Two probes and better than one: Development of a psychometrically reliable variant of the attentional probe task

The Impact of Intravenous Ketamine on Attentional Bias: Probing Mechanisms of Rapid-Acting Antidepressant Effects in Two Clinical Studies

BACKGROUND

Ketamine is known for its rapid antidepressant effect, but its impact on affective information processing (including attentional bias [AB], a putative cognitive mechanism of depression) remains largely unexplored. We leveraged a novel measurement of AB and sought to 1) establish adequate test-retest reliability and validity among participants with depression prior to ketamine treatment and 2) harness a single dose of ketamine to assess mechanistic shifts in AB and their relationship to antidepressant efficacy.

METHODS

A novel dual probe video task was used to index AB toward sad film clips. In study 1, treatment-seeking adults with moderate-to-severe depression (N = 40) completed the task at baseline, 1-week retest, and 1-month retest; a subset of participants (n = 15) also performed the task at 24 hours postketamine infusion (0.5 mg/kg over 40 minutes). In study 2, participants (N = 43) completed the task pre- and 24 hours postketamine.

RESULTS

Indices from the novel AB task were stable prior to ketamine, demonstrating good 1-week and 1-month test-retest reliability. Participants in both studies exhibited a robust reduction in AB from pre- to 24 hours postketamine infusion. In study 1, cross-sectional correlations were observed between AB and clinician-rated depressive symptoms at each pretreatment assessment. In study 2, changes in AB were correlated with improved symptoms from pre- to postinfusion.

CONCLUSIONS

Results provide evidence for the validity of a novel, psychometrically robust measure of AB among individuals with depression. Findings indicate that ketamine reliably and rapidly reduces AB, offering insight into a replicable, potential cognitive mechanism involved in its antidepressant action.

Negative affective priming: Reliability and associations with depression symptoms in three samples

The negative affective priming (NAP) task is a behavioral measure of inhibition of emotional stimuli. Previous studies using the NAP task have found that individuals with depression show reduced inhibition of negative stimuli, suggesting that inhibition biases may play a role in the etiology and maintenance of depression. However, the psychometric properties of the NAP task have not been evaluated or reported. In the present study, we report data on the association between NAP task performance and depression symptoms in three independent samples, and we evaluate the internal consistency and test-retest reliability of the NAP effect indices. The NAP effect for both negative and positive target words had poor internal consistency in all three samples, as well as poor 2-week (Study 2) and 6-month (Study 3) test-retest reliability. The internal consistency and test-retest reliability of response times (RT) for the individual trial types were moderate to high, as were the intercorrelations between trial types. This pattern of results indicates that overall RT is reliable but variance in RTs for the different trial types in the NAP task is indistinguishable from variance in overall RT. Depression symptom severity was not associated with the NAP effect for negative or positive target words in any of the samples, which could be due to the poor reliability of the NAP effect. Based on these findings, we do not recommend that researchers use the NAP task as a measure of individual differences in the inhibition of emotional stimuli.

Negative attention bias and attentional control as mechanisms in the association between insomnia and depression in young people

Evidence supports a causal role of insomnia in the development and maintenance of depression, yet mechanisms underlying this association in young people are not well established. Attention biases have been implicated separately in the sleep and depression fields and represents an important candidate mechanism. Poor sleep may lead to a negative attention bias (characteristic of depression) by impacting attentional control. This study assessed the hypothesis that attentional control and negative attention bias would sequentially mediate the relationship between insomnia and depressive symptoms in an unselected sample of young people (17-24 years). Concerns have been raised regarding the psychometric properties of tasks used to measure attention bias, and a Dual-Probe Task is emerging as a more reliable measure. Participants (N = 275, Male = 59, Mage = 19.40) completed the Dual-Probe Task, a behavioural measure of attentional control, and self-report measures of insomnia and depression. Participants completed a one-week sleep diary. Results were consistent with negative attention bias, but not attentional control, as a mechanism which partially accounts for the relationship between sleep (i.e., insomnia severity, sleep duration, sleep efficiency, sleep latency) and depression. This study highlights sleep and negative attention bias as potentially modifiable risk factors to reduce depressive symptoms in young people.

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.

An experimental investigation of biased attention in non-suicidal self-injury: The effects of perfectionism and emotional valence on attentional engagement and disengagement

BACKGROUND AND OBJECTIVES

Theoretical models of non-suicidal self-injury (NSSI) propose that individuals who self-injure may find their attention more strongly captured by negative emotion, and that this intensifies distress which leads to episodes of NSSI. Elevated perfectionism is associated with NSSI, and when an individual is highly perfectionistic, a focus on perceived flaws/failures may increase risk of NSSI. We explored how history of NSSI and trait perfectionism are associated with different types of attention bias (engagement vs. disengagement) to stimuli that differ in emotional valence (negative vs positive) and perfectionism relevance (relevant vs irrelevant).

