Anxiety and attention to threat: Cognitive mechanisms and treatment with attention bias modification

The Differential Effect of Anxiety and ADHD Symptoms on Inhibitory Control and Sustained Attention for Threat Stimuli: A Go/No-Go Eye-Movement Study

Objective: This study examined the synergistic effects of ADHD and anxiety symptoms on attention and inhibitory control depending on the emotional content of the stimuli. Method: Fifty-four typically developing individuals (27 children/adolescents and 27 adults) completed an eye-movement based emotional Go/No-Go task, using centrally presented (happy, angry) faces and neutral/symbolic stimuli. Sustained attention was measured through saccade latencies and saccadic omission errors (Go trials), and inhibitory control through saccadic commission errors (No-Go trials). ADHD and anxiety were assessed dimensionally. Results: Elevated ADHD symptoms were associated with more commission errors and slower saccade latencies for angry (vs. happy) faces. In contrast, angry faces were linked to faster saccade onsets when anxiety symptoms were high, and this effect prevailed when both anxiety and ADHD symptoms were high. Conclusion: Social threat impacted performance in individuals with sub-clinical anxiety and ADHD differently. The effects of anxiety on threat processing prevailed when both symptoms were high.

Validating the Diathesis–Stress Model Based Case Conceptualization Procedure in Cognitive Behavioral Therapies: The LIBET (Life Themes and Semi-Adaptive Plans—Implications of Biased Beliefs, Elicitation and Treatment) Procedure

Cognitive behavioral therapy (CBT) approaches use case formulation procedures based on the diathesis–stress conceptualization model, arranged in two dimensions: emotional vulnerability (present in a patient’s consciousness in terms of core beliefs) and coping strategies. Nevertheless, despite its pivotal role, there are a limited number of validation studies for this model. Life themes and semi-adaptive plans: Implications of biased beliefs, elicitation and treatment (LIBET) is a CBT case formulation method grounded on the CBT diathesis–stress model that aims to help validate the CBT case formulation model, and, in particular, its bidimensional arrangement. In LIBET, the two classic CBT dimensions are called “life themes,” which are mental states of focused attention to emotional sensitivities represented as core beliefs in consciousness, and “semi-adaptive plans,” which are the rigid management strategies of “life themes” implemented by adopting coping strategies such as anxious safety behaviors, compulsive controls and aggressive or rewarding strategies. The study uses quantitative textual analysis to validate the LIBET procedure in a clinical sample. The investigation discusses the extent to which the results can be considered a validation of the arrangement of the general CBT diathesis–stress model in the two dimensions of core beliefs and coping strategies.

The roles of disgust sensitivity and anxiety sensitivity in attentional bias in dental anxiety

Individuals with dental anxiety show biased attentional processing of threat- and dental-related information. Disgust sensitivity and anxiety sensitivity are both associated with dental fears and attentional biases. Whereas disgust sensitivity is generally associated with attentional avoidance (Armstrong et al., 2014), anxiety sensitivity may be associated with attentional engagement (Keogh et al., 2001a). Elucidating the role of these constructs in dental anxiety-relevant attentional biases could inform theoretical models and/or intervention recommendations. Participants (N = 51) with high dental anxiety completed a Posner paradigm to assess attentional biases to dental versus neutral stimuli. We examined whether disgust sensitivity and anxiety sensitivity moderated degree of attentional bias. Results indicated that both disgust sensitivity (mutilation subscale) and anxiety sensitivity (physical concerns subscale) statistically moderated degree of attentional bias at trend level, and in opposite directions. Simple effects analyses further indicated that disgust sensitivity regarding mutilation was associated with less attentional bias toward dental relative to neutral stimuli, potentially indicating attentional avoidance, and remained so when adjusting for anxiety sensitivity. In contrast, simple effects analysis indicated that anxiety sensitivity regarding physical concerns was not associated with magnitude of attentional bias. If replicated, findings highlight the potential role of disgust in dental anxiety.

Electroencephalographic evidence of unconscious and conscious attentional bias in people with functional gastrointestinal disorders: A pilot study

Debate continues as to whether an attentional bias towards threat displayed by sufferers of functional gastrointestinal disorders (FGIDs) is conscious and, thus, more amenable to change through psychological therapy. We compared the amplitudes of early (unconscious) and later (conscious) electroencephalographic (EEG) event-related potentials following silent reading of symptom-related, emotionally neutral, and emotionally negative nouns across two participant groups: 30 female FGID-sufferers who met diagnostic criteria for irritable bowel syndrome or functional dyspepsia, and 30 female healthy controls. Analogous indices based on alpha desynchronization were also examined, as were correlations between the EEG-based indices and a range of psychosocial variables. FGID-sufferers displayed marginally significantly higher occipital EPN amplitudes for all nouns, indicating marginally higher levels of unconscious attention in the task. FGID-sufferers also displayed, for negative as compared to neutral nouns, significantly lower central N400 amplitudes indicative of higher conscious attention. The result was only apparent in post-hoc pairwise comparisons, however. Uniquely among FGID-sufferers, central N400 was strongly negatively correlated with a range of negative psychosocial traits and states. The findings provide preliminary evidence of hypervigilance to general (as opposed to symptom-specific) threat among FGID-sufferers. Amidst concerns over Type I error, recommendations are made for fine-tuning the operationalisation of unconscious and conscious attentional bias in this population.

Cognitive Reserve and Anxiety Interactions Play a Fundamental Role in the Response to the Stress

The aims of the present study were to assess the possible interaction between Cognitive Reserve (CR) and State Anxiety (SA) on adrenocortical and physiological responses in coping situations. Forty healthy, middle-aged men completed the Cognitive Reserve Scale and the State-Trait Anxiety Inventory. We used an Observational Fear Conditioning (OFC) paradigm in order to assess emotional learning and to induce stress. Electrodermal activity (EDA) and salivary cortisol concentrations were measured throughout the conditions. Our results indicate that those who indicated having higher state anxiety showed a lower capacity for learning the contingency, along with presenting higher salivary cortisol peak response following the observational fear-conditioning paradigm. The most prominent finding was the interaction between cognitive reserve and state anxiety on cortisol response to the post observational fear-conditioning paradigm. Thus, those who showed a high anxiety-state and, at the same time, a high cognitive reserve did not present an increased salivary cortisol response following the observational fear-conditioning paradigm. Given these results, we postulate that the state anxiety reported by participants, reflects emotional activation that hinders the attention needed to process and associate emotional stimuli. However, cognitive reserve has an indirect relation with conditioning, enabling better emotional learning. In this context, cognitive reserve demonstrated a protective effect on hormonal response in coping situations, when reported anxiety or emotional activation were high. These findings suggest that cognitive reserve could be used as a tool to deal with the effects of stressors in life situations, limiting development of the allostatic load.

