Attentional biases in human anxiety

Abstract

Across clinical and subclinical samples, anxiety has been associated with increased attentional capture by cues signaling danger. Various cognitive models attribute the onset and maintenance of anxiety symptoms to maladaptive selective information processing. In this brief review, we 1) describe the evidence for the relations between anxiety and attention bias toward threat, 2) discuss the neurobiology of anxiety-related differences in threat bias, 3) summarize work investigating the developmental origins of attention bias toward threat, and 4) examine efforts to translate threat bias research into clinical intervention. Future directions in each area are discussed, including the use of novel analytic approaches improving characterization of threat-processing-related brain networks, clarifying the role of cognitive control in the development of attention bias toward threat, and the need for larger, well-controlled randomized clinical trials examining moderators and mediators of treatment response. Ultimately, this work has important implications for understanding the etiology of and for intervening on anxiety difficulties among children and adults.

Keywords: Amygdala; Anxiety; Attention bias; Development; Intervention; Prefrontal cortex; Temperament; Threat.

Figure 1.

Schematic of dot-probe task. Adapted from Gober et al., 2021. In this example, participants are asked to indicate the direction of the arrow via a button press. Faster reaction times on threat congruent trials (when the arrow appears in the previous location of the angry face) than on threat incongruent trials (when the arrow appears in the previous location of the neutral face) may indicate the presence of an attention bias toward threat. In the assessment version of the task, the probes appear with equal probability at the location of the threat-related (threat congruent trials) and neutral stimuli (threat incongruent trials; MacLeod et al., 1986). However, when adapted for attention bias modification (ABM) training, the probes nearly always (e.g., on approximately 90% of trials) appear in the previous location of the neutral stimulus. By reducing the likelihood that the probe will appear at the position of the threatening stimulus, ABM aims to shift attention away from threat gradually and implicitly over repeated trials (MacLeod & Mathews, 2012; Shechner & Bar-Haim, 2016).

Figure 2.

Model of relations among behavioral inhibition, attention toward potential threat, cognitive control style, and anxiety.