movement execution. Besides common tics, there are other "non-tic" symptoms that are primarily related to sensory perception, sensorimotor integration, attention, and social cognition. The existence of these symptoms, the sensory tic triggers, and the modifying effect of attention and cognitive control mechanisms on tics may indicate the salience network's (SN) involvement in the neurophysiology of TD. Resting-state functional MRI measurements were performed in 26 participants with TD and 25 healthy controls (HC). The group differences in resting-state functional connectivity patterns were measured based on seed-to-voxel connectivity analyses. Compared to HC, patients with TD exhibited altered connectivity between the core regions of the SN (insula, anterior cingulate cortex, and temporoparietal junction) and sensory, associative, and motor-related cortices. Furthermore, connectivity changes were observed in relation to the severity of tics in the TD group. The SN, particularly the insula, is likely to be an important site of dysregulation in TD. Our results provide evidence for large-scale neural deviations in TD beyond the CSTC pathologies. These findings may be relevant for developing treatment targets.

Semantic Stroop interference is modulated by the availability of executive resources: Insights from delta-plot analyses and cognitive load manipulation.

We investigated whether, during visual word recognition, semantic processing is modulated by attentional control mechanisms directed at matching semantic information with task-relevant goals. In previous research, we analyzed the semantic Stroop interference as a function of response latency (delta-plot analyses) and found that this phenomenon mainly occurs in the slowest responses. Here, we investigated whether this pattern is due to reduced ability to proactively maintain the task goal in these slowest trials. In two pairs of experiments, participants completed two semantic Stroop tasks: a classic semantic Stroop task (Experiment 1A and 2A) and a semantic Stroop task combined with an n-back task (Experiment 1B and 2B). The two pairs of experiments only differed in the trial pace, which was slightly faster in Experiments 2A and 2B than in Experiments 1A and 1B. By taxing the executive control system, the n-back task was expected to hinder proactive control. Delta-plot analyses of the semantic Stroop task replicated the enhanced effect in the slowest responses, but only under sufficient time pressure. Combining the semantic Stroop task with the n-back task produced a change in the distributional profile of semantic Stroop interference, which we ascribe to a general difficulty in the use of proactive control. Our findings suggest that semantic Stroop interference is, to some extent, dependent on the available executive resources, while also being sensitive to subtle variations in task conditions.

Neuropsychology of Self-regulation : Attention Control Mechanism for Controlling Thinking and Other Cognitive Processes

This paper presents a comprehensive theoretical framework for understanding and consciously controlling the cognitive faculty of attention. It analyzes how language and the subject-object dichotomy fundamentally shape human thought processes. The pivotal role of attention in steering cognitive functions is examined, along with how it is influenced by cognitive biases. The brain is conceptualized as an information processing system, with attention serving as the navigational mechanism guiding cognitive faculties. The framework emphasizes the importance of articulation to effectively regulate attentional allocation. Innovative techniques are given, including a modified self-questioning method that leverages the linguistic basis of cognition to monitor and rectify attentional lapses. Grounded in neuroscience, psychology, and evolutionary theory, the paper elucidates neurological mechanisms behind conscious attentional control, including how to stop the thinking process. Potential applications range from improving cognitive performance and emotional regulation to facilitating goal attainment and overall well-being across domains.

Secondary language impairment in posterior cortical atrophy: insights from sentence repetition.

