Lies Notebaert

Absence of evidence or evidence of absence: reflecting on therapeutic implementations of attentional bias modification

Attentional bias modification (ABM) represents one of a number of cognitive bias modification techniques which are beginning to show promise as therapeutic interventions for emotional pathology. Numerous studies with both clinical and non-clinical populations have now demonstrated that ABM can reduce emotional vulnerability. However, some recent studies have failed to achieve change in either selective attention or emotional vulnerability using ABM methodologies, including a recent randomised controlled trial by Carlbring et al. Some have sought to represent such absence of evidence as a sound basis not to further pursue ABM as an online intervention. While these findings obviously raise questions about the specific conditions under which ABM procedures will produce therapeutic benefits, we suggest that the failure of some studies to modify selective attention does not challenge the theoretical and empirical basis of ABM. The present paper seeks to put these ABM failures in perspective within the broader context of attentional bias modification research. In doing so it is apparent that the current findings and future prospects of ABM are in fact very promising, suggesting that more research in this area is warranted, not less.

Signals of Threat Do Not Capture, but Prioritize, Attention: A Conditioning Approach

Research suggests that threatening information captures attention more rapidly than neutral information. However, in most studies threat stimuli differ perceptually from neutral stimuli and are instrumental to perform the task, leaving the question unanswered whether threat is sufficient to capture attention. In experiment 1, we designed a visual search task with stimuli of equal salience (colored circles) that have the potential to lead to efficient search (10 ms/item). In experiment 2, one of the colors (conditioned stimulus, CS+) was made threatening by means of fear conditioning. Participants responded to a target presented in one of the circles. Overall, the search was faster on congruent trials (where the target was presented in the CS+) than on baseline trials (where the CS + was absent). Furthermore, the search was slower on incongruent trials (where the target was presented in another color than the CS+) than on baseline trials. The search on congruent trials was affected by set size (90 ms/item), but to a lesser extent than on baseline trials (105 ms/item). We conclude that threat prioritizes, but does not capture attention.

Attentional Bias to Threat: A Perceptual Accuracy Approach

To investigate attentional bias to threatening information, the authors propose a new version of the spatial cueing paradigm in which the focus is on perceptual accuracy instead of response speed. In two experiments, healthy volunteers made unspeeded discriminations between three visual targets presented left or right. Each target was preceded by a visual cue (colored rectangle) at either the same (valid) or opposite (invalid) location. By means of differential classical conditioning with aversive white noise, a threat cue and a control cue were created. Analyses of error rates showed that cueing effects (lower proportion of errors in valid trials relative to invalid trials) were more pronounced in threat trials than in neutral trials. This threat-related bias was particularly because of threat cues reducing accuracy in invalid trials, indicating difficulty disengaging attention from threatening information. Engagement of attention was not affected by threat, as threat cues did not facilitate the processing of targets in valid trials. The findings are discussed in light of the strengths and limitations of spatial cueing tasks.

Attempts to control pain prioritize attention towards signals of pain: An experimental study

&NA; Clinical evidence suggests that a persistent search for solutions for chronic pain may bring along costs at the cognitive, affective, and behavioral level. Specifically, attempts to control pain may fuel hypervigilance and prioritize attention towards pain‐related information. This hypothesis was investigated in an experiment with 41 healthy volunteers. Prioritization of attention towards a signal for pain was measured using an adaptation of a visual search paradigm in which participants had to search for a target presented in a varying number of colored circles. One of these colors (Conditioned Stimulus) became a signal for pain (Unconditioned Stimulus: electrocutaneous stimulus at tolerance level) using a classical conditioning procedure. Intermixed with the visual search task, participants also performed another task. In the pain‐control group, participants were informed that correct and fast responses on trials of this second task would result in an avoidance of the Unconditioned Stimulus. In the comparison group, performance on the second task was not instrumental in controlling pain. Results showed that in the pain‐control group, attention was more prioritized towards the Conditioned Stimulus than in the comparison group. The theoretical and clinical implications of these results are discussed. Using a visual search task, we showed that the goal to avoid pain leads to enhanced prioritization of signals of pain.

Validation of a novel attentional bias modification task: The future may be in the cards

Attentional bias modification (ABM) is a promising therapeutic tool aimed at changing patterns of attentional selectivity associated with heightened anxiety. A number of studies have successfully implemented ABM using the modified dot-probe task. However others have not achieved the attentional change required to achieve emotional benefits, highlighting the need for new ABM methods. The current study compared the effectiveness of a newly developed ABM task against the traditional dot-probe ABM task. The new person-identity-matching (PIM) task presented participants with virtual cards, each depicting a happy and angry person. The task encourages selective attention toward or away from threat by requiring participants to make matching judgements between two cards, based either on the identities of the happy faces, or of the angry faces. Change in attentional bias achieved by both ABM tasks was measured by a dot-probe assessment task. Their impact on emotional vulnerability was assessed by measuring negative emotional reactions to a video stressor. The PIM task succeeded in modifying attentional bias, and exerting an impact on emotional reactivity, whereas this was not the case for the dot-probe task. These results are considered in relation to the potential clinical utility of the current task in comparison to traditional ABM methodologies.

Looking out for danger: An attentional bias towards spatially predictable threatening stimuli.

