Yair Bar-Haim

Threat-Related Attentional Bias in Anxious and Nonanxious Individuals: A Meta-Analytic Study

This meta-analysis of 172 studies (N = 2,263 anxious,N = 1,768 nonanxious) examined the boundary conditions of threat-related attentional biases in anxiety. Overall, the results show that the bias is reliably demonstrated with different experimental paradigms and under a variety of experimental conditions, but that it is only an effect size of d = 0.45. Although processes requiring conscious perception of threat contribute to the bias, a significant bias is also observed with stimuli outside awareness. The bias is of comparable magnitude across different types of anxious populations (individuals with different clinical disorders, high-anxious nonclinical individuals, anxious children and adults) and is not observed in nonanxious individuals. Empirical and clinical implications as well as future directions for research are discussed.

Attention Bias Modification Treatment: A Meta-Analysis Toward the Establishment of Novel Treatment for Anxiety

BACKGROUND Attention Bias Modification Treatment (ABMT) is a newly emerging, promising treatment for anxiety disorders. Although recent randomized control trials (RCTs) suggest that ABMT reduces anxiety, therapeutic effects have not been summarized quantitatively. METHODS Standard meta-analytic procedures were used to summarize the effect of ABMT on anxiety. With MEDLINE, January 1995 to February 2010, we identified RCTs comparing the effects on anxiety of ABMT and quantified effect sizes with Hedges d. RESULTS Twelve studies met inclusion criteria, including 467 participants from 10 publications. Attention Bias Modification Treatment produced significantly greater reductions in anxiety than control training, with a medium effect (d = .51 [corrected] (p < .001). Age and gender did not moderate the effect of ABMT on anxiety, whereas several characteristics of the ABMT training did. CONCLUSIONS Attention Bias Modification Treatment shows promise as a novel treatment for anxiety. Additional RCTs are needed to fully evaluate the degree to which these findings replicate and apply to patients. Future work should consider the precise role for ABMT in the broader anxiety-disorder therapeutic armamentarium.

Research Review: attention bias modification (ABM): a novel treatment for anxiety disorders

Attention bias modification (ABM) is a newly emerging therapy for anxiety disorders that is rooted in current cognitive models of anxiety and in established experimental data on threat-related attentional biases in anxiety. This review describes the evidence indicating that ABM has the potential to become an enhancing tool for current psychological and pharmacological treatments for anxiety or even a novel standalone treatment. The review also outlines the gaps in need of bridging before ABM techniques could be routinely applied and incorporated into standard treatment protocols.

Development of the EEG from 5 months to 4 years of age.

OBJECTIVES This report provides a systematic longitudinal analysis of the EEG from infancy into early childhood. Particular emphasis is placed on the empirical confirmation of a 6-9 Hz alpha-range frequency band that has previously been used in the infant EEG literature. METHODS EEG data in 1-Hz bins from 3 to 12 Hz were analyzed from a longitudinal sample of 29 participants at 5, 10, 14, 24, and 51 months of age. RESULTS Inspection of power spectra averaged across the whole sample indicated the emergence of a peak in the 6-9 Hz range across multiple scalp regions. Coding of peaks in the power spectra of individual infants showed a clear developmental increase in the frequency of this peak. A rhythm in the 6-9 Hz emerged at central sites that was independent of the classical alpha rhythm at posterior sites. The relative amplitude of this central rhythm peaked in the second year of life, when major changes are occurring in locomotor behavior. CONCLUSIONS The 6-9 Hz band is a useful alpha-range band from the end of the first year of life into early childhood. The findings also complement other research relating the infant central rhythm with the adult sensorimotor mu rhythm.

Attentional bias in anxiety: A behavioral and ERP study

Accumulating evidence suggests the existence of a processing bias in favor of threat-related stimulation in anxious individuals. Using behavioral and ERP measures, the present study investigated the deployment of attention to face stimuli with different emotion expressions in high-anxious and low-anxious participants. An attention-shifting paradigm was used in which faces with neutral, angry, fearful, sad, or happy expressions were presented singly at fixation. Participants had to fixate on the face cue and then discriminate a target shape that appeared randomly above, below, to the left, or right of the fixated face. The behavioral data show that high-anxious participants were slower to respond to targets regardless of the emotion expressed by the face cue. In contrast, the ERP data indicate that threat-related faces elicited faster latencies and greater amplitudes of early ERP components in high-anxious than in low-anxious individuals. The between-group pattern in ERP waveforms suggests that the slower reaction times in high-anxious participants might reflect increased attentional dwelling on the face cues, rather than a general slowing of response enacting.

Attention biases to threat and behavioral inhibition in early childhood shape adolescent social withdrawal.

