Attention bias of anxious youth during extended exposure of emotional face pairs: an eye-tracking study

Anxiety symptoms and children's eye gaze during fear learning

BACKGROUND

The eye region of the face is particularly relevant for decoding threat-related signals, such as fear. However, it is unclear if gaze patterns to the eyes can be influenced by fear learning. Previous studies examining gaze patterns in adults find an association between anxiety and eye gaze avoidance, although no studies to date examine how associations between anxiety symptoms and eye-viewing patterns manifest in children. The current study examined the effects of learning and trait anxiety on eye gaze using a face-based fear conditioning task developed for use in children.

METHODS

Participants were 82 youth from a general population sample of twins (aged 9-13 years), exhibiting a range of anxiety symptoms. Participants underwent a fear conditioning paradigm where the conditioned stimuli (CS+) were two neutral faces, one of which was randomly selected to be paired with an aversive scream. Eye tracking, physiological, and subjective data were acquired. Children and parents reported their child's anxiety using the Screen for Child Anxiety Related Emotional Disorders.

RESULTS

Conditioning influenced eye gaze patterns in that children looked longer and more frequently to the eye region of the CS+ than CS- face; this effect was present only during fear acquisition, not at baseline or extinction. Furthermore, consistent with past work in adults, anxiety symptoms were associated with eye gaze avoidance. Finally, gaze duration to the eye region mediated the effect of anxious traits on self-reported fear during acquisition.

CONCLUSIONS

Anxiety symptoms in children relate to face-viewing strategies deployed in the context of a fear learning experiment. This relationship may inform attempts to understand the relationship between pediatric anxiety symptoms and learning.

Gaze-Based Assessments of Vigilance and Avoidance in Social Anxiety: a Review

PURPOSE OF REVIEW

A broad base of research has sought to identify the biases in selective attention which characterize social anxiety, with the emergent use of eye tracking-based methods. This article seeks to provide a review of eye tracking studies examining selective attention biases in social anxiety.

RECENT FINDINGS

Across a number of contexts, social anxiety may be associated with a mix of both vigilant and avoidant patterns of attention with respect to the processing of emotional social stimuli. Socially anxious individuals may additionally avoid maintaining eye contact and may exhibit a generalized vigilance via hyperscanning of their environment. The findings highlight the utility of eye tracking methods for increasing understanding of the gaze-based biases which characterize social anxiety disorder, with promising avenues for future research.

The influence of attention biases and adult attachment style on treatment outcome for adults with social anxiety disorder

BACKGROUND

Attention biases figure prominently in CBT models of social anxiety and are thought to maintain symptoms of social anxiety disorder (SAD). Studies have shown that individual differences in pre-treatment attention biases predict cognitive behavioural therapy (CBT) outcome. However, these findings have been inconsistent as to whether vigilance towards threat predicts better or poorer treatment outcome. Adult attachment style is an individual characteristic that may influence the relationship between attention bias and SAD. This study investigates the relationship between attention biases and CBT treatment outcome for SAD. Furthermore, we examined the influence of adult attachment style on this relationship.

METHOD

Participants with a primary diagnosis of SAD completed a passive viewing (measuring vigilance towards threat) and a novel difficulty to disengage (measuring difficulty to disengage attention) eye-tracking task prior to attending 12 CBT group sessions targeting SAD. Symptom severity was measured at pre- and post-treatment. Regression analyses were conducted on a sample of 50 participants.

RESULTS

Greater vigilance for threat than avoidance of threat at pre-treatment predicted poorer treatment outcomes. Greater difficulty disengaging from happy faces, compared to neutral faces, predicted poorer treatment outcomes. Attachment style did not moderate these relationships.

LIMITATIONS

The associations between attention biases and specific components of CBT treatment were not examined. The novel findings regarding difficulty to disengage attention require replication.

CONCLUSIONS

The findings have implications for the theoretical models of SAD and for the treatment of SAD.

