Attentional control predicts change in bias in response to attentional bias modification

Enhanced brain network flexibility by physical exercise in female methamphetamine users

Methamphetamine (MA) abuse is increasing worldwide, and evidence indicates that MA causes degraded cognitive functions such as executive function, attention, and flexibility. Recent studies have shown that regular physical exercise can ameliorate the disturbed functions. However, the potential functional network alterations resulting from physical exercise have not been extensively studied in female MA users. We collaborated with a drug rehabilitation center for this study to investigate changes in brain activity and network dynamics after two types of acute and long-term exercise interventions based on 64-channel electroencephalogram recordings of seventy-nine female MA users, who were randomly divided into three groups: control group (CG), dancing group (DG) and bicycling group (BG). Over a 12-week period, we observed a clear drop in the rate of brain activity in the exercise groups, especially in the frontal and temporal regions in the DG and the frontal and occipital regions in the BG, indicating that exercise might suppress hyperactivity and that different exercise types have distinct impacts on brain networks. Importantly, both exercise groups demonstrated enhancements in brain flexibility and network connectivity entropy, particularly after the acute intervention. Besides, a significantly negative correlation was found between Δattentional bias and Δbrain flexibility after acute intervention in both DG and BG. Analysis strongly suggested that exercise programs can reshape patient brains into a highly energy-efficient state with a lower activity rate but higher information communication capacity and more plasticity for potential cognitive functions. These results may shed light on the potential therapeutic effects of exercise interventions for MA users.

Supplementary Information

The online version contains supplementary material available at 10.1007/s11571-022-09848-5.

Contamination fear and attention bias variability early in the COVID-19 pandemic

The onset of the COVID-19 pandemic resulted in a dramatic increase in the salience and importance of information relating to both the risk of infection, and factors that could mitigate against such risk. This is likely to have contributed to elevated contamination fear concerns in the general population. Biased attention for contamination-related information has been proposed as a potential mechanism underlying contamination fear, though evidence regarding the presence of such biased attention has been inconsistent. A possible reason for this is that contamination fear may be characterised by variability in attention bias that has not yet been examined. The current study examined the potential association between attention bias variability for both contamination-related and mitigation-related stimuli, and contamination fear during the early stages of the COVID-19 pandemic. A final sample of 315 participants completed measures of attention bias and contamination fear. The measure of average attention bias for contamination-related stimuli and mitigation-related stimuli was not associated with contamination fear (r = 0.055 and r = 0.051, p > 0.10), though both attention bias variability measures did show a small but statistically significant relationship with contamination fear (r = 0.133, p < 0.05; r = 0.147, p < 0.01). These attention bias variability measures also accounted for significant additional variance in contamination fear above the average attention bias measure (and controlling for response time variability). These findings provide initial evidence for the association between attention bias variability and contamination fear, underscoring a potential target for cognitive bias interventions for clinical contamination fear.

Attention bias vs. attention control modification for social anxiety disorder: A randomized controlled trial

Gaze-Contingent Music Reward Therapy (GC-MRT) is an eye-tracking-based attention bias modification protocol for social anxiety disorder (SAD) with established clinical efficacy. However, it remains unclear if improvement following GC-MRT hinges on modification of threat-related attention or on more general enhancement of attention control. Here, 50 patients with SAD were randomly allocated to GC-MRT using either threat faces or shapes. Results indicate comparable reductions in social anxiety and co-morbid depression symptoms in the two conditions. Patients in the shapes condition showed a significant increase in attention control and a reduction in attention to both the trained shapes and threat faces, whereas patients in the faces condition showed a reduction in attention to threat faces only. These findings suggest that enhancement of attention control, independent of valence-specific attention modification, may facilitate reduction in SAD symptoms. Alternative interpretations and clinical implications of the current findings are discussed.

