Attention modification program in individuals with generalized anxiety disorder.

Abstract

Research suggests that individuals with Generalized Anxiety Disorder (GAD) show an attention bias for threat-relevant information. However, few studies have examined the causal role of attention bias in the maintenance of anxiety and whether modification of such biases may reduce pathological anxiety symptoms. In the current paper, we tested the hypothesis that an eight-session attention modification program would (a) decrease attention bias to threat and (b) reduce symptoms of GAD. Participants completed a probe detection task by identifying letters ("E" or "F") replacing one member of a pair of words. We trained attention by including a contingency between the location of the probe and the non-threat word in one group (Attention Modification program, AMP) and not in the other (Attention Control condition, ACC). Participants in the AMP showed change in attention bias and a decrease in anxiety, as indicated by both self report and interviewer measures. These effects were not present in the ACC group. These results are consistent with the hypothesis that attention plays a causal role in the maintenance of GAD and suggest that altering attention mechanisms may effectively reduce anxiety.Researchers have used a wide range of methods borrowed from cognitive psychology to examine attention bias to threat in individuals with Generalized Anxiety Disorder (GAD; Mathews & MacLeod, 1985MacLeod, Mathews, & Tata, 1986;Mogg, Millar, & Bradley, 2000). Research using these methods has consistently produced evidence that patients with GAD preferentially attend to threat relevant stimuli over neutral stimuli when the two compete for processing priority.In a seminal study, MacLeod, Mathews, and Tata (1986) developed the probe detection paradigm to measure attention bias to threat in GAD. In this paradigm, participants see two words, one above the other, on a computer screen. One word is neutral (e.g., table), and the other word has a threatening meaning (e.g., disease). Participants are asked to read the upper word and ignore the lower word. On critical trials (25%), either the upper or the lower word is replaced with a dot probe (·) and participants are asked to signal the presence of the probe by pressing a button. MacLeod et al. (1986) found that individuals with Generalized Anxiety Disorder detect probes that replace threat words, either in the upper or the lower portion of the screen, faster than probes that replace neutral words. Thus, clinically anxious individuals with GAD consistently showed an attention bias toward threat. On the other hand, non-anxious controls tended to demonstrate an attention bias away from threat in this paradigm. In a later replication of this study, MacLeod and Mathews (1988) threat stimuli from the mean response latency for trials where the probe replaced the neutral stimuli, such that larger numbers revealed greater bias for threat. Using this index, these authors again found that individuals with GAD show an attention bias toward threat.Two recent reviews of attention bias in anxiety ...

Exploring the function of selective attention and hypervigilance for threat in anxiety

“…An example of an ATT protocol based on a modified version of the dot probe paradigm was developed by Amir and colleagues (Amir, Beard, Burns, & Bomyea, 2009;Amir, Beard, Taylor, Klumpp, Elias, & Burns, 2009). This ATT involved trials in which a threat-neutral or neutral-neutral stimulus pair was followed by a probe stimulus that the participant had to identify (an E or an F).…”

Attentional retraining can reduce chocolate consumption.

“…The latter study did, however, ATTENTIONAL RE-TRAINING REDUCES CHOCOLATE INTAKE 6 find an effect of attentional bias modification on cigarette craving, with male smokers in the 'attend smoking' group reporting an increased urge to smoke. More generally, attentional bias modification has been shown to reduce symptoms of anxiety (Amir, Beard, Burns & Bomyea, 2009;Hazen, Vasey & Schmidt, 2009;Schmidt, Richey, Buckner & Timpano, 2009) and attenuate emotional responses to a subsequent stressor (MacLeod, Rutherford, Campbell, Ebsworthy & Holker, 2002;See, MacLeod & Bridle, 2009). …”

Attentional bias modification based on visual probe task: methodological issues, results and clinical relevance

“…62,65 Similar encouraging results were found in two other recent studies. 63,64 In the first, groups were trained either to attend to healthy food or to attend to unhealthy food, and 33 Avoid (-)/control Yes No Amir et al 6 Avoid (-)/control Yes Yes Hazen et al 26 Avoid (-)/control Yes Yes Heeren et al 27 Avoid (-)/control Yes Yes See et al 28 Avoid (-)/control Yes Yes Heeren et al 29 Avoid (-)/control Yes No MacLeod et al 7 Avoid (-)/attend (+) Yes Yes Browning et al 19 Avoid (-)/attend (+) Yes Yes MacLeod et al 34 Avoid (-)/attend (+) Yes Yes Van Bockstaele et al 35 Avoid (-)/attend (+) Yes No Van Bockstaele et al 36 Avoid (-)/attend (+) Yes No Eldar et al 37 Avoid (-)/attend (+) Partly No O'Toole et al 38 Avoid (-)/attend (+) Partly No Heeren et al 39 Attend (-)/control Yes Yes Krebs et al 40 Attend (-)/control Yes Yes Hayes et al 41 Attend (+)/control Yes Yes Li et al 42 Attend (+)/control Yes Yes Taylor et al 43 Attend (+)/control Yes Yes Wadlinger et al 44 Attend (+)/control Yes Yes Cowart et al 46 Avoid (-) Not applicable Not applicable Amir et al 45 Avoid (-) Yes Yes Brosan et al 47 Avoid (-) Yes Yes Heeren et al 48 Avoid (-)/attend (+)/control Yes Yes Klumpp et al 49 Avoid (-)/attend (+)/control No No Boettcher et al 50 Attend ( 51 Avoid (-)/attend (+) Yes Yes Schoenmakers et al 10 Avoid (-)/control Yes No Schoenmakers et al 53 Avoid (-)/control Yes Partly Kerst et al 54 Avoid (-)/control Yes Partly Lopes et al 55 Avoid (-)/control Yes No McHugh et al 52 Avoid (-)/control No No Fie...…”

“…As attention to events associated with a pathology may complicate its treatment, attentional bias modification (ABM) has been recently studied as an implicit training strategy to disengage attention from threatening events related to anxiety [6][7][8] and to prevent relapse in individuals with alcohol dependence, 9,10 as well as among smokers. 11,12 Of the techniques to achieve ABM included in studies, the most commonly used is a modified version of a visual probe task developed in 2002.…”

“…6,[26][27][28] The other five studies [29][30][31][32][33] found no effects of generalization on AB reduction or correlations with other variables.…”