Eye-Tracking Evidence of a Maintenance Bias in Social Anxiety

Background: The mechanisms and triggers of the attentional bias in social anxiety are not yet fully determined, and the modulating role of personality traits is being increasingly acknowledged. Aims: Our main purpose was to test whether social anxiety is associated with mechanisms of hypervigilance, avoidance (static biases), vigilance-avoidance or the maintenance of attention (dynamic biases). Our secondary goal was to explore the role of personality structure in shaping the attention bias. Method: Participants with high vs low social anxiety and different personality structures viewed pairs of faces (free-viewing eye-tracking task) representing different emotions (anger, happiness and neutrality). Their eye movements were registered and analysed for both whole-trial (static) and time-dependent (dynamic) measures. Results: Comparisons between participants with high and low social anxiety levels did not yield evidence of differences in eye-tracking measures for the whole trial (latency of first fixation, first fixation direction, total dwell time), but the two groups differed in the time course of overt attention during the trial (dwell time across three successive time segments): participants with high social anxiety were slower in disengaging their attention from happy faces. Similar results were obtained using a full-sample, regression-based analysis. Conclusion: Our results speak in favour of a maintenance bias in social anxiety. Preliminary results indicated that personality structure may not affect the maintenance (dynamic) bias of socially anxious individuals, although depressive personality structures may favour manifestations of a (static) hypervigilance bias.

State anxiety and emotional face recognition in healthy volunteers

High trait anxiety has been associated with detriments in emotional face processing. By contrast, relatively little is known about the effects of state anxiety on emotional face processing. We investigated the effects of state anxiety on recognition of emotional expressions (anger, sadness, surprise, disgust, fear and happiness) experimentally, using the 7.5% carbon dioxide (CO2) model to induce state anxiety, and in a large observational study. The experimental studies indicated reduced global (rather than emotion-specific) emotion recognition accuracy and increased interpretation bias (a tendency to perceive anger over happiness) when state anxiety was heightened. The observational study confirmed that higher state anxiety is associated with poorer emotion recognition, and indicated that negative effects of trait anxiety are negated when controlling for state anxiety, suggesting a mediating effect of state anxiety. These findings may have implications for anxiety disorders, which are characterized by increased frequency, intensity or duration of state anxious episodes.

Developmental Differences in Infants' Attention to Social and Nonsocial Threats

Research has demonstrated that humans detect threatening stimuli more rapidly than nonthreatening stimuli. Although the literature presumes that biases for threat should be normative, present early in development, evident across multiple forms of threat, and stable across individuals, developmental work in this area is limited. Here, we examine the developmental differences in infants' (4- to 24-month-olds) attention to social (angry faces) and nonsocial (snakes) threats using a new age-appropriate dot-probe task. In Experiment 1, infants' first fixations were more often to snakes than to frogs, and they were faster to fixate probes that appeared in place of snakes vs. frogs. There were no significant age differences, suggesting that a perceptual bias for snakes is present early in life and stable across infancy. In Experiment 2, infants fixated probes more quickly after viewing any trials that contained an angry face compared to trials that contained a happy face. Further, there were age-related changes in infants' responses to face stimuli, with a general increase in looking time to faces before the probe and an increase in latency to fixate the probe after seeing angry faces. Together, this work suggests that different developmental mechanisms may be responsible for attentional biases for social vs. nonsocial threats.

Gender Differences in the Difficulty in Disengaging from Threat among Children and Adolescents With Social Anxiety

There is some research showing that social anxiety is related with attentional bias to threat. However, others fail to find this relationship and propose that gender differences may play a role. The aim of this study was to investigate the gender differences in the subcomponents of attentional bias to threat (hypervigilance and difficulty in disengaging) among children and adolescents with social anxiety. Overall, 181 youngsters aged between 10 and 14 participated in the current study. Images of disgusted faces were used as threat stimuli in an Exogenous Cueing Task was used to measure the subcomponents of attentional bias. Additionally, the Social Anxiety Scale for Children was used to measure social anxiety. The repeated measures ANOVA showed that male participants with high social anxiety showed difficulty in disengaging from threat, but this was not the case for female participants. Our results indicated that social anxiety is more related with attentional bias to threat among male children and adolescents than females. These findings suggested that developing gender-specific treatments for social anxiety may improve treatment effects.

