Attention training to reduce attention bias and social stressor reactivity: an attempt to replicate and extend previous findings

Attentional bias modification in male college smokers: The changes of facilitated attention, difficulty in disengagement and the transfer effects of training

BACKGROUND

Attentional bias modification (ABM) has been used to modify the attentional bias (AB) towards smoking-related cues. Still, the effects of ABM are extensively controversial. The present study aimed to investigate the effects of ABM on AB and its two sub-processes named facilitated attention and difficulty in disengagement at two different stimulus durations, as well as test whether the effects of ABM could transfer to new measures of AB.

METHOD

Forty-six male college smokers were allocated to either ABM group using a modified visual probe task (n = 24), or the corresponding placebo training (PT) group (n = 22). Participants performed three sessions of training in one week. The pre- and post-training AB and its sub-processes were measured using visual probe task. Cue-target task and pictorial Stroop task were used for testing the transfer effects of ABM.

RESULTS

The AB in ABM group was significantly decreased compared with the PT group. Specifically, the facilitated attention was significantly reduced at 200 ms stimulus duration, while the difficulty in disengagement was significantly decreased at 500 ms stimulus duration. The benefit of ABM training could transfer to the cue-target task, but not to the pictorial Stroop task. Meanwhile, no effects of ABM were observed on smoking craving and nicotine dependence.

CONCLUSIONS

These findings suggested that the stimulus duration is a crucial factor for the efficacy of ABM on the facilitated attention and the difficulty in disengagement in male college smokers and detected the transfer effects between different measures of AB to some extent. Future studies need to further explore the influence mechanism in distinct stimulus durations.

The influence of single-session reward-based attentional bias modification on attentional biases towards threat as measured by the N2pc component

Attentional biases toward threatening faces have repeatedly been studied in the context of social anxiety, with etiological theories suggesting exacerbated biases as a possible cause for the latter. To counteract these postulated effects, research has focused on the concept of attentional bias manipulation (ABM), in which spatial contingencies between succeeding stimuli are traditionally employed in training paradigms designed to deliberately shift automatic attention processes away from threat-related stimuli. The ABM research field has been faced with various methodological challenges, such as inconsistent results, low reliabilities of dependent variables and a high susceptibility to moderating factors. We aimed to combine several recent approaches to address these issues. Drawing upon theories of value-driven attention, we explored reward-based contingencies in a Dot Probe task to improve the training's efficacy, combined with neurophysiological measures for greater reliability compared to reaction times, while evaluating the moderating effect of explicitness in the instruction. In a healthy sample (N = 60) and within a single session, we found a general attentional bias toward angry faces present across all conditions as indicated by the N2pc, which was, however, marked by large intrinsic lateralization effects, with submeasures exhibiting opposing polarities. This prompted us to explore an alternative, intrahemispheric calculation method. The new N2pc variant showed the attentional bias to have disappeared at the end of the training session within the explicit instruction group. Reliabilities of the main dependent variables were varied from excellent to questionable, which, together with the exploratory nature of the analysis, leaves this result as preliminary.

The effect of immersive virtual reality-based attentional bias modification on anxiety mitigation in healthy population

The present study compared an immersive virtual reality-based attentional bias modification (immersive VR-ABM) with the desktop version of the VR-ABM and an immersive virtual reality-based game (immersive VR-game) to examine the possible effect of the immersive presence on self-reported emotional reactions to a stressful task. One hundred and twenty participants were randomly assigned into three groups, and each group received a three-turn induction-intervention training. Anxiety symptoms were assessed at pre-induction, post-induction, and post-training. Results showed that virtual reality-based anxiety was induced and alleviated successfully in all three groups, but only the immersive VR-ABM group showed an accumulated effect on self-reported anxiety across sessions. The attentional bias based on probe latencies indicated no significant change in either the immersive or desktop VR-ABM groups. The present findings support the hypothesized VR-ABM's effect on self-reported anxiety at the immersive presence. The practical implications of using immersive VR-ABM are discussed for obtaining ecological validity.

Single Session and Short-Term Exercise for Mental Health Promotion in Tertiary Students: A Scoping Review

Exercise can improve mental health; however many tertiary students do not reach recommended levels of weekly engagement. Short-term exercise may be more achievable for tertiary students to engage in to promote mental health, particularly during times of high stress. The current scoping review aimed to provide an overview of controlled trials testing the effect of short-term (single bout and up to 3 weeks) exercise across mental health domains, both at rest and in response to an experimentally manipulated laboratory stress task, in tertiary students. The search was conducted using 'Evidence Finder,' a database of published and systematic reviews and controlled trials of interventions in the youth mental health field. A total of 14 trials meet inclusion criteria, six measured mental health symptoms in response to an experimentally manipulated laboratory stress task and the remaining eight measured mental health symptoms. We found that short-term exercise interventions appeared to reduce anxiety like symptoms and anxiety sensitivity and buffered against a drop in mood following an experimentally manipulated laboratory stress task. There was limited available evidence testing the impacts of exercise on depression like symptoms and other mental health mental health domains, suggesting further work is required. Universities should consider implementing methods to increase student knowledge about the relationship between physical exercise and mental health and student access to exercise facilities.

Poor reporting of physical activity and exercise interventions in youth mental health trials: A brief report

AIM

To describe the quality and completeness of the description and reporting of physical activity and exercise interventions delivered to young people to promote mental health or treat mental illness.

METHODS

We conducted a series of scoping reviews identifying 64 controlled trials of physical activity and exercise interventions delivered to young people. We extracted: intervention characteristics, personnel and delivery format, the intensity, duration, frequency and type of physical activity or exercise.

