Attentional threat biases and their role in anxiety: A neurophysiological perspective

Smartphone-Delivered Attentional Bias Modification Training for Mental Health: Systematic Review and Meta-Analysis

BACKGROUND

Smartphone-delivered attentional bias modification training (ABMT) intervention has gained popularity as a remote solution for alleviating symptoms of mental health problems. However, the existing literature presents mixed results indicating both significant and insignificant effects of smartphone-delivered interventions.

OBJECTIVE

This systematic review and meta-analysis aims to assess the impact of smartphone-delivered ABMT on attentional bias and symptoms of mental health problems. Specifically, we examined different design approaches and methods of administration, focusing on common mental health issues, such as anxiety and depression, and design elements, including gamification and stimulus types.

METHODS

Our search spanned from 2014 to 2023 and encompassed 4 major databases: MEDLINE, PsycINFO, PubMed, and Scopus. Study selection, data extraction, and critical appraisal were performed independently by 3 authors using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. When necessary, we pooled the standardized mean difference with a 95% CI. In addition, we conducted sensitivity, subgroup, and meta-regression analyses to explore moderator variables of active and placebo ABMT interventions on reducing symptoms of mental health problems and attentional bias.

RESULTS

Our review included 12 papers, involving a total of 24,503 participants, and we were able to conduct a meta-analysis on 20 different study samples from 11 papers. Active ABMT exhibited an effect size (Hedges g) of -0.18 (P=.03) in reducing symptoms of mental health problems, while the overall effect remained significant. Similarly, placebo ABMT showed an effect size of -0.38 (P=.008) in reducing symptoms of mental health problems. In addition, active ABMT (Hedges g -0.17; P=.004) had significant effects on reducing attentional bias, while placebo ABMT did not significantly alter attentional bias (Hedges g -0.04; P=.66).

CONCLUSIONS

Our understanding of smartphone-delivered ABMT's potential highlights the value of both active and placebo interventions in mental health care. The insights from the moderator analysis also showed that tailoring smartphone-delivered ABMT interventions to specific threat stimuli and considering exposure duration are crucial for optimizing their efficacy. This research underscores the need for personalized approaches in ABMT to effectively reduce attentional bias and symptoms of mental health problems.

TRIAL REGISTRATION

PROSPERO CRD42023460749; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=460749.

The label-feedback effect is influenced by target category in visual search

The label-feedback hypothesis states that language can modulate visual processing. In particular, hearing or reading aloud target names (labels) speeds up performance in visual search tasks by facilitating target detection and such advantage is often measured against a condition where the target name is shown visually (i.e. via the same modality as the search task). The current study conceptually complements and expands previous investigations. The effect of a multimodal label presentation (i.e., an audio+visual, AV, priming label) in a visual search task is compared to that of a multimodal (i.e. white noise+visual, NV, label) and two unimodal (i.e. audio, A, label or visual, V, label) control conditions. The name of a category (i.e. a label at the superordinate level) is used as a cue, instead of the more commonly used target name (a basic level label), with targets belonging to one of three categories: garments, improper weapons, and proper weapons. These categories vary for their structure, improper weapons being an ad hoc category (i.e. context-dependent), unlike proper weapons and garments. The preregistered analysis shows an overall facilitation of visual search performance in the AV condition compared to the NV condition, confirming that the label-feedback effect may not be explained away by the effects of multimodal stimulation only and that it extends to superordinate labels. Moreover, exploratory analyses show that such facilitation is driven by the garments and proper weapons categories, rather than improper weapons. Thus, the superordinate label-feedback effect is modulated by the structural properties of a category. These findings are consistent with the idea that the AV condition prompts an "up-regulation" of the label, a requirement for enhancing the label's beneficial effects, but not when the label refers to an ad hoc category. They also highlight the peculiar status of the category of improper weapons and set it apart from that of proper weapons.

Childhood Maltreatment and Amygdala-Mediated Anxiety and Posttraumatic Stress Following Adult Trauma

Background

Childhood abuse (physical, emotional, and sexual) is associated with aberrant connectivity of the amygdala, a key threat-processing region. Heightened amygdala activity also predicts adult anxiety and posttraumatic stress disorder (PTSD) symptoms, as do experiences of childhood abuse. The current study explored whether amygdala resting-state functional connectivity may explain the relationship between childhood abuse and anxiety and PTSD symptoms following trauma exposure in adults.

Methods

Two weeks posttrauma, adult trauma survivors (n = 152, mean age [SD] = 32.61 [10.35] years; women = 57.2%) completed the Childhood Trauma Questionnaire and underwent resting-state functional magnetic resonance imaging. PTSD and anxiety symptoms were assessed 6 months posttrauma. Seed-to-voxel analyses evaluated the association between childhood abuse and amygdala resting-state functional connectivity. A mediation model evaluated the potential mediating role of amygdala connectivity in the relationship between childhood abuse and posttrauma anxiety and PTSD.

Results

Childhood abuse was associated with increased amygdala connectivity with the precuneus while covarying for age, gender, childhood neglect, and baseline PTSD symptoms. Amygdala-precuneus resting-state functional connectivity was a significant mediator of the effect of childhood abuse on anxiety symptoms 6 months posttrauma (B = 0.065; 95% CI, 0.013-0.130; SE = 0.030), but not PTSD. A secondary mediation analysis investigating depression as an outcome was not significant.

Conclusions

Amygdala-precuneus connectivity may be an underlying neural mechanism by which childhood abuse increases risk for anxiety following adult trauma. Specifically, this heightened connectivity may reflect attentional vigilance for threat or a tendency toward negative self-referential thoughts. Findings suggest that childhood abuse may contribute to longstanding upregulation of attentional vigilance circuits, which makes one vulnerable to anxiety-related symptoms in adulthood.