METHODS

Undergraduate university students (N = 242) completed measures of NSSI, perfectionism, and a modified dot-probe task to measure attentional engagement with and disengagement from both positive and negative stimuli.

RESULTS

There were interactions between NSSI and perfectionism in attention biases. Amongst individuals who engage in NSSI, those with elevated trait perfectionism exhibit speeded responding to and disengagement from emotional stimuli (both positive and negative). Furthermore, individuals with a history of NSSI and elevated perfectionism were slower to respond to positive stimuli, and faster to negative stimuli.

LIMITATIONS

This experiment was cross-sectional in design so does not provide information about temporal ordering of these relationships, and given the use of a community sample, would benefit from replication in clinical samples.

CONCLUSIONS

These findings lend support to the emerging idea that biased attention plays a role in how perfectionism is associated with NSSI. Future studies should replicate these findings using other behavioural paradigms and diverse samples.

Body dissatisfaction and selective attention to thin-ideal bodies: The moderating role of attentional control

It has been widely hypothesised that elevated body dissatisfaction is characterised by a biased pattern of attentional selectivity that reflects increased attention to stimuli portraying the thin-ideal. Empirical evidence in support of this notion, however, has been inconsistent. The current study aimed to examine the potential moderating role of attentional control in the association between body dissatisfaction and selective attentional responding to thin-ideal bodies. Female undergraduate students (N = 232) completed a self-report measure of body dissatisfaction followed by performance-based measures of attentional control and selective attention. Results provided support for the moderating role of attentional control. Specifically, a positive association between body dissatisfaction and biased selective attention towards thin-ideal bodies was evident only amongst individuals with relatively low levels of attentional control. A general association between body dissatisfaction and selective attention was not observed. These findings may explain previous inconsistent findings and highlight the importance of considering the potential role of attentional control in the expression of body dissatisfaction-linked attentional responding to thin-ideal bodies.

Approach-Bias Retraining and Other Training Interventions as Add-On in the Treatment of AUD Patients

In the past two decades, a variety of cognitive training interventions have been developed to help people overcome their addictive behaviors. Conceptually, it is important to distinguish between programs in which reactions to addiction-relevant cues are trained (varieties of cognitive bias modification, CBM) and programs in which general abilities are trained such as working memory or mindfulness. CBM was first developed to study the hypothesized causal role in mental disorders: by directly manipulating the bias, it was investigated to what extent this influenced disorder-relevant behavior. In these proof-of-principle studies, the bias was temporarily modified in volunteers, either temporarily increased or decreased, with corresponding effects on behavior (e.g., beer consumption), in case the bias was successfully manipulated. In subsequent clinical randomized controlled trials (RCTs), training (away from the substance vs. sham training) was added to clinical treatment. These studies have demonstrated that CBM, as added to treatment, reduces relapse with a small effect of about 10% (similar effect size as for medication, with the strongest evidence for approach-bias modification). This has not been found for general ability training (e.g., working memory training), although effects on other psychological functions have been found (e.g., impulsivity). Mindfulness also has been found to help people overcome addictions, and different from CBM, also as stand-alone intervention. Research on (neuro-)cognitive mechanisms underlying approach-bias modification has pointed to a new perspective in which automatic inferences rather than associations are influenced by training, which has led to the development of a new variety of training: ABC training.

The questionable validity of attention bias variability: Evidence from two conceptually unrelated cognitive tasks

Background

Attention bias variability is thought to measure fluctuations in attention towards and away from threat-related information and is elevated in affective disorders. However, recent evidence suggests that attention bias variability may quantify general reaction time variability rather than attention bias behavior per se.

Methods

The current study calculated "attention bias variability" from two conceptually unrelated cognitive tasks: the dot-probe task (measuring attentional bias) and the arrow flanker task (measuring cognitive control).

Results

Attention bias variability measures were correlated across these unrelated tasks. Yet, when general reaction time variability was controlled, attention bias variability across tasks was no longer correlated. In addition, the reliability of attention bias variability measures decreased when controlling for general reaction time variability. Finally, although attention bias variability calculated from the dot-probe task initially correlated with anxious symptoms, this association was no longer significant when controlling for general reaction time variability.