Contributions of gains and losses to attentional capture and disengagement: evidence from the gap paradigm

It is known that movements of visual attention are influenced by features in a scene, such as colors, that are associated with value or with loss. The present study examined the detailed nature of these attentional effects by employing the gap paradigm-a technique that has been used to separately reveal changes in attentional capture and shifting, and changes in attentional disengagement. In four experiments, participants either looked toward or away from stimuli with colors that had been associated either with gains or with losses. We found that participants were faster to look to colors associated with gains and slower to look away from them, revealing effects of gains on both attentional capture and attentional disengagement. On the other hand, participants were both slower to look to features associated with loss, and faster to look away from such features. The pattern of results suggested, however, that the latter finding was not due to more rapid disengagement from loss-associated colors, but instead to more rapid shifting of attention away from such colors. Taken together, the results reveal a complex pattern of effects of gains and losses on the disengagement, capture, and shifting of visual attention, revealing a remarkable flexibility of the attention system.

Using mobile eye-tracking technology to examine adolescent daughters' attention to maternal affect during a conflict discussion

Attention to socio-emotional stimuli (i.e., affect-biased attention) is an integral component of emotion regulation and human communication. Given the strong link between maternal affect and adolescent behavior, maternal affect may be a critical influence on adolescent affect-biased attention during mother-child interaction. However, prior methodological constraints have precluded fine-grained examinations of factors such as maternal affect on adolescent attention during real-world social interaction. Therefore, this pilot study capitalized on previously validated technological advances by using mobile eye-tracking and facial affect coding software to quantify the influence of maternal affect on adolescents' attention to the mother during a conflict discussion. Results from 7,500 to 9,000 time points sampled for each mother-daughter dyad (n = 28) indicated that both negative and positive maternal affect, relative to neutral, elicited more adolescent attentional avoidance of the mother (ORs = 2.68-9.20), suggesting that typically developing adolescents may seek to avoid focusing on maternal affect of either valence during a conflict discussion. By examining the moment-to-moment association between in vivo displays of maternal affect and subsequent adolescent attention toward the mother's face, these results provide preliminary evidence that maternal affect moderates adolescent attention. Our findings are consistent with cross-species approach-avoidance models suggesting that offspring respond to affectively charged conversations with greater behavioral avoidance or deference.

What's in a Face? Amygdalar Sensitivity to an Emotional Threatening Faces Task and Transdiagnostic Internalizing Disorder Symptoms in Participants Receiving Attention Bias Modification Training

Background

Altered amygdala activation in response to the emotional matching faces (EMF) task, a task thought to reflect implicit emotion detection and reactivity, has been found in some patients with internalizing disorders; mixed findings from the EMF suggest individual differences (within and/or across diagnoses) that may be important to consider. Attention Bias Modification (ABM), a mechanistic attention-targeting intervention, has demonstrated efficacy in treatment of internalizing disorders. Individual differences in neural activation to a relatively attention-independent task, such as the EMF, could reveal novel neural substrates relevant in ABM's transdiagnostic effects, such as the brain's generalized threat reactivity capacity.

Methods

In a sample of clinically anxious patients randomized to ABM (n = 43) or sham training (n = 18), we measured fMRI activation patterns during the EMF and related them to measures of transdiagnostic internalizing symptoms (i.e., anxious arousal, general distress, anhedonic depression, and general depressive symptoms).

Results

Lower baseline right amygdala activation to negative (fearful/angry) faces, relative to shapes, predicted greater pre-to-post reduction in general depression symptoms in ABM-randomized patients. Greater increases in bilateral amygdalae activation from pre-to-post ABM were associated with greater reductions in general distress, anhedonic depression, and general depression symptoms.

Conclusions

ABM may lead to greater improvement in depressive symptoms in individuals exhibiting blunted baseline amygdalar responses to the EMF task, potentially by enhancing neural-level discrimination between negative and unambiguously neutral stimuli. Convergently, longitudinal increases in amygdala reactivity from pre-to-post-ABM may be associated with greater improvement in depression, possibly secondary to improved neural discrimination of threat and/or decreased neurophysiological threat avoidance in these specific patients.

Visual Attention and Sexual Function in Women

Purpose of Review

Theoretical models situate attention as integral to the onset and regulation of sexual response and propose that problems with sexual response and subsequent sexual dysfunction result from insufficient attentional processing of sexual stimuli. The goal of this paper is to review literature examining the link between attentional processing of sexual stimuli and sexual function in women. Specifically, we sought to understand whether women with and without sexual dysfunction differ in their visual attention to sexual stimuli and examined the link with sexual response, which would support attention as a mechanism underlying sexual dysfunction.

Recent Findings

Across women with and without sexual concerns, sexual stimuli are preferentially attended to relative to nonsexual stimuli, suggesting that sexual stimuli are more salient than nonsexual stimuli. Differences between women with and without sexual dysfunction emerge when examining visual attention toward the most salient features of sexual stimuli (e.g., genital regions depicting sexual activity). Consistent with theoretical models, visual attention and sexual response are related, such that increasing attention to sexual cues facilitates sexual arousal, whereas reduced attention to sexual stimuli appears to suppress sexual arousal, which may contribute to sexual difficulties in women.

Summary

Taken together, the research supports the role of visual attention in sexual response and sexual function. These findings provide empirical support for interventions that target attentional processing of sexual stimuli. Future research is required to further delineate the specific attentional mechanisms involved in sexual response and investigate whether these are modifiable. This knowledge may be beneficial for developing novel psychological interventions targeting attentional processes in the treatment of sexual dysfunctions.

Inhibitory attentional control under cognitive load in social anxiety: An investigation using a novel dual-task paradigm

Research suggests that socially anxious (SA) individuals exhibit poorer attentional inhibition than their non-anxious (NA) counterparts. Attentional control theory presumes that cognitive load worsens the adverse effects of anxiety on attentional inhibition. However, previous studies examined the effects of cognitive load on attentional inhibition in social anxiety yielded inconsistent results. In this study, cognitive load was manipulated by adding a 1-back (low cognitive load) and 2-back task (high cognitive load) to the emotional antisaccade task, investigating the effects of cognitive load on attentional inhibition in the presence of social evaluative stimuli in SA and NA individuals. Results revealed that cognitive load improved the efficiency but impeded the effectiveness of inhibitory attentional control in SA participants. Under high cognitive load, SA participants made more erroneous saccades for threat-related than nonthreat-related faces while NA participants showed no differences in error rates among different face types. Moreover, regardless of cognitive levels, SA participants had shorter saccade latencies for angry faces than happy and neutral faces. NA participants did not show differences in saccade latencies among different face types. Implications of these findings for understanding the role that cognitive load plays in the processes of attentional control and interventions for social anxiety are discussed.