RESULTS

There was limited reporting of intervention details across studies; 52% did not provide information to confidently assess intervention intensity, 29% did not state who delivered the intervention, and 44% did not specify the intervention delivery format.

CONCLUSIONS

We recommend that authors adhere to the CONSORT reporting requirements and its intervention reporting extensions, (a) the Template for Intervention Description and Replication, (b) Consensus for Exercise Reporting Template and (c) as part of this, detail the frequency, intensity, time and type of physical activity recommendations and prescriptions. Without this, future trials are unable to replicate and extend previous work to support or disconfirm existing knowledge, leading to research waste and diminishing translation and implementation potential.

Low working memory load facilitates attention bias modification training

Implementations of attention bias modification training (ABMT) attempt to retrain attention away from rather than towards threat, thereby disrupting the anxiety-related attentional bias (AB). Yet, results of ABMT studies have been mixed due to limitations in knowledge of mechanisms underlying ABMT efficacy. Dual-process models of anxiety posit that ABMT works primarily through strengthening of the top-down cognitive control of attention to threat. If this is the case, introducing a working memory load (WML) during ABMT should reduce training efficacy. However, prior studies employing this method show mixed results (Booth, Mackintosh, Mobini, Oztop, & Nunn, 2014; Clarke et al., 2017) and fail to directly compare low and high WML with no WML or to account for individual differences in anxiety and working memory capacity (WMC). The present study (N = 306) assessed trait anxiety and WMC in neurotypical adults who were then randomly assigned to ABMT that trained attention toward or away from threat, with either no, low, or high WML, for a total of six training groups. Attentional bias was assessed before and after training. Results showed ABMT successfully trained attention under low WML, but not under high or no WML, suggesting that ABMT is facilitated by engaging but not overtaxing WML.

tDCS-Augmented in vivo exposure therapy for specific fears: A randomized clinical trial

Exposure therapy is highly effective for anxiety-related disorders, but there is a need for enhancement. Recent trials of adjunctive neuromodulation have shown promise, warranting evaluation of transcranial direct current stimulation (tDCS) as an augmentation. In a double-blind, placebo-controlled trial, contamination- and animal-phobic participants (N = 49) were randomized to active tDCS (1.7 mA, 20 min; n = 27), or sham tDCS (1.7 mA, 30 s; n = 22), followed by 30 min of in-vivo exposure. Active tDCS targeted excitation of the left mPFC and inhibition of the right dlPFC; polarity was counterbalanced for controls. We predicted tDCS would result in accelerated and better maintained gains, contingent on the subsequent in-session response, and baseline negative prognostic indicators. Consistent with predictions, tDCS promoted engagement and reductions in threat appraisals during exposure, and greater reductions in distress and threat appraisals through 1-month, although effects did not uniformly generalize. tDCS was most beneficial given high phobic severity, anxiety sensitivity, and a suboptimal early response. tDCS may promote engagement and response among individuals who are resistant or refractory to standard treatment. tDCS should be applied to more severe anxiety-related disorders, with parameters yoked to individual differences to improve outcomes in exposure-based interventions.

Effect of Acute Aerobic Exercise on Ocular Measures of Attention to Emotionally Expressive Faces

BACKGROUND

Mechanisms underlying exercise-induced mood enhancement are not well understood, but it is plausible that adaptive changes in attention to emotional stimuli underlie this effect. Thus, this study examined the effects of acute aerobic exercise on eye-tracking metrics while participants viewed emotionally expressive faces.

METHODS

Thirty-four adults (18 women) aged 21.1 ± 1.4 years completed two counterbalanced 30-min conditions: vigorous running or seated rest. Eye tracking occurred pre- and 20-min post-condition. Participants viewed positive (n = 15), negative (n = 15), and neutral (n = 15) emotional facial expressions from the NimStim repository. Fixation duration, longest fixation, number of fixations, and scan path length were analyzed using repeated measures ANOVAs.

RESULTS

Exercise improved mood, but had no effect on the dependent measures (all 3-way interactions p > 0.66). However, a main effect of emotionally expressive content for fixation duration (p = 0.04, η = 0.10) and a marginally significant effect for longest fixation (p = 0.06, ηp2 = 0.09) were detected, such that fixation duration and longest fixation were greatest for faces expressing positive emotions.

CONCLUSION

These preliminary findings indicated that acute exercise did not alter the processing of expressive faces as indexed by eye-tracking metrics of attention. However, eye tracking effectively detected processing patterns indicative of a pleasure bias while viewing emotional facial expressions.

Assessing the Relative Impact of Diverse Stressors among Public Safety Personnel

Public Safety Personnel (PSP; e.g., correctional workers and officers, firefighters, paramedics, police officers, and public safety communications officials (e.g., call center operators/dispatchers)) are regularly exposed to potentially psychologically traumatic events (PPTEs). PSP also experience other occupational stressors, including organizational (e.g., staff shortages, inconsistent leadership styles) and operational elements (e.g., shift work, public scrutiny). The current research quantified occupational stressors across PSP categories and assessed for relationships with PPTEs and mental health disorders (e.g., anxiety, depression). The participants were 4820 PSP (31.7% women) responding to established self-report measures for PPTEs, occupational stressors, and mental disorder symptoms. PPTEs and occupational stressors were associated with mental health disorder symptoms (ps < 0.001). PSP reported substantial difficulties with occupational stressors associated with mental health disorder symptoms, even after accounting for diverse PPTE exposures. PPTEs may be inevitable for PSP and are related to mental health; however, leadership style, organizational engagement, stigma, sleep, and social environment are modifiable variables that appear significantly related to mental health.