Brief mindfulness meditation intervention improves attentional control of athletes in virtual reality shooting competition: Evidence from fNIRS and eye tracking

Attentional control is a crucial cognitive ability for sports performance. The current research aimed to investigate whether a brief (20-min) pre-competition mindfulness meditation (MM) intervention enhances athletes' attentional control during competitions and alters the activity of brain regions related to attentional control. We created a virtual reality shooting competition to compare the eye-gaze indicators and functional near-infrared spectroscopy (fNIRS) parameters of 78 university athletes after 20 min of MM or 20 min of mind wandering (MW). Participants' average fixation durations (AFDs) on task-relevant information (targets) were significantly longer in the MM group. In contrast, both average fixation counts (AFCs) and AFDs on task-irrelevant information (the ranking screen) were significantly lower in the MM group than in the MW group. Additionally, the MM group exhibited significantly stronger activation of the left and right dorsolateral prefrontal cortex (dlPFC) as well as higher levels of oxygenated haemoglobin [HbO] and greater functional connectivity (FC) of the right dlPFC, which was considered evidence of recruitment for attentional control. Moreover, the MM group achieved significantly better shooting performance than the MW group. Overall, the findings suggest that one session 20-min MM practice pre-competition facilitates focus during competition and improves athletic performance. We recommend the application of brief mindfulness practice in sports, especially in closed-skill sports that require high attention participation (e.g., shooting, archery, darts, golf, gymnastics, skating etc.).

The impact of pandemic-related stress on attentional bias and anxiety in alexithymia during the COVID-19 pandemic

The COVID-19 pandemic had negative consequences for mental health, yet it is unknown how and to what extent the psychological outcomes of this stressful event are moderated by individual traits. Alexithymia is a risk factor for psychopathology, and thus likely predicted individual differences in resilience or vulnerability to stressful events during the pandemic. This study explored the moderating role of alexithymia in the relationships of pandemic-related stress with anxiety levels and attentional bias. The participants were 103 Taiwanese individuals who completed a survey during the outbreak of the Omicron wave. Additionally, an emotional Stroop task including pandemic-related or neutral stimuli was used to measure attentional bias. Our results demonstrate that pandemic-related stress had a lesser impact on anxiety in individuals with a higher level of alexithymia. Moreover, we found that in individuals with higher exposure to pandemic-related stressors, a higher level of alexithymia indicated less attentional bias toward COVID-19-related information. Thus, it is plausible that individuals with alexithymia tended to avoid pandemic-related information, which could temporarily relieve stressors during the pandemic.

Attentional bias malleability as a predictor of daily pain interference

ABSTRACT

Despite a preponderance of pain-related attentional bias research, little is known about how these biases arise and change over time. We tested whether the degree of attentional bias malleability , that is, ability to acquire and relinquish patterns of selective attention towards pain information, predicts daily pain interference. Individuals with chronic pain (N = 66) completed a novel attentional bias malleability procedure based on a modified dot-probe paradigm. Participants received a contingency that encouraged an attentional preference toward and away from pain words across 2 counterbalanced blocks, and attentional bias was assessed before and after each contingency block. Participants then completed a daily diary for 7 days, including the Patient-Reported Outcomes Measurement Information System-29 pain severity and interference. Multilevel modelling was conducted to predict daily pain interference from attentional bias malleability constructs, controlling for pain severity and demographic factors. Greater attentional bias (F 1,391 = 3.97, P = 0.047), greater readiness to acquire an attentional bias (F 1,389 = 4.92, P = 0.027), and less readiness to lose an acquired attentional bias toward pain (F 1,354 = 5.18, P = 0.024) all predicted less pain interference. There was also an interaction between pain severity and overall attentional bias malleability (F 1,62 = 5.48, P = 0.023), such that as pain severity increased, those who showed greater attentional bias malleability showed less corresponding increase in their pain interference than those who showed less attentional bias malleability. This study adds new thinking to the dynamic nature of attentional bias and how such biases might arise and influence pain outcomes.