Fearful Temperament and the Risk for Child and Adolescent Anxiety: The Role of Attention Biases and Effortful Control

Fearful temperament represents one of the most robust predictors of child and adolescent anxiety; however, not all children with fearful temperament unvaryingly develop anxiety. Diverse processes resulting from the interplay between automatic processing (i.e., attention bias) and controlled processing (i.e., effortful control) drive the trajectories toward more adaptive or maladaptive directions. In this review, we examine the associations between fearful temperament, attention bias, and anxiety, as well as the moderating effect of effortful control. Based on the reviewed literature, we propose a two-mechanism developmental model of attention bias that underlies the association between fearful temperament and anxiety. We propose that the sub-components of effortful control (i.e., attentional control and inhibitory control) play different roles depending on individuals' temperaments, initial automatic biases, and goal priorities. Our model may help resolve some of the mixed findings and conflicts in the current literature. It may also advance our knowledge regarding the cognitive mechanisms linking fearful temperament and anxiety, as well as facilitate the continuing efforts in identifying and intervening with children who are at risk. Finally, we conclude the review with a discussion on the existing limitations and then propose questions for future research.

Perception during use of force and the likelihood of firing upon an unarmed person

Stress can impact perception, especially during use-of-force. Research efforts can thus advance both theory and practice by examining how perception during use-of-force might drive behavior. The current study explored the relationship between perceptual judgments and performance during novel close-combat training. Analyses included perceptual judgments from close-combat assessments conducted pre-training and post-training that required realistic use-of-force decisions in addition to an artificially construed stress-inoculation event used as a training exercise. Participants demonstrated significant reductions in situational awareness while under direct fire, which correlated to increased physiological stress. The initial likelihood of firing upon an unarmed person predicted the perceptual shortcomings of later stress-inoculation training. Subsequently, likelihood of firing upon an unarmed person was reduced following the stress-inoculation training. These preliminary findings have several implications for low or zero-cost solutions that might help trainers identify individuals who are underprepared for field responsibilities.

The COVID-19 anxiety syndrome and selective attentional bias towards COVID-19-related stimuli in UK residents during the 2020-2021 pandemic

The psychological and social effects of the COVID‐19 pandemic are pervasive, and there is potential for a long‐lasting impact on mental health. In the current study, we sought to provide, in a representative sample of UK residents during the third COVID‐19 lockdown in February 2021, further evidence for the validation of the COVID‐19 anxiety syndrome construct. We did this by evaluating the COVID‐19 anxiety syndrome against measures of personality, health anxiety and COVID‐19 anxiety in predicting levels of generalized anxiety and depression and by examining whether increased health anxiety and COVID‐19 psychological distress (COVID‐19 anxiety and COVID‐19 anxiety syndrome) scores were associated with increased attentional bias to COVID‐19‐related stimuli. A series of correlation analyses revealed that neuroticism, health anxiety, COVID‐19 anxiety and COVID‐19 anxiety syndrome scores were positively and significantly correlated with generalized anxiety and depression scores and that the perseveration component of the COVID‐19 anxiety syndrome predicted generalized anxiety and depression scores independently of age, gender, conscientiousness, openness, health anxiety and COVID‐19 anxiety. Furthermore, results indicated that only the total COVID‐19 anxiety syndrome score and the scores on the avoidance and perseveration components were positively and significantly correlated with attentional bias indices. More specifically, the general attentional bias index was only shown to be positively and significantly correlated with the total COVID‐19 anxiety syndrome score and its perseveration component, while slowed disengagement was only shown to be negatively and significantly correlated with the total COVID‐19 anxiety syndrome score and its avoidance component. The implications of these findings are discussed.

Gaming Your Mental Health: A Narrative Review on Mitigating Symptoms of Depression and Anxiety Using Commercial Video Games

Globally, depression and anxiety are the two most prevalent mental health disorders. They occur both acutely and chronically, with various symptoms commonly expressed subclinically. The treatment gap and stigma associated with such mental health disorders are common issues encountered worldwide. Given the economic and health care service burden of mental illnesses, there is a heightened demand for accessible and cost-effective methods that prevent occurrence of mental health illnesses and facilitate coping with mental health illnesses. This demand has been exacerbated post the advent of the COVID-19 pandemic and the subsequent increase in incidence of mental health disorders. To address these demands, a growing body of research is exploring alternative solutions to traditional mental health treatment methods. Commercial video games have been shown to impart cognitive benefits to those playing regularly (ie, attention control, cognitive flexibility, and information processing). In this paper, we specifically focus on the mental health benefits associated with playing commercial video games to address symptoms of depression and anxiety. In light of the current research, we conclude that commercial video games show great promise as inexpensive, readily accessible, internationally available, effective, and stigma-free resources for the mitigation of some mental health issues in the absence of, or in addition to, traditional therapeutic treatments.

EEG Theta/Beta Ratio Neurofeedback Training in Healthy Females

A growing number of studies suggest that EEG theta/beta ratio (TBR) is inversely related to executive cognitive control. Neurofeedback training aimed at reducing TBR (TBR NFT) might provide a tool to study causality in this relation and might enhance human performance. To investigate whether TBR NFT reduces TBR in healthy participants. Twelve healthy female participants were assigned (single blind) to one of three groups. Groups differed on baseline durations and one group received only sham NFT. TBR NFT consisted of eight or fourteen 25-min sessions. No evidence was found that TBR NFT had any effect on TBR. The current TBR NFT protocol is possibly ineffective. This is in line with a previous study with a different protocol.