Attentional Bias Modification in Virtual Reality - A VR-Based Dot-Probe Task With 2D and 3D Stimuli

Background

Attentional bias modification (ABM) aims to reduce anxiety by attenuating bias toward threatening information. The current study incorporated virtual reality (VR) technology and three-dimensional stimuli with a dot-probe task to evaluate the effects of a VR-based ABM training on attentional bias and anxiety symptoms.

Methods

A total of 100 participants were randomized 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-months follow-up.

Results

Change in anxiety did not correlate with change in bias (p = 0.24). A repeated-measures ANOVA showed no significant difference in bias from pre- to post-ABM (p = 0.144), or between groups (p = 0.976). 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 < 0.001). However, no other significant main effect or interactions were found. A clinically significant change analysis revealed that 9% of participants were classified as ‘recovered’ at 3-months follow-up.

Conclusion

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

Therapeutic strategies for social anxiety disorder: where are we now?

Introduction: Classical well-established treatments of social anxiety disorder (SAD) are now complemented by more recent therapeutic strategies. This review aims to summarize available therapies for SAD and discuss recent evidence-based findings on the management of this disorder.Areas covered: Recent guidelines recommend psychotherapy, particularly cognitive-behavioral therapy (CBT), and pharmacotherapy, as first-line treatments of patients with SAD, without a clear superiority of one option over the other. CBT includes classical approaches such as in vivo exposure to social situations and cognitive therapy, but new modalities and techniques have been recently developed: third-wave approaches, internet-delivered therapy, virtual reality exposure, and cognitive bias modification. Selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors have been also extensively studied and shown to be effective in SAD. Two alternative strategies have been developed to treat SAD with disappointing results: cognitive bias modification, and pharmacological augmentation of psychotherapy using D-cycloserine during exposure sessions.Expert opinion: Personalized treatments for SAD patients are now available. Innovative strategies such as online psychotherapy and virtual reality exposure are useful alternatives to CBT and SSRIs. Future developments and optimization of attention bias modification and of pharmacological augmentation of psychotherapy can be promising.

Pinpointing mechanisms of a mechanistic treatment: Dissociable roles for overt and covert attentional processes in acute and long-term outcomes following Attention Bias Modification

Biased patterns of attention towards threat are implicated as key mechanisms in anxiety which can be modified through automated intervention (Attention Bias Modification; ABM). Intervention refinement and personalized dissemination efforts are substantially hindered by gaps in understanding the precise attentional components that underlie ABM's effects on symptoms-particularly with respect to longer-term outcomes. Seventy adults with transdiagnostic anxiety were randomized to receive 8 sessions of active ABM (n=49) or sham training (n=21). Reaction time and eyetracking data, collected at baseline, post-training, and 1-month follow-up, dissociated multiple core attentional processes, spanning overt and covert processes of engagement and disengagement. Self-reported symptoms were collected out to 1-year follow-up. Covert disengagement bias was specifically reduced by ABM, unlike all other indices. Overt disengagement bias at baseline predicted acute post-ABM outcomes, while covert engagement bias was non-specifically predictive of symptom trajectories out to 1-year follow-up. Results suggest unique and dissociable roles for each discrete mechanism.

Emotion-in-Motion, a Novel Approach for the Modification of Attentional Bias: An Experimental Proof-of-Concept Study

Background

Individuals with heightened anxiety vulnerability tend to preferentially attend to emotionally negative information, with evidence suggesting that this attentional bias makes a causal contribution to anxiety vulnerability. Recent years have seen an increase in the use of attentional bias modification (ABM) procedures to modify patterns of attentional bias; however, often this change in bias is not successfully achieved.

Objective

This study presents a novel ABM procedure, Emotion-in-Motion, requiring individuals to engage in patterns of attentional scanning and tracking within a gamified, complex, and dynamic environment. We aimed to examine the capacity of this novel procedure, as compared with the traditional probe-based ABM procedure, to produce a change in attentional bias and result in a change in anxiety vulnerability.

Methods

We administered either an attend-positive or attend-negative version of our novel ABM task or the conventional probe-based ABM task to undergraduate students (N=110). Subsequently, participants underwent an anagram stressor task, with state anxiety assessed before and following this stressor.

Results

Although the conventional ABM task failed to induce differential patterns of attentional bias or affect anxiety vulnerability, the Emotion-in-Motion training did induce a greater attentional bias to negative faces in the attend-negative training condition than in the attend-positive training condition (P=.003, Cohen d=0.87) and led to a greater increase in stressor-induced state anxiety faces in the attend-negative training condition than in the attend-positive training condition (P=.03, Cohen d=0.60).

Conclusions

Our novel, gamified Emotion-in-Motion ABM task appears more effective in modifying patterns of attentional bias and anxiety vulnerability. Candidate mechanisms contributing to these findings are discussed, including the increased stimulus complexity, dynamic nature of the stimulus presentation, and enriched performance feedback.

Affect-Driven Attention Biases as Animal Welfare Indicators: Review and Methods

Attention bias describes the differential allocation of attention towards one stimulus compared to others. In humans, this bias can be mediated by the observer's affective state and is implicated in the onset and maintenance of affective disorders such as anxiety. Affect-driven attention biases (ADABs) have also been identified in a few other species. Here, we review the literature on ADABs in animals and discuss their utility as welfare indicators. Despite a limited research effort, several studies have found that negative affective states modulate attention to negative (i.e., threatening) cues. ADABs influenced by positive-valence states have also been documented in animals. We discuss methods for measuring ADAB and conclude that looking time, dot-probe, and emotional spatial cueing paradigms are particularly promising. Research is needed to test them with a wider range of species, investigate attentional scope as an indicator of affect, and explore the possible causative role of attention biases in determining animal wellbeing. Finally, we argue that ADABs might not be best-utilized as indicators of general valence, but instead to reveal specific emotions, motivations, aversions, and preferences. Paying attention to the human literature could facilitate these advances.