Annual Research Review: An expanded account of information-processing mechanisms in risk for child and adolescent anxiety and depression

BACKGROUND

Anxiety and depression occurring during childhood and adolescence are common and costly. While early-emerging anxiety and depression can arise through a complex interplay of 'distal' factors such as genetic and environmental influences, temperamental characteristics and brain circuitry, the more proximal mechanisms that transfer risks on symptoms are poorly delineated. Information-processing biases, which differentiate youth with and without anxiety and/or depression, could act as proximal mechanisms that mediate more distal risks on symptoms. This article reviews the literature on information-processing biases, their associations with anxiety and depression symptoms in youth and with other distal risk factors, to provide direction for further research.

METHODS

Based on strategic searches of the literature, we consider how youth with and without anxiety and/or depression vary in how they deploy attention to social-affective stimuli, discriminate between threat and safety cues, retain memories of negative events and appraise ambiguous information. We discuss how these information-processing biases are similarly or differentially expressed on anxiety and depression and whether these biases are linked to genetic and environmental factors, temperamental characteristics and patterns of brain circuitry functioning implicated in anxiety and depression.

FINDINGS

Biases in attention and appraisal characterise both youth anxiety and depression but with some differences in how these are expressed for each symptom type. Difficulties in threat-safety cue discrimination characterise anxiety and are understudied in depression, while biases in the retrieval of negative and overgeneral memories have been observed in depression but are understudied in anxiety. Information-processing biases have been studied in relation to some distal factors but not systematically, so relationships remain inconclusive.

CONCLUSIONS

Biases in attention, threat-safety cue discrimination, memory and appraisal may characterise anxiety and/or depression risk. We discuss future research directions that can more systematically test whether these biases act as proximal mechanisms that mediate other distal risk factors.

Attention allocation and social worries predict interpretations of peer-related social cues in adolescents

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Across scenes, increasing social anxiety was associated with greater endorsement of negative interpretations.

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Greater attentional deployment to peers predicted increased endorsements of negative interpretations.

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Self-relevant scenes yielded more negative interpretations.

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Older adolescents selected more benign interpretations.

Adolescence is a sensitive period for increases in normative but also debilitating social fears and worries. As the interpretation of interpersonal cues is pertinent to social anxiety, investigating mechanisms that may underlie biases in social cue appraisal is important.

Fifty-one adolescents from the community aged 14–19 were presented with self- and other-relevant naturalistic social scenes for 5 s and then required to rate either a negative or a positive interpretation of the scene. Eye-tracking data were collected during the free viewing period to index attentional deployment. Individual differences in social worries were measured via self-report.

Social anxiety levels significantly predicted biases in interpretation ratings across scenes. Additionally, cumulative attentional deployment to peer cues also predicted these interpretation biases: participants who spent more time on facial displays perceived more threat, i.e. endorsed more negative and less positive interpretations. Self-relevant scenes yielded greater tendencies to draw negative interpretations. Finally, older adolescents also selected more benign interpretations.

Social anxiety is associated with a bias in interpreting social cues; a cognitive bias that is also influenced by attentional deployment. This study contributes to our understanding of the possible attention mechanisms that shape cognitions relevant to social anxiety in this at-risk age group.

No Significant Evidence of Cognitive Biases for Emotional Stimuli in Children At-Risk of Developing Anxiety Disorders

This paper explores whether the increased vulnerability of children of anxious parents to develop anxiety disorders may be partially explained by these children having increased cognitive biases towards threat compared with children of non-anxious parents. Parents completed questionnaires about their child’s anxiety symptoms. Children aged 5–9 (n = 85) participated in two cognitive bias tasks: 1) an emotion recognition task, and 2) an ambiguous situations questionnaire. For the emotion recognition task, there were no significant differences between at-risk children and children of non-anxious parents in their cognitive bias scores for reaction times or for accuracy in identifying angry or happy facial expressions. In addition, there were no significant differences between at-risk children and children of non-anxious parents in the number of threat interpretations made for the ambiguous situations questionnaire. It is possible that these cognitive biases only become present subsequent to the development of an anxiety disorder, or only in older at-risk children.

