Josh M. Cisler

Mechanisms of attentional biases towards threat in anxiety disorders: An integrative review.

A wealth of research demonstrates attentional biases toward threat in the anxiety disorders. Several models have been advanced to explain these biases in anxiety, yet the mechanisms comprising and mediating the biases remain unclear. In the present article, we review evidence regarding the mechanisms of attentional biases through careful examination of the components of attentional bias, the mechanisms underlying these components, and the stage of information processing during which the biases occur. Facilitated attention, difficulty in disengagement, and attentional avoidance comprise the components of attentional bias. A threat detection mechanism likely underlies facilitated attention, a process that may be neurally centered around the amygdala. Attentional control ability likely underlies difficulty in disengagement, emotion regulation goals likely underlie attentional avoidance, and both of these processes may be neurally centered around prefrontal cortex functioning. The threat detection mechanism may be a mostly automatic process, attentional avoidance may be a mostly strategic process, and difficulty in disengagement may be a mixture of automatic and strategic processing. Recommendations for future research are discussed.

Efficacy of Cognitive Behavioral Therapy for Anxiety Disorders: A Review of Meta-Analytic Findings

Numerous clinical trials have supported the efficacy of cognitive behavioral therapy (CBT) for the treatment of anxiety disorders. Accordingly, CBT has been formally recognized as an empirically supported treatment for anxiety-related conditions. This article reviews the evidence supporting the efficacy of CBT for anxiety disorders. Specifically, contemporary meta-analytic studies on the treatment of anxiety disorders are reviewed and the efficacy of CBT is examined. Although the specific components of CBT differ depending on the study design and the anxiety disorder treated, meta-analyses suggest that CBT procedures (particularly exposure-based approaches) are highly efficacious. CBT generally outperforms wait-list and placebo controls. Thus, CBT provides incremental efficacy above and beyond nonspecific factors. For some anxiety disorders, CBT also tends to outperform other psychosocial treatment modalities. The implications of available meta-analytic findings in further delineating the efficacy and dissemination of CBT for anxiety disorders are discussed.

Phenomenological Characteristics of Attentional Biases Towards Threat: A Critical Review.

Although research has consistently revealed the presence of a general attentional bias towards threat, empirical and theoretical ambiguity exists in determining whether attentional biases are comprised of facilitated attention to threat, difficulty in disengagement from threat, or both, as well as whether attentional biases reflect automatic or strategic processes. This paper reviews empirical investigations across four common assessment tasks: the Stroop (masked and unmasked), dot probe, visual search, and the Posner tasks. Although the review finds inconsistencies both within and between assessment tasks, the evidence suggests that attentional biases towards threat are comprised of each of the phenomenological characteristics addressed in this paper. Contemporary theoretical models of attentional biases in anxiety are summarized and critically reviewed in light of the current evidence. Suggestions for future research are addressed, including a need to investigate the psychometric properties of the assessment tasks, to utilize consistent theoretically driven operationalizations of attentional biases, and to provide a temporal description of the characteristics of attentional biases towards threat.

Disgust, Fear, and the Anxiety Disorders: A Critical Review

Anxiety disorders have traditionally been conceptualized as reflecting the emotions of fear and anxiety. A developing program of research demonstrates a relation between disgust and three specific anxiety disorders: blood-injection-injury (BII) phobia, spider phobia, and contamination-related obsessive-compulsive disorder (OCD). This review serves three purposes. First, the authors review the response patterns predicted to be observed if the emotional response in these disorders involved disgust versus fear. The review suggests specific response patterns that characterize disgust and fear in the domains of heart rate, facial expression, neural activity, and cognitive processes. Second, the authors review extant research employing measures of these domains in spider phobia, BII phobia, and contamination-related OCD. The evidence suggests that both fear and disgust characterize each of these disorders, but the magnitude at which the emotions characterize the disorders may depend on the response domain measured. For example, disgust may be more involved in spider phobia in appraisals and facial expression, but less involved in neural correlates or heart rate domains. Third, the authors suggest guidelines for future research, including concurrent use of specific measures as well as examining whether the different emotions in different response domains respond to similar interventions (e.g., exposure).

Is disgust associated with psychopathology? Emerging research in the anxiety disorders

Recent evidence indicates that the propensity towards experiencing disgust may contribute to the development and maintenance of some anxiety disorders. This article summarizes the empirical evidence with emphasis on illuminating potential mediators, moderators, and mechanisms of the disgust-anxiety disorder association that may inform the development of an integrative conceptual model. Early research using neuroimaging methods suggest that disgust processing is associated with activation of the insula. This research has the potential to facilitate progress in developing an empirically informed psychobiological theory on the causal role of disgust in the anxiety disorders.