Posterior cortical atrophy (PCA) is a neurodegenerative syndrome characterized by progressive impairment in visuospatial and perceptual function linked to atrophy of the occipito-parietal cortex. Besides the salient visual impairment, several studies have documented subtle changes in language may also be present. Sentence repetition is a highly constrained linguistic task involving multiple linguistic and cognitive processes and have been shown to be impaired in other AD spectrum disorders, with little consensus on its relevance in PCA. This aim of this study was to further delineate the linguistic and cognitive features of impaired language in PCA using a sentence repetition task. Seven PCA patients and 16 healthy controls verbally repeated 16 sentences from the Boston Diagnostic Aphasia Examination. Responses were transcribed orthographically and coded for accuracy (percentage accuracy; percentage Correct Information Units; Levenshtein Distance) and for temporal characteristics (preparation duration (ms); utterance duration (ms); silent pause duration (ms); speech duration (ms); dysfluency duration (ms)). The potential modulating effects of attentional control and working memory capacity were explored. PCA patients showed lower overall accuracy with retained semantic content of the sentences, and lower phonological accuracy. Temporal measures revealed longer preparation and utterance duration for PCA patients compared to controls, alongside longer speech duration but comparable dysfluency duration. PCA patients also showed comparable silent pause duration to controls. Attentional control, measured using the Hayling sentence completion task, predicted accuracy of sentence repetition. The findings suggest that sentence repetition is impaired in PCA and is characterized by phonological, response planning and execution difficulties, underpinned in part by attentional control mechanisms. The emerging profile of language impairment in PCA suggests vulnerability of similar cognitive systems to other Alzheimer's syndromes, with subtle differences in clinical presentation.

Be prepared for interruptions: EEG correlates of anticipation when dealing with task interruptions and the role of aging

Dealing with task interruptions requires the flexible use of working memory and attentional control mechanisms, which are prone to age-related changes. We investigated effects of age on dealing with task interruptions and potential advantages of anticipating an interruption using EEG and a retrospective cueing (retro-cue) paradigm. Thirty-two young (18–30 years) and 28 older (55–70 years) participants performed a visual working memory task, where they had to report the orientation of a target following a retro-cue. Within blocks of 10 trials, they were always, never, or randomly interrupted with an arithmetic task before the onset of the retro-cue. The interruption-induced decline in primary task performance was more pronounced in older participants, while only these benefited from anticipation. The EEG analysis revealed reduced theta and alpha/beta response to the retro-cue following interruptions, especially for the older participants. In both groups, anticipated interruptions were associated with increased theta and alpha/beta power prior and during the interruption, and stronger beta suppression to the retro-cue. The results indicate that interruptions impede the refocusing of attention on the task-relevant representation of the primary task, especially in older people, while anticipation facilitates preparation for the interruption task and resumption of the primary task.

Trichotomy revisited: A monolithic theory of attentional control

The control of attention was long held to reflect the influence of two competing mechanisms of assigning priority, one goal-directed and the other stimulus-driven. Learning-dependent influences on the control of attention that could not be attributed to either of those two established mechanisms of control gave rise to the concept of selection history and a corresponding third mechanism of attentional control. The trichotomy framework that ensued has come to dominate theories of attentional control over the past decade, replacing the historical dichotomy. In this theoretical review, I readily affirm that distinctions between the influence of goals, salience, and selection history are substantive and meaningful, and that abandoning the dichotomy between goal-directed and stimulus-driven mechanisms of control was appropriate. I do, however, question whether a theoretical trichotomy is the right answer to the problem posed by selection history. If we reframe the influence of goals and selection history as different flavors of memory-dependent modulations of attentional priority and if we characterize the influence of salience as a consequence of insufficient competition from such memory-dependent sources of priority, it is possible to account for a wide range of attention-related phenomena with only one mechanism of control. The monolithic framework for the control of attention that I propose offers several concrete advantages over a trichotomy framework, which I explore here.

The impact of internal-generated contextual clues on EFL vocabulary learning: insights from EEG.