Attention to Threat as a Predictor of Shyness in the Context of Internalizing and Externalizing Problems

The duration of children's attention to putative threat has been documented as a consistent predictor of later anxiety in inhibited children across childhood (Fox, 2010; Perez-Edgar & Fox, 2005). However, attention to threat has not been broadly examined within existing behavioral contexts, and has seldom been studied in very early childhood. Whereas toddlers with high levels of internalizing behavior may view fear-inducing stimuli as a threat, toddlers with high levels of externalizing behavior may demonstrate attention out of interest or sensation seeking. Thus, attention to threat was expected to predict increased toddler shyness in the context of either high internalizing problems or low externalizing behavior. We examined 117 24-month-old toddlers to determine whether attention to threat interacted with internalizing and externalizing behavior at 24 months of age to predict toddler shyness one year later. Results indicated that attention to threat predicted toddlers' lower shyness at 36 months when toddlers' externalizing behavior at age 24 months were high, but there was no significant interaction between toddlers' internalizing behavior and their attention to threat in predicting later shyness. These results expand our understanding of the contexts in which attention to threat in early childhood is a viable predictor of later shyness.

Stimulus-Driven Attention, Threat Bias, and Sad Bias in Youth with a History of an Anxiety Disorder or Depression

Attention biases towards threatening and sad stimuli are associated with pediatric anxiety and depression, respectively. The basic cognitive mechanisms associated with attention biases in youth, however, remain unclear. Here, we tested the hypothesis that threat bias (selective attention for threatening versus neutral stimuli) but not sad bias relies on stimulus-driven attention. We collected measures of stimulus-driven attention, threat bias, sad bias, and current clinical symptoms in youth with a history of an anxiety disorder and/or depression (ANX/DEP; n = 40) as well as healthy controls (HC; n = 33). Stimulus-driven attention was measured with a non-emotional spatial orienting task, while threat bias and sad bias were measured at a short time interval (150 ms) with a spatial orienting task using emotional faces and at a longer time interval (500 ms) using a dot-probe task. In ANX/DEP but not HC, early attention bias towards threat was negatively correlated with later attention bias to threat, suggesting that early threat vigilance was associated with later threat avoidance. Across all subjects, stimulus-driven orienting was not correlated with early threat bias but was negatively correlated with later threat bias, indicating that rapid stimulus-driven orienting is linked to later threat avoidance. No parallel relationships were detected for sad bias. Current symptoms of depression but not anxiety were related to decreased stimulus-driven attention. Together, these results are consistent with the hypothesis that threat bias but not sad bias relies on stimulus-driven attention. These results inform the design of attention bias modification programs that aim to reverse threat biases and reduce symptoms associated with pediatric anxiety and depression.

A developmental neuroscience perspective on affect-biased attention

There is growing interest regarding the impact of affect-biased attention on psychopathology. However, most of the research to date lacks a developmental approach. In the present review, we examine the role affect-biased attention plays in shaping socioemotional trajectories within a developmental neuroscience framework. We propose that affect-biased attention, particularly if stable and entrenched, acts as a developmental tether that helps sustain early socioemotional and behavioral profiles over time, placing some individuals on maladaptive developmental trajectories. Although most of the evidence is found in the anxiety literature, we suggest that these relations may operate across multiple domains of interest, including positive affect, externalizing behaviors, drug use, and eating behaviors. We also review the general mechanisms and neural correlates of affect-biased attention, as well as the current evidence for the co-development of attention and affect. Based on the reviewed literature, we propose a model that may help us better understand the nuances of affect-biased attention across development. The model may serve as a strong foundation for ongoing attempts to identify neurocognitive mechanisms and intervene with individuals at risk. Finally, we discuss open issues for future research that may help bridge existing gaps in the literature.

Attention and interpretation processes and trait anger experience, expression, and control

This study explored attention and interpretation biases in processing facial expressions as correlates of theoretically distinct self-reported anger experience, expression, and control. Non-selected undergraduate students (N = 101) completed cognitive tasks measuring attention bias, interpretation bias, and Spielberger's State-Trait Anger Expression Inventory (STAXI-2). Attention bias toward angry faces was associated with higher trait anger and anger expression and with lower anger control-in and anger control-out. The propensity to quickly interpret ambiguous faces as angry was associated with greater anger expression and its subcomponent of anger expression-out and with lower anger control-out. Interactions between attention and interpretation biases did not contribute to the prediction of any anger component suggesting that attention and interpretation biases may function as distinct mechanisms. Theoretical and possible clinical implications are discussed.