Relations of emotion-related temperamental characteristics to attentional biases and social functioning

The current study examined whether an important temperamental characteristic, effortful control (EC), moderates the associations between dispositional anger and sadness, attention biases, and social functioning in a group of preschool-aged children (N = 77). Preschoolers' attentional biases toward angry and sad facial expressions were assessed using eye-tracking, and we obtained teachers' reports of children's temperament and social functioning. Associations of dispositional anger and sadness with time looking at relevant negative emotional stimuli were moderated by children's EC, but relations between time looking at emotional faces and indicators of social functioning, for the most part, were direct and not moderated by EC. In particular, time looking at angry faces (and low EC) predicted high levels of aggressive behaviors, whereas longer time looking at sad faces (and high EC) predicted higher social competence. Finally, latency to detect angry faces predicted aggressive behavior under conditions of average and low levels of EC. Findings are discussed in terms of the importance of differentiating between components of attention biases toward distinct negative emotions, and implications for attention training. (PsycINFO Database Record

Attention and interpretation bias modification treatment for social anxiety disorder: A randomized clinical trial of efficacy and synergy

BACKGROUND AND OBJECTIVES

Attention bias modification treatment (ABMT) and cognitive bias modification of interpretation (CBM-I) both have demonstrated efficacy in alleviating social anxiety, but how they compare with each other, their combination, and with a combined control condition has not been studied. We examined their relative and combined efficacy compared to control conditions in a randomized controlled trial (RCT).

METHODS

Ninety-five adults diagnosed with social anxiety disorder (SAD), were randomly allocated to 4 groups: ABMT + CBM-I control (hereafter ABMT; n = 23), CBM-I + ABMT control (hereafter CBM-I; n = 24), combined ABMT + CBM-I (n = 23), and combined control (n = 25). Treatment included eight sessions over four weeks. Clinician-rated and self-reported measures of social anxiety symptoms, functional impairment, and threat-related attention and interpretive biases were evaluated at baseline, post-treatment, and 3-month follow-up.

RESULTS

ABMT yielded greater symptom reduction as measured by both clinician-ratings (Cohen's ds = 0.57-0.70) and self-reports (ds = 0.70-0.85) compared with the CBM-I, the combined ABMT + CBM-I, and the combined control conditions. Neither of the other conditions demonstrated superior symptom change compared to the control condition. No group differences were found for functioning or cognitive biases measures.

LIMITATIONS

Limitations mainly include the mix of active and control treatments applied across the different groups. Therefore, the net effect of each of the treatments by itself could not be clearly tested.

CONCLUSIONS

Results suggest superiority of ABMT compared to CBM-I and their combination in terms of symptom reduction. Possible interpretations and methodological issues underlying the observed findings are discussed.

Core Mechanisms of Cognitive Behavioral Therapy for Anxiety and Depression: A Review

This article reviews the extant literature on mediators of change in cognitive behavioral therapy (CBT) for anxiety and depression. The authors briefly discuss the efficacy of CBT for anxiety and depression and methods of mediation analysis and detection. Then the authors discuss fear extinction in anxiety treatment and cognitive change in depression treatment.

Effects of cognitive bias modification on social anxiety: A meta-analysis

Background

Cognitive bias modification (CBM), a set of techniques for modifying bias in information processing—is considered a novel intervention for social anxiety disorder (SAD), which has drawn considerable interest from researchers. However, the effects of CBM on SAD are not consistent. Some studies have demonstrated significant positive effects compared to control groups, while others have found no such effects.

Aims

We conducted a meta-analysis aimed at quantitatively assessing the effects of CBM on SAD at post-test.

Method

Through a systematic literature search by two independent raters, 34 articles (36 randomized studies) including 2,550 participants were identified. A multilevel modeling approach was employed to assess the effects of CBM on SAD, and to explore the potentially crucial procedures and sample characteristics that enhance the effectiveness of benign training.

Results

In general, there were small but significant effects of CBM on the primary symptoms of SAD (g = 0.17), cognitive bias (CB) toward threat (g = 0.32), and reactivity in stressful situations (g = 0.25), but non-significant effects on secondary symptoms. However, the interpretation modification program was more effective than was attentional bias modification in reducing SAD primary symptoms and negative CB. Laboratory training procedures produced larger primary symptom reductions compared to Internet-based training, whereas the percentage of contingency and feedback about training performance boosted cognitive effects only. Finally, the following groups were more likely to benefit from CBM: younger participants (primary symptoms and cognitive effects), women (primary symptom effects), and samples with stronger CB (stressor effects). The quality of the randomized controlled trials was less than desirable, as there was some indication of publication bias in our study.

Conclusions

Current findings broadly supported cognitive theories of SAD that consider a bidirectional or mutually reinforcing relationship between symptoms and CBs. However, the small therapeutic effect observed here indicates that it is necessary to develop more reliable and efficient CBM interventions that are specific to SAD.

Attentional bias modification based on visual probe task: methodological issues, results and clinical relevance

INTRODUCTION

Attentional bias, the tendency that a person has to drive or maintain attention to a specific class of stimuli, may play an important role in the etiology and persistence of mental disorders. Attentional bias modification has been studied as a form of additional treatment related to automatic processing.

OBJECTIVES

This systematic literature review compared and discussed methods, evidence of success and potential clinical applications of studies about attentional bias modification (ABM) using a visual probe task.

METHODS

The Web of Knowledge, PubMed and PsycInfo were searched using the keywords attentional bias modification, attentional bias manipulation and attentional bias training. We selected empirical studies about ABM training using a visual probe task written in English and published between 2002 and 2014.