With the popularity of learning vocabulary online among English as a Foreign Language (EFL) learners today, educators and researchers have been considering ways to enhance the effectiveness of this approach. Prior research has underscored the significance of contextual clues in vocabulary acquisition. However, few studies have compared the context provided by instructional materials and that generated by learners themselves. Hence, this present study sought to explore the impact of internal-generated contextual clues in comparison to those provided by instructional materials on EFL learners' online vocabulary acquisition. A total of 26 university students were enrolled and underwent electroencephalography (EEG). Based on a within-subjects design, all participants learned two groups of vocabulary words through a series of video clips under two conditions: one where the contexts were externally provided and the other where participants themselves generated the contexts. In this regard, participants were tasked with either viewing contextual clues presented on the screen or creating their own contextual clues for word comprehension. EEG signals were recorded during the learning process to explore neural activities, and post-tests were conducted to assess learning performance after each vocabulary learning session. Our behavioral results indicated that comprehending words with internal-generated contextual clues resulted in superior learning performance compared to using context provided by instructional materials. Furthermore, EEG data revealed that learners expended greater cognitive resources and mental effort in semantically integrating the meaning of words when they self-created contextual clues, as evidenced by stronger alpha and beta-band oscillations. Moreover, the stronger alpha-band oscillations and lower inter-subject correlation (ISC) among learners suggested that the generative task of creating context enhanced their top-down attentional control mechanisms and selective visual processing when learning vocabulary from videos. These findings underscored the positive effects of internal-generated contextual clues, indicating that instructors should encourage learners to construct their own contexts in online EFL vocabulary instruction rather than providing pre-defined contexts. Future research should aim to explore the limits and conditions of employing these two types of contextual clues in online EFL vocabulary learning. This could be achieved by manipulating the quality and understandability of contexts and considering learners' language proficiency levels.

The dynamics of statistical learning in visual search and its interaction with salience processing: An EEG study

Visual attention can be guided by statistical regularities in the environment, that people implicitly learn from past experiences (statistical learning, SL). Moreover, a perceptually salient element can automatically capture attention, gaining processing priority through a bottom-up attentional control mechanism. The aim of our study was to investigate the dynamics of SL and if it shapes attentional target selection additively with salience processing, or whether these mechanisms interact, e.g. one gates the other. In a visual search task, we therefore manipulated target frequency (high vs. low) across locations while, in some trials, the target was salient in terms of colour. Additionally, halfway through the experiment, the high-frequency location changed to the opposite hemifield. EEG activity was simultaneously recorded, with a specific interest in two markers related to target selection and post-selection processing, respectively: N2pc and SPCN. Our results revealed that both SL and saliency significantly enhanced behavioural performance, but also interacted with each other, with an attenuated saliency effect at the high-frequency target location, and a smaller SL effect for salient targets. Concerning processing dynamics, the benefit of salience processing was more evident during the early stage of target selection and processing, as indexed by a larger N2pc and early-SPCN, whereas SL modulated the underlying neural activity particularly later on, as revealed by larger late-SPCN. Furthermore, we showed that SL was rapidly acquired and adjusted when the spatial imbalance changed. Overall, our findings suggest that SL is flexible to changes and, combined with salience processing, jointly contributes to establishing attentional priority.

Attentional control systems for emergent strategic issues in the post-Chandlerian world

Scholars have recently emphasized a need to advance the attention-based view to account for a new “post-Chandlerian” environment wherein firms organized along Chandlerian m-form lines are increasingly unable to cope with rapid and discontinuous changes and strategic issues that can emerge anywhere in the organization. This article works to make such an advance by drawing on the underdeveloped idea of attentional control—that is direction of members’ attention—within the attention-based view. The article develops the concept of attentional control systems and, as its core contribution, proposes that firms can use issue-specific emergent attentional control systems to address emergent strategic issues that are characteristic of post-Chandlerian environments. Key components of these systems include emergent, issue-specific communication channels, reconfigured roles, and interactive control practices. These three interrelated attentional control mechanisms enable attentional dynamism and high-quality attention to be directed toward emergent strategic issues, thus mediating effective strategic decision-making as well as resource commitment and ultimately enhancing strategic adaptation.