Unpredictable threat increases early event-related potential amplitudes and cardiac acceleration: A brain-heart coupling study

In the face of unpredictable threat, rapid processing of external events and behavioral mobilization through early psychophysiological responses are crucial for survival. While unpredictable threat generally enhances early processing, it would seem adaptive to particularly increase sensitivity for unexpected events as they may signal danger. To examine this possibility, n = 77 participants performed an auditory oddball paradigm and received unpredictable shocks in threat but not in safe contexts while a stream of frequent (standard) and infrequent (deviant) tones was presented. We assessed event-related potentials (ERP), heart period (HP), and time-lagged within-subject correlations of single-trial EEG and HP (cardio-EEG covariance tracing, CECT) time-locked to the tones. N1 and P2 ERP amplitudes were generally enhanced under threat. The P3 amplitude was enhanced to deviants versus standards and this effect was reduced in the threat condition. Regarding HP, both threat versus safe and unexpected versus expected tones led to stronger cardiac acceleration, suggesting separate effects of threat and stimulus expectancy on HP. Finally, CECTs revealed two correlation clusters, indicating that single-trial EEG magnitudes in the N1/P2 and P3 time-windows predicted subsequent cardiac acceleration. The current results show that an unpredictable threat context enhances N1 and P2 amplitudes and cardiac acceleration to benign auditory stimuli. They further suggest separable cortical correlates of different effects on cardiac activity: an early N1/P2 correlate associated with threat-effects on HP and a later P3 correlate associated with expectedness-effects. Finally, the results indicate that unpredictable threat attenuates rather than enhances the processing of unexpected benign events during the P3 latency.

The threat sensitivity scale: A brief self-report measure of dispositional sensitivity toward perceiving threats to physical harm

The possibility of experiencing physical harm caused by an object, animal, or person is an omnipresent risk in almost any situation. People show variability in their in the propensity to perceive the possibility of harm from any ostensibly innocuous object or situation-a so-called threat bias. Despite the important psychological and societal consequences resulting from individual differences in physical threat bias, there does not currently exist an easily administered means to capture this disposition. We therefore endeavored to create a brief reliable self-report index of threat sensitivity for use by the many fields interested in the role of threat processing. We present here a physical threat sensitivity scale (TSS) that captures the dispositional tendency to perceive the possibility of physical harm in ostensibly innocuous situations or objects. We detail the development and validation of the TSS as a reliable index of individual threat bias (Studies 1a and 1b) and provide strong convergent evidence of the relationship between TS and both relevant individual differences (Study 2) and behavioral and perceptual indicates of threat bias (Study 3 and Study 4).

Vulnerabilities in social anxiety: Integrating intra- and interpersonal perspectives

What are the major vulnerabilities in people with social anxiety? What are the most promising directions for translational research pertaining to this condition? The present paper provides an integrative summary of basic and applied translational research on social anxiety, emphasizing vulnerability factors. It is divided into two subsections: intrapersonal and interpersonal. The intrapersonal section synthesizes research relating to (a) self-representations and self-referential processes; (b) emotions and their regulation; and (c) cognitive biases: attention, interpretation and judgment, and memory. The interpersonal section summarizes findings regarding the systems of (a) approach and avoidance, (b) affiliation and social rank, and their implications for interpersonal impairments. Our review suggests that the science of social anxiety and, more generally, psychopathology may be advanced by examining processes and their underlying content within broad psychological systems. Increased interaction between basic and applied researchers to diversify and elaborate different perspectives on social anxiety is necessary for progress.

The impact of attention bias modification training on behavioral and physiological responses

Attention bias modification training aims to alter attentional deployment to symptom-relevant emotionally salient stimuli. Such training has therapeutic applications in the management of disorders including anxiety, depression, addiction and chronic pain. In emotional reactions, attentional biases interact with autonomically-mediated changes in bodily arousal putatively underpinning affective feeling states. Here we examined the impact of attention bias modification training on behavioral and autonomic reactivity. Fifty-eight participants were divided into two groups. A training group (TR) received attention bias modification training to enhance attention to pleasant visual information, while a control group (CT) performed a procedure that did not modify attentional bias. After training, participants performed an evaluation task in which pairs of emotional and neutral images (unpleasant-neutral, pleasant-neutral, neutral-neutral) were presented, while behavioral (eye movements) and autonomic (skin conductance; heart rate) responses were recorded. At the behavioral level, trained participants were faster to orientate attention to pleasant images, and slower to orientate to unpleasant images. At the autonomic level, trained participants showed attenuated skin conductance responses to unpleasant images, while stronger skin conductance responses were generally associated with higher anxiety. These data argue for the use of attentional training to address both the attentional and the physiological sides of emotional responses, appropriate for anxious and depressive symptomatology, characterized by atypical attentional deployment and autonomic reactivity.

The effect of uncertainty on attentional bias in subclinical worriers: Evidence from reaction time and eye-tracking

BACKGROUND AND OBJECTIVES

High-worry individuals have been assumed to show attentional bias towards threat, particularly under high uncertainty. This study experimentally investigated the effect of uncertainty on attentional bias in subclinical worriers.

METHODS

A visual dot-probe task combined with eye-tracking was used to assess participants' attentional bias towards blurred and unfiltered stimuli. Fifty high-worry and 47 low-worry participants were randomly assigned to either the high- or low-uncertainty threat condition. Aversive noise bursts were delivered either unpredictably (the high-uncertainty threat condition) or predictably (the low-uncertainty threat condition) during the visual dot-probe task.

