BackgroundAnxiety vulnerability is associated with biases in attention: a tendency to selectively process negative relative to neutral or positive information. It is not clear whether this bias is: 1) related to the physiological response to stressful events, and 2) causally related to the development of anxiety disorders.MethodsWe tested the predictive value of both preconscious and conscious attention biases in a prospective study of stress reactivity in a nonclinical sample. One hundred four male participants were assessed at baseline and then again 4 months (n = 82) and 8 months later (n = 70). Salivary cortisol and self-report measures were obtained at the baseline testing session in addition to measures of biased attention. Subsequent emotional reactivity was assessed by means of salivary cortisol and self-reported state-anxiety responses during a laboratory-based stressor (4 months later) as well as during a real-life stressor 8 months later (i.e., examination period).ResultsRegression analyses indicated that a preconscious negative processing bias was the best predictor of the cortisol response to stressful events. Importantly, a measure of selective processing provided a better indicator of subsequent emotional reactivity than self-report measures of neuroticism, trait-anxiety, and extraversion.ConclusionsThese results suggest that preconscious biases toward negative material play a causal role in heightened anxiety vulnerability. Our results illustrate the potential utility of preconscious biases in attention in providing an early marker of anxiety vulnerability and a potential target for treatment intervention.

Background and objectivesAttention Bias Modification (ABM) targets attention bias (AB) towards threat and is a potential therapeutic intervention for anxiety. The current study investigated whether initial AB (towards or away from spider images) influenced the effectiveness of ABM in spider fear.MethodsAB was assessed with an attentional probe task consisting of spider and neutral images presented simultaneously followed by a probe in spider congruent or spider incongruent locations. Response time (RT) differences between spider and neutral trials > 25 ms was considered ‘Bias Toward’ threat. RT difference < - 25 ms was considered ‘Bias Away’ from threat, and a difference between −25 ms and +25 ms was considered ‘No Bias’. Participants were categorized into Initial Bias groups using pre-ABM AB scores calculated at the end of the study. 66 participants' (Bias Toward n = 27, Bias Away n = 18, No Bias n = 21) were randomly assigned to ABM-active training designed to reduce or eliminate a bias toward threat and 61 (Bias Toward n = 17, Bias Away n = 18, No Bias n = 26) to ABM-control.ResultsABM-active had the largest impact on those demonstrating an initial Bias Towards spider images in terms of changing AB and reducing Spider Fear Vulnerability, with the Bias Away group experiencing least benefit from ABM. However, all Initial Bias groups benefited equally from active ABM in a Stress Task.LimitationsParticipants were high spider fearful but not formally diagnosed with a specific phobia. Therefore, results should be confirmed within a clinical population.ConclusionsIndividual differences in Initial Bias may be an important determinant of ABM efficacy.

The process by which risk assessment is undertaken can be reliably statistically modelled to allow an in-depth examination of an individual practitioner or comparisons between practitioners, which can be used to support efforts to improve assessment reliability. Senior practitioners may be more consistent in applying information to clinical judgements of self-harm. Apparent agreement over a categorical judgement of risk may mask an underlying disagreement over numerical probabilities. The term 'low risk' may be particularly subject to variability in its interpretation. The term 'risk' can be ambiguous, reflecting the probability of occurrence for some practitioners and the severity of its occurrence for others, a problem that may be compounded if it is unclear exactly which event is being assessed (e.g., risk of initiating the behaviour versus risk of re-occurrence).