The State- and Trait-Level Effects and Candidate Mechanisms of Four Mindfulness-Based Cognitive Therapy (MBCT) Practices: Two Exploratory Studies

ObjectivesThe primary aim was to explore state- and trait-level effects and candidate mechanisms of four Mindfulness-Based Cognitive Therapy (MBCT) practices.MethodOne hundred sixty adults self-selected from the general population were randomized to one of four mindfulness practices: body scan, mindful movement, breath and body, and befriending. Study 1 explored state-level self-compassion, mindfulness, decentering (mechanisms), and pleasantness of thoughts, emotions, and body sensations at multiple time points using two single mindfulness sessions. Study 2 explored trait-level self-compassion, mindfulness, decentering, interoceptive awareness, attentional control (mechanisms), anxiety, depression, and psychological quality of life pre-post 2 weeks of daily practice.ResultsIn study 1, state-level effects were demonstrated in all candidate mechanisms and outcomes within the whole sample across time points (d = 0.27 to 0.86), except for state decentering. After controlling for pre-scores and additional covariates, no between-group effects were found (p = 0.050 to 0.973). In study 2, trait-level effects were demonstrated in psychological quality of life and most candidate mechanisms within the whole sample (d = 0.26 to 0.64) but no between-group effects were found (p = 0.080 to 0.805). Within the whole sample, after controlling for pre-scores, changes in mindfulness, self-compassion, decentering, and interoceptive awareness (i.e. body listening) were associated with improvements in psychological quality of life (r = 0.23 to 0.40) and self-led mindfulness practice (r = 0.18 to 0.23).ConclusionsFuture research should test the generated hypotheses using well-designed, adequately powered, and theory-driven studies that address universal and specific mechanisms in different populations and contexts.Pre-registrationThis study is not pre-registered.

A coactivation mechanism of goal-directed and stimulus-driven attentional control

A coactivation mechanism of goal-directed and stimulus-driven attentional control

Top-down control of exogenous attentional selection is mediated by beta coherence in prefrontal cortex

Salience-driven exogenous and goal-driven endogenous attentional selection are two distinct forms of attention that guide selection of task-irrelevant and task-relevant targets in primates. Top-down attentional control mechanisms enable selection of the task-relevant target by limiting the influence of sensory information. Although the lateral prefrontal cortex (LPFC) is known to mediate top-down control, the neuronal mechanisms of top-down control of attentional selection are poorly understood. Here, we trained two rhesus monkeys on a two-target, free-choice luminance-reward selection task. We demonstrate that visual-movement (VM) neurons and nonvisual neurons or movement neurons encode exogenous and endogenous selection. We then show that coherent beta activity selectively modulates mechanisms of exogenous selection specifically during conflict and consequently may support top-down control. These results reveal the VM-neuron-specific network mechanisms of attentional selection and suggest a functional role for beta-frequency coherent neural dynamics in the modulation of sensory communication channels for the top-down control of attentional selection.

The role of working memory in probabilistic cuing of visual search.

In a typical probabilistic cuing experiment, participants are asked to find a visual target among a series of distractors. Although participants are not informed about this, the target appears more frequently in one region of the display, resulting in faster search times for targets located in this region. This bias is thought to depend on a habit-like attentional control mechanism, unconstrained by the availability of working memory (WM) resources. However, the only study that has explored this feature in the past suffers from methodological shortcomings that leave the results open to alternative explanations. In three experiments, we aimed to confirm whether probabilistic cuing is unaffected by visual, spatial, and spatiotemporal WM load. For each experiment, one group of participants performed the visual search task during the retention interval of a WM task (high-load group), whereas another group of participants (no-load group) carried out the visual search task after the WM task. We hypothesized that the probabilistic cuing effect would be larger for the no-load group compared to the high-load group. This hypothesis was confirmed in one experiment, but exploratory analyses suggest that the results can be highly dependent on the analytic approach, casting doubts on its robustness. Overall, our results provide partial support for the hypothesis that probabilistic cuing is not affected by a secondary task. However, given that some analyses reveal an effect of WM load, we conclude that it might be premature to rule out the possibility that the expression of this attentional bias requires WM resources. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Attentional control and priming: The distractor set hypothesis.

