Jessica Bomyea

Attention modification program in individuals with Generalized Anxiety Disorder

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 present article, the authors tested the hypothesis that an 8-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. The authors trained attention by including a contingency between the location of the probe and the nonthreat 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.

The Effect of a Single-Session Attention Modification Program on Response to a Public-Speaking Challenge in Socially Anxious Individuals

Research suggests that individuals with social anxiety show an attention bias for threat-relevant information However, few studies have directly manipulated attention to examine its effect on anxiety. In the current article, the authors tested the hypothesis that an attention modification program would be effective in reducing anxiety response and improving performance on a public-speaking challenge. Socially anxious participants completed a probe detection task by identifying letters (E or F) replacing one member of a pair of faces (neutral or disgust). The authors trained attention by including a contingency between the location of the neutral face and the probe in one group (Attention Modification Program; AMP). Participants in the AMP group showed significantly less attention bias to threat after training and lower levels of anxiety in response to a public-speaking challenge than did the participants in the Attention Control Condition (ACC) group. Moreover, blind raters judged the speeches of those in the AMP group as better than those in the ACC group. These results are consistent with the hypothesis that attention plays a causal role in the maintenance of social anxiety.

A consideration of select pre-trauma factors as key vulnerabilities in PTSD

Posttraumatic stress disorder (PTSD) is a pathological response to a traumatic event. A number of risk and vulnerability factors predicting PTSD development have been identified in the literature. Many of these variables are specific factors occurring during and after exposure to a traumatic event or are not measured prospectively to assess temporal sequence. Recent research, however, has begun to focus on pre-trauma individual differences that could contribute to risk for developing PTSD. The present review proposes that a number of biological and cognitive vulnerability factors place individuals at risk for PTSD development prior to the actual experience of trauma. Accordingly, this review provides a summary of evidence for a select number of these factors as pre-trauma vulnerabilities to PTSD. Included is a discussion of biological factors, including molecular genetic studies of systems regulating serotonin, catecholamines, and glucocorticoids as well as aspects of the neuroendocrine system. Specific cognitive factors are also considered, including intelligence, neuropsychological functioning and cognitive biases such as negative attributional style and appraisals. For each factor, the present review summarizes evidence to date regarding PTSD vulnerability and highlights directions for future research in this area.

The theoretical and empirical basis for meditation as an intervention for PTSD.

In spite of the existence of good empirically supported treatments for posttraumatic stress disorder (PTSD), consumers and providers continue to ask for more options for managing this common and often chronic condition. Meditation-based approaches are being widely implemented, but there is minimal research rigorously assessing their effectiveness. This article reviews meditation as an intervention for PTSD, considering three major types of meditative practices: mindfulness, mantra, and compassion meditation. The mechanisms by which these approaches may effectively reduce PTSD symptoms and improve quality of life are presented. Empirical evidence of the efficacy of meditation for PTSD is very limited but holds some promise. Additional evaluation of meditation-based treatment appears to be warranted.

Attentional bias away from positive social information mediates the link between social anxiety and anxiety vulnerability to a social stressor.

Accumulating evidence suggests that social anxiety is associated with biased processing of positive social information. However, it remains to be determined whether those biases are simply correlates of, or play a role in maintaining social anxiety. The current study examined whether diminished attentional allocation for positive social cues mediates the link between social anxiety and anxiety reactivity to a social-evaluative task. Forty-three undergraduate students ranging in severity of social anxiety symptoms completed a baseline measure of attentional bias for positive social cues (i.e., modified probe detection task) and subsequently delivered an impromptu videotaped speech. Mediation analyses revealed that the tendency to allocate attention away from positive social stimuli mediated the effect of social anxiety on change in state anxiety in response to the stressor. The current findings add to a nascent empirical literature suggesting that aberrant processing of positive social information may contribute to the persistence of excessive social anxiety.

Malleability of attentional bias for positive emotional information and anxiety vulnerability.

Recent research supports a causal link between attentional bias for negative emotional information and anxiety vulnerability. However, little is known about the role of positive emotional processing in modulating anxiety reactivity to stress. In the current study, we used an attentional training paradigm designed to experimentally manipulate the processing of positive emotional cues. Participants were randomly assigned to complete a computerized probe detection task designed to induce selective processing of positive stimuli or to a sham condition. Following training, participants were exposed to a laboratory stressor (i.e., videotaped speech), and state anxiety and positive affect in response to the stressor were assessed. Results revealed that individual variability in the capacity to develop an attentional bias for positive information following training predicted subsequent emotional responses to the stressor. Moreover, individual differences in social anxiety, but not depression, moderated the effects of the attentional manipulation, such that, higher levels of social anxiety were associated with diminished attentional allocation toward positive cues. The current findings point to the potential value of considering the role of positive emotional processing in anxiety vulnerability.