RESULTS

In the low-uncertainty threat condition, high-worry participants exhibited enhanced attentional engagement towards blurred pictures compared to low-worry participants. They also had shorter initial fixation latencies on blurred pictures than on unfiltered pictures. In the high-uncertainty threat condition, high-worry participants demonstrated more difficulty in disengaging from threatening pictures compared to low-worry participants.

LIMITATION

First, this study used a nonclinical sample. Second, the power was limited with regard to the analysis of eye-movement data. Third, anxiety and worry induced by noise bursts were measured using subjective rating scales only. Fourth, some picture characteristics, such as luminosity and complexity, were not controlled. Finally, uncertainty related to delivery of noise bursts and pictures were both manipulated dichotomously.

CONCLUSION

This study highlights the importance of uncertainty in the maintenance of attentional bias towards threat-related pictures in high-worry individuals.

An Integrative Model of Youth Anxiety: Cognitive-Affective Processes and Parenting in Developmental Context

Multiple theoretical frameworks have been proposed to provide a more comprehensive picture of the risk factors that influence anxiety-related developmental trajectories. Nonetheless, there remains a need for an integrative model that outlines: (1) which risk factors may be most pertinent at different points in development, and (2) how parenting may maintain, exacerbate, or attenuate an affective style that is characterized by high negative emotional reactivity to unfamiliar, uncertain, and threatening situations. A developmentally informed, integrative model has the potential to guide treatment development and delivery, which is critical to reducing the public health burden associated with these disorders. This paper outlines a model integrating research on many well-established risk mechanisms for anxiety disorders, focusing on (1) the developmental progression from emotional reactivity constructs early in life to those involving higher-level cognitive processes later in youth, and (2) potential pathways by which parenting may impact the stability of youth's cognitive-affective responses to threat-relevant information across development.

Topographical similarity of cortical thickness represents generalized anxiety symptoms in adolescence

Generalized anxiety disorder (GAD) is a common condition characterized by excessive and uncontrollable worry, along with its high comorbidity rates. Despite increasing efforts to identify the neural underpinnings of GAD, neuroimaging research using cortical thickness have yielded largely inconsistent results. To address this, we adopted an inter-subject representational similarity analysis framework to explore a potential nonlinear relationship between vertex-wise cortical thickness and generalized anxiety symptom severity. We utilized a sample of 120 adolescents (13-18 years of age) from the Healthy Brain Network dataset. Here, we found greater topographical resemblance among participants with heightened generalized anxiety symptoms in the left caudal anterior cingulate and pericalcarine cortex. These results were not driven by the effects of age, sex, ADHD diagnosis, and GAD diagnosis. Such associations were not observed when including a group of younger participants (11-12 years of age) for analyses, highlighting the importance of age range selection when considering the link between cortical thickness and anxiety. Our findings reveal a novel cortical thickness topography that represents generalized anxiety in adolescents, which is embedded within the shared geometries between generalized anxiety symptoms and cortical thickness.

Understanding anxiety symptoms as aberrant defensive responding along the threat imminence continuum

Threat-anticipatory defensive responses have evolved to promote survival in a dynamic world. While inherently adaptive, aberrant expression of defensive responses to potential threat could manifest as pathological anxiety, which is prevalent, impairing, and associated with adverse outcomes. Extensive translational neuroscience research indicates that normative defensive responses are organized by threat imminence, such that distinct response patterns are observed in each phase of threat encounter and orchestrated by partially conserved neural circuitry. Anxiety symptoms, such as excessive and pervasive worry, physiological arousal, and avoidance behavior, may reflect aberrant expression of otherwise normative defensive responses, and therefore follow the same imminence-based organization. Here, empirical evidence linking aberrant expression of specific, imminence-dependent defensive responding to distinct anxiety symptoms is reviewed, and plausible contributing neural circuitry is highlighted. Drawing from translational and clinical research, the proposed framework informs our understanding of pathological anxiety by grounding anxiety symptoms in conserved psychobiological mechanisms. Potential implications for research and treatment are discussed.

Anodal transcranial direct current stimulation (tDCS) over the left dorsolateral prefrontal cortex improves attentional control in chronically stressed adults

Introduction

Chronic stress is a long-term condition that negatively affects cognitive ability and mental health. Individuals who experience chronic stress show poor attentional control. Transcranial direct current stimulation (tDCS) to the dorsolateral prefrontal cortex (DLPFC) modulates executive function domains. Therefore, it is beneficial to investigate whether tDCS of the DLPFC could improve attentional control and relieve stress in chronically stressed individuals.

Methods

We assess the event-related potentials (ERPs) associated with attentional control in individuals with chronic stress after the tDCS intervention. Forty individuals were randomly assigned to either the anodal tDCS group, which received 5 sessions of the 20 min tDCS over the DLPFC (2 mA; n = 20), or the sham tDCS (n = 20). Participants' stress levels, anxiety, depressive symptoms, and state affects were assessed and compared before and after the intervention. The ERP was collected through electroencephalography (EEG) technology during an attentional network test.

Results

After the anodal tDCS, we found a significant decrease in the perceived stress scale (PSS) scores (from an average score of 35.05 to 27.75), p = 0.01 as well as the State-Trait Anxiety Inventory (STAI) scores, p = 0.002. Better performance in the attentional network test, a significant reduction in the N2 amplitudes, and an enhancement in the P3 amplitudes (both cues and targets) were also found in the anodal tDCS group.

Discussion

Our study findings suggest that tDCS to the left DLPFC could effectively relieve chronic stress, potentially reflected by increased attentional control.