Repeating a single-prime stimulus as a target to respond to usually facilitates responses. However, sometimes, prime repetition slows the responses and produces the single-prime negative priming effect. In this study, the distractor set hypothesis was proposed as a mechanism of attentional control that can contribute toward single-prime negative priming. In Experiments 1a-1d, an integrated Stroop task was used. The results showed that the prime produced negative priming only when it matched the form of the competing distractors. A separate Stroop task was used in Experiments 2 and 3 and a flanker task was used in Experiments 4a and 4b. In both tasks, the results suggested that a prime produced negative priming when the location of the prime matched that of the distractors. In Experiment 5, alternative explanations including the effects of the prime-to-distractor similarity and the target set were examined. The results revealed that the distractor set, rather than the target set and the similarity between the prime and distractor, could better account for the negative priming effect. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Integrated effects of top-down attention and statistical learning during visual search: An EEG study

The present study aims to investigate how the competition between visual elements is solved by top-down and/or statistical learning (SL) attentional control (AC) mechanisms when active together. We hypothesized that the “winner” element that will undergo further processing is selected either by one AC mechanism that prevails over the other, or by the joint activity of both mechanisms. To test these hypotheses, we conducted a visual search experiment that combined an endogenous cueing protocol (valid vs. neutral cue) and an imbalance of target frequency distribution across locations (high- vs. low-frequency location). The unique and combined effects of top-down control and SL mechanisms were measured on behaviour and amplitudes of three evoked-response potential (ERP) components (i.e., N2pc, P1, CNV) related to attentional processing. Our behavioural results showed better performance for validly cued targets and for targets in the high-frequency location. The two factors were found to interact, so that SL effects emerged only in the absence of top-down guidance. Whereas the CNV and P1 only displayed a main effect of cueing, for the N2pc we observed an interaction between cueing and SL, revealing a cueing effect for targets in the low-frequency condition, but not in the high-frequency condition. Thus, our data support the view that top-down control and SL work in a conjoint, integrated manner during target selection. In particular, SL mechanisms are reduced or even absent when a fully reliable top-down guidance of attention is at play.

Statistical learning speeds visual search: More efficient selection, or faster response?

Learning statistical regularities of target objects speeds visual search performance. However, we do not yet know whether this statistical learning effect is driven by biasing attentional selection at the early perceptual stage of processing, as theories of attention propose, or by improving the decision-making efficiency at a late response-related stage. Leveraging the high-temporal resolution of the event-related potential (ERP) technique, we had 16 human observers perform a visual search task where we inserted a fine-grained statistical regularity that the target shapes appeared in different colors with six unique probabilities. Observers unintentionally learned these regularities such that they were faster to report targets that appeared in more likely target colors. The observers' ERPs showed that this learning effect resulted in subjects making faster decisions about the target presence, and not by preferentially shifting attention to more rapidly select likely target colors, as is often assumed by the attentional selection account, supporting a post-selection account for statistical learning of the probabilistic regularities of target features. These results provide fundamental insights into the attentional control mechanisms of statistical learning. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Two Oscillatory Correlates of Attention Control in the Alpha-Band with Distinct Consequences on Perceptual Gain and Metacognition.

Behavioral consequences and neural underpinnings of visuospatial attention have long been investigated. Classical studies using the Posner paradigm have found that visual perception systematically benefits from the use of a spatially informative cue pointing to the to-be-attended spatial location, compared with a noninformative cue. Lateralized α amplitude modulation during visuospatial attention shifts has been suggested to account for such perceptual gain. However, recent studies on spontaneous fluctuations of prestimulus α amplitude have challenged this notion. These studies showed that spontaneous fluctuations of prestimulus α amplitude were associated with the subjective appreciation of stimulus occurrence, while objective accuracy was instead best predicted by the frequency of α oscillations, with faster prestimulus α frequency accounting for better perceptual performance. Here, in male and female humans, by using an informative cue in anticipation of lateralized stimulus presentation, we found that the predictive cue not only modulates preparatory α amplitude but also α frequency in a retinotopic manner. Behaviorally, the cue significantly impacted subjective performance measures (metacognitive abilities [meta-d']) and objective performance gain (d'). Importantly, α amplitude directly accounted for confidence levels, with ipsilateral synchronization and contralateral desynchronization coding for high-confidence responses. Crucially, the contralateral α amplitude selectively predicted interindividual differences in metacognitive abilities (meta-d'), thus anticipating decision strategy and not perceptual sensitivity, probably via excitability modulations. Instead, higher perceptual accuracy both within and across participants (d') was associated with faster contralateral α frequency, likely by implementing higher sampling at the attended location. These findings provide critical new insights into the neural mechanisms of attention control and its perceptual consequences.SIGNIFICANCE STATEMENT Prior knowledge serves the anticipation of sensory input to reduce sensory ambiguity. The growing interest in the neural mechanisms governing the integration of sensory input into our internal representations has highlighted a pivotal role of brain oscillations. Here we show that distinct but interacting oscillatory mechanisms are engaged during attentional deployment: one relying on α amplitude modulations and reflecting internal decision processes, associated with subjective perceptual experience and metacognitive abilities; the other relying on α frequency modulations and enabling mechanistic sampling of the sensory input at the attended location to influence objective performance. These insights are crucial for understanding how we reduce sensory ambiguity to maximize the efficiency of our conscious experience, but also in interpreting the mechanisms of atypical perceptual experiences.