RESULTS

Fifty-seven studies met inclusion criteria. Most (78%) succeeded in training attention in the predicted direction, and in 71% results were generalized to other measures correlated with the symptoms.

CONCLUSIONS

ABM has potential clinical utility, but to standardize methods and maximize applicability, future studies should include clinical samples and be based on findings of studies about its effectiveness.

Online attention modification for social anxiety disorder: replication of a randomized controlled trial

Social anxiety disorder (SAD) models posit vigilance for external social threat cues and exacerbated self-focused attention as key in disorder development and maintenance. Evidence indicates a modified dot-probe protocol may reduce symptoms of SAD; however, the efficacy when compared to a standard protocol and long-term maintenance of treatment gains remains unclear. Furthermore, the efficacy of such protocols on SAD-related constructs remains relatively unknown. The current investigation clarified these associations using a randomized control trial replicating and extending previous research. Participants with SAD (n = 113; 71% women) were randomized to complete a standard (i.e. control) or modified (i.e. active) dot-probe protocol consisting of 15-min sessions twice weekly for four weeks. Self-reported symptoms were measured at baseline, post-treatment, and 4-month and 8-month follow-ups. Hierarchical linear modeling indicated significant self-reported reductions in symptoms of social anxiety, fear of negative evaluation, trait anxiety, and depression, but no such reductions in fear of positive evaluation. Symptom changes did not differ based on condition and were maintained at 8-month follow-up. Attentional biases during the dot-probe task were not related to symptom change. Overall, our results replicate support for the efficacy of both protocols in reducing symptoms of SAD and specific related constructs, and suggest a role of exposure, expectancy, or practice effects, rather than attention modification, in effecting such reductions. The current results also support distinct relationships between fears of negative and positive evaluation and social anxiety. Further research focused on identifying the mechanisms of change in attention modification protocols appears warranted.

An integrative network approach to social anxiety disorder: The complex dynamic interplay among attentional bias for threat, attentional control, and symptoms

Cognitive models posit that social anxiety disorder (SAD) is associated with and maintained by biased attention allocation vis-à-vis social threat. However, over the last decade, there has been intense debate regarding whether AB in SAD results from preferential engagement with or difficulty in disengaging from social threat. Further, recent evidence suggests that AB may merely result from top-down attentional impairments vis-à-vis non-emotional material. Consequently, uncertainty still abounds regarding both the relative importance and the mutual interactions of these different processes and SAD symptoms. Inspired by novel network approaches to psychopathology that conceptualize symptoms as complex dynamic systems of mutually interacting variables, we computed weighted directed networks to investigate potential causal relations among laboratory measures of attentional components and symptoms of social anxiety disorder. Global and local connectivity of network structures revealed that the three most central variables were the orienting component of attention as well as both avoidance and fear of social situations. Neither preferential attention engagement with threat nor difficulty disengaging from threat exhibited high relative importance as predictors of symptoms in the network. Together, these findings suggest the value of extending the network approach beyond self-reported clinical symptoms to incorporate process-level measures from laboratory tasks to gain new insight into the mechanisms of SAD.

How to Modify (Implicit) Evaluations of Fear-Related Stimuli: Effects of Feature-Specific Attention Allocation

We demonstrate that feature-specific attention allocation influences the way in which repeated exposure modulates implicit and explicit evaluations toward fear-related stimuli. During an exposure procedure, participants were encouraged to assign selective attention either to the evaluative meaning (i.e., Evaluative Condition) or a non-evaluative, semantic feature (i.e., Semantic Condition) of fear-related stimuli. The influence of the exposure procedure was captured by means of a measure of implicit evaluation, explicit evaluative ratings, and a measure of automatic approach/avoidance tendencies. As predicted, the implicit measure of evaluation revealed a reduced expression of evaluations in the Semantic Condition as compared to the Evaluative Condition. Moreover, this effect generalized toward novel objects that were never presented during the exposure procedure. The explicit measure of evaluation mimicked this effect, although it failed to reach conventional levels of statistical significance. No effects were found in terms of automatic approach/avoidance tendencies. Potential implications for the treatment of anxiety disorders are discussed.

Untangling attention bias modification from emotion: A double-blind randomized experiment with individuals with social anxiety disorder

BACKGROUND

Uncertainty abounds regarding the putative mechanisms of attention bias modification (ABM). Although early studies showed that ABM reduced anxiety proneness more than control procedures lacking a contingency between cues and probes, recent work suggests that the latter performed just as well as the former did. In this experiment, we investigated a non-emotional mechanism that may play a role in ABM.

METHODS

We randomly assigned 62 individuals with a DSM-IV diagnosis of social anxiety disorder to a single-session of a non-emotional contingency training, non-emotional no-contingency training, or control condition controlling for potential practice effects. Working memory capacity and anxiety reactivity to a speech challenge were assessed before and after training.

RESULTS

Consistent with the hypothesis of a practice effect, the three groups likewise reported indistinguishably significant improvement in self-report and behavioral measures of speech anxiety as well as in working memory. Repeating the speech task twice may have had anxiolytic benefits.

LIMITATIONS

The temporal separation between baseline and post-training assessment as well as the scope of the training sessions could be extended.

CONCLUSIONS

The current findings are at odds with the hypothesis that the presence of visuospatial contingency between non-emotional cues and probes produces anxiolytic benefits. They also show the importance of including a credible additional condition controlling for practice effects.