Early neural potentiation to centrally and peripherally presented fear-conditioned faces

For humans, it is vitally important to rapidly detect and process threatening signals regardless of whether stimuli occur at fixation or in the periphery. However, it is unknown whether eccentricity affects early neuronal electrophysiological responses to fear-conditioned stimuli. We examined early event-related potentials (ERPs) of the electroencephalogram (EEG) to fear-conditioned faces to address this question. Participants (N = 80) were presented with faces, either paired with an aversive (CS+) or neutral sound (CS-), at central or peripheral positions. We ensured constant central fixation using online eye-tracking but directed attention to either centrally or peripherally presented faces. Manipulation checks showed successful fear-conditioning (i.e., on average lower ratings in valence and higher ratings in arousal and perceived threat) and successful shifts of visuospatial attention indexed by high task performance and pre-stimulus alpha lateralization of the EEG spectra. We observed a generally increased P1 to fear-conditioned faces regardless of presentation location. An N170 difference between fear-conditioned and neutral stimuli was found but was restricted to the central location and depended on the effectivity of fear-conditioning. A similar effect was observed for the early posterior negativity (EPN). Trait anxiety was not related to differential ERP responses to CS+ versus CS- faces for any ERP component. These findings suggest that the P1 indexes early responses to centrally and peripherally presented fear-conditioned faces. Subsequent stages are modulated by the spatial location of the stimuli. This suggests different stages of neural processing of fear-conditioned faces depending on their spatial location. Finally, our results question the hypothesis that trait anxiety in healthy participants is related to altered visual processing of fear-conditioned faces.

Potentiated early neural responses to fearful faces are not driven by specific face parts

Prioritized processing of fearful compared to neutral faces is reflected in increased amplitudes of components of the event-related potential (ERP). It is unknown whether specific face parts drive these modulations. Here, we investigated the contributions of face parts on ERPs to task-irrelevant fearful and neutral faces using an ERP-dependent facial decoding technique and a large sample of participants (N = 83). Classical ERP analyses showed typical and robust increases of N170 and EPN amplitudes by fearful relative to neutral faces. Facial decoding further showed that the absolute amplitude of these components, as well as the P1, was driven by the low-frequency contrast of specific face parts. However, the difference between fearful and neutral faces was not driven by any specific face part, as supported by Bayesian statistics. Furthermore, there were no correlations between trait anxiety and main effects or interactions. These results suggest that increased N170 and EPN amplitudes to task-irrelevant fearful compared to neutral faces are not driven by specific facial regions but represent a holistic face processing effect.

A novel probe of attentional bias for threat in specific phobia: Application of the "MouseView.js" approach

Although attentional bias for threat has been implicated in anxiety disorders, traditional attentional bias measures have been criticized for lack of reliability and validity, and eye tracking technologies can be cost-prohibitive. MouseView.js was recently developed to mimic eye tracking online by using the computer cursor as a proxy for gaze, and although it is equally reliable, MouseView.js' utility for capturing attentional bias for threat in anxiety-related disorders remains unclear. To fill this knowledge gap, snake phobic and non-phobic participants (N = 62) completed a behavioral avoidance task (BAT) and the MouseView.js task which consisted of 10-second exposures to blurred, side-by-side images of either pleasant-neutral or threat-neutral pairings and were instructed to freely move the mouse to reveal the images. Results demonstrated that snake phobic participants had significantly shorter average mouse dwell time on threat images than non-phobic individuals and showed a significant reduction in average dwell time on threat images following the first presentation of the threat-neutral pairing. Additionally, dwell time on threat images significantly mediated the group differences in steps completed on the BAT. Results highlight the utility of MouseView.js in capturing avoidant patterns of attentional bias for threat that may also partially drive avoidance in snake phobia. Implications for capturing attentional bias for threat in anxiety disorders more broadly are discussed.

High-trait anxious individuals show positive relationship between HRV and threat vigilance

Selectively attending to threat-related stimuli in the environment, known as threat bias (TB), is a prominent feature of anxiety. Individuals with high anxiety also tend to show lower heart rate variability (HRV), a reflection of reduced parasympathetic cardiac control. Previous investigations have established associations between low HRV and various attentional processes that facilitate attention to threat, though these have primarily been conducted among non-anxious individuals. The current analysis, derived from a larger TB modification study, examined the relationship between TB and HRV among a young, nonclinical sample of individuals with either high or low trait anxiety (HTA, LTA, respectively; M_age  = 25.8, SD = 13.2, 61.3% female). Consistent with expectations, HTA (β = -.18, p = .087) trended toward an association with higher threat vigilance. A significant moderation effect showed the relationship between HRV and threat vigilance was influenced by TA (β = .42, p = .004). Simple slopes analysis revealed that for the LTA group, lower HRV trended toward higher threat vigilance (p = .123), consistent with expectations. However, this relationship was unexpectedly reversed for the HTA group, for whom higher HRV was a significant predictor of higher threat vigilance (p = .015). These results are interpreted within a cognitive control framework, in which regulatory ability, as assessed via HRV, may influence which cognitive strategy is employed when encountering threatening stimuli. Results suggest that HTA individuals with greater regulatory ability may employ a contrast avoidance mechanism, while those with reduced regulatory ability engage in cognitive avoidance.

Effects of attention bias modification for anxiety: Neurophysiological indices and moderation by symptom severity

OBJECTIVE

Attention bias modification (ABM) aims to decrease anxiety symptom severity through the reduction of threat-related attention bias (AB). Individual differences in treatment response and poor measurement reliability of AB have called its clinical promise into question. The current study examined whether individual differences in anxiety severity at baseline moderated treatment response, and employed both behavioral and neurophysiological metrics of AB.

METHODS

Participants (N = 99) were randomly assigned to four weeks of ABM or placebo control training (PT). Self-reported anxiety symptom severity, and AB metrics and ERPs generated during the dot probe task were collected at baseline (Time 1), one-week post-intervention (Time 5), and at a three-month follow-up (Time 6).