Dynamics of alpha suppression index both modality specific and general attention processes

EEG alpha power varies under many circumstances requiring visual attention. However, mounting evidence indicates that alpha may not only serve visual processing, but also the processing of stimuli presented in other sensory modalities, including hearing. We previously showed that alpha dynamics during an auditory task vary as a function of competition from the visual modality (Clements et al., 2022) suggesting that alpha may be engaged in multimodal processing. Here we assessed the impact of allocating attention to the visual or auditory modality on alpha dynamics at parietal and occipital electrodes, during the preparatory period of a cued-conflict task. In this task, bimodal precues indicated the modality (vision, hearing) relevant to a subsequent reaction stimulus, allowing us to assess alpha during modality-specific preparation and while switching between modalities. Alpha suppression following the precue occurred in all conditions, indicating that it may reflect general preparatory mechanisms. However, we observed a switch effect when preparing to attend to the auditory modality, in which greater alpha suppression was elicited when switching to the auditory modality compared to repeating. No switch effect was evident when preparing to attend to visual information (although robust suppression did occur in both conditions). In addition, waning alpha suppression preceded error trials, irrespective of sensory modality. These findings indicate that alpha can be used to monitor the level of preparatory attention to process both visual and auditory information, and support the emerging view that alpha band activity may index a general attention control mechanism used across modalities.

Non-invasive brain stimulation and pain neuroscience education in the cognitive-affective treatment of chronic low back pain: Evidence and future directions

Chronic low back pain (CLBP) is among the leading causes of disability worldwide. Beyond the physical and functional limitations, people's beliefs, cognitions, and perceptions of their pain can negatively influence their prognosis. Altered cognitive and affective behaviors, such as pain catastrophizing and kinesiophobia, are correlated with changes in the brain and share a dynamic and bidirectional relationship. Similarly, in the presence of persistent pain, attentional control mechanisms, which serve to organize relevant task information are impaired. These deficits demonstrate that pain may be a predominant focus of attentional resources, leaving limited reserve for other cognitively demanding tasks. Cognitive dysfunction may limit one's capacity to evaluate, interpret, and revise the maladaptive thoughts and behaviors associated with catastrophizing and fear. As such, interventions targeting the brain and resultant behaviors are compelling. Pain neuroscience education (PNE), a cognitive intervention used to reconceptualize a person's pain experiences, has been shown to reduce the effects of pain catastrophizing and kinesiophobia. However, cognitive deficits associated with chronic pain may impact the efficacy of such interventions. Non-invasive brain stimulation (NIBS), such as transcranial direct current stimulation (tDCS) or repetitive transcranial magnetic stimulation (rTMS) has been shown to be effective in the treatment of anxiety, depression, and pain. In addition, as with the treatment of most physical and psychological diagnoses, an active multimodal approach is considered to be optimal. Therefore, combining the neuromodulatory effects of NIBS with a cognitive intervention such as PNE could be promising. This review highlights the cognitive-affective deficits associated with CLBP while focusing on current evidence for cognition-based therapies and NIBS.