For whom the bell tolls: Neurocognitive individual differences in the acute stress-reduction effects of an attention bias modification game for anxiety

The efficacy of attention bias modification training (ABMT) for anxiety is debated, in part because individual differences in task engagement and pre-training threat bias impact training efficacy. In the present study, an engaging, gamified ABMT mobile application, or "app," was utilized in 42 (21 females) trait-anxious adults. EEG was recorded during pre- and post-training threat bias assessment to generate scalp-recorded event-related potentials (ERPs) reflecting neurocognitive responses to threat. Following app play (ABMT versus placebo), subjective anxiety and stress responses (observed and self-reported) were measured. ABMT, versus placebo, resulted in improved behavioral performance during the stress task for females, and in potentiation of the N2 ERP to threat for males, suggesting increased attention control. Training groups did not differ in self-reported anxiety. ABMT also resulted in improved performance during the stress task among those evidencing specific pre-training ERP responses: decreased P1, suggesting less attention allocation, but potentiated N170, suggesting enhanced attention selection and discrimination. Differences in behavioral threat bias did not moderate training effects. Results suggest that efficient allocation of attention to threat combined with enhanced discrimination between threat and non-threat may facilitate stress-reduction effects of ABMT. Targeting neurocognitive responses to threat to personalize ABMT and develop more effective methods of treatment delivery, such as gamification, are discussed.

Attention bias modification via single-session dot-probe training: Failures to replicate

BACKGROUND AND OBJECTIVES

Across three experiments we investigated transfer effects of single-session attention bias modification via dot-probe training.

METHODS

In experiment 1, participants received training either toward or away from negative images or no-training, and transfer to an affective task-switching task was examined. In two other experiments, participants were trained to orient attention toward either positive or negative words (experiment 2a) or facial expressions (experiment 2b), and transfer to an interpretation bias task was examined.

RESULTS

In all experiments, the dot-probe training procedure did not effectively modify biases in attention allocation at the training condition level, but produced a large variability in individual attention bias acquisition within and across conditions. Individual differences in pre-training attention bias and attention bias acquisition were not related to performance on the affective task-switching task or the interpretation tasks.

LIMITATIONS

The present investigations are limited by the lack of effectiveness of ABM at the condition level, the order in which transfer tasks were administered, and the restricted range of affective symptoms that could moderate training and transfer effects.

CONCLUSIONS

The findings from three experiments provided no evidence for single-session dot-probe ABM procedures to effectively manipulate attention bias toward negative, away from negative, or toward positive stimuli at a training condition level. At the individual differences level of analysis, again no evidence was found for transfer of attention training. The observations invite further empirical scrutiny into factors that moderate attentional plasticity in response to dot-probe ABM procedures to optimize the conditions for effective implementation and transfer of training.

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

BACKGROUND

Attention bias modification (ABM) aims to reduce attentional bias for threat (AB), thereby diminishing anxiety symptoms. However, recent meta-analyses indicated mixed effects. Recent works suggest that the presence of AB prior to ABM can be considered as a critical moderating factor that may account for these mixed results.

METHODS

We assessed AB among highly trait-anxious individuals (n = 77) using both a face-version and a word-version of the dot-probe task at multiple time points: two weeks before ABM (t1), just prior to ABM (t2), and after ABM (t3). All participants were submitted to an ABM procedure including facial expressions. Analyses focused on 2 components of AB prior to ABM: a stable component, representing variance shared between the two baseline points (t1 and t2), and a dynamic component, representing variance that is specific to that point (t1 or t2).

RESULTS

The stable component of AB at baseline predicted the intensity of AB after ABM (t3) while the dynamic component did not. The dynamic component of AB at baseline positively predicts performance improvement during ABM procedure, while the stable component negatively predicted it.

LIMITATIONS

The findings depicted above only appear with the face-version of the dot-probe task.

CONCLUSIONS

The present results highlight the contribution of both the stable individual differences and dynamic components of preexistent AB. They also show the importance of moving the conceptualization of AB beyond the group-based analysis by integrating the notion and the assessment of within-person variability.

Does attention redirection contribute to the effectiveness of attention bias modification on social anxiety?

Attention bias modification (ABM) is designed to modify threat-related attention bias and thus alleviate anxiety. The current research examined whether consistently directing attention towards targeted goals per se contributes to ABM efficacy. We randomly assigned 68 non-clinical college students with elevated social anxiety to non-valence-specific attend-to-geometrics (AGC), attention modification (AMC), or attention control (ACC) conditions. We assessed subjective, behavioral, and physiological reactivity to a speech task and self-reported social anxiety symptoms. After training, participants in the AMC exhibited an attention avoidance from threat, and those in the AGC responded more rapidly toward targeted geometrics. There was a significant pre- to post-reduction in subjective speech distress across groups, but behavioral and physiological reactivity to speech, as well as self-report social anxiety symptoms, remained unchanged. These results lead to questions concerning effectiveness of ABM training for reducing social anxiety. Further examination of the current ABM protocol is required.

META-ANALYSIS OF ACUTE EXERCISE EFFECTS ON STATE ANXIETY: AN UPDATE OF RANDOMIZED CONTROLLED TRIALS OVER THE PAST 25 YEARS

BACKGROUND

One prominent and well-cited meta-analysis published nearly 25 years ago reported that an acute or single bout of exercise reduced state anxiety by approximately ¼ standard deviation. We conducted a meta-analysis of randomized controlled trials (RCTs) published after that meta-analysis for updating our understanding of the acute effects of exercise on state anxiety.

METHODS

We searched PubMed, EBSCOHost, Medline, PsycINFO, ERIC, and ScienceDirect for RCTs of acute exercise and state anxiety as an outcome. There were 36 RCTs that met inclusion criteria and yielded data for effect size (ES) generation (Cohen's d). An overall ES was calculated using a random effects model and expressed as Hedge's g.

