Increased attention allocation to socially threatening faces in social anxiety disorder: A replication study

Aberrant reward learning, but not negative reinforcement learning, is related to depressive symptoms: an attentional perspective

BACKGROUND

Aberrant reward functioning is implicated in depression. While attention precedes behavior and guides higher-order cognitive processes, reward learning from an attentional perspective - the effects of prior reward-learning on subsequent attention allocation - has been mainly overlooked.

METHODS

The present study explored the effects of reward-based attentional learning in depression using two separate, yet complimentary, studies. In study 1, participants with high (HD) and low (LD) levels of depression symptoms were trained to divert their gaze toward one type of stimuli over another using a novel gaze-contingent music reward paradigm - music played when fixating the desired stimulus type and stopped when gazing the alternate one. Attention allocation was assessed before, during, and following training. In study 2, using negative reinforcement, the same attention allocation pattern was trained while substituting the appetitive music reward for gazing the desired stimulus type with the removal of an aversive sound (i.e. white noise).

RESULTS

In study 1 both groups showed the intended shift in attention allocation during training (online reward learning), while generalization of learning at post-training was only evident among LD participants. Conversely, in study 2 both groups showed post-training generalization. Results were maintained when introducing anxiety as a covariate, and when using a more powerful sensitivity analysis. Finally, HD participants showed higher learning speed than LD participants during initial online learning, but only when using negative, not positive, reinforcement.

CONCLUSIONS

Deficient generalization of learning characterizes the attentional system of HD individuals, but only when using reward-based positive reinforcement, not negative reinforcement.

Exploring the 'mood congruency' hypothesis of attention allocation - An eye-tracking study

BACKGROUND

The 'mood-congruency' hypothesis of attention allocation postulates that individuals' current emotional states affect their attention allocation, such that mood-congruent stimuli take precedence over non-congruent ones. This hypothesis has been further suggested as an underlying mechanism of biased attention allocation in depression.

METHODS

The present research explored the mood-congruency hypothesis using a novel video-based mood elicitation procedure (MEP) and an established eye-tracking attention allocation assessment task, elaborating prior research in the field. Specifically, in Study 1 (n = 91), a video-based MEP was developed and rigorously validated. In study 2 (n = 60), participants' attention allocation to sad and happy face stimuli, each presented separately alongside neutral faces, was assessed before and after the video-based MEP, with happiness induced in one group (n = 30) while inducing sadness in the other (n = 30).

RESULTS

In Study 1, the MEP yielded the intended modification of participants' current mood states (eliciting either sadness or happiness). Study 2 showed that while the MEP modified mood in the intended direction in both groups, replicating the results of Study 1, corresponding changes in attention allocation did not ensue in either group. A Bayesian analysis of pre-to-post mood elicitation changes in attention allocation supported this null finding. Moreover, results revealed an attention bias to happy faces across both groups and assessment points, suggestive of a trait-like positive bias in attention allocation among non-selected participants.

CONCLUSION

Current results provide no evidence supporting the mood-congruency hypothesis, which suggests that (biased) attention allocation may be better conceptualized as a depressive trait, rather than a mood-congruent state.

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.

Increased attention allocation to stimuli reflecting end-states of compulsive behaviors among obsessive compulsive individuals

Attentional research in OCD has focused solely on threat stimuli, assumed to provoke related obsessions and ensuing compulsions. OCD-related stimuli depicting the completion of compulsive acts ("end-states") have yet to be examined. Past research also neglected to explore the reliability of tasks used. Here, attention allocation to both stimuli types was examined. Participants with high (HOC) and low (LOC) levels of obsessive-compulsive symptoms freely viewed three blocks of 30 two-by-two picture matrices, each including two OCD-related (cleaning\checking\ordering) and two neutral pictures, presented for eight seconds, while their gaze was recorded. Participants completed two task versions - one with traditional threat stimuli and one with novel stimuli signaling compulsions end-states. Only the end-state version yielded significant results, showing that HOC participants, compared to LOC participants, spent significantly more time fixating on OCD-related stimuli. Results remained significant after controlling for anxiety, stress, and depression. Task reliability was high. OCD-related stimuli signaling end-states of compulsive behavior should be incorporated in attentional research in OCD.

Attention allocation to negatively-valenced stimuli in PTSD is associated with reward-related neural pathways

BACKGROUND

In a recent eye-tracking study we found a differential dwell time pattern for negatively-valenced and neutral faces among patients with posttraumatic stress disorder (PTSD), trauma-exposed healthy control (TEHCs), and healthy control (HC) participants. Here, we explored whether these group differences relate to resting-state functional connectivity (rsFC) patterns of brain areas previously linked to both attention processes and PTSD. These encompass the amygdala, dorsal anterior cingulate cortex (dACC), dorsolateral prefrontal cortex (dlPFC), ventrolateral prefrontal cortex (vlPFC), and nucleus accumbens (NAcc).