Differential functional connectivity within an emotion regulation neural network among individuals resilient and susceptible to the depressogenic effects of early life stress

BACKGROUND Early life stress (ELS) is a significant risk factor for depression. The effects of ELS exposure on neural network organization have not been differentiated from the effect of depression. Furthermore, many individuals exposed to ELS do not develop depression, yet the network organization patterns differentiating resiliency versus susceptibility to the depressogenic effects of ELS are not clear. METHOD Women aged 18-44 years with either a history of ELS and no history of depression (n = 7), a history of ELS and current or past depression (n = 19), or a history of neither ELS nor depression (n = 12) underwent a resting-state 3-T functional magnetic resonance imaging (fMRI) scan. An emotion regulation brain network consisting of 21 nodes was described using graph analyses and compared between groups. RESULTS Group differences in network topology involved decreased global connectivity and hub-like properties for the right ventrolateral prefrontal cortex (vlPFC) and decreased local network connectivity for the dorsal anterior cingulate cortex (dACC) among resilient individuals. Decreased local connectivity and increased hub-like properties of the left amygdala, decreased hub-like properties of the dACC and decreased local connectivity of the left vlPFC were observed among susceptible individuals. Regression analyses suggested that the severity of ELS (measured by self-report) correlated negatively with global connectivity and hub-like qualities for the left dorsolateral PFC (dlPFC). CONCLUSIONS These preliminary results suggest functional neural connectivity patterns specific to ELS exposure and resiliency versus susceptibility to the depressogenic effects of ELS exposure.

A comparison of statistical methods for detecting context-modulated functional connectivity in fMRI

Many cognitive and clinical neuroscience research studies seek to determine how contextual factors modulate cognitive processes. In fMRI, hypotheses about how context modulates distributed patterns of information processing are often tested by comparing functional connectivity between neural regions A and B as a function of task conditions X and Y, which is termed context-modulated functional connectivity (FC). There exist two exploratory statistical approaches to testing context-modulated FC: the beta-series method and psychophysiological interaction (PPI) analysis methods. While these approaches are commonly used, their relative power for detecting context-modulated FC is unknown, especially with respect to real-world experimental parameters (e.g., number of stimulus repetitions, inter-trial-interval, stimulus duration). Here, we use simulations to compare power for detecting context-modulated FC between the standard PPI formulation (sPPI), generalized PPI formulation (gPPI), and beta series methods. Simulation results demonstrate that gPPI and beta series methods are generally more powerful than sPPI. Whether gPPI or beta series methods performed more powerfully depended on experiment parameters: block designs favor the gPPI, whereas the beta series method was more powerful for designs with more trial repetitions and it also retained more power under conditions of hemodynamic response function variability. On a real dataset of adolescent girls, the PPI methods appeared to have greater sensitivity in detecting task-modulated FC when using a block design and the beta series method appeared to have greater sensitivity when using an event-related design with many trial repetitions. Implications of these performance results are discussed.

Exposure to interpersonal violence and risk for PTSD, depression, delinquency, and binge drinking among adolescents: Data from the NSA-R

Interpersonal violence (IPV) is associated with a range of subsequent negative outcomes; however, research has yet to test whether IPV operates as a specific risk factor for separate psychopathology outcomes, such as posttraumatic stress disorder (PTSD) symptoms, depressive symptoms, delinquent acts, or binge drinking. To address this, cumulative exposure to IPV and non-IPV-related traumatic events, PTSD symptoms, depressive symptoms, delinquent acts, and binge drinking were measured 3 times over approximately 3 years among a nationally representative sample of adolescents aged 12-17 (N = 3,614 at Wave 1). Results demonstrated that cumulative IPV exposure predicted subsequent PTSD, depression, delinquency, and binge drinking (βs = .07, .12, .10, and .09, respectively; all ps < .01) when all cross-relationships (e.g., the effect of delinquency on future binge drinking) were in the model. Exposure to non-IPV traumatic events generally did not confer vulnerability to subsequent psychopathology outcomes. Overall, findings from this study advance the literature in this area by exploring consequences for adolescents following cumulative IPV exposure.

Components of attentional biases in contamination fear: Evidence for difficulty in disengagement

Attentional bias for threat has been implicated in the contamination fear (CF) subtype of obsessive-compulsive disorder, but the components of the bias (facilitated attention versus difficulty in disengagement) and the stage of processing during which the bias occurs (early versus late stage of processing) remains unclear. Further, it is unclear whether attentional biases in CF are towards fear or disgust-related stimuli. The present study examined attentional biases in a group of individuals selected to have elevated CF (n = 23) and a control group (n = 28) using the spatial cueing task. Stimuli were neutral, disgusting, or frightening pictures presented for either 100 or 500 ms. Results revealed evidence for delayed disengagement from both fear and disgust stimuli in the CF group, but not in the control group. The effect appeared to be greater at 500 ms stimulus presentation, but did not appear to differ between fear and disgust stimuli. The CF group was associated with delayed disengagement from threat even when controlling for generic response slowing. Theoretical and clinical implications are discussed.

The Emotional Stroop Task and Posttraumatic Stress Disorder: a Meta-Analysis

Posttraumatic stress disorder (PTSD) is associated with significant impairment and lowered quality of life. The emotional Stroop task (EST) has been one means of elucidating some of the core deficits in PTSD, but this literature has remained inconsistent. We conducted a meta-analysis of EST studies in PTSD populations in order to synthesize this body of research. Twenty-six studies were included with 538 PTSD participants, 254 non-trauma exposed control participants (NTC), and 276 trauma exposed control participants (TC). PTSD-relevant words impaired EST performance more among PTSD groups and TC groups compared to NTC groups. PTSD groups and TC groups did not differ. When examining within-subject effect sizes, PTSD-relevant words and generally threatening words impaired EST performance relative to neutral words among PTSD groups, and only PTSD-relevant words impaired performance among the TC groups. These patterns were not found among the NTC groups. Moderator analyses suggested that these effects were significantly greater in blocked designs compared to randomized designs, toward unmasked compared to masked stimuli, and among samples exposed to assaultive traumas compared to samples exposed to non-assaultive traumas. Theoretical and clinical implications are discussed.