Do the eyes have it? A comparison of eye-movement and attentional-probe-based approaches to indexing attentional control within the antisaccade paradigm

Individual differences in the ability to control visual attention, often termed "attentional control," have been of particular interest to cognitive researchers. This has led to the development of numerous tasks intended to measure attentional control, including the antisaccade task. While attentional performance on the antisaccade task is typically indexed through the recording of eye movements, increasingly researchers are reporting the use of probe-based methods of indexing attentional performance on the task. Critically, no research has yet determined the convergence of measures yielded by each of these assessment methods, nor compared the reliability of these measures. The purpose of the present study was to examine whether antisaccade cost measures yielded by a probe-based adaptation of the task converge with antisaccade cost measures yielded by an eye movement task in the sample of individuals, and whether these alternative approaches have comparable levels of psychometric reliability. Ninety-three individuals completed an eye movement task and a probe-based task at two assessment times, and an index of antisaccade cost was computed from each task at each assessment time. Analyses revealed that the antisaccade cost index yielded by each task demonstrated high internal reliability (eye-movement, r_SB = .92; probe-based, r_SB = .80-.84) and high test-retest reliability (eye-movement, r_SB = .82; probe-based, r_SB = .72), but modest measurement convergence (r = .21-.35). Findings suggest that probe-based and eye-movement based antisaccade tasks measure shared variance in attentional control, although their measures do not converge strongly enough to be considered equivalent measures of attentional control.

Assessing anxiety-linked impairment in attentional control without eye-tracking: The masked-target antisaccade task

Contemporary cognitive theories of anxiety and attention processing propose that heightened levels of anxiety vulnerability are associated with a decreasing ability to inhibit the allocation of attention towards task-irrelevant information. Existing performance-based research has most often used eye-movement assessment variants of the antisaccade paradigm to demonstrate such effects. Critically, however, eye-movement assessment methods are limited by expense, the need for expert training in administration, and limited mobility and scalability. These barriers have likely led to researchers' use of suboptimal methods of assessing the relationship between attentional control and anxiety vulnerability. The present study examined the capacity for a non-eye-movement-based variant of the antisaccade task, the masked-target antisaccade task (Guitton et al., 1985), to detect anxiety-linked differences in attentional control. Participants (N = 342) completed an assessment of anxiety vulnerability and performed the masked-target antisaccade task in an online assessment session. Greater levels of anxiety vulnerability predicted poorer performance on the task, consistent with findings observed from eye-movement methods and with cognitive theories of anxiety and attention processing. Results also revealed the task to have high internal reliability. Our findings indicate that the masked-target antisaccade task provides a psychometrically reliable, low-cost, mobile, and scalable assessment of anxiety-linked differences in attentional control.

No preconscious attentional bias towards itch in healthy individuals

Rapidly attending towards potentially harmful stimuli to prevent possible damage to the body is a critical component of adaptive behavior. Research suggests that individuals display an attentional bias, i.e., preferential allocation of attention, for consciously perceived bodily sensations that signal potential threat, like itch or pain. Evidence is not yet clear whether an attentional bias also exists for stimuli that have been presented for such a short duration that they do not enter the stream of consciousness. This study investigated whether a preconscious attentional bias towards itch-related pictures exists in 127 healthy participants and whether this can be influenced by priming with mild itch-related stimuli compared to control stimuli. Mild itch was induced with von Frey monofilaments and scratching sounds, while control stimuli where of matched modalities but neutral. Attentional bias was measured with a subliminal pictorial dot-probe task. Moreover, we investigated how attentional inhibition of irrelevant information and the ability to switch between different tasks, i.e., cognitive flexibility, contribute to the emergence of an attentional bias. Attentional inhibition was measured with a Flanker paradigm and cognitive flexibility was measured with a cued-switching paradigm. Contrary to our expectations, results showed that participants attention was not biased towards the itch-related pictures, in facts, attention was significantly drawn towards the neutral pictures. In addition, no effect of the itch-related priming was observed. Finally, this effect was not influenced by participants’ attentional inhibition and cognitive flexibility. Therefore, we have no evidence for a preconscious attentional bias towards itch stimuli. The role of preconscious attentional bias in patients with chronic itch should be investigated in future studies.