Anxiety biases audiovisual processing of social signals

In everyday life, information from multiple senses is integrated for a holistic understanding of emotion. Despite evidence of atypical multisensory perception in populations with socio-emotional difficulties (e.g., autistic individuals), little research to date has examined how anxiety impacts on multisensory emotion perception. Here we examined whether the level of trait anxiety in a sample of 56 healthy adults affected audiovisual processing of emotion for three types of stimuli: dynamic faces and voices, body motion and dialogues of two interacting agents, and circles and tones. Participants judged emotion from four types of displays - audio-only, visual-only, audiovisual congruent (e.g., angry face and angry voice) and audiovisual incongruent (e.g., angry face and happy voice) - as happy or angry, as quickly as possible. In one task, participants based their emotional judgements on information in one modality while ignoring information in the other, and in a second task they based their judgements on their overall impressions of the stimuli. The results showed that the higher trait anxiety group prioritized the processing of angry cues when combining faces and voices that portrayed conflicting emotions. Individuals in this group were also more likely to benefit from combining congruent face and voice cues when recognizing anger. The multisensory effects of anxiety were found to be independent of the effects of autistic traits. The observed effects of trait anxiety on multisensory processing of emotion may serve to maintain anxiety by increasing sensitivity to social-threat and thus contributing to interpersonal difficulties.

Cognitive vulnerabilities to anxiety symptoms among Chinese adolescents: A 3-year longitudinal study

OBJECTIVE

This study established cognitive vulnerability of anxiety symptoms among high school students.

METHOD

A total of 72 grade 9-11 students completed measures on levels of anxiety sensitivity (AS), selective attentional processing, and anxiety symptoms annually between 2016 and 2018.

RESULTS

Latent class growth analysis (unconditional model) showed a four-class model: High (stable) (6.94%), low (stable) (11.11%), medium (decreasing) (61.11%), and medium (increasing) (20.83%). The conditioned model controlling for the physical-concerns dimension of AS and negative attentional bias demonstrated that a two-class model consisted of a low anxiety class (n = 59, 81.9%) and a high anxiety class (n = 13, 18.1%) provided the best fit for the data. Negative attentional bias is a significant factor related to the development of anxiety trajectories.

CONCLUSION

Attentional bias modification to disengage from negative stimuli may serve as a potential target of intervention to reduce chronic anxiety among high school students.

Recoiling from Threat: Anxiety is Related to Heightened Suppression of Threat, Not Increased Attention to Threat

Increased attention to threat is considered a core feature of anxiety. However, there are multiple mechanisms of attention and multiple types of threat, and the relationships among attention, threat, and anxiety are poorly understood. The present study used event-related potentials (ERPs) to separately isolate attentional selection (N2pc) and suppression (P_D) of pictorial threats (photos of weapons, snakes, etc.) and conditioned threats (colored shapes paired with electric shock). In a sample of 48 young adults, both threat types were initially selected for increased attention (an N2pc), but only conditioned threats elicited subsequent suppression (a P_D) and a reaction time (RT) bias. Levels of trait anxiety were unrelated to N2pc amplitude, but increased anxiety was associated with larger P_Ds (i.e., greater suppression) and reduced RT bias to conditioned threats. These results suggest that anxious individuals do not pay more attention to threats, but rather engage more attentional suppression to overcome threats.

Neutral and threatening distracter word stimuli are unnecessarily stored in working memory but do not differ in their degree of working memory storage

Evidence suggests that threatening stimuli induce attentional biases compared to neutral stimuli, leading to subsequent storage in working memory. The current study examined how threatening versus neutral word distracters influence attention, and how this affects the unnecessary storage of these task-irrelevant stimuli in working memory. We measured the N2pc and contralateral delay activity (CDA), two event-related potentials (ERPs) that index attentional selection and the number of items maintained in WM, respectively, as participants completed a lateralized change detection task using word stimuli. Our results replicated work demonstrating a CDA effect for word stimuli, and found that distracter words are unnecessarily stored in working memory. However, we observed non-significant differences in attentional bias and working memory storage between distracter word conditions, and individual variation in anxiety was not associated with these processes. Bayes Factor analyses supported these null effects, suggesting that differences between neutral and threatening distracter words are unlikely.

Can attention bias modification augment the effect of CBT for anxiety disorders? A systematic review and meta-analysis

Attention Bias Modification (ABM) is a novel computerized therapy for anxiety disorders and is thought to augment the effect of Cognitive Behavior Therapy (CBT) as it may target different mechanisms. Recently, a growing number of studies have examined the combined effects of ABM and CBT on clinically anxious patients, with mixed results. This review examined the combined efficacy of ABM and CBT. A literature search was conducted in four main databases: PsycINFO, Embase, Pubmed and the Cochrane library, resulting in 11 randomized studies. The combination of ABM and CBT had small but significant effects on clinician-rated anxiety symptoms and attention bias towards threat compared to the control group, while ESs for anxiety (all measures), self-reported or parent-reported anxiety measures and depression symptoms were non-significant. Studies in which ABM was conducted as an integral part of each CBT session yielded greater reduction in anxiety symptoms than those conducting ABM and CBT at separate time points. Older participants and patients with social anxiety disorder tended to benefit less from the combination of ABM and CBT based on bias scores. This study may provide preliminary evidence that ABM and CBT have the potential to complement each other, especially when they are conducted integrally.

A systematic review of event-related potentials as outcome measures of attention bias modification

Attention bias modification (ABM) was initially developed with the goal of reducing attentional bias to threat-and subsequently anxious symptoms-in individuals with heightened anxiety. Although controversial, ABM appears to be generally effective in achieving this goal. Yet, the primary outcome measure of ABM (i.e., the reaction time-based differences score) has poor reliability and temporal resolution, which limits the inferences that can be drawn. In contrast, event-related potentials (ERPs) have superior reliability as well as temporal resolution and may therefore be better outcome measures of ABM. In this review, I systematically assess the research using ERPs as outcome measures in ABM protocols. I focus on the extent to which the ERPs modified by ABM represent earlier or later stages of information processing. In addition, I explore the extent to which ABM produces near and/or far transfer of learning effects on ERP measures. The reviewed literature suggests that ERPs are promising outcome measures of ABM. ABM modulates the effects of affective stimuli on posterior visually evoked ERPs (i.e., P1) as well as ERPs at anterior electrodes (i.e., P2, N2, and ERN). Based on the state of the field, several directions for future research are identified.