METHODS

Ten minutes magnetic resonance imaging rsFC scans were recorded in 17 PTSD patients, 21 TEHCs, and 16 HCs. Participants then completed a free-viewing eye-tracking task assessing attention allocation outside the scanner. Dwell time on negatively-valenced stimuli (DT%) were assessed relative to functional connectivity in the aforementioned seed regions of interest (amygdala, dACC, dlPFC, vlPFC, and NAcc) to whole-brain voxel-wise rsFC.

RESULTS

As previously reported, group differences occurred in attention allocation to negative-valence stimuli, with longer dwell time on negatively valence stimuli in the PTSD and TEHC groups than the HC group. Higher DT% correlated with weaker NAcc-orbitofrontal cortex (OFC) connectivity in patients with PTSD. Conversely, a positive association emerged in the HC group between DT% and NAcc-OFC connectivity.

CONCLUSIONS

While exploratory in nature, present findings may suggest that reward-related brain areas are involved in disengaging attention from negative-valenced stimuli, and possibly in regulating ensuing negative emotions.

Attention Bias Modification Treatment Versus a Selective Serotonin Reuptake Inhibitor Or Waiting List Control for Social Anxiety Disorder: A Randomized Clinical Trial

OBJECTIVE

Social anxiety disorder is common and impairing. The efficacy of pharmacotherapy is moderate, highlighting the need for alternative therapies. This study compared the efficacy of gaze-contingent music reward therapy (GC-MRT), an eye-tracking-based attention bias modification treatment, with a selective serotonin reuptake inhibitor (SSRI) treatment or a waiting list control condition in reducing social anxiety disorder symptoms. Superior clinical effects of similar magnitude were expected for the active treatments relative to the control condition.

METHODS

Participants were 105 treatment-seeking adults with social anxiety disorder, randomly allocated to 12 weeks of GC-MRT, SSRI, or waiting list control. Mean changes in clinician-rated and self-reported social anxiety symptoms from baseline to mid- and posttreatment assessments were compared between groups using generalized estimating equations. Changes in attentional dwell time on threat were also examined.

RESULTS

Analysis indicated a significant differential reduction in symptoms between groups. Patients in the GC-MRT and SSRI groups had lower social anxiety scores at the mid- and posttreatment assessments compared with patients in the waiting list group. The efficacy of the active treatments did not differ. Only patients in the GC-MRT group showed reduction in dwell time on threat from baseline to posttreatment assessment.

CONCLUSIONS

Eye-tracking-based attention bias modification is an acceptable and effective treatment option for social anxiety disorder.

Attention allocation in OCD: A systematic review and meta-analysis of eye-tracking-based research

INTRODUCTION

Cognitive models of obsessive-compulsive disorder (OCD) implicate heightened attention allocation to stimuli related to one's obsessions in the disorder. Recently, to overcome several limitations of reaction time-based measures, eye-tracking methodology has been increasingly used in attentional research.

METHODS

A meta-analysis of studies examining attention allocation towards OCD-related vs. neutral stimuli, using eye-tracking methodology and a group-comparison design, was conducted conforming to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Separate meta-analyses were performed for attentional vigilance (both latency and location of first fixations) and maintenance (total dwell time and total fixation count, conjointly). Each meta-analysis was conducted twice - once including all studies (main analysis) and once only including studies using the free-viewing paradigm (secondary analysis).

RESULTS

The systematic search yielded a total of nine studies. Of those, eight provided the needed data to be included in the meta-analysis. No evidence emerged for vigilance via latency to first fixation. Vigilance reflected via first fixation location emerged in the main analysis, but not in the secondary one. Evidence for attentional maintenance was found only when analyzing free-viewing studies exclusively (the secondary analysis).

LIMITATIONS

To increase the accuracy of the research question, correlational studies were excluded, resulting in a small number of available studies.

CONCLUSIONS

OCD may be characterized by vigilance, but mainly in tasks entailing specific demands and/or goals. Conversely, attentional maintenance may be evident only when using tasks that pose no requirements or demands for participants.