Attentional bias to threat is well established, however, the influence of spatial predictability on this attentional bias has never been investigated. Here we investigated how threat affects attentional capture and disengagement when its spatial location is predictable. Using a visual search paradigm, participants were required to identify a target inside one of a variable number of colored circles. One color (Conditioned Stimulus, CS+) was fear-conditioned using an electrocutaneous stimulus at tolerance level. In the experimental group the CS+ was made spatially predictable (occurred more often at one location in the visual display), while this was not the case in the control group. Results showed no complete automatic capture of attention by the CS+, but the experimental group did show more prioritization of the CS+ and less difficulty to disengage from the CS+ than the control group. Of further importance was the finding that the experimental group also attended to the location that was predictive of the CS+, even when no CS+ was presented. Findings are discussed in terms the effects of predictability on anxiety.

Simply imagining sunshine, lollipops and rainbows will not budge the bias: The role of ambiguity in interpretive bias modification

Imagery-based interpretive bias modification (CBM-I) involves repeatedly imagining scenarios that are initially ambiguous before being resolved as either positive or negative in the last word/s. While the presence of such ambiguity is assumed to be important to achieve change in selective interpretation, it is also possible that the act of repeatedly imagining positive or negative events could produce such change in the absence of ambiguity. The present study sought to examine whether the ambiguity in imagery-based CBM-I is necessary to elicit change in interpretive bias, or, if the emotional content of the imagined scenarios is sufficient to produce such change. An imagery-based CBM-I task was delivered to participants in one of four conditions, where the valence of imagined scenarios were either positive or negative, and the ambiguity of the scenario was either present (until the last word/s) or the ambiguity was absent (emotional valence was evident from the start). Results indicate that only those who received scenarios in which the ambiguity was present acquired an interpretive bias consistent with the emotional valence of the scenarios, suggesting that the act of imagining positive or negative events will only influence patterns of interpretation when the emotional ambiguity is a consistent feature.

Assessing the Therapeutic Potential of Targeted Attentional Bias Modification for Insomnia Using Smartphone Delivery

Creation of experimental word stimuli Research assessing the presence of attentional bias in insomnia has consistently employed paired word stimuli that contain a threatening member, which communicates a meaning relevant to the concerns of those with sleep disturbance, and an emotionally neutral stimulus member (see [1]). In line with this, we included 48 threatening sleeprelated words characteristic of pre-sleep worry thoughts, paired with neutral words matched for length and spoken frequency [2] for the purpose of modification and assessment of attentional bias. The threat words were selected from an initial pool of 96 candidate words. These words were generated on the basis of three factors identified by Wicklow and Espie [3] as core themes relevant to presleep worry consistently reported by individuals with insomnia: active problem solving (e.g. thoughts about the negative consequences of poor sleep), present-state monitoring (e.g. thoughts about bodily functions), and reactivity to external stimuli (e.g. thoughts about environmental factors disturbing sleep). All 96 candidate words were rated by 12 independent judges using a 7-point scale on emotional valence, from 1 (Very negative) to 7 (Very positive) and relatedness to sleep concerns, from 1 (Not at all) to 7 (Extremely). The final selected threat words were rated to be strongest in negative valence (M = 2.35, SD = 0.78) and most relevant to sleep concerns (M = 4.67, SD = 0.93). The word pairs were randomised and divided into two separate stimulus subsets (Subset A and Subset B). For half the participants in each condition Subset A was used in the training/control component and Subset B was used in the assessment component of the task, while the remaining participants received the reverse allocation. The use of different stimuli in the training and assessment components ensures that any change in attentional bias can be attributed to the class of stimulus and not to specific stimuli themselves. These stimuli are provided in Supplementary Table 1.

Confusing procedures with process when appraising the impact of cognitive bias modification on emotional vulnerability

If meta-analysis is to provide valuable answers, then it is critical to ensure clarity about the questions being asked. Here, we distinguish two important questions concerning cognitive bias modification research that are not differentiated in the meta-analysis recently published by Cristea et al (2015) in this journal: (1) do the varying procedures that investigators have employed with the intention of modifying cognitive bias, on average, significantly impact emotional vulnerability?; and (2) does the process of successfully modifying cognitive bias, on average, significantly impact emotional vulnerability? We reanalyse the data from Cristea et al to address this latter question. Our new analyses demonstrate that successfully modifying cognitive bias does significantly alter emotional vulnerability. We revisit Cristea et als conclusions in light of these findings.

Task relevance of emotional information affects anxiety-linked attention bias in visual search

Task relevance affects emotional attention in healthy individuals. Here, we investigate whether the association between anxiety and attention bias is affected by the task relevance of emotion during an attention task. Participants completed two visual search tasks. In the emotion-irrelevant task, participants were asked to indicate whether a discrepant face in a crowd of neutral, middle-aged faces was old or young. Irrelevant to the task, target faces displayed angry, happy, or neutral expressions. In the emotion-relevant task, participants were asked to indicate whether a discrepant face in a crowd of middle-aged neutral faces was happy or angry (target faces also varied in age). Trait anxiety was not associated with attention in the emotion-relevant task. However, in the emotion-irrelevant task, trait anxiety was associated with a bias for angry over happy faces. These findings demonstrate that the task relevance of emotional information affects conclusions about the presence of an anxiety-linked attention bias.