Personal relative deprivation impairs ability to filter out threat-related distractors from visual working memory

The literature has indicated that personal relative deprivation (PRD) results in anxiety disorders. Given that some cognitive models propose that attention bias toward a threat causes and maintains anxiety, relatively deprived individuals may have difficulty gating threat from working memory. To test this hypothesis, this study investigated the influence of PRD on the filtering ability of happy, angry, and neutral facial distractors from visual working memory using electroencephalography (EEG). Participants were randomly assigned to a PRD (n = 24) or a non-PRD group (n = 24). Filtering ability was reflected by comparing the contralateral delay activity (CDA) amplitude for one-target, one-target-one-distractor, and two-targets conditions. The CDA was measured as the difference in mean amplitudes between activity in the hemispheres contralateral and ipsilateral to the to-be-remembered information. Results indicated that individuals in the PRD group showed a reduced ability to filter out neutral and angry facial distractors, as reflected by similar CDA amplitudes for one-target-one-distractor and two-targets conditions for both angry and neutral distractors in the PRD group. However, PRD did not impair the ability to filter out happy facial distractors, as reflected by similar CDA amplitudes for one-target-one-distractor and one-target conditions for happy distractors in the PRD group. As neutral faces might then be taken as potentially threatening information by relatively deprived individuals, these results support the hypothesis that relatively deprived individuals might have difficulty filtering out threat-related information.

Autonomic reactivity to emotion: A marker of sub-clinical anxiety and depression symptoms?

Anxiety and depression are both characterized by dysregulated autonomic reactivity to emotion. However, most experiments until now have focused on autonomic reactivity to stimuli presented in central vision (CV) even if affective saliency is also observed in peripheral vision (PV). We compared autonomic reactivity to CV and PV emotional stimulation in 58 participants with high anxious (HA) or low anxious (LA) and high depressive (HD) or low depressive (LD) symptomatology, based on STAI-B and BDI scores, respectively. Unpleasant (U), pleasant (P), and neutral (N) pictures from IAPS were presented at three eccentricities (0°: CV; -12 and 12°: PV). Skin conductance (SC), skin temperature, pupillary diameter, and heart rate (HR) were recorded. First, HA participants showed greater pupil dilation to emotional than to neutral stimuli in PV than in CV. Second, in contrast to HD, the valence effect indexed by SC and emotional arousal effect indexed by skin temperature were observed in LD. Third, both anxiety and depression lead to a valence effect indexed by pupillary light reflex and heart rate. These results suggest a hyperreactivity to emotion and hypervigilance to PV in anxiety. Depression is associated with an attenuation of positive effect and a global blunted autonomic reactivity to emotion. Moreover, anxiety mostly modulates the early processes of autonomic reactivity whereas depression mainly affects the later processes. The differential impact of emotional information over the visual field suggests the use of new stimulation strategies in order to attenuate anxious and depressive symptoms.

The Generalization of Conscious Attentional Avoidance in Response to Threat Among Breast Cancer Women With Persistent Distress

Objectives

A sample of women with persistent distress following breast cancer (BC) previously exhibited attentional bias (AB) away from supraliminally presented cancer-or threat-related information, responses consistent with avoidance coping, and showed negative interpretation bias. Here, we attempt to characterize the nature of supraliminal AB and interpretation bias in that sample of women by comparing against healthy controls.

Methods

Extending our previous work, we compared AB patterns for supraliminally presented negatively valenced words and cancer-related information (CRI) assessed by modified dot-probe tasks and negative interpretation bias assessed by an ambiguous cue task between 140 BC women previously identified as featuring low-stable or persistent high anxiety and 150 age-matched non-BC healthy controls having HADS-defined low or high anxiety (HADS-anxiety scores = 8).

Results

Attentional avoidance of non-cancer-related negatively valenced words was seen among the anxious BC group, while heightened attention toward such words was seen in anxious healthy controls, F(3, 282) = 3.97, p = 0.009. However, all anxious women in both BC and healthy groups directed attention away from CRI under supraliminal conditions. Interpretation bias scores were significantly higher in BC women with high anxiety vs. healthy controls with high anxiety, F(3, 282) = 13.26, p < 0.001.

Conclusion

Women with high anxiety generalized conscious attentional avoidance responses to negatively valenced stimuli, indicating a likely hypersensitivity to potential threat in ambiguous cues and exaggerated threat perception. This may cause (or reflect) maladaptive emotional regulation. Attention focus training, reducing threat salience or modifying threat appraisal, may help women alleviate anxiety levels after BC.

Computational modelling of attentional bias towards threat in paediatric anxiety

Computational modelling can be used to precisely characterize the cognitive processes involved in attentional biases towards threat, yet so far has only been applied in the context of adult anxiety. Furthermore, studies investigating attentional biases in childhood anxiety have largely used tasks that conflate automatic and controlled attentional processes. By using a perceptual load paradigm, we separately investigate contributions from automatic and controlled processes to attentional biases towards negative stimuli and their association with paediatric anxiety. We also use computational modelling to investigate these mechanisms in children for the first time. In a sample of 60 children (aged 5‐11 years) we used a perceptual load task specifically adapted for children, in order to investigate attentional biases towards fearful (compared with happy and neutral) faces. Outcome measures were reaction time and percentage accuracy. We applied a drift diffusion model to investigate the precise cognitive mechanisms involved. The load effect was associated with significant differences in response time, accuracy and the diffusion modelling parameters drift rate and extra‐decisional time. Greater anxiety was associated with greater accuracy and the diffusion modelling parameter ‘drift rate’ on the fearful face trials. This was specific to the high load condition. These findings suggest that attentional biases towards fearful faces in childhood anxiety are driven by increased perceptual sensitivity towards fear in automatic attentional systems. Our findings from computational modelling suggest that current attention bias modification treatments should target perceptual encoding directly rather than processes occurring afterwards.

The Missing Pieces of the Puzzle: A Review on the Interactive Nature of A-Priori Expectancies and Attention Bias toward Threat

The role of attention bias in the etiology and maintenance of anxiety disorders has been studied extensively over decades. Attention bias reflects maladaptation in cognitive processing, as perceived threatening stimuli receive prioritized processing even when they are task-irrelevant or factually unthreatening. Recently, there has been some interest in the role of a-priori expectancies in attention bias toward threat. The current review article will present recent studies as examples that emphasize the need for more comprehensive research about the interactive effects of various factors that affect the relationship between expectancies and attention bias toward threatening stimuli in anxiety. The current review article suggests a holistic view, which advocates for more integrative research, as a dynamic network could underlie changes in attention bias. The study of the interaction between such factors, with a focus on expectancy, can lead to more ecological and clinically important results, and thus to more informed and fine-tuned treatments that are based on manipulation of expectancies. Such methods, in turn, can also help in shedding light on the research of attention bias, in a mutual relationship between research and therapy.