Personalized attention control therapy for PTSD: effectiveness and moderators of outcome in a randomized controlled trial

BACKGROUND

Previous randomized controlled trials (RCTs) suggest that attention control therapy (ACT), targeting aberrant fluctuations of attention toward and away from threats in patients with PTSD, may be effective in reducing symptoms. The current RCT examined whether the use of personalized-trauma stimuli enhances ACT efficacy in patients with PTSD. Additional moderators of treatment outcome were tested on an exploratory basis.

METHODS

Sixty patients with PTSD were randomly assigned to either personalized ACT, non-personalized ACT, or a control condition. Changes in symptoms were examined across pre-treatment, post-treatment, and a 3-month follow-up. Attentional interference was examined pre- and post-treatment. Baseline clinical and cognitive indices as well as the time elapsed since the trauma were tested as potential moderators of treatment outcome.

RESULTS

A significant reduction in clinical symptoms was noted for all three conditions with no between-group differences. Attention bias variability decreased following ACT treatment. Personalized ACT was more effective relative to the control condition when less time had elapsed since the trauma. Baseline clinical and cognitive indices did not moderate treatment outcome.

CONCLUSIONS

In this RCT of patients with PTSD, ACT was no more effective in reducing PTSD symptoms than a control condition. The data also suggest a potential benefit of personalized ACT for patients who experienced their trauma more recently.

A longitudinal trait-state model of attentional control: Implications for repetitive negative thinking

BACKGROUND

Attentional control refers to the ability to direct, focus, and shift attention voluntarily, and poor attentional control may confer risk for various affective disorders by increasing repetitive negative thinking. Although attentional control has been described as a trait, it is unclear if it is a time-varying (TV) or state-like factor versus a time-invariant (TI) or trait-like personality characteristic.

METHODS

In a 6-wave, 5-month longitudinal study, community participants (n = 1,251) completed the Attentional Control Scale (Derryberry & Reed, 2002), the most commonly used measure of attentional control that includes two components: Focusing and Shifting. A latent variable (trait-state-occasion) model was applied to the two components.

RESULTS

The results showed that although estimates of TI factor variance and TV factor variance were both significant for Focusing and Shifting, the proportion of TI factor variance (0.81, 0.77) was significantly greater than the amount of TV factor variance (0.18, 0.22). Furthermore, although TV factor stability was statistically significant for Focusing and Shifting, the size of the coefficients was small to moderate in magnitude. In predicting latent repetitive negative thinking at each of the six time points, regression weights for the attentional control TI factor were significant and larger than those for the TV factor (which were generally not significant).

LIMITATIONS

Relatively short timeframe of 5 months and exclusive reliance on self-report measures.

CONCLUSIONS

These findings suggest that self-reported attentional control is largely TI and that it is this TI component that predicts repetitive negative thinking.

Acute alcohol does not impair attentional inhibition as measured with Stroop interference scores but impairs Stroop performance

RATIONALE

Inhibition is a core executive function and refers to the ability to deliberately suppress attention, behavior, thoughts, and/or emotions and instead act in a specific manner. While acute alcohol exposure has been shown to impair response inhibition in the stop-signal and Go/NoGo tasks, reported alcohol effects on attentional inhibition in the Stroop task are inconsistent. Notably, studies have operationalized attentional inhibition variably and there has been intra- and inter-individual variability in alcohol exposure.

OBJECTIVE

This study aimed to examine the acute effects of alcohol on attentional inhibition, considering previous limitations.

METHODS

In a single-blind, cross-over design, 40 non-dependent participants with a medium-to-high risk drinking behavior performed a Counting Stroop task (CST) under a baseline and an arterial blood alcohol concentration (aBAC) clamp at 80 mg%. Attentional inhibition was assessed as the alteration of reaction times (RT), error rates (ER), and inverse efficiency scores (IES) between incongruent and congruent trials (interference score). Stroop performance was also assessed regardless of trial-type.

RESULTS

Compared to saline, acute alcohol exposure via an aBAC clamp did not affect CST interference scores but increased RTs and IES in both incongruent and congruent trials.