RESULTS

ABM, relative to PT, reduced ERPs indexing attention discrimination (N170) and increased ERPs indexing salience tracking (P3). Increases in P3 were associated with ABM-related reductions in anxiety. Anxiety severity was reduced following ABM, but only among those with higher baseline anxiety symptom severity.

CONCLUSIONS

ABM effectively reduced symptom severity among those with higher levels of anxiety, and modulated neurophysiological indices of AB.

SIGNIFICANCE

Results provide evidence for attention-relevant ERPs as outcomes of ABM treatment responsivity and suggest that ABM may be most beneficial for those with more severe anxiety symptoms.

General deficits of attentional inhibition in high trait anxiety: ERP evidence

Behavioral evidence shows that individuals with high trait anxiety tend to be distracted by irrelevant stimulation not only for threat-related stimuli but also for non-emotional neutral stimuli. These findings suggest that there may be a general deficit of attentional control in trait anxiety. However, the neural mechanism underlying the anxiety-related deficit in attentional control, especially inhibition function, is still unclear. Here, we examined the attentional processing of the non-emotional neutral distractor on 66 young adults with different levels of trait anxiety, using the ERP indices of attentional selection (N2pc) and top-down inhibition (Pd) in a search task with geometric stimuli. We found that the distractor-evoked N2pc amplitude did not vary with anxiety levels, but increased anxiety was associated with smaller Pds (i.e. worse inhibition). Besides, delayed attentional selection of targets was associated with higher anxiety levels. These correlations of trait anxiety remained significant even after controlling for state anxiety, and state anxiety did not affect the attentional processing of distractors and targets, suggesting that trait anxiety, not current anxiety, affects attentional function. Our findings clarify the mechanism underlying the general attentional deficits in trait anxiety, e.g. reduced distractor inhibition and delayed target selection.

Behavioural inhibition and early neural processing of happy and angry faces interact to predict anxiety: a longitudinal ERP study

Limited prospective research has examined whether attention biases to emotion moderate associations between Behavioural Inhibition (BI) and anxiety in preschool-aged children. Furthermore, there has been an over-reliance on behavioral measures in previous studies. Accordingly, we assessed anxiety in a sample of preschool-aged children (3-4 years) at baseline, and again approximately 6 and 11 months later, after they started school. At baseline, children completed an assessment of BI and an EEG task where they were presented with angry, happy, and neutral faces. EEG analyses focused on ERPs (P1, P2, N2) associated with specific stages of attention allocation. Interactions between BI and emotion bias (ERP amplitude for emotional versus neutral faces) were found for N2 and P1. For N2, BI was significantly associated with higher overall anxiety when an angry bias was present. Interestingly for P1, BI was associated with higher overall anxiety when a happy bias was absent. Finally, interactions were found between linear time and happy and angry bias for P1, with a greater linear decrease in anxiety over time when biases were high. These results suggest that attention to emotional stimuli moderates the BI-anxiety relationship across early development.

Spatial attentional biases toward height-related words in young males with physical stature dissatisfaction

By recording event-related potentials (ERPs) during a dot-probe task, the present study examined the neural dynamics of attentional bias toward height-related words among height dissatisfied males. Sixty male participants screened by Negative Physical Self Scale-Stature Concerns subscale (NPS-S) were assigned into a high height dissatisfaction (HHD) group and a low height dissatisfaction (LHD) group. The results showed that tall-related versus neutral words elicited larger N2pc for both HHD and LHD groups, whereas short-related versus neutral words elicited larger N2pc only for the HHD group. Additionally, an evident Pd was elicited by tall-related words for the HHD group, but not for the LHD group. Taken together, these findings revealed attentional biases toward height-related information for HHD individuals on a neural level. Specifically, HHD individuals showed an enhanced spatial attention oriented toward both tall-related and short-related words, and then, the allocated attention to the tall-related words was terminated by an active suppression mechanism.

Time course of attentional bias in social anxiety: Evidence from visuocortical dynamics

Threat-related attentional bias is thought to have a causal influence on the etiology of social anxiety. However, there is uncertainty on whether attention dwells on or diverts away from threats, and the measurements typically utilized to explore attentional bias cannot continuously quantify changes in attention. Here, we used steady-state visual evoked potentials (ssVEPs) as a continuous neurophysiological measure of visual attentional processing to examine the time course of attentional bias in social anxiety. Participants with high (n = 18) and low (n = 18) social anxiety passively viewed two faces flickering at 15 and 20 Hz frequency to evoke ssVEPs, and completed Attentional Control Scale. The results showed that angry faces, as compared to happy and neutral faces, elicited larger ssVEP amplitudes for the time window of 180-500 ms after facial stimuli onset only in the high socially anxious individuals, and the effect extended to the next two periods of 500-1000 ms and 1000-1500 ms. The ssVEP amplitudes differed most when individuals with high social anxiety viewed angry-neutral expression combinations. Additionally, attentional control was negatively correlated with social anxiety and threat-related attentional bias. The results suggested that individuals with social anxiety initially oriented attention toward the threat and subsequently exhibited difficulty in disengaging attention from it, possibly due to impaired attentional control.