Limitations

Our sample was comprised of high trait anxious individuals. Replication in clinical samples is warranted.

Conclusions

These findings collectively provide strong empirical evidence that attention bias variability is not a valid measure of attention-related behavior, but reflective of general reaction time variability more broadly.

Trial-level bias score versus mean bias score: Comparison of the reliability and external validity using dot-probe task among daily smokers

INTRODUCTION

Attentional bias (AB) is an individual difference risk factor that represents the extent to which cigarette cues capture one's attention. AB is typically indexed by mean bias score (MBS), theoretically assuming that AB is static. However, poor reliability of MBS has threatened valid interpretation of the results on AB. Based on observed trial-by-trial temporal fluctuation and variability of attentional allocation, trial-level bias score (TLBS) has been introduced as an alternative index with evidence of better psychometric properties in various populations, as compared to MBS. However, such evidence is limited among daily smokers. The current study aimed to replicate and extend extant findings in a sample of daily smokers by hypothesizing that TLBS, as compared to MBS, would demonstrate superior reliability and external validity.

METHODS

Forty-eight daily smokers completed self-reports, ad-libitum smoking, and a dot-probe task three times, which was comprised of 36 pairs of pictorial stimuli of cigarette and neutral cues, yielding 144 total trials.

RESULTS

The TLBS demonstrated superior internal (range intra class correlation [ICC] = 0.79-0.95) and test-retest reliability (range ICC = 0.64-0.88) compared to MBS (range ICC = 0.31-0.40 and 0.06-0.16, respectively). However, few significant relations between either the MBS or TLBS and measures of biobehavioral and self-report indices of smoking reinforcement were observed.

CONCLUSIONS

The current findings demonstrate that TLBS, as compared to MBS, is a more reliable measure of AB among daily smokers, while evidence of its external validity is limited.

An experimental test of integrating imagery with approach bias modification for alcohol: A cautionary tale

OBJECTIVES

In terms of dual process models, behaviour can be conceived of as the outcome of an interplay between reflective, top-down and impulsive, bottom-up processes. Behaviour change interventions may benefit from targeting both types of processes in a coherent way. One approach to this, in the context of reducing hazardous drinking, is to combine imagery involving real-life situations involving alcohol with the simple actions involved in Approach Bias Modification (ApBM), a form of Cognitive Bias Modification.

DESIGN

We developed and tested a version of this Imagery-enhanced Approach Bias Modification (IApBM) in an experimental design, with two independent factors: imagery versus control and ApBM versus control training components (N = 139).

METHODS

An effect of integrating the training factors was hypothesized on the alcohol-approach bias of an alcohol Approach-Avoidance Task. Further exploratory analyses were performed for the bias on alcohol-related Single Attribute Implicit Association Tests and on alcohol-related questionnaires. Finally, the psychometric properties of an imagery interference effect during training were explored.

RESULTS

Results showed no benefit of the training and in fact suggested a negative interaction in which combining the training components appeared to block reductions in craving effected by each in isolation. The reliability of the imagery-related interference effect was high and the effect was correlated with alcohol-related scales.

CONCLUSIONS

In conclusion, it appears that interference between training components decreases their individual effects when combining imagery and ApBM in the current way. The imagery-related interference effects that could be measured during training conditions may be useful as an implicit measure of automatic processes underlying hazardous drinking.

Attentional biases in human anxiety

Across clinical and subclinical samples, anxiety has been associated with increased attentional capture by cues signaling danger. Various cognitive models attribute the onset and maintenance of anxiety symptoms to maladaptive selective information processing. In this brief review, we 1) describe the evidence for the relations between anxiety and attention bias toward threat, 2) discuss the neurobiology of anxiety-related differences in threat bias, 3) summarize work investigating the developmental origins of attention bias toward threat, and 4) examine efforts to translate threat bias research into clinical intervention. Future directions in each area are discussed, including the use of novel analytic approaches improving characterization of threat-processing-related brain networks, clarifying the role of cognitive control in the development of attention bias toward threat, and the need for larger, well-controlled randomized clinical trials examining moderators and mediators of treatment response. Ultimately, this work has important implications for understanding the etiology of and for intervening on anxiety difficulties among children and adults.