CONCLUSIONS

Attentional inhibition (Stroop interference score) was not impaired by clamped moderate alcohol exposure. Acute alcohol impaired Stroop performance evidenced by a general increase in response times. Our findings suggest that response and attentional inhibition do not share the same neurocognitive mechanisms and are affected differently by alcohol. Results could also be explained by automated behaviors known to be relatively unaffected by acute alcohol.

Attending to the Attentional Control Scale for Children: Confirming its factor structure and measurement invariance

The Attentional Control Scale for Children (ACS-C) is a widely used self-report questionnaire that measures attentional control in youth. Previous research examined factor-structure and validation of the ACS-C and yielded a 2-factor structure with Attentional Focusing and Attentional Shifting subscales. This study used a confirmatory factor analysis in a large, ethnically diverse sample of clinic-referred anxious youth (N = 442, ages 7-16 years) to compare model fit of three models, the original two-factor model of the ACS-C, a two-factor model of a modified ACS-C (two items re-assigned from Attentional Focusing to Attentional Shifting, three items removed from Attentional Focusing, and two items removed from Attentional Shifting), and a single-factor model. Results reveal best model fit for the two-factor modified ACS-C. This model had strong factorial invariance across sex, partial invariance across ethnicity, and was variant across age. Also, total and subscale scores for the two-factor modified ACS-C correlated with anxiety and depression symptom scale scores, supporting its concurrent validity. Findings confirm the two-factor structure of the modified ACS-C. Future research implications relating to attentional control in children are discussed.

Attentional control moderates the relationship between pain catastrophizing and selective attention to pain faces on the antisaccade task

Cognitive models of chronic pain emphasize the critical role of pain catastrophizing in attentional bias to pain-related stimuli. The aim of this study was (a) to investigate the relationship between pain catastrophizing and the ability to inhibit selective attention to pain-related faces (attentional bias); and (b) to determine whether attentional control moderated this relationship. One hundred and ten pain-free participants completed the anti-saccade task with dynamic facial expressions, specifically painful, angry, happy, and neutral facial expressions and questionnaires including a measure of pain catastrophizing. As predicted, participants with high pain catastrophizing had significantly higher error rates for antisaccade trials with pain faces relative to other facial expressions, indicating a difficulty disinhibiting attention towards painful faces. In moderation analyses, data showed that attentional control moderated the relationship between attentional bias to pain faces and pain catastrophizing. Post-hoc analyses demonstrated that it was shifting attention (not focusing) that accounted for this effect. Only for those with high self-reported ability to shift attention was there a significant relationship between catastrophizing and attentional bias to pain. These findings confirm that attentional control is necessary for an association between attentional bias and catastrophizing to be observed, which may explain the lack of relationships between attentional bias and individual characteristics, such as catastrophizing, in prior research.

Impact of imagery-enhanced interpretation training on offline and online interpretations in worry

Worry and rumination are forms of repetitive negative thinking (RNT) that are maintained by negative interpretations and a predominance of abstract, verbal thinking. Hence, facilitating more positive interpretations and imagery-based thinking in combination may reduce RNT. Study 1 administered interpretation training with and without enhanced imagery, and an active control condition (designed not to change interpretations), in individuals with high levels of RNT (worry and/or rumination). Combining interpretation training with sustained imagery resulted in the highest levels of positive interpretation bias using an offline test of interpretation bias (when individuals have time to reflect). Study 2 investigated whether imagery-enhanced interpretation training influences online interpretations when ambiguous information is first encountered, indexed by reaction times and amplitude of the N400 event-related potential, as well as enhances offline positive interpretations in high worriers. It also examined whether imagery-enhanced interpretation training reduces negative thought intrusions associated with worry. Both online (reaction time) and offline interpretations were more positive following imagery-enhanced interpretation training, and negative thoughts were reduced, compared to the active control. However, no differences emerged on neurophysiological markers during the online task. Hence, brief interpretation training encompassing sustained imagery modifies online and offline interpretations, but further training may be required to impact upon neurophysiological measures.