The late positive potential during affective picture processing: Associations with daily life emotional functioning among adolescents with anxiety disorders

Pediatric anxiety disorders are characterized by potentiated threat responses and maladaptive emotion regulation (ER). The Late Positive Potential (LPP) is a neural index of heightened attention to emotional stimuli. Anxious individuals typically exhibit a larger LPP to unpleasant stimuli, but the LPP may also be blunted to unpleasant and pleasant stimuli for those with co-morbid depression. While a larger LPP is thought to reflect greater emotional reactivity, it is unknown to what extent variation in the LPP to laboratory stimuli corresponds to daily emotional functioning. We assessed the LPP in the laboratory in response to unpleasant, pleasant, and neutral images in combination with ecological momentary assessment of emotional reactivity and regulation in daily life among youth (9-14 years old; 55 % female) with anxiety disorders (ANX, N = 130) and no psychiatric diagnoses (ND, N = 47). We tested whether LPP amplitudes to unpleasant and pleasant stimuli (vs. neutral) are greater in ANX (vs. ND) youth and whether LPP amplitudes inversely correlate with co-morbid depression symptoms. We also examined associations between the LPP and daily life emotional functioning among ANX and ND youth. We found no group-by-valence effects on LPP amplitudes. Within ANX youth, higher depression symptoms were associated with smaller LPP amplitudes to unpleasant, but not pleasant, stimuli relative to neutral stimuli. Larger LPP amplitudes to emotional (relative to neutral) stimuli were correlated with use of specific ER strategies among ANX and ND youth but not emotional reactivity. While the LPP may reflect initial emotional reactivity to laboratory stimuli, it is associated with ER behaviors, and not emotional reactivity, in daily life.

Using expectation violation models to improve the outcome of psychological treatments

Expectations are a central maintaining mechanism in mental disorders and most psychological treatments aim to directly or indirectly modify clinically relevant expectations. Therefore, it is crucial to examine why patients with mental disorders maintain dysfunctional expectations, even in light of disconfirming evidence, and how expectation-violating situations should be created in treatment settings to optimize treatment outcome and reduce the risk of treatment failures. The different psychological subdisciplines offer various approaches for understanding the underlying mechanisms of expectation development, persistence, and change. Here, we convey recommendations on how to improve psychological treatments by considering these different perspectives. Based on our expectation violation model, we argue that the outcome of expectation violation depends on several characteristics: features of the expectation-violating situation; the dynamics between the magnitude of expectation violation and cognitive immunization processes; dealing with uncertainties during and after expectation change; controlled and automatic attention processes; and the costs of expectation changes. Personality factors further add to predict outcomes and may offer a basis for personalized treatment planning. We conclude with a list of recommendations derived from basic psychology that could contribute to improved treatment outcome and to reduced risks of treatment failures.

The role of healthy emotionality in the relationship between fear of COVID-19 and mental health problems: a cross-sectional study

Understanding pandemic-related psychopathology development is limited due to numerous individual and contextual factors. It is widely accepted that individual differences to endure or cope with distress predict psychopathology development. The present study investigated the influence of individual differences in neuroticism and healthy emotionality concerning the association between fear of COVID-19 and mental health problems. It was hypothesized that healthy emotionality would moderate the mediated link between fear of COVID-19 and mental health problems. A sample of 752 participants (351 males and 401 females) completed an online survey including the Emotional Style Questionnaire, Fear of COVID-19 Scale, the Neuroticism subscale of the Big Five Inventory, and General Health Questionnaire. The results showed that the fear of COVID-19 positively predicted mental health problems (β = .43, SE = .05, p < .001, Cohen's f 2 = .24). Neuroticism also showed a significant mediation effect on the relationship between fear of COVID-19 and mental health problems. Fear of COVID-19 indirectly predicted psychopathology through neuroticism (β = - .16, SE = .04, p < .001, t = 4.53, 95% CI [0.11, 0.23]). Moreover, healthy emotionality had a moderating effect on the relationship between fear of COVID-19 and mental health problems, β = - .21, SE = .03, p < .001, t = 5.91, 95% CI [- 0.26, - 0.14]. The study's findings are expected to contribute to a better understanding of the roles of both individual differences in personality traits and healthy emotionality in psychopathology development during the current pandemic.

No trait anxiety influences on early and late differential neuronal responses to aversively conditioned faces across three different tasks

The human brain's ability to quickly detect dangerous stimuli is crucial in selecting appropriate responses to possible threats. Trait anxiety has been suggested to moderate these processes on certain processing stages. To dissociate such different information-processing stages, research using classical conditioning has begun to examine event-related potentials (ERPs) in response to fear-conditioned (CS +) faces. However, the impact of trait anxiety on ERPs to fear-conditioned faces depending on specific task conditions is unknown. In this preregistered study, we measured ERPs to faces paired with aversive loud screams (CS +) or neutral sounds (CS −) in a large sample (N = 80) under three different task conditions. Participants had to discriminate face-irrelevant perceptual information, the gender of the faces, or the CS category. Results showed larger amplitudes in response to aversively conditioned faces for all examined ERPs, whereas interactions with the attended feature occurred for the P1 and the early posterior negativity (EPN). For the P1, larger CS + effects were observed during the perceptual distraction task, while the EPN was increased for CS + faces when deciding about the CS association. Remarkably, we found no significant correlations between ERPs and trait anxiety. Thus, fear-conditioning potentiates all ERP amplitudes, some processing stages being further modulated by the task. However, the finding that these ERP differences were not affected by individual differences in trait anxiety does not support theoretical accounts assuming increased threat processing or reduced threat discrimination depending on trait anxiety.

Neurophysiological Correlates for Dynamic Variability Between Vigilance and Avoidance in Test Anxiety

Attention bias (ABs) to threat is essential in the etiology and maintenance of test anxiety. However, little is known about the attention pattern of ABs in test anxiety. The stimulus duration affects the attention pattern in anxiety. Thus, the present research combined the dot-probe paradigm and event-related potentials (ERPs) and varied the stimulus duration (100ms or 500ms) to test the ABs in test anxiety. Consequently, both groups showed a threat N2pc in 100ms and 500ms duration, suggesting that both groups allocated attention to the test-related threat. However, in the 100ms duration, the high test-anxious (HTA) group had smaller target-elicited P1 and greater target-elicited N2 in the threat-congruent condition than in the neutral condition. In the 500ms duration, an earlier threat N2pc and a threat PD followed a greater target P1, and smaller target N2 were pronounced in the HTA group. The current results provided electrophysiological evidence that the HTA group kept a dynamic attention pattern that fluctuated shift between vigilance and avoidance in the 100ms and 500ms duration. The HTA group was more vigilant than the LTA group in the 500ms duration when strategic attention was concerned, proposing that the vigilance in test anxiety was not an automatic process.