The Effect of an Executive Functioning Training Program on Working Memory Capacity and Intrusive Thoughts

Recurrent intrusive thoughts are apparent across numerous clinical disorders, including depression (i.e., rumination) and anxiety disorders (e.g., worry, obsessions; Brewin et al. 2010). Theoretical accounts of intrusive thoughts suggest that individual differences in executive functioning, specifically poor inhibitory control, may account for the persistence of these thoughts in some individuals (e.g., Anderson and Levy 2009). The present study examined the causal effect of inhibitory control on intrusive thoughts by experimentally manipulating inhibition requirements in a working memory capacity (WMC) task and evaluating the effect of this training on intrusive thoughts during a thought suppression task. Unselected undergraduate participants were randomly assigned to repeatedly practice a task requiring either high inhibitory control (training condition) or low inhibitory control (control condition). Results indicated that individuals in the training condition demonstrated significantly greater WMC performance improvements from pre to post assessment relative to the control group. Moreover, individuals in the training group experienced fewer intrusions during a thought suppression task. These results provide support for theoretical accounts positing a relationship between inhibitory control and intrusive thoughts. Moreover, improving inhibitory control through computerized training programs may have clinical utility in disorders characterized by recurrent intrusive thoughts (e.g., depression, PTSD).

Working memory capacity in generalized social phobia.

Research suggests that understanding complex social cues depends on the availability of cognitive resources (e.g., Phillips, Channon, Tunstall, Hedenstrom, & Lyons, 2008). In spite of evidence suggesting that executive control functioning may impact anxiety (e.g., Eysenck, Derakshan, Santos, & Calvo, 2007), relatively few studies have examined working memory in individuals with generalized social phobia. Moreover, few studies have examined the role of threat-relevant content in working memory performance in clinically anxious populations. To this end, the present study assessed working memory capacity (WMC) in individuals with generalized social phobia and nonanxious controls using an operation span task with threat-relevant and neutral stimuli. Results revealed that nonanxious individuals demonstrated better WMC than individuals with generalized social phobia for neutral words but not for social threat words. Individuals with generalized social phobia demonstrated better WMC performance for threat words relative to neutral words. These results suggest that individuals with generalized social phobia may have relatively enhanced working memory performance for salient, socially relevant information. This enhanced working memory capacity for threat-relevant information may be the result of practice with this information in generalized social phobia.

Intolerance of uncertainty as a mediator of reductions in worry in a cognitive behavioral treatment program for generalized anxiety disorder

Growing evidence suggests that intolerance of uncertainty (IU) is a cognitive vulnerability that is a central feature across diverse anxiety disorders, including generalized anxiety disorder (GAD). Although cognitive behavioral therapy (CBT) has been shown to reduce IU, it remains to be established whether or not reductions in IU mediate reductions in worry. This study examined the process of change in IU and worry in a sample of 28 individuals with GAD who completed CBT. Changes in IU and worry, assessed bi-weekly during treatment, were analyzed using multilevel mediation models. Results revealed that change in IU mediated change in worry (ab = -0.20; 95% CI [-.35, -.09]), but change in worry did not mediate change in IU (ab = -0.16; 95% CI [-.06, .12]). Findings indicated that reductions in IU accounted for 59% of the reductions in worry observed over the course of treatment, suggesting that changes in IU are not simply concomitants of changes in worry. Findings support the idea that IU is a critical construct underlying GAD.

Suicidal ideation and risk factors in primary care patients with anxiety disorders

The presence of an anxiety disorder is associated with greater frequency of suicidal thoughts and behaviors. Given the high personal and societal costs of suicidal behaviors, suicide prevention is a priority. Understanding factors present within individuals with anxiety disorders that increase suicide risk may inform prevention efforts. The aims of the present study were to examine the prevalence of suicidal ideation and behaviors, as well as factors associated with suicide risk in patients with anxiety disorders in primary care. Data from a large scale randomized controlled study were analyzed to assess prevalence of suicidal thoughts and behaviors, as well as factors associated with suicide risk. Results revealed that suicidal ideation and behaviors were relatively common in this group. When examining mental and physical health factors jointly, presence of depression, mental health-related impairment, and social support each uniquely accounted for variance in suicide risk score. Methodological limitations include cross-sectional data collection and lack of information on comorbid personality disorders. Moreover, patients included were from a clinical trial with exclusion criteria that may limit generalizability. Results highlight the complex determinants of suicidal behavior and the need for more nuanced suicide assessment in this population, including evaluation of comorbidity and general functioning.