Attention Training for Generalized Social Anxiety Disorder

Department of Psychology, Florida State University, Tallahassee, FL 32306, USA.
Journal of Abnormal Psychology (Impact Factor: 4.86). 03/2009; 118(1):5-14. DOI: 10.1037/a0013643
Source: PubMed


Attentional bias toward negative social cues is thought to serve an etiological and/or maintaining role in social anxiety disorder (SAD). The current study tested whether training patients to disengage from negative social cues may ameliorate social anxiety in patients (N = 36) with a primary diagnosis of generalized SAD. Patients were randomly assigned to either an attention training condition (n = 18), in which patients completed a modified dot-probe task designed to facilitate attentional disengagement from disgusted faces, or a control dot-probe task condition (n = 18). As predicted, patients in the attention training condition exhibited significantly greater reductions in social anxiety and trait anxiety, compared with patients in the control condition. At termination, 72% of patients in the active treatment condition, relative to 11% of patients in the control condition, no longer met Diagnostic and Statistical Manual of Mental Disorders (4th ed.) criteria for SAD. At 4-month follow-up, patients in the attention training condition continued to maintain their clinical improvement, and diagnostic differences across conditions were also maintained. Results support attention-based models of anxiety and suggest that attention training is a promising alternative or complementary intervention.

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    • "The vast majority of ABM studies in anxious patients have trained attention away from threat (toward neutral information), invoking an attentional goal state akin to the pattern that conferred risk in our study. Although several studies showed immediate and short-term (e.g., at 4-month follow-up) benefits on anxiety measures (Amir et al., 2009; Schmidt, Richey, Buckner, & Timpano, 2009), more recent findings have been mixed (Linetzky, Pergamin-Hight, Pine, & Bar-Haim, 2015), and no published study has examined clinical effects (depression or anxiety) at longer-term follow-up. In the context of pediatric anxiety, it may be important to consider the possible detrimental effects of training in an avoidance pattern. "
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    ABSTRACT: Anxious youth are at heightened risk for subsequent development of depression; however, little is known regarding which anxious youth are at the highest prospective risk. Biased attentional patterns (e.g., vigilance and avoidance of negative cues) are implicated as key mechanisms in both anxiety and depression. Aberrant attentional patterns may disrupt opportunities to effectively engage with, and learn from, threatening aspects of the environment during development and/or treatment, compounding risk over time. Sixty-seven anxious youth (age 9-14; 36 female) completed a dot-probe task to assess baseline attentional patterns provoked by fearful-neutral face pairs. The time course of attentional patterns both during and after threat was assessed via eyetracking and pupilometry. Self-reported depressive and anxiety symptoms were assessed two years after the conclusion of a larger psychotherapy treatment trial. Eyetracking patterns indicative of threat avoidance predicted greater 2-year depression scores, over and above baseline and post-treatment symptoms. Sustained, post-threat pupillary avoidance (reflecting preferential neural engagement with the neutral relative to the previously threatening location) predicted further variance in depression scores, suggesting sustained avoidance in the wake of threat further exacerbated risk. Identical eyetracking and pupil indices were not predictive of anxiety at 2 years. These biobehavioral markers imply that avoidant attentional processing in the context of anxiety may be a gateway to depression across a key maturational window. Excessive avoidance of threat may interfere with acquisition of adaptive emotion regulation skills during development, culminating in the broad behavioral deactivation that typifies depression. Prevention efforts explicitly targeting avoidant attentional patterns may be warranted.
    Journal of Abnormal Psychology 12/2015; · 4.86 Impact Factor