Functional Connectivity Between Basal Forebrain and Superficial Amygdala Negatively Correlates with Social Fearfulness

Social anxiety is characterized by an intense fear of evaluation from others and/or withdrawal from social situations. Extreme social anxiety can lead to social anxiety disorder. There remains an urgent need to investigate the neural substrates of subclinical social anxiety for early diagnosis and intervention to reduce the risk to develop social anxiety disorder. Twenty-nine young adults were recruited (10 males/19 females; mean age (SD) = 20.34 (2.29)). Trait-like social anxiety was assessed by Liebowitz Social Anxiety Scale. Functional magnetic resonance imaging was used with an emotional face-matching paradigm to probe brain activation in response to emotional stimuli including angry, fearful, and happy faces, with shape-matching as a control condition. Behavioral results showed positive correlations between Liebowitz Social Anxiety Scale scores and the reaction time in both angry and fearful conditions. The activation of superficial amygdala and the deactivation of basal forebrain in response to angry condition showed positive correlations with the level of social anxiety. In addition, the resting-state functional connectivity between these two regions was negatively correlated with the level of social anxiety. These results may help to understand the individual difference and corresponding neural underpinnings of social anxiety in the subclinical population, and might provide some insight to develop strategies for early diagnosis and interventions of social anxiety to reduce the risk of deterioration from subclinical to clinical level of social anxiety.

Aberrant neural correlates of multisensory processing of audiovisual social cues related to social anxiety: An electrophysiological study

BACKGROUND

Social anxiety disorder (SAD) is characterized by abnormal fear to social cues. Although unisensory processing to social stimuli associated with social anxiety (SA) has been well described, how multisensory processing relates to SA is still open to clarification. Using electroencephalography (EEG) measurement, we investigated the neural correlates of multisensory processing and related temporal dynamics in social anxiety disorder (SAD).

METHODS

Twenty-five SAD participants and 23 healthy control (HC) participants were presented with angry and neutral faces, voices and their combinations with congruent emotions and they completed an emotional categorization task.

RESULTS

We found that face-voice combinations facilitated auditory processing in multiple stages indicated by the acceleration of auditory N1 latency, attenuation of auditory N1 and P250 amplitudes, and decrease of theta power. In addition, bimodal inputs elicited cross-modal integrative activity which is indicated by the enhancement of visual P1, N170, and P3/LPP amplitudes and superadditive response of P1 and P3/LPP. More importantly, excessively greater integrative activity (at P3/LPP amplitude) was found in SAD participants, and this abnormal integrative activity in both early and late temporal stages was related to the larger interpretation bias of miscategorizing neutral face-voice combinations as angry.

CONCLUSION

The study revealed that neural correlates of multisensory processing was aberrant in SAD and it was related to the interpretation bias to multimodal social cues in multiple processing stages. Our findings suggest that deficit in multisensory processing might be an important factor in the psychopathology of SA.

Looks interesting: Attention allocation in depression when using a news website - An eye tracking study

BACKGROUND

Eye-tracking-based attention research has shown attentional biases toward dysphoric and away from positive stimuli in depression. However, most research used prototypical stimuli (co-presented contrasting emotional faces/pictures), less reflective of real-life situations. The current study addressed this limitation by examining participants' attentional allocation patterns while freely viewing a news website containing dysphoric and positive news articles.

METHODS

Participants with high levels of depression (HD; n = 30) and with minimal levels of depression (MD; n = 30) freely viewed a fictitious news website for 3.5 min, containing six articles (picture + text) with dysphoric content and six with positive content. Gaze patterns on corresponding areas of interest (AOIs) were compared. Following the task, participants rated each article's valence, authenticity, and interest.

RESULTS

Compared to MD participants, HD participants spent more time dwelling on dysphoric articles and less time dwelling on positive articles. Within group analyses showed that while HD participants spent more time dwelling on dysphoric compared to positive articles, MD participants showed no preference, allocating their attention equally to both article types. Echoing within-group gaze patterns, HD participants rated the dysphoric articles as being more interesting than the positive articles, while MD participants rated both types of articles as being equally interesting.

CONCLUSION

Attentional biases in depression were also evident when using a more ecologically valid task such as viewing a news website, manifesting as increase attention allocation to dysphoric over positive content. This attention pattern may be related to corresponding differences in the level of interest participants found in each article type.

Lack of an Attention Bias Away From Relatively Negative Faces in Dysphoria Is Not Related to Biased Emotion Identification

Eye-tracking-based attention research has consistently shown a lack of a normative attentional bias away from dysphoric face stimuli in depression, characterizing the attention system of non-depressed individuals. However, this more equal attention allocation pattern could also be related to biased emotion identification, namely, an inclination of depressed individuals to attribute negative emotions to non-negative stimuli when processing mood-congruent stimuli. Here, we examined emotion identification as a possible mechanism associated with attention allocation when processing emotional faces in depression. Attention allocation and emotion identification of participants with high (HD; n = 30) and low (LD; n = 30) levels of depression symptoms were assessed using two corresponding tasks previously shown to yield significant findings in depression, using the same face stimuli (sad, happy, and neutral faces) across both tasks. We examined group differences on each task and possible between-task associations. Results showed that while LD participants dwelled longer on relatively positive faces compared with relatively negative faces on the attention allocation task, HD participants showed no such bias, dwelling equally on both. Trait anxiety did not affect these results. No group differences were noted for emotion identification, and no between-task associations emerged. Present results suggest that depression is characterized by a lack of a general attention bias toward relatively positive faces over relatively negative faces, which is not related to a corresponding bias in emotion identification.