A School-Based Comparison of Positive Search Training to Enhance Adaptive Attention Regulation with a Cognitive-Behavioural Intervention for Reducing Anxiety Symptoms in Children

Many children experience anxiety but have limited access to empirically-supported interventions. School-based interventions using brief, computer-assisted training provide a viable way of reaching children. Recent evidence suggests that computer-delivered 'positive search training' (PST) reduces anxiety in children. This multi-informant, randomised controlled trial compared classroom-based, computer-delivered PST (N = 116) to a classroom-based, therapist-delivered cognitive-behavioural intervention (CBI) (N = 127) and a curriculum-as-usual control condition (CAU) (N = 60) in 7-11 year old children. Primary outcomes were child and parent report of child anxiety symptoms. Secondary outcomes were child and parent report of child depressive symptoms and child attention biases. Outcomes were assessed before and after the interventions, and six- and 12-months post-intervention. Teacher report of children's social-emotional functioning was assessed at pre- and post-intervention. As expected, compared to CAU, children receiving PST and the CBI reported greater anxiety reductions by post-intervention and six-month follow-up but, unexpectedly, not at 12-month follow-up. Partially consistent with hypotheses, compared to CAU, parents reported greater anxiety reductions in children receiving PST, but not the CBI, at 12-month follow-up. Contrary to expectation, there was a pre- to post-intervention increase in threat attention bias in PST compared to the other conditions, with no significant differences at follow-up. In support of hypotheses, teachers reported higher post-intervention social-emotional functioning in Year 5 students receiving the CBI but, unexpectedly, lower post-intervention functioning in students receiving PST. There were no effects on depressive symptoms. Further research is needed on strategies to maintain long-term benefits and determine preventative versus early intervention effects.

The relations among worry, meta-worry, intolerance of uncertainty and attentional bias for threat in men at high risk for generalized anxiety disorder: a network analysis

BACKGROUND

Improving the psychotherapies for generalized anxiety disorder (GAD) is dependent on a deeper understanding of the relations between GAD and its associated cognitive factors. In the present study, we investigate how the core feature of GAD (i.e., worry) and its associated cognitive factors, such as meta-worry, intolerance of uncertainty, and attention bias towards threat, relate to each other in men at high risk for GAD.

METHODS

We used network analysis to explore the relations among these variables in a cross-sectional sample of 122 men at high risk for generalized anxiety disorder. Specifically, we computed the expected influence and predictability of each variable.

RESULTS

In the final network, we found that worry and meta-worry had the highest expected influence and predictability. In contrast, attention bias towards threat showed the lowest expected influence and predictability. The estimates of the expected influence of the nodes were stable (correlation stability coefficient = 0.52).

CONCLUSIONS

The present study is the first to investigate the relations among worry, meta-worry, intolerance of uncertainty, and attention bias towards threat in men at high risk for generalized anxiety disorder. These findings indicate that worry and meta-worry may play important roles in the present network. The implications for clinical interventions and future studies are discussed.

An Integrative Framework of Appraisal and Adaptation in Serious Medical Illness

Multiple randomized clinical trials have demonstrated that palliative care improves the quality of life of individuals with serious medical illness. Research also suggests that in patients with advanced cancer, palliative care's focus on symptom management, coping with illness, goals of care, and treatment decisions may be associated with improved patient quality of life in part by increasing patients' use of active (vs. passive) and approach-oriented (vs. avoidant) coping strategies. However, without a framework outlining the process that individuals with serious medical illness and their loved ones undergo, it is challenging to discern exactly where, how, and why palliative care may affect the serious medical illness experience. To address this gap, we propose a clinically applicable framework, derived from existing theory and research in the social and behavioral sciences. This framework, called the Integrative Framework of Appraisal and Adaptation in Serious Medical Illness, describes how patients and their loved ones cognitively and emotionally process the various events that may occur as they navigate serious medical illness and the end of life. The framework also describes how individuals and their loved ones use that event processing to determine next steps, while considering the impact of their surrounding external environment, their individual social roles, and their connections on this decision making. The framework presented in this article is intended to improve our ability to understand and care for individuals with serious medical illness and their loved ones, while stimulating further discussion and research to test and refine these ideas.

Neural mechanisms underlying heterogeneous expression of threat-related attention in social anxiety

Theoretical frameworks propose that threat-related attention, which is typically assessed using the dot-probe paradigm, plays a key role in social anxiety. Within the dot-probe paradigm, novel computational approaches demonstrate that anxious individuals exhibit multiple patterns of threat-related attention on separate trials. However, no research has leveraged such novel computational methods to delineate the neural substrates of threat-related attention patterns in social anxiety. To address this issue, fifty-three socially anxious adults (22.38 ± 3.12, 33 females) completed an fMRI-based dot-probe paradigm. A novel, response-based computation approach revealed conjoint patterns of vigilant orientation, avoidant orientation, slow disengagement, and fast disengagement, which were masked by standard computation measures. Compared to vigilant orientation and fast disengagement, avoidant orientation and slow disengagement were greater in magnitude, respectively. Mirroring behavioral findings, avoidant orientation and slow disengagement elicited greater deactivation of several regions within the Default Mode Network and stronger connectivity between the right amygdala and superior temporal sulcus. Taken together, these results suggest that distinct neural processes facilitate the heterogeneous expression of threat-related attention in social anxiety.

Temporal trends in attention disengagement from social threat as a function of social anxiety

BACKGROUND AND OBJECTIVES

Difficulty disengaging attention from threat has been observed in some anxious samples, but the evidence to date is mixed. The current study examines temporal trends in attention disengagement and compares this construct across multiple forms of social threat.

METHODS

Participants (85 adults with a principal diagnosis of social anxiety disorder) completed a spatial cueing task with four image categories (angry faces, disapproving faces, neutral faces, neutral objects). Attention disengagement was assessed via reaction time (RT) over 256 trials.

RESULTS

Participants with greater social anxiety exhibited an initial delay in attention disengagement from disapproving faces that habituated over the course of the task. RTs to angry and neutral stimuli did not differ as a function of social anxiety.

LIMITATIONS

The current task only allowed for examining speed of attention disengagement, and thus we were unable to compare our results to trajectories of speed at which participants orient towards threat. Additionally, disapproving facial images were created for this paradigm and may benefit from further validation.

CONCLUSIONS

Findings suggest that social anxiety is associated with an initial delay in attention disengagement from social threat that resolves over the course of repeated exposures to such stimuli. Treatment implications are discussed.

Seeking neutral: A VR-based person-identity-matching task for attentional bias modification - A randomised controlled experiment

BACKGROUND

Attentional bias modification (ABM) aims to reduce anxiety by attenuating bias towards threatening information. The current study incorporated virtual reality (VR) technology and 3-dimensional stimuli with a person-identity-matching (PIM) task to evaluate the effects of a VR-based ABM training on attentional bias and anxiety symptoms.