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    • "Ces études ont ainsi démontré que la modification du biais attentionnel était efficace dans la réduction de la symptomatologie clinique présentée par des personnes souffrant de phobie sociale généralisée (Amir et al., 2009a ; Heeren, Lievens, & Philippot, 2011 ; Heeren, Reese, McNally, & Philippot, 2012b ; Li, Tan, Qian, & Liu, 2008 ; Schmidt, Richey, Buckner, & Timpano, 2009) et de trouble d'anxiété généralisée (Amir, Beard, Burns, & Bomyea, 2009b ; See, MacLeod, & Bridle, 2009). En outre, la réduction de l'anxiété sociale et de l'anxiété généralisée était maintenue jusqu'à 4 mois après la fin de l'intervention quand bien même aucun autre élément thérapeutique n'avait été introduit dans la prise en charge (Amir et al., 2009a ; Schmidt et al., 2009). Une étude a également rapporté que l'administration d'une telle procédure auprès de patients souffrant d'un trouble obsessionnel-compulsif, incluant des stimuli liés aux obsessions propres des participants, menait à une réduction du biais attentionnel envers ces stimuli et à une réduction de la réponse de peur suscitée lors de l'exposition aux situations aversives (Najmi & Amir, 2010). "
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    ABSTRACT: Récemment, des chercheurs ont examiné la nature causale des biais attentionnels envers la menace (BA) dans le maintien des troubles anxieux, et ce en manipulant expérimentalement BA. Ils ont observé qu’entrainer des personnes souffrant d’anxiété à porter leur attention vers des stimuli non menaçants réduisait BA qui, en retour, réduisait le niveau de symptomatologie anxieuse. Cette observation soutient l’hypothèse que BA aurait un impact causal dans le maintien de l’anxiété. Cela étant, à un niveau fondamental, des incertitudes demeurent quant à la nature des processus sous-tendant le maintien de BA et, par conséquent, la plasticité de BA. Selon une première approche, le maintien de BA dans l’anxiété serait le résultat d’un système déficitaire d’évaluation de la valence. Selon une deuxième approche, BA résulterait d’un processus déficitaire de contrôle exécutif. L’objectif principal de cet article est de mettre en concurrence ces deux approches. Plus particulièrement, le présent article est structuré autour de trois questions principales. Premièrement, nous discutons l’hypothèse selon laquelle BA pourrait être la conséquence d’un système déficitaire d’évaluation de la valence. Ensuite, nous discutons de la possibilité que BA soit le résultat de perturbations au niveau des processus de contrôle exécutif. Finalement, nous discutons des interactions potentielles qui pourraient unir ces deux approches dans l’avènement de BA. L’implication potentielle de ces deux approches dans l’apparition de biais situés à d’autres niveaux de traitement et dans d’autres modalités sensorielles est également envisagée.
    L?Année psychologique 06/2015; in press. DOI:10.4074/S0003503315000202 · 0.36 Impact Factor
    • "Research has shown that cognitive biases are also modifiable using several computerized training paradigms. Biases have received successfully retraining in generalized anxiety disorder (attentional bias; Amir et al. 2009), social phobia (attentional bias: Schmidt et al. 2009), depression (attentional bias: Joorman et al. 2009), and alcohol abuse (implicit associations: Houben et al. 2010; action tendencies: Eberl et al. 2013; Wiers et al. 2010, 2011). In the first study by Wiers et al. (2010), for example, students were trained with the Approach-Avoidance Task (Rinck and Becker 2007) to either approach alcoholic stimuli and avoid non-alcoholic stimuli by pushing and pulling a joystick , or to approach alcoholic stimuli and avoid nonalcoholic stimuli. "
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    ABSTRACT: This study investigated implicit self-control dispositions—implicit approach tendencies towards low-caloric food rather than towards high-caloric food—in dieters. Action tendencies were assessed and trained using the Approach-Avoidance Task (AAT). Additionally, positive/negative affective associations [Brief Implicit Association Test (BIAT)], approach/avoidance associations (BIAT), and attentional biases [Dot Probe Task (DPT)] were assessed before and after training. Before training, dieters showed a more negative affective association with high-caloric food than non-dieters (positive/negative BIAT), consistent with the presence of self-control dispositions. On the AAT, all participants, not just dieters, showed more approach of low-caloric food than of high-caloric food. Results of neither the approach/avoidance BIAT nor the DPT showed any indication of implicit self-control dispositions. This study also investigated whether implicit self-control dispositions interfered with AAT training effects. This did not seem to be the case, as action tendencies could be strengthened even further. Moreover, training effects generalized to the DPT.
    Cognitive Therapy and Research 06/2015; 39(3):378-389. DOI:10.1007/s10608-014-9658-0 · 1.70 Impact Factor
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