Academic journal article Journal of Cognitive Psychotherapy

Attentional Bias in Anxiety Disorders Following Cognitive Behavioral Treatment

Academic journal article Journal of Cognitive Psychotherapy

Attentional Bias in Anxiety Disorders Following Cognitive Behavioral Treatment

Article excerpt

A substantive literature suggests that anxious people have an attentional bias toward threatening stimuli. To date, however, no systematic review has examined the effects of cognitive behavioral therapy (CBT) for anxiety on attentional bias. A better understanding of the extant literature on CBT and its effect on attentional bias can serve to bridge the gap between experimental research on cognitive bias and the implications for clinical treatment of anxiety disorders. The present review examined studies that measured the effects of CBT on attentional bias. Of the 13 studies reviewed, 10 demonstrated that attentional bias, as assessed by dichotic listening tasks, the emotional Stroop test, or probe detection tasks, was significantly reduced from pretreatment to posttreatment for obsessive-compulsive disorder, spider phobia, social phobia, and generalized anxiety disorder. Methodological issues are considered, and implications for cognitive behavioral treatments of anxiety are discussed.

Keywords: anxiety; cognitive behavioral therapy; attentional bias; information processing

Cognitive models of anxiety suggest that threat-relevant attentional biases cause and/ or maintain anxiety disorders. An attentional bias refers to the systematic tendency to preferentially attend to a particular class of stimuli (Harvey, Watkins, Mansell, & Shafran, 2004). The tendency to attend to threat-related information is adaptive in situations of real danger because it increases the individual's chance of responding to the danger in time (LeDoux, 1996). This tendency becomes maladaptive, however, when the individual responds to stimuli that are relatively harmless as if they were highly threatening (Lundh & Öst, 2001). As Beck, Emery, and Greenberg (2005) describe, individuals with clinical anxiety selectively focus their attention on objects or situations associated with danger or threat. These individuals are described as " hypervigilant for any cues relevant to danger" (Beck et al., 2005, p. 25). Conversely, a systematic tendency to avoid attending to certain stimuli, or attentional avoidance, is also a form of attentional bias (Harvey et al., 2004). Indeed, some models of attentional bias in anxiety posit that both initial orientation and subsequent avoidance of threat-relevant stimuli play important roles in the etiology and maintenance of anxiety disorders (e.g., vigilance-avoidance models; Koster, Crombez, Verschuere, Vanvolsem, & De Houwer, 2007; Mogg & Bradley, 2006; Vassilopoulos, 2005).

Although a substantive body of literature supports the existence of an attentional bias toward threatening stimuli in anxious adults (see Bar-Haim, Lamy, Pergamin, Bakermans-Kranenburg, & van IJzendoorn, 2007, for a meta-analysis) and in youth (Puliafico & Kendall, 2006), no systematic review of the literature has examined the effects of cognitive behavioral therapy (CBT) for anxiety on attentional bias. An important question is whether an attentional bias persists even when anxiety is successfully treated with CBT. If the bias abates over the course of treatment, then perhaps CBT can effectively target this cognitive vulnerability to anxiety. If the bias persists, then perhaps CBT affects state anxiety but not an enduring trait vulnerability to anxiety. The clinical applications of traditionally experimental paradigms measuring attentional bias include their use both as assessment tools that may be more sensitive to automatic processes associated with anxiety, and as an intervention tool through attentional training.

This article reviews studies that have investigated the effects of CBT for anxiety disorders on attentional bias. Cognitive theories of anxiety and selective attention are first reviewed, with a focus on how CBT is expected to modify these biases. Next, three measures of selective attention are discussed. The literature on treatment for anxiety and attentional bias outcomes are then reviewed systematically. …

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