Fast evidence accumulation in social anxiety disorder enhances decision making in a probabilistic reward task

Choices and response times in two-alternative decision-making tasks can be modeled by assuming that individuals steadily accrue evidence in favor of each alternative until a response boundary for one of them is crossed, at which point that alternative is chosen. Prior studies have reported that evidence accumulation during decision-making tasks takes longer in adults with psychopathology than in healthy controls, indicating that slow evidence accumulation may be transdiagnostic. However, few studies have examined perceptual decision making in anxiety disorders, where hypervigilance might enhance performance. Therefore, this study used the Hierarchical Drift Diffusion model to investigate evidence accumulation in adults with social anxiety disorder (SAD) and healthy controls as they performed a probabilistic reward task (PRT), in which social rewards were delivered for correct perceptual judgments. Adults with SAD completed the PRT before and after gaze-contingent music reward therapy (GCMRT), which trains attention allocation and has shown efficacy for SAD. Healthy controls also completed the PRT twice. Results revealed excellent performance in adults with SAD, especially after GCMRT: relative to controls, they showed faster evidence accumulation, better discriminability, and earned more rewards. These data highlight a positive effect of attention training on performance in anxious adults and show how a behavioral trait that is typically problematic-hypervigilance in SAD-can nevertheless confer advantages in certain contexts. The data also indicate that, in contrast to other forms of psychopathology, SAD is not characterized by slow evidence accumulation, at least in the context of the social PRT. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

AI-Based Prediction and Prevention of Psychological and Behavioral Changes in Ex-COVID-19 Patients

The COVID-19 pandemic has adverse consequences on human psychology and behavior long after initial recovery from the virus. These COVID-19 health sequelae, if undetected and left untreated, may lead to more enduring mental health problems, and put vulnerable individuals at risk of developing more serious psychopathologies. Therefore, an early distinction of such vulnerable individuals from those who are more resilient is important to undertake timely preventive interventions. The main aim of this article is to present a comprehensive multimodal conceptual approach for addressing these potential psychological and behavioral mental health changes using state-of-the-art tools and means of artificial intelligence (AI). Mental health COVID-19 recovery programs at post-COVID clinics based on AI prediction and prevention strategies may significantly improve the global mental health of ex-COVID-19 patients. Most COVID-19 recovery programs currently involve specialists such as pulmonologists, cardiologists, and neurologists, but there is a lack of psychiatrist care. The focus of this article is on new tools which can enhance the current limited psychiatrist resources and capabilities in coping with the upcoming challenges related to widespread mental health disorders. Patients affected by COVID-19 are more vulnerable to psychological and behavioral changes than non-COVID populations and therefore they deserve careful clinical psychological screening in post-COVID clinics. However, despite significant advances in research, the pace of progress in prevention of psychiatric disorders in these patients is still insufficient. Current approaches for the diagnosis of psychiatric disorders largely rely on clinical rating scales, as well as self-rating questionnaires that are inadequate for comprehensive assessment of ex-COVID-19 patients' susceptibility to mental health deterioration. These limitations can presumably be overcome by applying state-of-the-art AI-based tools in diagnosis, prevention, and treatment of psychiatric disorders in acute phase of disease to prevent more chronic psychiatric consequences.

Neurophysiological predictors of gaze-contingent music reward therapy among adults with social anxiety disorder

Social anxiety disorder (SAD) is associated with fear of negative evaluation and heightened performance monitoring. The best-established treatments help only a subset of patients, and there are no well-established predictors of treatment response. The current study investigated whether individual differences in processing errors might predict response to gaze-contingent music reward therapy (GC-MRT). At baseline, healthy control subjects (HC; n = 20) and adults with SAD (n = 29), ages 19-43 years, completed the Flanker Task while electroencephalography (EEG) data were recorded. SAD participants then received up to 12 sessions over 8 weeks of GC-MRT, designed to train participants' attention away from threatening and toward neutral faces. Clinical assessments were completed 9- (post-treatment) and 20-weeks (follow-up) after initiating the treatment. At baseline, compared to HC, SAD performed the task more accurately and exhibited increased error-related negativity (ERN) and delta power to error commission. After controlling for age and baseline symptoms, more negative ERN and increased frontal midline theta (FMT) predicted reduced self-reported social anxiety symptoms at post-treatment, and FMT also predicted clinician-rated and self-reported symptom reduction at the follow-up assessment. Hypervigilance to error is characteristic of SAD and warrants further research as a predictor of treatment response for GC-MRT.