Time Course of Attention in Socially Anxious Individuals: Investigating the Effects of Adult Attachment Style

Theoretical models of social anxiety propose that attention biases maintain symptoms of social anxiety. Research findings regarding the time course of attention and social anxiety disorder have been mixed. Adult attachment style may influence attention bias and social anxiety, thus contributing to the mixed findings. This study investigated the time course of attention toward both negative and positive stimuli for individuals diagnosed with social anxiety disorder (SAD) and assessed whether attachment style moderates this relationship. One hundred and thirty participants (age: M=29.03) were assessed using a semistructured clinical interview. Those meeting eligibility criteria for the clinical sample met DSM-IV criteria for SAD (n=90, age: M=32.18), while those in the control sample did not meet criteria for any mental disorder (n=23, age: M=26.04, 11 females). All participants completed self-report measures examining depression, social anxiety, adult attachment style, and completed an eye-tracking task used to measure the time course of attention. Eye-tracking data were analysed using growth curve analysis. The results indicate that participants in the control group overall displayed greater vigilance towards emotional stimuli, were faster at initially fixating on the emotional stimulus, and had a greater percentage of fixations towards the emotional stimulus as the stimulus presentation time progressed compared to those in the clinical group. Thus, the clinical participants were more likely to avoid fixating on emotional stimuli in general (both negative and positive) compared to those in the control group. These results support the Clark and Wells (1995) proposal that socially anxious individuals avoid attending to emotional information. Attachment style did not moderate this association, however anxious attachment was related to greater vigilance toward emotional compared to neutral stimuli.

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.

Social anxiety is related to increased dwell time on socially threatening faces

BACKGROUND

Identification of reliable targets for therapeutic interventions is essential for developing evidence-based therapies. Threat-related attention bias has been implicated in the etiology and maintenance of social anxiety disorder. Extant response-time-based threat bias measures have demonstrated limited reliability and internal consistency. Here, we examined gaze patterns of socially anxious and nonanxious participants in relation to social threatening and neutral stimuli using an eye-tracking task, comprised of multiple threat and neutral stimuli, presented for an extended time-period. We tested the psychometric properties of this task with the hope to provide a solid stepping-stone for future treatment development.

METHODS

Eye gaze was tracked while participants freely viewed 60 different matrices comprised of eight disgusted and eight neutral facial expressions, presented for 6000ms each. Gaze patterns on threat and neutral areas of interest (AOIs) of participants with SAD, high socially anxious students and nonanxious students were compared. Internal consistency and test-retest reliability were evaluated.

RESULTS

Participants did not differ on first-fixation variables. However, overall, socially anxious students and participants with SAD dwelled significantly longer on threat faces compared with nonanxious participants, with no difference between the anxious groups. Groups did not differ in overall dwell time on neutral faces. Internal consistency of total dwell time on threat and neutral AOIs was high and one-week test-retest reliability was acceptable.

LIMITATIONS

Only disgusted facial expressions were used. Relative small sample size.

CONCLUSION

Social anxiety is associated with increased dwell time on socially threatening stimuli, presenting a potential target for therapeutic intervention.

Vigilance in the laboratory predicts avoidance in the real world: A dimensional analysis of neural, behavioral, and ecological momentary data in anxious youth

Vigilance and avoidance of threat are observed in anxious adults during laboratory tasks, and are posited to have real-world clinical relevance, but data are mixed in anxious youth. We propose that vigilance-avoidance patterns will become evident in anxious youth through a focus on individual differences and real-world strategic avoidance. Decreased functional connectivity between the amygdala and prefrontal cortex (PFC) could play a mechanistic role in this link. 78 clinically anxious youth completed a dot-probe task to assess vigilance to threat while undergoing fMRI. Real-world avoidance was assessed using Ecological Momentary Assessment (EMA) of self-reported suppression and distraction during negative life events. Vigilance toward threat was positively associated with EMA distraction and suppression. Functional connectivity between a right amygdala seed region and dorsomedial and right dorsolateral PFC regions was inversely related to EMA distraction. Dorsolateral PFC-amygdalar connectivity statistically mediated the relationship between attentional vigilance and real-world distraction. Findings suggest anxious youth showing attentional vigilance toward threat are more likely to use suppression and distraction to regulate negative emotions. Reduced PFC control over limbic reactivity is a possible neural substrate of this pattern. These findings lend ecological validity to laboratory vigilance assessments and suggest PFC-amygdalar connectivity is a neural mechanism bridging laboratory and naturalistic contexts.