RESULTS

The weighted mean ES was small (Hedge's g = 0.16, standard error (SE) = 0.06), but statistically significant (P < 0.05), and indicated that a single bout of exercise resulted in an improvement in state anxiety compared with control. The overall ES was heterogeneous and post hoc, exploratory analyses using both random- and fixed-effects models identified several variables as moderators including sample age, sex and health status, baseline activity levels, exercise intensity, modality and control condition, randomization, overall study quality, and the anxiety measure (P < 0.05).

CONCLUSION

The cumulative evidence from high quality studies indicates that acute bouts of exercise can yield a small reduction in state anxiety. The research is still plagued by floor effects associated with recruiting persons with normal or lower levels of state anxiety, and this should be overcome in subsequent trials.

A randomized controlled trial of attention modification for social anxiety disorder

Social Anxiety Disorder (SAD) models implicate social threat cue vigilance (i.e., attentional biases) in symptom development and maintenance. A modified dot-probe protocol has been shown to reduce SAD symptoms, in some but not all studies, presumably by modifying an attentional bias. The current randomized controlled trial was designed to replicate and extend such research. Participants included treatment-seeking adults (n = 108; 58% women) who met diagnostic criteria for SAD. Participants were randomly assigned to a standard (i.e., control) or modified (i.e., active) dot-probe protocol condition and to participate in-lab or at home. The protocol involved twice-weekly 15-min sessions, for 4 weeks, with questionnaires completed at baseline, post-treatment, 4-month follow-up, and 8-month follow-up. Symptom reports were assessed with repeated measures mixed hierarchical modeling. There was a main effect of time from baseline to post-treatment wherein social anxiety symptoms declined significantly (p < .05) but depression and trait anxiety did not (p > .05). There were no significant interactions based on condition or participation location (ps > .05). Reductions were maintained at 8-month follow-up. Symptom reductions were not correlated with threat biases as indexed by the dot-probe task. The modified and standard protocol both produced significant sustained symptom reductions, whether administered in-lab or at home. There were no robust differences based on protocol type. As such, the mechanisms for benefits associated with modified dot-probe protocols warrant additional research.

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

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

The impact of attentional training on the salivary cortisol and alpha amylase response to psychosocial stress: importance of attentional control

INTRODUCTION

This study examined the effects of three consecutive days of attentional training on the salivary alpha amylase (sAA), cortisol, and mood response to the Trier Social Stress Test (TSST). The training was designed to elicit faster disengagement of attention away from threatening facial expressions and faster shifts of attention toward positive ones.

METHOD

Fifty-six healthy participants between the ages of 18 and 30 participated in a double-blind, within-subject experiment. Participants were randomly assigned to one of three attentional training conditions - supraliminal training: pictures shown with full conscious awareness, masked training: stimuli presented with limited conscious awareness, or control training: both supraliminal and masked pictures shown but no shifting of attention required. Following training, participants underwent the TSST. Self-reported mood and saliva samples were collected for the determination of emotional reactivity, cortisol, and sAA in response to stress post-training.

RESULTS

Unexpectedly, participants in both attentional training groups exhibited a higher salivary cortisol response to the TSST relative to participants who underwent the control training, F (4, 86)=4.07, p=.005, ηp(2)=.16. Supraliminal training was also associated with enhanced sAA reactivity, F (2, 44)=13.90, p=.000, ηp(2)=.38, and a more hostile mood response (p=.021), to the TSST. Interestingly, the effect of attention training on the cortisol response to stress was more robust in those with high attentional control than those with low attentional control (β=-0.134; t=-2.24, p=.03).

CONCLUSION

This is among the first experimental manipulations to demonstrate that attentional training can elicit a paradoxical increase in three different markers of stress reactivity. These findings suggest that attentional training, in certain individuals, can have iatrogenic effects.

Computerized attention retraining for individuals with elevated health anxiety

BACKGROUND AND OBJECTIVES

Current cognitive-behavioral theorists conceptualize hypochondriasis as excessive health anxiety (HA). Growing evidence suggests that elevated HA is associated with attentional bias (AB) toward potential health-threat information.

DESIGN

This study aimed to examine the effects of attention retraining among individuals with elevated HA, using the established attention modification programs (AMP) designed to train participants to disengage attention from ideographically chosen health-threat words.

METHODS

Thirty-six randomly assigned individuals with elevated HA completed eight twice-weekly sessions of the AMP (n = 18) or the attention control condition (ACC; n = 18).

RESULTS

Despite using the well-established AMP protocol widely used within the field of anxiety disorders, we did not find evidence for change in AB following training. Further, AMP did not outperform ACC in reducing HA and other relevant emotional symptoms. However, both AMP and ACC evidenced overall significant symptom reduction in most of the outcome measures, including overall HA, anxiety sensitivity, general depression and anxiety, and somatic complaints.

CONCLUSIONS

Further research is needed to better understand the effects and mechanisms of AMP as a possible cognitive intervention for HA.

Clinical efficacy of attentional bias modification procedures: an updated meta-analysis

CONTEXT

Attentional bias modification (ABM) treatment is a promising intervention tool for a variety of clinical conditions.

OBJECTIVES

This study provides an updated review of the clinical effect of ABM by employing standard meta-analytic procedures to (a) estimate the average effect size of ABM in reducing both attention bias (AB) and symptoms, (b) estimate the average effect size for different conditions (e.g., anxiety, depression, and substance abuse), (c) test possible variables that may moderate the effect sizes, and (d) investigate the relationship between preexistent AB and the reduction in AB and symptoms.

