A Novel Attention Bias Modification Single Session Training Improves Eye Gaze Behaviour in Social Anxiety Disorder: A Pilot Study

Louise F. Carey; Giles M. Anderson; Sanjay Kumar

doi:10.2478/gp-2020-0009

Abstract

Background

Attention bias modification (ABM) can reduce anxiety and attentional bias towards threatening stimuli, but evidence of its usefulness as a potential intervention for socially anxious individuals has been mixed. Eye contact avoidance, a maladaptive attentional strategy in social anxiety disorder (SAD), has yet to be targeted by ABM research.

Aims

This study sought to establish whether a new ABM training paradigm could increase attentional deployment towards eyes and what effect this would have on social and gaze-related anxiety.

Method

Participants (n = 23) recruited through adverts calling for people who felt anxious in social situations completed either a novel ABM training task designed to induce attentional bias towards images of eyes over images of noses, or control training. Data on response times (RTs), accuracy of responses, gaze behaviour (using an eye tracker) and scores on clinical measures of social and gaze-related anxiety were collected before and after both training tasks.

Results

ABM training produced a greater number of initial saccades towards eye images than did the control task, indicating an induced shift in early attentional deployment. ABM training was also associated with a marginal increase in fixation durations on eye images. No effect was observed on RTs or social and gaze-related anxiety.

Conclusions

Our results indicate that ABM can alter the gaze behaviour of socially anxious individuals. They also highlight the importance of eye tracking to ABM research, because it was more sensitive than analyses of RTs to changes in early attentional deployment.