Bias-contingent attention bias modification and attention control training in treatment of PTSD: a randomized control trial

BACKGROUND

Randomized control trials (RCTs) comparing attention control training (ACT) and attention bias modification (ABM) in posttraumatic stress disorder (PTSD) have shown mixed results. The current RCT extends the extant literature by comparing the efficacy of ACT and a novel bias-contingent-ABM (BC-ABM), in which direction of training is contingent upon the direction of pre-treatment attention bias (AB), in a sample of civilian patients with PTSD.

METHODS

Fifty treatment-seeking civilian patients with PTSD were randomly assigned to either ACT or BC-ABM. Clinician and self-report measures of PTSD and depression, as well as AB and attention bias variability (ABV), were acquired pre- and post-treatment.

RESULTS

ACT yielded greater reductions in PTSD and depressive symptoms on both clinician-rated and self-reported measures compared with BC-ABM. The BC-ABM condition successfully shifted ABs in the intended training direction. In the ACT group, there was no significant change in ABV or AB from pre- to post-treatment.

CONCLUSIONS

The current RCT extends previous results in being the first to apply ABM that is contingent upon AB at pre-treatment. This personalized BC-ABM approach is associated with significant reductions in symptoms. However, ACT produces even greater reductions, thereby emerging as a promising treatment for PTSD.

Attentional bias and its temporal dynamics among war veterans suffering from chronic pain: Investigating the contribution of post-traumatic stress symptoms

BACKGROUND

Cognitive models propose that attentional dysregulation, including an attentional bias towards threat, is one of the factors through which chronic pain and post-traumatic stress symptoms (PTSS) maintain and exacerbate one another. The current investigation assessed the attentional bias for painful facial expressions and its relationship with PTSS, using both traditional and variability-based attentional bias measures, among veterans with chronic pain and PTSS and controls.

METHOD

Fifty-four veterans with chronic pain and 30 age/education-matched controls participated in this investigation. Participants completed a self-report measure of PTSS and a modified version of the dot-probe task with painful, happy, and neutral facial expressions. Attention was assessed using both traditional and variability-based reaction time measures of attentional bias.

RESULTS

Veterans directed attention away from painful facial expressions (i.e., avoidance) relative to both the control group (between-subject effect) and relative to neutral faces (within-subject effect). Veterans also showed significantly elevated attentional bias variability for both happy and painful facial expressions compared to controls. Attentional bias variability for happy and painful facial expressions was correlated with PTSS among all participants.

CONCLUSION

Veterans with chronic pain and PTSS avoided pain-related stimuli and displayed an overall attentional dysregulation for emotional facial expressions. Avoidance of pain cues may be a coping strategy that these individuals develop under stressful conditions. Implications, limitations, and directions for future research are discussed.

Associations Between Attentional Bias and Interpretation Bias and Change in School Concerns and Anxiety Symptoms During the Transition from Primary to Secondary School

The transition from primary to secondary school is often associated with a period of heightened anxiety and worry. For most children, any feelings of anxiety subside relatively quickly but for a small minority, emotional difficulties can continue into the first year of secondary school and beyond. This study recruited 109 children and measured their anxiety symptoms and school concerns toward the end of primary school and again at the end of their first term of secondary school. We investigated for the first time whether pre-transition measures of attentional and interpretation bias, and the magnitude of change in attentional bias toward and away from threat stimuli were associated with pre- and post-transition measures of anxiety and school concerns, and the change in these measures over time. Over 50% of the current sample exceeded clinical levels of anxiety at pre-transition. However, anxiety symptoms and school concerns had significantly reduced by post-transition. Higher levels of pre-transition anxiety or school concerns, and a greater magnitude of change in attentional bias towards threat stimuli predicted a larger reduction in anxiety symptoms and school concerns across the transition period. A greater interpretation bias toward threat was associated with higher pre-transition anxiety symptoms and school concerns but not post-transition scores, or the change in these scores. While many children experience heightened anxiety prior to school transition, this appears to be largely temporary and self-resolves. Nonetheless, the current findings highlight the importance of monitoring children's anxiety and concerns, and related cognitive processes during this important transition period.