A systematic survey of face stimuli used in psychological research 2000-2020

For decades, psychology has relied on highly standardized images to understand how people respond to faces. Many of these stimuli are rigorously generated and supported by excellent normative data; as such, they have played an important role in the development of face science. However, there is now clear evidence that testing with ambient images (i.e., naturalistic images "in the wild") and including expressions that are spontaneous can lead to new and important insights. To precisely quantify the extent to which our current knowledge base has relied on standardized and posed stimuli, we systematically surveyed the face stimuli used in 12 key journals in this field across 2000-2020 (N = 3374 articles). Although a small number of posed expression databases continue to dominate the literature, the use of spontaneous expressions seems to be increasing. However, there has been no increase in the use of ambient or dynamic stimuli over time. The vast majority of articles have used highly standardized and nonmoving pictures of faces. An emerging trend is that virtual faces are being used as stand-ins for human faces in research. Overall, the results of the present survey highlight that there has been a significant imbalance in favor of standardized face stimuli. We argue that psychology would benefit from a more balanced approach because ambient and spontaneous stimuli have much to offer. We advocate a cognitive ethological approach that involves studying face processing in natural settings as well as the lab, incorporating more stimuli from "the wild".

Attentional Bias to Alcohol Information: a Novel Dual-Probe Task

BACKGROUND

Even when motivated to consume less alcohol, attempts to do so are not always successful. Attentional bias to positive and negative alcohol-related information may play a role in shaping unintended drinking behaviour. The present exploratory study adapted a novel attentional bias task, to test whether selective attention to positive relative to negative information about alcohol consumption predicts mismatch between alcohol consumption intention and alcohol consumption behaviour.

METHOD

Thirty-five university students attempting to reduce their alcohol consumption participated in the study. Participants completed a novel attentional bias assessment task where two positive and negative audio-visual messages about alcohol consumption were simultaneously presented. At random intervals during these messages, two different probes were briefly and simultaneously presented, so that only one could be detected. Attention to positive vs. negative messages was inferred from the location of the probe recorded by the participant. Alcohol consumption in relation to participants' goals was measured using a real-time diary over the subsequent 7 days.

RESULTS

An attentional bias towards positive (relative to negative) messages about alcohol consumption predicted the degree to which participants consumed more alcohol than planned, but did not predict alcohol consumption itself.

CONCLUSION

This is the first study to our knowledge that has investigated the relationship between biased attention to alcohol-related information and variation in the success of intended reduction in alcohol consumption, and we suggest that it paves the way for further research into the role of attentional biases in health risk behaviours.

Enhanced capacity to switch but not to maintain: The basis of attentional bias to high calorie foods in restrained eaters

It has been argued that high restrained eaters (i.e., people who fluctuate between restrictive food intake and overeating) are characterised by a heightened attentional bias to high calorie foods. However, the validity of this hypothesis has not yet been convincingly established. The current study sought to empirically evaluate this hypothesis using two directional measures of attentional bias: the well-established dot probe bias assessment task and the more novel Chase the Food bias assessment task. The latter attentional assessment approach has the capacity to differentiate between attentional switching and attentional maintenance within a complex and dynamic food environment. Participants (61 high restrained eaters and 38 low restrained eaters) completed the dot probe task and the Chase the Food task. Findings obtained on the dot probe task did not reveal a group difference in terms of biased attentional responding towards high calorie vs. low calorie food. Conversely, the two groups were found to differ on one of the measures obtained on the Chase the Food task. Specifically, high restrained eaters, as compared to low restrained eaters, demonstrated speeded attentional switching to high calorie foods, rather than a greater ability to maintain attention on high calorie foods when required to do so. These novel findings imply that high restrained eaters are potentially characterised by facilitated attentional switching towards high calorie foods. Implications are discussed including the possibility of targeting biased attentional switching using training variants of the Chase the Food task in interventions designed to reduce maladaptive eating behaviours.

When Alcohol Adverts Catch the Eye: A Psychometrically Reliable Dual-Probe Measure of Attentional Bias

Existing tasks assessing substance-related attentional biases are characterized by low internal consistency and test–retest reliability. This study aimed to assess the psychometric properties of a novel dual-probe task to measure alcohol-related attentional bias. Undergraduate students were recruited in June 2019 (N = 63; final N = 57; mean age = 20.88, SD = 2.63, 67% females). In the dual-probe task, participants were presented with simultaneous visual streams of adverts promoting either alcoholic or non-alcoholic drinks, and probes were presented in both streams. The dual-probe task measured the percentage of accurately identified probes that appeared on alcohol adverts in relation to total accuracy. The dual-probe task displayed excellent split-half reliability (M = 0.90, SD = 0.11; α = 0.90; 95% CI [0.84, 0.93]), and the derived attentional bias measure was significantly positively associated with beer drinking in a taste-test (r (57) = 0.33, p = 0.013; 95% CI [0.07, 0.54]), with habitual drinking (r (57) = 0.27, p = 0.045; 95% CI [0.01, 0.49]), and with increased craving (r (57) = 0.29, p = 0.031; 95% CI [0.03, 0.51]). Thus, the dual-probe task assessed attentional bias with excellent internal consistency and was associated with laboratory and habitual drinking measures, demonstrating initial support for the task’s utility in addiction research.

