Nader Amir

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.

Attention Training in Individuals with Generalized Social Phobia: A Randomized Controlled Trial

The authors conducted a randomized, double-blind placebo-controlled trial to examine the efficacy of an attention training procedure in reducing symptoms of social anxiety in 44 individuals diagnosed with generalized social phobia (GSP). Attention training comprised a probe detection task in which pictures of faces with either a threatening or neutral emotional expression cued different locations on the computer screen. In the attention modification program (AMP), participants responded to a probe that always followed neutral faces when paired with a threatening face, thereby directing attention away from threat. In the attention control condition (ACC), the probe appeared with equal frequency in the position of the threatening and neutral faces. Results revealed that the AMP facilitated attention disengagement from threat from pre- to postassessment and reduced clinician- and self-reported symptoms of social anxiety relative to the ACC. The percentage of participants no longer meeting Diagnostic and Statistical Manual (4th ed.) criteria for GSP at postassessment was 50% in the AMP and 14% in the ACC. Symptom reduction in the AMP group was maintained during 4-month follow-up assessment. These results suggest that computerized attention training procedures may be beneficial for treating social phobia.

Attentional Biases for Facial Expressions in Social Phobia: The Face-in-the-Crowd Paradigm

The present study examines the attentional bias hypothesis for individuals with generalised social phobia (GSPs). Socially phobic individuals were hypothesised to exhibit attentional bias towards threat stimuli relevant to interpersonal situations. This hypothesis was tested using the face-in-the-crowd paradigm. GSPs and nonanxious controls (NACs) detected an angry, happy, neutral, or disgust target face in a crowd of 12 distracter photographs. Results indicated that, compared to NACs, GSPs exhibited greater attentional biases for angry than for happy faces in a neutral crowd. GSPs were more slowed down in their performance by happy and angry versus neutral distracters; NACs did not exhibit such sensitivity to distracter type. Finally, GSPs were faster in detecting anger than disgust expressions; NACs detected both types of faces equally quickly. Implications of these findings for the maintenance of social phobia are discussed.

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 multi-session interpretation modification program: Changes in interpretation and social anxiety symptoms

Previous research suggests that socially anxious individuals interpret ambiguous social information in a more threatening manner compared to non-anxious individuals. Recently, studies have experimentally modified interpretation and shown that this subsequently affected anxiety in non-anxious individuals. If similar procedures can modify interpretation biases in socially anxious individuals, they may lead to a reduction in social anxiety symptoms. In the current study, we examined the effect of a computerized Interpretation Modification Program (IMP) on interpretation bias and social anxiety symptoms. Twenty-seven socially anxious individuals were randomly assigned to the IMP or a control condition. Participants completed eight computer sessions over four weeks. The IMP modified interpretation by providing positive feedback when participants made benign interpretations and negative feedback in response to threat interpretations. The IMP successfully decreased threat interpretations, increased benign interpretations, and decreased social anxiety symptoms compared to the control condition. Moreover, changes in benign interpretation mediated IMPs effect on social anxiety. This initial trial suggests that interpretation modification may have clinical utility when applied as a multi-session intervention.

Internet-delivered attention bias modification training in individuals with social anxiety disorder - a double blind randomized controlled trial

BackgroundComputerized cognitive bias modification for social anxiety disorder has in several well conducted trials shown great promise with as many as 72% no longer fulfilling diagnostic criteria after a 4 week training program. To test if the same program can be transferred from a clinical setting to an internet delivered home based treatment the authors conducted a randomized, double-blind placebo-controlled trial.MethodsAfter a diagnostic interview 79 participants were randomized to one of two attention training programs using a probe detection task. In the active condition the participant was trained to direct attention away from threat, whereas in the placebo condition the probe appeared with equal frequency in the position of the threatening and neutral faces.ResultsResults were analyzed on an intention-to-treat basis, including all randomized participants. Immediate and 4-month follow-up results revealed a significant time effect on all measured dimensions (social anxiety scales, general anxiety and depression levels, quality of life). However, there were no time x group interactions. The lack of differences in the two groups was also mirrored by the infinitesimal between group effect size both at post test and at 4-month follow-up.ConclusionWe conclude that computerized attention bias modification may need to be altered before dissemination for the Internet.Trial registrationISRCTN01715124