Investigating the Effects of Inhibition Training on Attentional Bias Change: A Simple Bayesian Approach

Attention bias modification (ABM), in which participants are trained to direct attention away from negative information, has been shown to reduce anxiety. However, such findings have been inconsistent. Changes in attentional bias are often absent, suggesting need for further investigation of the underlying mechanisms of ABM, as well as better statistical methods to analyze ABM data in order to reduce inferential error. In this study, we (a) compared inhibition control training to standard ABM training conditions, and (b) demonstrated the benefits of using simple Bayesian analyses to analyze ABM data. We recruited 116 participants and assessed their attentional bias prior to and after training, which involved practice avoiding negative stimuli, attending to negative stimuli, or avoiding a non-emotional, exogenous attentional cue (inhibitory control training). Our results suggested no impact of any of the training conditions on attentional bias. We further demonstrate Bayesian analyses may help control for both Type I and Type II error relative to a frequentist approach.

Inhibitory attentional control in anxiety: Manipulating cognitive load in an antisaccade task

Theorists have proposed that heightened anxiety vulnerability is characterised by reduced attentional control performance and have made the prediction in turn that elevating cognitive load will adversely impact attentional control performance for high anxious individuals to a greater degree than low anxious individuals. Critically however, existing attempts to test this prediction have been limited in their methodology and have presented inconsistent findings. Using a methodology capable of overcoming the limitations of previous research, the present study sought to investigate the effect of manipulating cognitive load on inhibitory attentional control performance of high anxious and low anxious individuals. High and low trait anxious participants completed an antisaccade task, requiring the execution of prosaccades towards, or antisaccades away from, emotionally toned stimuli while eye movements were recorded. Participants completed the antisaccade task under conditions that concurrently imposed a lesser cognitive load, or greater cognitive load. Analysis of participants' saccade latencies revealed high trait anxious participants demonstrated generally poorer inhibitory attentional control performance as compared to low trait anxious participants. Furthermore, conditions imposing greater cognitive load, as compared to lesser cognitive load, resulted in enhanced inhibitory attentional control performance across participants generally. Crucially however, analyses did not reveal an effect of cognitive load condition on anxiety-linked differences in inhibitory attentional control performance, indicating that elevating cognitive load did not adversely impact attentional control performance for high anxious individuals to a greater degree than low anxious individuals. Hence, the present findings are inconsistent with predictions made by some theorists and are in contrast to the findings of earlier investigations. These findings further highlight the need for research into the relationship between anxiety, attentional control, and cognitive load.

Attention bias modification augments cognitive-behavioral group therapy for social anxiety disorder: a randomized controlled trial

BACKGROUND

Cognitive-behavioral group therapy (CBGT) is a first-line treatment for social anxiety disorder (SAD). However, since many patients remain symptomatic post-treatment, there is a need for augmenting procedures. This randomized controlled trial (RCT) examined the potential augmentation effect of attention bias modification (ABM) for CBGT.

METHODS

Fifty patients with SAD from three therapy groups were randomized to receive an 18-week standard CBGT with either ABM designed to shift attention away from threat (CBGT + ABM), or a placebo protocol not designed to modify threat-related attention (CBGT + placebo). Therapy groups took place in a large mental health center. Clinician and self-report measures of social anxiety and depression were acquired pre-treatment, post-treatment, and at 3-month follow-up. Attention bias was assessed at pre- and post-treatment.

RESULTS

Patients randomized to the CBGT + ABM group, relative to those randomized to the CBGT + placebo group, showed greater reductions in clinician-rated SAD symptoms post-treatment, with effects maintained at 3-month follow-up. Group differences were not evident for self-report or attention-bias measures, with similar reductions in both groups. Finally, reduction in attention bias did not mediate the association between group and reduction in Liebowitz Social Anxiety Scale Structured Interview (LSAS) scores.

CONCLUSIONS

This is the first RCT to examine the possible augmenting effect of ABM added to group-based cognitive-behavioral therapy for adult SAD. Training patients' attention away from threat might augment the treatment response to standard CBGT in SAD, a possibility that could be further evaluated in large-scale RCTs.