From anxious youth to depressed adolescents: Prospective prediction of 2-year depression symptoms via attentional bias measures

Anxious youth are at heightened risk for subsequent development of depression; however, little is known regarding which anxious youth are at the highest prospective risk. Biased attentional patterns (e.g., vigilance and avoidance of negative cues) are implicated as key mechanisms in both anxiety and depression. Aberrant attentional patterns may disrupt opportunities to effectively engage with, and learn from, threatening aspects of the environment during development and/or treatment, compounding risk over time. Sixty-seven anxious youth (ages 9-14; 36 female) completed a dot-probe task to assess baseline attentional patterns provoked by fearful-neutral face pairs. The time course of attentional patterns both during and after threat was assessed via eye-tracking and pupilometry. Self-reported depressive and anxiety symptoms were assessed 2 years after the conclusion of a larger psychotherapy treatment trial. Eye-tracking patterns indicating threat avoidance predicted greater 2-year depression scores, over and above baseline and posttreatment symptoms. Sustained, postthreat pupillary avoidance (reflecting preferential neural engagement with the neutral relative to the previously threatening location) predicted additional variance in depression scores, suggesting sustained avoidance in the wake of threat further exacerbated risk. Identical eye-tracking and pupil indices were not predictive of anxiety at 2 years. These biobehavioral markers imply that avoidant attentional processing in the context of anxiety may be a gateway to depression across a key maturational window. Excessive avoidance of threat could interfere with acquisition of adaptive emotion regulation skills during development, culminating in the broad behavioral deactivation that typifies depression. Prevention efforts explicitly targeting avoidant attentional patterns may be warranted.

Threats, rewards, and attention deployment in anxious youth and adults: An eye tracking study

The current study examines anxiety and age associations with attention allocation and physiological response to threats and rewards. Twenty-two healthy-adults, 20 anxious-adults, 26 healthy-youth, and 19 anxious-youth completed two eye-tracking tasks. In the Visual Scene Task (VST), participants' fixations were recorded while they viewed a central neutral image flanked by two threatening or two rewarding stimuli. In the Negative Words Task (NWT), physiological response was measured by means of pupil diameter change while negative and neutral words were presented. For both tasks, no interaction was found between anxiety and age-group. In the VST, anxious participants avoided the threatening images when groups were collapsed across age. Similarly, adults but not adolescents avoided the threatening images when collapsed across anxiety. No differences were found for rewarding images. In NWT, all subjects demonstrated increase in pupil dilation after word presentation. Only main effect of age emerged with stronger pupil dilation in adults than children. Finally, maximum pupil change was correlated with threat avoidance bias in the scene task. Gaze patterns and pupil dilation show that anxiety and age are associated with attention allocation to threats. The relations between attention and autonomic arousal point to a complex interaction between bottom-up and top-down processes as they relate to attention allocation.

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.

Dynamics of attentional bias to threat in anxious adults: bias towards and/or away?

The aim of the present study was to question untested assumptions about the nature of the expression of Attentional Bias (AB) towards and away from threat stimuli. We tested the idea that high trait anxious individuals (N = 106; M(SD)_age = 23.9(3.2) years; 68% women) show a stable AB towards multiple categories of threatening information using the emotional visual dot probe task. AB with respect to five categories of threat stimuli (i.e., angry faces, attacking dogs, attacking snakes, pointed weapons, violent scenes) was evaluated. In contrast with current theories, we found that 34% of participants expressed AB towards threat stimuli, 20.8% AB away from threat stimuli, and 34% AB towards some categories of threat stimuli and away from others. The multiple observed expressions of AB were not an artifact of a specific criterion AB score cut-off; not specific to certain categories of threat stimuli; not an artifact of differences in within-subject variability in reaction time; nor accounted for by individual differences in anxiety-related variables. Findings are conceptualized as reflecting the understudied dynamics of AB expression, with implications for AB measurement and quantification, etiology, relations, and intervention research.

