Vigilant and avoidant attention biases as predictors of response to cognitive behavioral therapy for social phobia

Abstract

Background Attention bias for socially threatening information, an empirically supported phenomenon, figures prominently in models of social phobia. However, all published studies examining this topic to date have relied on group means to describe attention bias patterns; research has yet to examine potential subgroups of attention bias among individuals with social phobia (e.g., vigilant or avoidant). Furthermore, almost no research has examined how attention biases in either direction may predict change in symptoms as a result of treatment. Methods This study (N=24) compared responses to cognitive behavioral therapy (CBT) for social phobia between individuals with avoidant and vigilant biases for threatening faces at pretreatment. Results Participants with avoidant biases reported significantly and clinically higher symptom levels at posttreatment than did those with vigilant biases. Conclusions These findings suggest that an avoidant attention bias may be associated with reduced response to CBT for social phobia.

Direction of attention bias to threat relates to differences in fear acquisition and extinction in anxious children

“…Based on previous findings of elevated responding in anxious relative to control children to both CSs during acquisition and/or extinction (e.g., Craske, Kircanski, et al, 2008;Craske, Waters, et al, 2008;Lau et al, 2008;Waters, Henry, et al, 2009), we hypothesised that these effects would be most pronounced in anxious children with a threat avoidant versus a threat vigilant attention bias. Specifically, we predicted that in comparison to threat vigilant anxious children, those who avoided threat would (a) be more reactive to an aversive US on CSþ trials as well as CSÀ trials, as indexed by skin conductance response magnitude (SCRs) (e.g., Craske, Kircanski, et al, 2008;Craske, Waters, et al, 2008;Waters, Henry, et al, 2009), (b) display larger SCRs to both CSs during extinction trials (e.g., Craske, Kircanski, et al, 2008;Craske, Waters, et al, 2008), (c) rate the CSþ and CSÀ as more unpleasant and arousing after acquisition and extinction (e.g., Lau et al, 2008), and (d) report higher subjective anxiety ratings post-extinction, consistent with previous findings of poorer outcomes following exposure-based CBT in threat avoidant compared to threat vigilant anxious adults and children (e.g., Niles et al, 2013;Price et al, 2011;Waters et al, 2012).…”

“…The clinical translation of these effects, whether due to underlying associative, non-associative or combined mechanisms, may be that threat avoidant anxious children are slower than threat vigilant anxious children to respond to the same 'dose' of exposure therapy. In accord, several studies have found poorer outcomes following exposure-based CBT in anxious adults and children who are threat avoidant compared to threat vigilant (e.g., Niles, Mesri, Burklund, Lieberman, & Craske, 2013;Price et al, 2011;Waters et al, 2012).…”

“…Two studies have shown that although all anxious participants improved from pre-to post-treatment, a pretreatment bias away from threat compared to a bias towards threat was associated with a poorer response following exposurebased CBT in adults with social phobia (Price, Tone, & Anderson, 2011) and anxious children (Waters, Mogg, & Bradley, 2012). Another study has shown that adults with social phobia who were slower to disengage from threat stimuli (i.e.…”

Attention Control and Attention to Emotional Stimuli in Anxious Children Before and After Cognitive Behavioral Therapy

“…Other studies, which have been designed to assess relationships between attentional bias and CBT outcome in larger samples of anxious children, have provided mixed results, suggesting that pre-treatment attention bias towards threat may predict poorer outcome (e.g., Legerstee et al 2010;Manassis et al 2013) or better outcome (Waters et al 2012; see also Price et al 2011, for similar findings in anxious adults). Such mixed results may be due to variation in experimental methods for assessing attentional bias (e.g., severity of threat stimuli; different tasks, see Waters et al 2012, for further discussion).…”

Look for good and never give up: A novel attention training treatment for childhood anxiety disorders

“…In addition to examining the correlations between symptom change and pre-treatment threat bias scores, the latter was also dichotomised to reflect 'threat bias direction' in order to allow direct comparison with previous research (Price et al, 2011;Waters et al, 2012), whereby children were classified as threat vigilant (pre-treatment threat bias score > zero; n = 15) or avoidant (score < zero; n = 22). The effect of pre-treatment happy face bias scores was examined in the same way.…”