METHOD

We included 43 controlled trials with a total of 2,268 participants providing 47 group comparisons (i.e., training vs. control condition). Inclusion criteria were as follows: AB was specifically targeted to reduce symptomatology and emotional vulnerability; participants were randomized to the experimental conditions; a control condition (defined as sham training) existed; symptoms were assessed at least postintervention; sufficient data were provided to allow effect size estimation.

RESULTS

We obtained a small overall effect size on symptoms postintervention, g = 0.160, 95% confidence interval (CI) = [0.055, 0.265], driven by anxiety studies, g = 0.260, 95% CI = [0.132, 0.388], and studies conducted in healthy participants, g = 0.211, 95% CI = [0.046, 0.375]; no significant effect sizes were found postintervention for other symptom categories.

CONCLUSION

The therapeutic benefit of ABM is rather small for anxiety, while the amount of data for other symptom categories is limited. We argue that more efficient, psychometrically sound procedures are needed for assessing and modifying AB.

Attention Feedback Awareness and Control Training (A-FACT): experimental test of a novel intervention paradigm targeting attentional bias

We present an experimental investigation of a novel intervention paradigm targeting attentional bias - Attention Feedback Awareness and Control Training (A-FACT). A-FACT is grounded in the novel hypothesis that training awareness of (biased) attentional allocation will lead to greater self-regulatory control of attention and thereby ameliorate attentional bias and its maladaptive sequelae. To do so, A-FACT delivers computerized, personalized, real-time feedback regarding a person's (biased) allocation of attention concurrent with its expression. In a randomized control experimental design, we tested A-FACT relative to an active placebo control condition among anxious adults (N=40, 52.5% women, M(SD)=24.3(4) years old). We found that relative to the placebo control condition, A-FACT led to: (a) reduced levels of attentional bias to threat; (b) (non-significantly) lower rate of behavioral avoidance of exposure to an anxiogenic stressor; and (c) faster rate of emotional recovery following the stressor. The findings are discussed with respect to the novelty and significance of the proposed conceptual perspective, methodology, and intervention paradigm targeting attentional bias.

The Effects of Exercise Training on Anxiety

This review summarizes the extant evidence of the effects of exercise training on anxiety among healthy adults, adults with a chronic illness, and individuals diagnosed with an anxiety disorder. A brief discussion of selected proposed mechanisms that may underlie relations of exercise and anxiety is also provided. The weight of the available empirical evidence indicates that exercise training reduces symptoms of anxiety among healthy adults, chronically ill patients, and patients with panic disorder. Preliminary data suggest that exercise training can serve as an alternative therapy for patients with social anxiety disorder, generalized anxiety disorder, and obsessive–compulsive disorder. Anxiety reductions appear to be comparable to empirically supported treatments for panic and generalized anxiety disorders. Large trials aimed at more precisely determining the magnitude and generalizability of exercise training effects appear to be warranted for panic and generalized anxiety disorders. Future well-designed randomized controlled trials should (a) examine the therapeutic effects of exercise training among understudied anxiety disorders, including specific phobias, social anxiety disorder and posttraumatic stress disorder; (b) focus on understudied exercise modalities, including resistance exercise training and programs that combine exercise with cognitive-behavioral therapies; and (c) elucidate putative mechanisms of the anxiolytic effects of exercise training.

Internet-based attention bias modification for social anxiety: a randomised controlled comparison of training towards negative and training towards positive cues

Biases in attention processes are thought to play a crucial role in the aetiology and maintenance of Social Anxiety Disorder (SAD). The goal of the present study was to examine the efficacy of a programme intended to train attention towards positive cues and a programme intended to train attention towards negative cues. In a randomised, controlled, double-blind design, the impact of these two training conditions on both selective attention and social anxiety were compared to that of a control training condition. A modified dot probe task was used, and delivered via the internet. A total of 129 individuals, diagnosed with SAD, were randomly assigned to one of these three conditions and took part in a 14-day programme with daily training/control sessions. Participants in all three groups did not on average display an attentional bias prior to the training. Critically, results on change in attention bias implied that significantly differential change in selective attention to threat was not detected in the three conditions. However, symptoms of social anxiety reduced significantly from pre- to follow-up-assessment in all three conditions (d_within  = 0.63–1.24), with the procedure intended to train attention towards threat cues producing, relative to the control condition, a significantly greater reduction of social fears. There were no significant differences in social anxiety outcome between the training condition intended to induce attentional bias towards positive cues and the control condition. To our knowledge, this is the first RCT where a condition intended to induce attention bias to negative cues yielded greater emotional benefits than a control condition. Intriguingly, changes in symptoms are unlikely to be by the mechanism of change in attention processes since there was no change detected in bias per se. Implications of this finding for future research on attention bias modification in social anxiety are discussed.

Trial Registration

ClinicalTrials.gov NCT01463137

Attention bias modification: the Emperor's new suit?

A series of primarily laboratory-based studies found attention bias modification in socially anxious participants to lead to reduced anxiety. It is argued that the failure to replicate the positive results of attention bias modification in the study of Carlbring et al. may be due to reasons other than the application through the Internet. A number of controlled studies failed to replicate the positive effects of attention bias modification in clinically rather than subclinically socially anxious subjects. Given the lack of robust evidence for attention bias modification in clinically socially anxious individuals, the author is inclined to consider attention bias modification as 'the Emperor's new suit'. Results achieved with regular Internet-based treatments for social anxiety disorder based on cognitive therapy and exposure methods are much better than those achieved with attention bias modification procedures delivered 'face to face' in clinically distressed participants. Given the lack of robust evidence for attention bias modification in clinical samples, there is no need yet to investigate the implementation of attention bias modification through the Internet.Please see related article: http://www.biomedcentral.com/1471-244X/12/66.