Raising the bar: improving methodological rigour in cognitive alcohol research

BACKGROUND AND AIMS

A range of experimental paradigms claim to measure the cognitive processes underpinning alcohol use, suggesting that heightened attentional bias, greater approach tendencies and reduced cue-specific inhibitory control are important drivers of consumption. This paper identifies methodological shortcomings within this broad domain of research and exemplifies them in studies focused specifically on alcohol-related attentional bias.

ARGUMENT AND ANALYSIS

We highlight five main methodological issues: (i) the use of inappropriately matched control stimuli; (ii) opacity of stimulus selection and validation procedures; (iii) a credence in noisy measures; (iv) a reliance on unreliable tasks; and (v) variability in design and analysis. This is evidenced through a review of alcohol-related attentional bias (64 empirical articles, 68 tasks), which reveals the following: only 53% of tasks use appropriately matched control stimuli; as few as 38% report their stimulus selection and 19% their validation procedures; less than 28% used indices capable of disambiguating attentional processes; 22% assess reliability; and under 2% of studies were pre-registered.

CONCLUSIONS

Well-matched and validated experimental stimuli, the development of reliable cognitive tasks and explicit assessment of their psychometric properties, and careful consideration of behavioural indices and their analysis will improve the methodological rigour of cognitive alcohol research. Open science principles can facilitate replication and reproducibility in alcohol research.

Experimental control of conflict in a predictive visual probe task: Highly reliable bias scores related to anxiety

Concerns have been raised about the low reliability of measurements of spatial attentional bias via RT differences in dot-probe tasks. The anticipatory form of the bias, directed towards predicted future stimuli, appears to have relatively good reliability, reaching around 0.70. However, studies thus far have not attempted to experimentally control task-related influence on bias, which could further improve reliability. Evoking top-down versus bottom-up conflict may furthermore reveal associations with individual differences related to mental health. In the current study, a sample of 143 participants performed a predictive Visual Probe Task (predVPT) with angry and neutral face stimuli online. In this task, an automatic bias is induced via visually neutral cues that predict the location of an upcoming angry face. A task-relevant bias was induced via blockwise shifts in the likely location of target stimuli. The bias score resulting from these factors was calculated as RTs to target stimuli at locations of predicted but not actually presented angry versus neutral faces. Correlations were tested with anxiety, depression, self-esteem and aggression scales. An overall bias towards threat was found with a split-half reliability of 0.90, and 0.89 after outlier removal. Avoidance of threat in blocks with a task-relevant bias away from threat was correlated with anxiety, with correction for multiple testing. The same relationship was nominally significant for depression and low self-esteem. In conclusion, we showed high reliability of spatial attentional bias that was related to anxiety.

The relationship between worry and attentional bias to threat cues signalling controllable and uncontrollable dangers

People vary in the frequency with which they worry and there is large variation in the degree to which this worry disrupts their everyday functioning. Heightened tendency to experience disruptive worry is characterised by an attentional bias towards threat. While this attentional bias is often considered maladaptive, it can be adaptive when it concerns threat cues signalling dangers that can be mitigated through personal action. In this case, the resulting worry may increase the likelihood of this action being taken, with beneficial rather than disruptive consequences for everyday functioning. Thus, depending on its focus, attentional bias to threat could potentially drive worry that is high or low in disruptiveness. The current study addressed this possibility, by testing the novel hypothesis that the degree to which worry is disruptive is a function of the degree to which this attentional bias concerns all threat cues, rather than being restricted to threat cues signalling controllable dangers. Participants completed a novel probe task assessing their attention to threat cues signalling a future danger that could be controlled on some blocks, but not on others. Thus, the task revealed the degree to which their selective attention to threat cues was ‘aligned’ with danger controllability, by being more evident on blocks that permitted participant control of the danger signalled by the threat cues. The results indicate, contradicting the hypothesis under test, participants who reported high levels of disruptive worry demonstrated alignment of attentional bias to variations in danger controllability, whereas this was not the case for participants who reported high levels of non-disruptive worry. While caution is needed in the interpretation of the results due to methodological limitations, this study provides a new conceptual and methodological framework for future research on the attentional basis of individual differences in the tendency to experience disruptive vs non-disruptive worry.