Behavioral inhibition (BI) is a temperament characterized in young children by a heightened sensitivity to novelty, social withdrawal, and anxious behaviors. For many children, these social difficulties dissipate over time. For others, patterns of social withdrawal continue into adolescence. Over time, attention biases to threat may influence the stability of BI and its association with social withdrawal, ultimately modulating the risk for anxiety disorders in BI children. However, we know relatively little about the cognitive processes that accompany BI and shape later socio-emotional functioning. We examined the relations among BI in childhood, attention biases to threat in adolescence, and adolescent social withdrawal in a longitudinal study (N = 126, Mean age = 15 years). As has been reported in anxious adults, adolescents who were behaviorally inhibited as toddlers and young children showed heightened attention bias to threat. In addition, attention bias to threat moderated the relation between childhood BI and adolescent social withdrawal.

Challenges in Developing Novel Treatments for Childhood Disorders: Lessons from Research on Anxiety

Alterations in brain development may contribute to chronic mental disorders. Novel treatments targeted toward the early-childhood manifestations of such chronic disorders may provide unique therapeutic opportunities. However, attempts to develop and deliver novel treatments face many challenges. Work on pediatric anxiety disorders illustrates both the inherent challenges as well as the unusual opportunities for therapeutic advances. The present review summarizes three aspects of translational research on pediatric anxiety disorders as the work informs efforts to develop novel interventions. First, the review summarizes data on developmental conceptualizations of anxiety from both basic neuroscience and clinical perspectives. This summary is integrated with a discussion of the two best-established treatments, cognitive behavioral therapy and selective serotonin reuptake inhibitors. Second, the review summarizes work on attention bias to threat, considering implications for both novel treatments and translational research on neural circuitry functional development. This illustrates the manner in which clinical findings inform basic systems neuroscience research. Finally, the review summarizes work in basic science on fear learning, as studied in fear conditioning, consolidation, and extinction paradigms. This summary ends by describing potential novel treatments, illustrating the manner in which basic neuroscience informs therapeutics.

Neural plasticity in response to attention training in anxiety

BACKGROUND Behavioral studies show that attention training can alter threat bias, influence vulnerability to stress and reduce clinical anxiety symptoms. The aim of this study was to examine which cognitive functions of attention processing are modulated by attention training, and how a priori anxiety interacts with the attention training procedure. Specifically, we expected modulation in the P1/N1 event-related potential (ERP) complex if early spatial attention was to be affected by training and modulation in later ERP components (P2, N2, P3) had training affected top-down attentional processes. METHOD Thirty anxious and 30 non-anxious adults performed a modified probe detection task. Electroencephalograms (EEGs) were recorded throughout for later ERP analyses. Half the participants in each anxiety group were randomly assigned to undergo a training procedure designed to divert their attention away from threat and the other half received placebo training. RESULTS Anxious participants who were trained to avoid threat showed a linear reduction in response time (RT) to targets replacing neutral faces with the progression of training. This change in RT was not observed among non-anxious participants or among anxious participants who were exposed to placebo training. Following training, the anxious participants who were trained to avoid threat showed a reduction in P2 and P3 mean amplitudes and an enhancement in N2 mean amplitude. CONCLUSIONS Attention training affects anxious participants whereas non-anxious participants seem not to respond to it. The ERP data suggest that attention training modulates top-down processes of attention control rather than processes of early attention orienting.

Plasticity in attention: implications for stress response in children.

Attention bias has been suggested as an etiological and maintaining factor in anxiety. However, empirical evidence establishing this causal association is scarce and has been provided only in adults. In this preliminary study, we tested whether an induction of attentional bias can cause changes in vulnerability to stress in children reporting normal anxiety levels. Twenty-six 7-12 year-old children were randomly assigned to two groups. One group was exposed to a training condition designed to induce an attentional bias away from threat. The other group was exposed to a training condition designed to induce an attentional bias toward threat. Children who were trained to attend to threat developed attentional vigilance to threat-related information. The training procedure was ineffective with children who were trained to avoid threat, and their attention remained unbiased. Children from both training groups reported elevated depression scores following stress-induction. However, only the children who were trained to attend to threat subsequently reported elevations in anxiety. The findings suggest that biased attentional responses to threat, among children, can exert a specific influence on the tendency to experience anxiety in the face of stress.

Life-Threatening Danger and Suppression of Attention Bias to Threat

OBJECTIVE Life-threatening danger is assumed to produce, in tandem, increases in both vigilance toward threat and stress-related symptoms, but no data test the validity of this assumption. The authors examined associations, in real time, among imminent life-threatening danger, stress-related symptoms, and vigilance. METHOD Symptoms of posttraumatic stress disorder (PTSD), depression, and anxiety were measured in a civilian population (N=131) as a function of war-related stress, operationalized as the time available for seeking cover from rocket attack. A computerized measure of threat-related vigilance using a classic dot-probe attention task was also collected. RESULTS PTSD symptoms, depression, and anxiety increased as a function of war-related threat. Acute proximal threat was associated with avoidance of, rather than vigilance toward, negative valence information. For participants within rocket range, the magnitude of threat bias varied with the magnitude of distress symptoms, such that as bias away from threat increased, distress symptoms increased. CONCLUSIONS These data challenge current thinking about the role of attention in stress responding. Attentional threat avoidance may reduce the acute impact of imminent threat, but this may come at a price in terms of an elevated risk for psychopathology.