Attention bias dynamics and symptom severity during and following CBT for social anxiety disorder.

Abstract

Objective: Threat-related attention bias figures prominently in contemporary accounts of the maintenance of anxiety disorders, yet longitudinal intervention research relating attention bias to anxiety symptom severity is limited. Capitalizing on recent advances in the conceptualization and measurement of attention bias, we aimed to examine the relation between attention bias, indexed using trial-level bias scores (TLBSs) to quantify temporal dynamics reflecting dysregulation of attentional processing of threat (as opposed to aggregated mean bias scores) and social anxiety symptom severity over the course of cognitive–behavioral therapy (CBT) and 1-month follow-up. Method: Adults with social anxiety disorder (N = 39) assigned to either yohimbine- or placebo-augmented CBT completed measures of attention bias and social anxiety symptom severity weekly throughout CBT (5 sessions) and at 1-week and 1-month posttreatment. Results: TLBSs of attention bias temporal dynamics showed stronger psychometric properties than mean aggregated scores and were highly interrelated, in line with within-subject temporal variability fluctuating in time between attentional overengagement and strategic avoidance from threat. Attention bias toward threat and temporal variability in attention bias (i.e., attentional dysregulation), but not attention bias away from threat, significantly reduced over the course of CBT. Cross-lag analyses revealed no evidence of a causal relation between reductions in attentional dysregulation leading to symptom severity reduction, or vice versa. Observed relations did not vary as a function of time. Conclusions: We found no evidence for attentional dysregulation as a causal mechanism for symptom reduction in CBT for social anxiety disorders. Implications for future research are discussed.

Network changes associated with transdiagnostic depressive symptom improvement following cognitive behavioral therapy in MDD and PTSD

“…Among children with a history of anxiety or depression, the magnitude of the VA system rs-FC was correlated with measures of attention bias towards threat [54]. CBT has been shown to significantly decrease bias towards threat [55], in keeping with addressing an over-active VA system.…”

Capturing Dynamics of Biased Attention: Are New Attention Variability Measures the Way Forward?

“…Given our findings, we feel that it is very worrisome that dynamic bias measures are being used as if they are already fully developed and validated, bypassing the question of what it is that they measure. They are being implemented at a rapid speed, thereby propagating the idea that these methods provide valid and reliable indices of attention bias, suitable for use in clinical samples [23,26–28] and as a target outcome for treatment [29–32]. We strongly caution against this development as much more basic science is required, while skirting this stage will likely lead to considerable waste of time and money.…”

Dynamic measures of anxiety-related threat bias: Links to stress reactivity

“…This approach is intended to capture the degree to which the bias changes on a trial-by-trial basis over the course of the task. The TL-BS variability metric has been shown to predict, above and beyond the traditional bias measure, clinical diagnosis of specific phobia (Zvielli et al, 2014b), posttraumatic stress symptoms in soldiers (Iacoviello, Wu, Abend, Murrough, Feder, Fruchter et al, 2014), and is directly reduced by cognitive behavioral therapy in individuals with social anxiety disorder (Davis, Rosenfield, Bernstein, Zvielli, Reinecke, Beevers et al, 2016). Additionally, greater emotion dysregulation predicts the TL-BS variability metric in the presence of threatening stimuli (Bardeen, Daniel, Hinnant, & Orcutt, 2017).…”