Memory Bias in Generalized Social Phobia: Remembering Negative Emotional Expressions

In two experiments, the authors examined memory for facial emotional expressions in patients with generalized social phobia (GSP) and in nonanxious control (NAC) participants. Three main questions were addressed. First, do patients with GSP differ from NAC participants in their overall memory for facial expressions? Second, do patients with GSP exhibit a memory bias for negative versus nonnegative expressions? Third, if such a bias exists, is it specific to angry expressions? The results of both experiments indicated that patients with GSP have better memory for all facial expressions than do NAC participants. Results of experiment 2 suggest that patients with GSP exhibit enhanced recognition for negative compared with nonnegative expressions; in contrast, NAC participants did not exhibit such enhancement. Results concerning specificity were equivocal. The importance of examining cognitive biases in patients with GSP via the use of facial expression is discussed.

The effect of attention training on a behavioral test of contamination fears in individuals with subclinical obsessive-compulsive symptoms.

In the current study, we evaluated the effectiveness of attention training in individuals with subclinical obsessive-compulsive symptoms. We hypothesized that after completing attention training, participants would be more likely to complete steps in a hierarchy approaching their feared contaminant compared with participants in the control condition. Participants completed a probe detection task by identifying letters replacing one member of a pair of words (neutral or contamination related). We trained attention by building a contingency between the location of the contamination-related word in the active condition and not in the control condition. Participants in the active group showed a significant reduction in attention bias for threat and completed significantly more steps when approaching their feared objects compared with participants in the control group. Our results suggest that attention disengagement training may facilitate approaching feared objects in individuals with obsessive-compulsive symptoms.

Predictors of response to an attention modification program in generalized social phobia.

OBJECTIVE At least 3 randomized, placebo-controlled, double-blind studies have supported the efficacy of computerized attention modification programs (AMPs) in reducing symptoms of anxiety in patients diagnosed with an anxiety disorder. In this study we examined patient characteristics that predicted response to AMP in a large sample of individuals diagnosed with generalized social phobia. METHOD The sample comprised 112 individuals seeking treatment for generalized social phobia who completed a randomized clinical trial comparing AMP (n = 55) with a placebo condition (i.e., attention control condition; n = 57). We examined the following domains of baseline predictors of treatment response: (a) demographic characteristics (gender, age, ethnicity, years of education); (b) clinical characteristics (Axis I comorbidity, trait anxiety, depression); and (c) cognitive disturbance factors (attentional bias for social threat, social interpretation bias). RESULTS Results revealed that ethnicity predicted treatment response across both conditions: Participants who self-identified as non-Caucasian displayed better overall response than did Caucasians. The only prescriptive variable to emerge was attentional bias for social threat at preassessment. Participants in the AMP group who exhibited larger attentional bias scores displayed significantly greater reductions in clinician-rated social anxiety symptoms than did their counterparts in the attention control condition. CONCLUSIONS These results suggest that AMP may be targeted to individuals most likely to benefit from these programs.

Interpretation Bias and Social Anxiety

Socially anxious (SA) individuals interpret ambiguous social events negatively. It is not clear, however, whether this bias is due to general distress (e.g., depression and general anxiety) or level of social anxiety. In the current study we conducted two experiments examining interpretation bias in SA individuals using videos. Each video involved an actor or actress who approached the camera and commented on some aspect of the individual’s belongings or actions. Twenty-four (24) videos were ambiguous (e.g., “That is an interesting shirt you have on”), 24 were positive (e.g., “I really like your shoes”), and 24 were negative (e.g., “That is a horrible hair cut”). Participants were instructed to rate the emotional valance of each video as to how they would feel in that situation. SA individuals rated the valance of ambiguous social interactions as more negative than did nonanxious individuals. Moreover, SA individuals maintained this bias when compared to a high trait anxious and dysphoric control group. These findings demonstrate the unique role of social anxiety in the biased interpretation of ambiguous social interactions.