References

Amir, N., Taylor, C. T., & Donohue, M. C. (2011). Predictors of response to an attention modification program in generalized social phobia. Journal of Consulting and Clinical psychology, 79(4), 533–541.
Search in Google Scholar Back to article
Amir, N., Weber, G., Beard, C., Bomyea, J., & Taylor, C. T. (2008). The effect of a single-session attention modification program on response to a public-speaking challenge in socially anxious individuals. Journal of Abnormal psychology, 117(4), 860–868.
Search in Google Scholar Back to article
Anderson, G. M., Heinke, D., & Humphreys, G. W. (2013). Top-down guidance of eye movements in conjunction search. Vision Research, 79, 36–46.
Search in Google Scholar Back to article
Clark, D., & Wells, A. (1995). A cognitive model of social phobia. In Heimberg, R.; Liebowitz, M.; Hope, D.; Schneier, F. (Eds.), Social phobia: Diagnosis, Assessment, and Treatment (pp. 69–94). New York: The Guildford Press.
Search in Google Scholar Back to article
Enock, P. M., Hofmann, S. G., & McNally, R. J. (2014). Attention bias modification training via smartphone to reduce social anxiety: A randomized, controlled multi-session experiment. Cognitive Therapy and Research, 38(2), 200–216.
Search in Google Scholar Back to article
Hedlund, J., & Vieweg, B. (1979). The Hamilton rating scale for depression: a comprehensive review. Journal of Operational psychiatry, 10(2), 149–165.
Search in Google Scholar Back to article
Heimberg, R. G., Horner, K. J., Juster, H. R., Safren, S. A, Brown, E. J., Schneier, F. R., & Liebowitz, M. R. (1999). Psychometric properties of the Liebowitz Social Anxiety Scale. psychological Medicine, 29(1), 199–212.
Search in Google Scholar Back to article
Holm, S. (1979). A simple sequentially rejective multiple test procedure. Scandinavian Journal of Statistics, 6(2), 65–70.
Search in Google Scholar Back to article
Horley, K., Williams, L. M., Gonsalvez, C., & Gordon, E. (2003). Social phobics do not see eye to eye: A visual scanpath study of emotional expression processing. Journal of Anxiety Disorders, 17(1), 33–44.
Search in Google Scholar Back to article
Langer, J. K., Lim, M. H., Fernandez, K. C., & Rodebaugh, T. L. (2017). Social Anxiety Disorder is Associated with Reduced Eye Contact During Conversation Primed for Conflict. Cognitive Therapy and Research, 41(2), 220–229.
Search in Google Scholar Back to article
Langer, J. K., & Rodebaugh, T. L. (2013). Social anxiety and gaze avoidance: Averting gaze but not anxiety. Cognitive Therapy and Research, 37(6), 1110–1120.
Search in Google Scholar Back to article
Liu, H., Li, X., Han, B., & Liu, X. (2017). Effects of cognitive bias modification on social anxiety: A meta-analysis. PLoS One, 12(4).
Search in Google Scholar Back to article
MacLeod, C., Rutherford, E., Campbell, L., Ebsworthy, G., & Holker, L. (2002). Selective attention and emotional vulnerability: Assessing the causal basis of their association through the experimental manipulation of attentional bias. Journal of Abnormal psychology, 111(1), 107–123.
Search in Google Scholar Back to article
Mathews, A., & MacLeod, C. (2002). Induced processing biases have causal effects on anxiety. Cognition & Emotion, 16(3), 331–354.
Search in Google Scholar Back to article
Mennin, D. S., Fresco, D. M., Heimberg, R. G., Schneier, F. R., Davies, S. O., & Liebowitz, M. R. (2002). Screening for social anxiety disorder in the clinical setting: Using the Liebowitz Social Anxiety Scale. Journal of Anxiety Disorders, 16(6), 661–673.
Search in Google Scholar Back to article
Mogg, K., Waters, A. M., & Bradley, B. P. (2017). Attention Bias Modification (ABM): Review of Effects of Multisession ABM Training on Anxiety and Threat-Related Attention in High-Anxious Individuals. Clinical psychological Science, 26.04.17. doi: 10.1177/2167702617696359.
Open DOI Search in Google Scholar Back to article
Nosofsky, R. M., & Alfonso-Reese, L. A. (1999). Effects of similarity and practice on speeded classification response times and accuracies: further tests of an exemplar-retrieval model. Memory & Cognition, 27(1), 78–93.
Search in Google Scholar Back to article
Pelissolo, A., Abou Kassm, S., & Delhay, L. (2019). Therapeutic strategies for social anxiety disorder: where are we now? Expert Review of Neurotherapeutics, 19(12).
Search in Google Scholar Back to article
Pessôa, C. V. B. B., Perez, W. F., Endemann, P., Huziwara, E. M., & Tomanari, G. Y. (2006). Eye fixations to figures in a four-choice situation with luminance balanced areas: Evaluating practice effects. Journal of Eye Movement Research, 2(5), 1–6.
Search in Google Scholar Back to article
Samuelsson, H., Jarnvik, K., Henningsson, H., Andersson, J., & Carlbring, P. (2012). The Umeå University Database of Facial Expressions: a validation study. Journal of Medical Internet Research, 14(5).
Search in Google Scholar Back to article
Schneier, F. R., Rodebaugh, T. L., Blanco, C., Lewin, H., & Liebowitz, M. R. (2011). Fear and avoidance of eye contact in social anxiety disorder. Comprehensive psychiatry, 52(1), 81–87.
Search in Google Scholar Back to article
Schofield, C. A., Johnson, A. L., Inhoff, A. W., & Coles, M. E. (2012). Social anxiety and difficulty disengaging threat: Evidence from eye-tracking. Cognition & Emotion, 26(2), 300–311.
Search in Google Scholar Back to article
Schulze, L., Renneberg, B., & Lobmaier, J. S. (2013). Gaze perception in social anxiety and social anxiety disorder. Frontiers in Human Neuroscience, 7(December), 872.
Search in Google Scholar Back to article
See, J., MacLeod, C., & Bridle, R. (2009). The reduction of anxiety vulnerability through the modification of attentional bias: a real-world study using a home-based cognitive bias modification procedure. Journal of Abnormal psychology, 118(1), 65–75.
Search in Google Scholar Back to article
Shafiei, H., & Zare, H. (2019). Effectiveness of attention bias modification by computerized attention training on reducing social anxiety of adolescents. Advances in Cognitive Sciences, 21(2).
Search in Google Scholar Back to article
SR Research Ltd. (2011). SR Research Experiment Builder 1.10.165 [Computer software]. Mississauga, Ontario, Canada: SR Research Ltd.
Search in Google Scholar Back to article
Taylor, C. T., Aupperle, R. L., Flagan, T., Simmons, A. N., Amir, N., Stein, M. B., & Paulus, M. P. (2014). Neural correlates of a computerized attention modification program in anxious subjects. Social Cognitive and Affective Neuroscience.
Search in Google Scholar Back to article
Tottenham, N., Tanaka, J. W., Leon, A. C., McCarry, T., Nurse, M., Hare, T. A.,… Nelson, C. (2009). The NimStim set of facial expressions: Judgments from untrained research participants. Psychiatry Research, 168(3), 242–249.
Search in Google Scholar Back to article
Woud, M. L., & Becker, E. S. (2014). Editorial for the special issue on cognitive bias modification techniques: An introduction to a time traveller’s tale. Cognitive Therapy and Research, 38(2), 83–88.
Search in Google Scholar Back to article