Attentional bias toward health-threat in health anxiety: a systematic review and three-level meta-analysis

Abstract

Attentional bias toward health-threat may theoretically contribute to the development and maintenance of health anxiety, but the empirical findings have been controversial. This study aimed to synthesize and explore the heterogeneity in a health-threat related attentional bias of health-anxious individuals, and to determine the theoretical model that better represents the pattern of attentional bias in health anxiety. Four databases (Web of Science, PubMed, PsycINFO, and Scopus) were searched for relevant studies, with 17 articles (N = 1546) included for a qualitative review and 16 articles (18 studies) for a three-level meta-analysis (N = 1490). The meta-analytic results indicated that the health anxiety group, compared to the control group, showed significantly greater attentional bias toward health-threat (g = 0.256). Further analyses revealed that attentional bias type, paradigm, and stimuli type were significant moderators. Additionally, compared to the controls, health-anxious individuals displayed significantly greater attention maintenance (g = 0.327) but nonsignificant attention vigilance to health-threat (g = −0.116). Our results provide evidence for the attention maintenance model in health-anxious individuals. The implications for further research and treatment of elevated health anxiety in the context of coronavirus disease-2019 (COVID-19) were also discussed.

Inhibitory Learning versus Habituation in an Experimental Exposure Intervention for People With Heightened Health Anxiety: Increase of Distress Tolerance as a Joint Mechanism of Change?

“…In summary, no significant differences between illness-/ symptom-related and neutral stimuli in relation to SDT measures as well as reaction times both pre-intervention and from pre-to post-intervention were observed. This finding contradicts a quite impressive body of research on cognitive biases in PHA (e.g., Shi et al, 2022;Witthöft et al, 2016), all pointing to a "stronger" response to illness-/symptomrelated stimuli in people with PHA (compared to neutral stimuli). First, the debatable construct validity of the affective n-back task, only correlating to a very limited extent with other working memory tasks (e.g., digit span) and potentially even measuring other constructs (e.g., fluid intelligence) especially in higher load levels (Jaeggi, Buschkuehl et al, 2010;Jaeggi et al, 2010), could have played a role.…”

“…The effect of cognitive load in the hereby used affective n-back task should therefore not be underestimated: the cognitive demand the affective n-back task posed on individuals could have hindered interference effects of illness-/symptom-related material. Possibly supporting this assumption, cognitive biases in PHA, so far, have mainly been observed in lower-demanding tasks (e.g., attention tasks, such as the dot probe task; Shi et al, 2022), which rather reflect the cognitive processing of people with PHA when only little distraction is present, whereas higher-demanding tasks (e.g., IAT) have revealed ambiguous or little effects of illness-/health-related material (e.g., Witthöft et al, 2016). Even elaborating further, this hypothesis raises questions, if current experimental tasks can realistically operationalize cognitive functioning of people with PHA under “normal” (i.e., more distracting) conditions.…”

“…Even elaborating further, this hypothesis raises questions, if current experimental tasks can realistically operationalize cognitive functioning of people with PHA under “normal” (i.e., more distracting) conditions. Second, findings on attention biases rather indicate a reduced disengagement from than an enhanced vigilance towards health-/illness-related stimuli (Jasper & Witthöft, 2011; Lee et al, 2013; for an overview see Shi et al, 2022). Due to the disengagement “problem” even a transference to emotionally irrelevant or neutral stimuli could be possible, then reducing observable differences between stimulus categories.…”

Interpretation bias in health anxiety: a systematic review and meta-analysis

“…The cognitive-behavioral model of health anxiety holds that cognitive biases play an important role in the development and maintenance of health anxiety (Cooper, Gregory, Walker, Lambe, & Salkovskis, 2017; Salkovskis & Warwick, 1986). Most previous studies on this topic focused on an attentional bias to health threat stimuli (Shi et al, 2022). Interpretation bias, the tendency to judge ambiguous information as negative or threatening (Hirsch, Meeten, Krahé, & Reeder, 2016; Würtz et al, 2022), is also commonly seen in health anxiety.…”

“…Third, health anxiety is thought to occur continuously from no health anxiety to pathological health anxiety (Williams, 2004), so we assume individuals drawn from the clinical population are likely to report the highest levels of negative interpretation bias. Finally, we tested potential moderators that are often included in meta-analyses, such as gender, age, culture, publication year, and journal impact factor (Chen et al, 2020; Everaert et al, 2017; Shi et al, 2022).…”