Using Neurofeedback from Steady-State Visual Evoked Potentials to Target Affect-Biased Attention in Augmented Reality

Biases in attention to emotional stimuli (i.e., affect-biased attention) contribute to the development and mainte-nance of depression and anxiety and may be a promising target for intervention. Past attempts to therapeutically modify affect-biased attention have been unsatisfactory due to issues with reliability and precision. Electroencephalogram (EEG)-derived steady-state visual evoked potentials (SSVEPS) provide a temporally-sensitive biological index of attention to competing visual stimuli at the level of neuronal populations in the visual cortex. SSVEPS can potentially be used to quantify whether affective distractors vs. task-relevant stimuli have "won" the competition for attention at a trial-by-trial level during neuro-feedback sessions. This study piloted a protocol for a SSVEP-based neurofeedback training to modify affect-biased attention using a portable augmented-reality (AR) EEG interface. During neurofeedback sessions with five healthy participants, signifi-cantly greater attention was given to the task-relevant stimulus (a Gabor patch) than to affective distractors (negative emotional expressions) across SSVEP indices (p<0.000l). SSVEP indices exhibited excellent internal consistency as evidenced by a maximum Guttman split-half coefficient of 0.97 when comparing even to odd trials. Further testing is required, but findings suggest several SSVEP neurofeedback calculation methods most deserving of additional investigation and support ongoing efforts to develop and implement a SSVEP-guided AR-based neurofeedback training to modify affect-biased attention in adolescent girls at high risk for depression.

Alpha-2 Adrenoreceptor Antagonist Yohimbine Potentiates Consolidation of Conditioned Fear

BACKGROUND

Hyperconsolidation of aversive associations and poor extinction learning have been hypothesized to be crucial in the acquisition of pathological fear. Previous animal and human research points to the potential role of the catecholaminergic system, particularly noradrenaline and dopamine, in acquiring emotional memories. Here, we investigated in a between-participants design with 3 groups whether the noradrenergic alpha-2 adrenoreceptor antagonist yohimbine and the dopaminergic D2-receptor antagonist sulpiride modulate long-term fear conditioning and extinction in humans.

METHODS

Fifty-five healthy male students were recruited. The final sample consisted of n = 51 participants who were explicitly aware of the contingencies between conditioned stimuli (CS) and unconditioned stimuli after fear acquisition. The participants were then randomly assigned to 1 of the 3 groups and received either yohimbine (10 mg, n = 17), sulpiride (200 mg, n = 16), or placebo (n = 18) between fear acquisition and extinction. Recall of conditioned (non-extinguished CS+ vs CS-) and extinguished fear (extinguished CS+ vs CS-) was assessed 1 day later, and a 64-channel electroencephalogram was recorded.

RESULTS

The yohimbine group showed increased salivary alpha-amylase activity, confirming a successful manipulation of central noradrenergic release. Elevated fear-conditioned bradycardia and larger differential amplitudes of the N170 and late positive potential components in the event-related brain potential indicated that yohimbine treatment (compared with a placebo and sulpiride) enhanced fear recall during day 2.

CONCLUSIONS

These results suggest that yohimbine potentiates cardiac and central electrophysiological signatures of fear memory consolidation. They thereby elucidate the key role of noradrenaline in strengthening the consolidation of conditioned fear associations, which may be a key mechanism in the etiology of fear-related disorders.

Supportive Therapy to Reduce Anxiety Levels of COVID-19 Nurses in Isolation ICU Room

BACKGROUND: COVID-19 for this year has had a negative impact on life, particularly the psychological impact of anxiety. Anxiety occurs in the general public and in health workers, one of which is a nurse. If anxiety continues, it will affect the quality of life and performance of nurses. Supportive therapy is one of the non-pharmacological treatments to reduce anxiety. AIM: This study was to determine the effectiveness of supportive therapy in reducing the anxiety of COVID-19 nurses in isolation ICU. METHODS: This study used quantitative research with a quasi-experimental design. The researcher wanted to know the effectiveness of a treatment, namely, supportive therapy, against the anxiety of the COVID-19 nurses of isolation ICU room. This study used a pre-post-test one-group intervention method. The therapy mechanism applied 1–4 sessions of supportive therapy by dividing each session into 3 days. Forty respondents participated in this study. The data obtained were analyzed using paired t-test. RESULTS: The results show that 55% of respondents experience moderate anxiety before supportive therapy, and 60% are not anxious after supportive therapy. It is also found that p = 0.000 is considered and lower than the alpha value of 0.05 (0.000 < 0.05). Therefore, there is a statistically significant difference before and after supportive therapy. CONCLUSION: The conclusion that can be drawn is the influence of supportive therapy on reducing anxiety in COVID-19 isolation ICU nurses.

Seizure phobia: A distinct psychiatric disorder among people with epilepsy

OBJECTIVE

Epilepsy is characterized by unpredictable attacks. Hence, people with epilepsy (PWE) may develop anxious anticipation of upcoming seizures. Seizure phobia is an anxiety disorder wherein seizure anticipatory situations trigger fear, accompanied by avoidance behaviors. Research on seizure phobia among PWE is scarce. Therefore, we aimed to describe the diagnosis of seizure phobia and its association with demographic, psychiatric and neurological variables.