Temperament, peer victimization, and nurturing parenting in child anxiety: a moderated mediation model

Research has linked fearful temperament and childhood anxiety. Yet there remain numerous factors that moderate and mediate this relation. Two specific factors, identified in separate lines of research, are peer victimization and parenting. The current study tested a moderated mediational model to investigate the respective effects of peer victimization and nurturing parenting on the relation between fearful temperament and child anxiety. Participants were 124 parent-child dyads recruited from the community. Children were between the ages of 7 and 12 (56.5% male, 93.5% Caucasian) and most parents were mothers. Overall the data fit the model well. Analyses indicated that peer victimization was a mediator of the temperament to child anxiety relation, while nurturing parenting moderated this mediated effect. Nurturing parenting did not mediate the temperament to child anxiety relation directly. The findings suggest that nurturing parenting may be a specific, rather than global, protective factor for peer victimization in child anxiety.

Attention bias modification treatment augmenting effects on cognitive behavioral therapy in children with anxiety: randomized controlled trial

OBJECTIVE

Attention bias modification treatment (ABMT) is a promising novel treatment for anxiety disorders, but clinical trials have focused largely on stand-alone formats among adults. This randomized controlled trial examined the augmenting effects of threat-based ABMT on cognitive behavioral therapy (CBT) in clinically anxious youth.

METHOD

Sixty-three treatment-seeking children with anxiety disorder were randomly assigned to 1 of the following 3 treatment groups: ABMT + CBT; ABMT placebo + CBT; and CBT-alone. Participants in the 2 ABMT conditions received repeated training on dot-probe tasks either designed to shift attention away from threats (active) or designed to induce no changes in attention patterns (placebo). Primary outcome measures were frequency and severity of anxiety symptoms as determined by a clinician using a semi-structured interview. Self- and parent-rated anxiety measures and threat-related attention bias scores were also measured before and after treatment.

RESULTS

Both the active and placebo ABMT groups showed greater reductions in clinician-rated anxiety symptoms than the CBT-alone group. Furthermore, only the active ABMT group showed significant reduction in self- or parent-rated anxiety symptoms. Finally, all groups showed a shift in attention patterns across the study, starting with a bias toward threat at baseline and shifting attention away from threat after treatment.

CONCLUSIONS

Active and placebo ABMT might augment the clinical response to CBT for anxiety. This effect could arise from benefits associated with performing computer-based paradigms such as the dot-probe task. Given the absence of group differences in attention-bias changes during treatment, possible mechanisms and methodological issues underlying the observed findings are discussed. Clinical trial registration information-Augmenting Effects of ABMT on CBT in Anxious Children: A Randomized Clinical Trial; http://clinicaltrials.gov/; NCT01730625.

Temperament and Attention as Core Mechanisms in the Early Emergence of Anxiety

Anxiety is a pervasive, impairing, and early appearing form of psychopathology. Even when anxiety remits, children remain at a two- to threefold increased risk for the later emergence of a mood disorder. Therefore, it is imperative to identify and examine underlying mechanisms that may shape early emerging patterns of behavior that are associated with anxiety. One of the strongest and first visible risk factors is childhood temperament. In particular, children who are behaviorally inhibited or temperamentally shy are more likely to exhibit signs of anxiety by adolescence. However, not all shy children do so, despite the early risk. We know that attention mechanisms, particularly the presence of attention biases toward or away from threat, can play a critical role in the emergence of anxiety. The current chapter will bring together these separate lines of research to examine the ways in which attention can modulate the documented link between early temperament and later anxiety. In doing so, the chapter will highlight multiple levels of analysis that focus on the behavioral, cognitive, and neural mechanisms in the temperament-attention-anxiety network. The chapter will help identify both markers and mechanisms of risk, supporting future work aimed at improving theory and intervention by focusing on attention biases to environmental threat.

A systems neuroscience approach to the pathophysiology of pediatric mood and anxiety disorders

Emotional dysregulation is a core feature of pediatric mood and anxiety disorders. Emerging evidence suggests that these disorders are mediated by abnormalities in the functions and structures of the developing brain. This chapter reviews recent behavioral and functional magnetic resonance imaging (fMRI) research on pediatric mood and anxiety disorders, focusing on the neural mechanisms underlying these disorders. Throughout the chapter, we highlight the relationship between neural and behavioral findings, and potential novel treatments. The chapter concludes with directions for future research.