METHODS

One hundred participants with elevated social anxiety were randomised to four training groups. Attentional bias was assessed at pre- and post-training, and anxiety symptoms were assessed at pre-training, post-training, 1-week follow-up, and 3-month follow-up.

RESULTS

Change in anxiety did not correlate with change in bias (r = -0.08). A repeated-measures ANOVA showed no significant difference in bias from pre- to post-ABM, or between groups. For anxiety symptoms, a linear mixed-effects model analysis revealed a significant effect of time. Participants showed reduction in anxiety score at each successive assessment (p < .001, Nagelkerke's pseudo r ² = 0.65). However, no other significant main effect or interactions were found. A clinically significant change analysis revealed that 4% of participants were classified as 'recovered' at 3-month follow-up.

CONCLUSIONS

A single session of VR-based PIM task did not change attentional bias. The significant reduction in anxiety was not specific to active training, and the majority of participants remained clinically unchanged.

Time course of pupillary response to threat words before and after attention bias modification for transdiagnostic anxiety disorders: A randomized controlled trial

INTRODUCTION

Altered attention to threatening stimuli at initial and sustained stages of processing may be dissociable dimensions that influence the development and maintenance of transdiagnostic symptoms of anxiety, such as vigilance, and possibly require distinct intervention. Attention bias modification (ABM) interventions were created to implicitly train attention away from threatening stimuli and have shown efficacy in treating anxiety. ABM alters neurocognitive functioning during initial stages of threat processing, but less is known regarding effects of ABM on neural indices of threat processing at sustained (i.e., intermediate and late) stages, or if ABM-related neural changes relate to symptom response. The current study utilized pupillary response as a temporally sensitive and cost-effective peripheral marker of neurocognitive response to ABM.

MATERIALS AND METHODS

In a randomized controlled trial, 79 patients with transdiagnostic anxiety provided baseline data, 70 were randomized to receive eight sessions of twice-weekly ABM (n = 49) or sham training (n = 21), and 65 completed their assigned treatment condition and returned for post-training assessment.

RESULTS

Among ABM, but not sham, patients, pupillary response to threat words during initial and intermediate stages decreased from pre- to post-training. Pre- to post-training reductions in intermediate and late pupillary response to threat were positively correlated with reductions in patient-reported vigilance among ABM, but not sham, patients.

CONCLUSIONS

All measured stages of threat processing had relevance in understanding the neural mechanisms of ABM, with overlapping yet dissociable roles exhibited within a single neurophysiological marker across an initial-intermediate-late time continuum. Pupillometry may be well suited to measure both target engagement and treatment outcome following ABM.

Influence of hunger on attentional engagement with and disengagement from pictorial food cues in women with a healthy weight

Because of inconsistencies in the field of attentional bias to food cues in eating behavior, this study aimed to re-examine the assumption that hungry healthy weight individuals have an attentional bias to food cues, but satiated healthy weight individuals do not. Since attentional engagement and attentional disengagement have been proposed to play a distinct role in behavior, we used a performance measure that is specifically designed to differentiate between these two attentional processes. Participants were healthy weight women who normally eat breakfast. In the satiated condition (n = 54), participants were instructed to have breakfast just before coming to the lab. In the fasted condition (n = 50), participants fasted on average 14 h before coming into the lab. Satiated women showed no stronger attentional engagement or attentional disengagement bias to food cues than to neutral cues. Fasted women did show stronger attentional engagement to food cues than to neutral cues that were shown briefly (100 ms). They showed no bias in attentional engagement to food cues that were shown longer (500 ms) or in attentional disengagement from food cues. These findings are in line with the assumption that healthy weight individuals show an attentional bias to food cues when food stimuli are motivationally salient. Furthermore, the findings point to the importance of differentiating between attentional engagement and attentional disengagement.

Oxytocin Differentially Modulates Amygdala Responses during Top-Down and Bottom-Up Aversive Anticipation

The ability to successfully regulate negative emotions such as fear and anxiety is vital for mental health. Intranasal administration of the neuropeptide oxytocin (OXT) has been shown to reduce amygdala activity but to increase amygdala-prefrontal cortex connectivity during exposure to threatening stimuli suggesting that it may act as an important modulator of emotion regulation. The present randomized, between-subject, placebo-controlled pharmacological study combines the intranasal administration of OXT with functional magnetic resonance imaging (fMRI) during an explicit emotion regulation paradigm in 65 healthy male participants to investigate the modulatory effects of OXT on both bottom-up and top-down emotion regulation. OXT attenuates the activation in the posterior insular cortex and amygdala during anticipation of top-down regulation of predictable threat stimuli in participants with high trait anxiety. In contrast, OXT enhances amygdala activity during the bottom-up anticipation of unpredictable threat stimuli in participants with low trait anxiety. OXT may facilitate top-down goal-directed attention by attenuating amygdala activity in high anxiety individuals, while promoting bottom-up attention/vigilance to unexpected threats by enhancing amygdala activity in low anxiety individuals. OXT may thus have the potential to promote an adaptive balance between bottom-up and top-down attention systems depending on an individual's trait anxiety level.

Attentional bias towards negative stimuli in healthy individuals and the effects of trait anxiety

This study aimed to investigate the time course of attentional bias for negative information in healthy individuals and to assess the associated influence of trait anxiety. Thirty-eight healthy volunteers performed an emotional dot-probe task with pairs of negative and neutral scenes, presented for either 1 or 2 s and followed by a target placed at the previous location of either negative or neutral stimulus. Analyses included eye movements during the presentation of the scenes and response times associated with target localization. In a second step, analyses focused on the influence of trait anxiety. While there was no significant difference at the behavioral level, the eye-tracking data revealed that negative information held longer attention than neutral stimuli once fixated. This initial maintenance bias towards negative pictures then increased with increasing trait anxiety. However, at later processing stages, only individuals with the highest trait anxiety appeared to fixate longer on negative pictures than neutral pictures, individuals with low trait anxiety showing the opposite pattern. This study provides novel evidence that healthy individuals display an attentional maintenance bias towards negative stimuli, which is associated with trait anxiety.