METHODS

This is a cross-sectional study of adult PWE in a tertiary epilepsy outpatient clinic. Data were collected from semi-structured interviews, demographic questionnaires and medical records. Patients with and without seizure phobia were compared in terms of sociodemographic, psychiatric, and neurological variables. A logistic regression analysis was performed to identify variables that predicted seizure phobia.

RESULTS

Among 69 PWE included in the study, 19 (27.5%) were diagnosed with seizure phobia. In comparison with PWE without seizure phobia, PWE with seizure phobia were predominantly female (84.2% vs 44.2%, p = 0.005), and had more comorbid anxiety disorders (84.2% vs 34.9%, p = 0.01), past major depressive episode (MDE) (63.2% vs 20.9%, p = 0.003), and post-traumatic stress disorder (26.3% vs 7%, p = 0.05). There was a significant association between seizure phobia and comorbid psychogenic non-epileptic seizures (36.8% vs 11.6%, p = 0.034). However, no significant association was found with epilepsy-related variables. A multivariate logistic regression model indicated anxiety and a past MDE as predictive factors for seizure phobia (R² = 0.43).

CONCLUSION

Seizure phobia is a distinct psychiatric entity among PWE. Further research is required to understand its etiology, risk factors, and potential interventions for these patients.

The Role of Neuropsychological Factors in Perceived Threat of SARS-CoV-2 in Healthy Ageing

The COVID-19 pandemic is known to increase older adults' vulnerability to adverse outcomes. Alongside increased physical frailty, anxiety symptoms associated with the risk of SARS-CoV-2 contagion appear to represent its most prominent 'sequelae'. The attentional and linguistic resources required for decoding virus-related information may also influence the perceived threat of contagion. However, the possible role of neuropsychogeriatric factors on the latter dimension has never been assessed in a longitudinal study on the older population. To fill this gap, 50 healthy cognitively preserved older adults underwent a neuropsychological and physical frailty assessment before the pandemic (T0). Subsequently, they agreed to be interviewed and re-assessed during the lockdown (T1) and immediately after it (T2) through a longitudinal one-year study. Perceived threat of SARS-CoV-2 at T2 was predicted both by baseline anxiety and frailty scores, and by decreased performance in information processing speed and language comprehension tests. While confirming the joint role of frailty and anxiety, a moderation/interaction model showed that each of them was sufficient, at its highest level, to support the maximum degree of perceived threat of contagion. The contribution of neuropsychological factors to perceived threat of SARS-CoV-2 highlights their importance of tailoring information campaigns addressed to older people.

Anxiety and Attentional Processes: The Role of Resting Heart Rate Variability

Individuals with high anxiety preferentially focus attention on emotional information. The autonomic nervous system (ANS) plays an important role in modulating both anxiety and attentional processes. Despite many studies having evaluated attentional bias in anxious people, few of them have investigated the change blindness phenomenon associated with the attentional response toward salient stimuli, considering the role of the ANS. This study aimed to examine the role of heart rate variability (HRV) in trait anxiety and top-down and bottom-up attentional processes toward emotional stimuli. Seventy-five healthy university students were divided into high (N = 39) and low (N = 36) trait anxiety groups and completed a change detection flicker task with neutral, positive, and negative stimuli. The results evidenced a different attentional pattern between people with high and low anxiety considering both the two attentional processes and the valence of the stimuli. Specifically, individuals with high anxiety showed a bias in elaborating emotional stimuli related to their salience (i.e., negative stimuli were faster elaborated than neutral and positive stimuli when top-down attentional mechanisms were involved, while slower performances were highlighted considering bottom-up attentional mechanisms in response to emotional stimuli compared to neutral stimuli). Moreover, an association between HRV, trait anxiety levels, and change blindness phenomenon was confirmed. These results underline the role of HRV as a possible predictor of the alteration of attentional mechanism in anxiety.

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

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

Learning dynamics of electrophysiological brain signals during human fear conditioning

Electrophysiological studies in rodents allow recording neural activity during threats with high temporal and spatial precision. Although fMRI has helped translate insights about the anatomy of underlying brain circuits to humans, the temporal dynamics of neural fear processes remain opaque and require EEG. To date, studies on electrophysiological brain signals in humans have helped to elucidate underlying perceptual and attentional processes, but have widely ignored how fear memory traces evolve over time. The low signal-to-noise ratio of EEG demands aggregations across high numbers of trials, which will wash out transient neurobiological processes that are induced by learning and prone to habituation. Here, our goal was to unravel the plasticity and temporal emergence of EEG responses during fear conditioning. To this end, we developed a new sequential-set fear conditioning paradigm that comprises three successive acquisition and extinction phases, each with a novel CS+/CS- set. Each set consists of two different neutral faces on different background colors which serve as CS+ and CS-, respectively. Thereby, this design provides sufficient trials for EEG analyses while tripling the relative amount of trials that tap into more transient neurobiological processes. Consistent with prior studies on ERP components, data-driven topographic EEG analyses revealed that ERP amplitudes were potentiated during time periods from 33-60 ms, 108-200 ms, and 468-820 ms indicating that fear conditioning prioritizes early sensory processing in the brain, but also facilitates neural responding during later attentional and evaluative stages. Importantly, averaging across the three CS+/CS- sets allowed us to probe the temporal evolution of neural processes: Responses during each of the three time windows gradually increased from early to late fear conditioning, while long-latency (460-730 ms) electrocortical responses diminished throughout fear extinction. Our novel paradigm demonstrates how short-, mid-, and long-latency EEG responses change during fear conditioning and extinction, findings that enlighten the learning curve of neurophysiological responses to threat in humans.