Attentional Bias and Training in Individuals With High Dental Anxiety

Dental anxiety is common and associated with negative outcomes. According to information-processing models, anxiety is maintained by maladaptive patterns of processing threatening information. Furthermore, attention training interventions can reduce anxiety in one session. Fifty-three individuals with high levels of dental anxiety completed a Posner reaction-time task. Participants were randomized to attention training or control using a dot-probe task, and then attentional bias was remeasured using another Posner task. Participants then completed a script-driven imaginal exposure task. Results indicated that individuals high in dental anxiety exhibit threat-relevant attentional bias. There was mixed evidence about the efficacy of attention training. On the one hand, training did not eliminate attentional bias and training condition did not predict distress during the imagery task. On the other hand, cue dependency scores in the control group were higher for dental than neutral cues, but did not differ in the training group. In addition, cue dependency scores for both dental and neutral cues predicted subjective anxiety in anticipation of the imagery task. The mixed results of training are considered in terms of the possibility that it enhanced attentional control, rather than reducing bias.

Attentional avoidance of emotions in functional movement disorders

OBJECTIVE

Emotional difficulties are common in functional movement disorders (FMD), yet their contribution to the disease remains unclear. We explored the potential role of emotional difficulties as risk and maintaining factors of FMD by looking at the effect of emotions on attention.

METHOD

The dot-probe task was used to investigate attentional biases induced by emotional faces in 25 patients with FMD and 25 healthy controls (HC). A pair of faces, one emotional (happy, angry, sad) and the other neutral, was displayed on a monitor to either the left or the right side of a central fixation cross. The face disappeared and a dot was flashed in place of one of the faces. Participants had to indicate the location of the dot. All participants completed the Toronto Alexithymia Scale. Psychological assessment of 23 patients also involved the Short Form Health Survey, the Hamilton Anxiety and the Hamilton Depression Rating Scales.

RESULTS

A general attentional bias away from emotional faces was noted for the FMD group compared to the HC. A more fine-tuned analysis revealed an attentional bias specifically away from sad faces for the FMD.

CONCLUSION

Our findings suggest a specific effect of emotions on attention in FMD that likely involves avoidance of sadness. Since this was not related to alexithymia or mood, we excluded these factors in explaining the results. Attentional bias away from sad faces correlated with general health, suggesting that avoidance of sadness might contribute to the perception of a better general health status in FMD.

Association of Intrinsic Brain Architecture With Changes in Attentional and Mood Symptoms During Development

Importance

Understanding the neurodevelopmental trajectory of psychiatric symptoms is important for improving early identification, intervention, and prevention of mental disorders.

Objective

To test whether the strength of the coupling of activation between specific brain regions, as measured by resting-state functional magnetic resonance imaging (fMRI), predicted individual children's developmental trajectories in terms of attentional problems characteristic of attention-deficit/hyperactivity disorder and internalizing problems characteristics of major depressive disorder (MDD).

Design, Setting, and Participants

A community cohort of 94 children was recruited from Vanderbilt University between 2010 and 2013. They were followed up longitudinally for 4 years and the data were analyzed from 2016 to 2019. Based on preregistered hypotheses and an analytic plan, we examined whether specific brain connectivity patterns would be associated with longitudinal changes in scores on the Child Behavior Checklist (CBCL), a parental-report assessment used to screen for emotional, behavioral, and social problems and to predict psychiatric illnesses.

Main Outcomes and Measures

We used the strength of resting-state fMRI connectivity at age 7 years to predict subsequent changes in CBCL measures 4 years later and investigated the mechanisms of change by associating brain connectivity changes with changes in the CBCL.

Results

We analyzed data from a longitudinal brain development study involving children assessed at age 7 years (n = 94; 41 girls [43.6%]) and 11 years (n = 54; 32 girls [59.3%]). As predicted, less positive coupling at age 7 years between the medial prefrontal cortex and dorsolateral prefrontal cortex (DLPFC) was associated with a decrease in attentional symptoms by age 11 years (t49 = 2.38; P = .01; β = 0.32). By contrast, a less positive coupling between a region implicated in mood, the subgenual anterior cingulate cortex (sgACC), and DLPFC at age 7 years was associated with an increase in internalizing (eg, anxiety/depression) behaviors by age 11 years (t49 = -2.4; P = .01; β = -0.30). Logistic regression analyses revealed that sgACC-DLPFC connectivity was a more accurate predictor than baseline CBCL measures for progression to a subclinical score on internalization (t50 = -2.61; P = .01; β = -0.29). We then replicated and extended the sgACC-DLPFC result in an independent sample of children with (n = 25) or without (n = 18) familial risk for MDD.

Conclusions and Relevance

These resting-state fMRI metrics are promising biomarkers for the early identification of children at risk of developing MDD or attention-deficit/hyperactivity disorder.

Attentional biases in older adults with generalized anxiety disorder

Cognitive theories of anxiety propose that selective attention to negative information plays a central role in the development and maintenance of anxiety. The presence of such attentional bias has been confirmed in younger adults. Nevertheless, there are few studies that have explored anxiety-linked attentional bias in older adults, and the available results are inconclusive. Conversely, the socioemotional selectivity theory posits that there are age-related changes in emotional information processing and, consistent with this account, it has been found that older adults preferentially pay more attention to positive stimuli compared with younger adults ("positivity effect"). The present study aimed to explore attentional bias towards negative and positive information in a sample of older adults with generalized anxiety disorder (GAD) compared with a control group. The results showed that older adults with GAD displayed an attentional preference for negative information and attentional avoidance for positive information, whereas healthy older adults showed the reverse pattern of attentional deployment. These results suggest that selective attention toward negative information and selective avoidance of positive information may be a relevant factor in clinically anxious older adults.

Effects of an Acute Physical Activity Break on Test Anxiety and Math Test Performance

(1) Background: Test anxiety has been found to negatively affect students' mental health and academic performance. A primary explanation for this is that anxiety-related thoughts occupy working memory resources during testing that cannot be used for test-related processes (such as information retrieval and problem-solving). The present intervention study investigated whether physical activity could decrease anxiety levels and improve maths test performance in sixth-grade children. (2) Methods: Sixty-eight children of 11-12 years from two primary schools in New South Wales, Australia were categorised as low or high anxious from their scores on a trait-anxiety questionnaire. After this assessment, they were randomly assigned to the activity break condition, in which they had to do several physical activities of moderate intensity (i.e., star jumps) for 10 min, or the control condition, in which they played a vocabulary game for 10 min. The outcome measures were children's anxiety levels at the beginning, during, and at the end of the test, invested mental effort, perceived task difficulty and maths test performance. (3) Results: Results showed that regardless of the condition, low anxious students performed better on the maths test than high anxious children. No differences were found for any of the variables between the activity break condition and the control condition. (4) Conclusions: Although test anxiety was not reduced as expected, this study showed that short physical activity breaks can be used before examinations without impeding academic performance.