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The Technique of Attention Bias Modification: characteristics and uses

The Technique of Attention Bias Modification: characteristics and uses

March 13, 2023

Although there are multiple theories, today there is still no clear and universal definition of the concept of attention. However, what is known with absolute certainty is that this basic cognitive process is of paramount importance in the origin and maintenance of mental disorders and, in particular, in anxiety disorders.

In the following lines we will expose the repercussion that the technique of the Attention Bias Modification is having , a new attentional psychological technique designed for the treatment of social anxiety disorder or social phobia.

  • Related article: "The 4 differences between shyness and social phobia"

The care and treatment of mental disorders

As pointed out by Shechner et al. (2012), attention is a basic process that encompasses different cognitive functions that allow the brain to prioritize the processing of certain information. The fact of attending or not to certain stimuli or information can affect the development of the person, because Attention is the basis of memory and learning . You can only learn and memorize experiences to which you are attending.

According to the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders), social phobia is characterized by "intense fear or anxiety in one or more social situations in which the individual is exposed to possible examination by other people" .

The person feels fear to behave in a certain way that can be valued negatively by those around her. That is to say, is afraid to be judged by others and to be rejected for her performance in a situation that involves several people. These situations can range from giving a talk to a considerable audience, to having a simple conversation with someone you know.

Najmi, Kuckertz and Amir (2011), showed that people with anxiety selectively attend to elements of the environment that they consider threatening, failing to attend to the rest of the environment, in which they could find neutral or positive elements. This attentional bias often leads to mistaken value judgments that result in increased anxiety and long-term persistence of the disorder.

For example, if a person with social anxiety disorder was making an oral presentation to an audience of 20 people, although 16 people were paying attention to the presentation and showing interest, if one person was yawning, another was playing with the phone and other two talking among themselves, the speaker would only look at these last actions, interpreting that their execution is being catastrophic and boring, leading to an increase in anxiety and, therefore, to an increase in the probability of making mistakes and worsen their execution, accompanied by a greater persistence of the fear of speaking in public in the future.

On the contrary, if the person did not suffer from social anxiety, the behavior of these four individuals could possibly go unnoticed, and he would interpret it as lack of sleep and / or interest in the subject of those particular persons and not by their own execution.

  • Maybe you're interested: "Types of Anxiety Disorders and their characteristics"

Modification of attention bias

In this context, Amir et al. (2009) created a virtual technique in order to correct this attentional bias . The patient is instructed to stand in front of a computer and determine the appearance of the letters "e" or "f" as quickly as possible and trying not to make mistakes using the mouse ("e" left button, "f" right button ) during multiple trials.

The key is that, during all attempts, before the appearance of the letter, two images of faces are presented : a face with a neutral expression and a face with an expression of disgust or rejection. 80% of the attempts, the letter "e" or "f" always appears where the neutral face was located before. In this way, even if an explicit order is not given about not attending to the faces of rejection, the person learns unconsciously not to pay attention to the stimuli that he fears.

Despite the simplicity of the technique, these authors managed, in 8 sessions of 20 minutes during 4 weeks, that 50% of patients with social phobia reduce both the symptoms and not be able to be diagnosed according to the DSM criteria. Other authors such as Boettcher et al. (2013) and Schmidt et al. (2009) they obtained similar results in their experiments .

This technique is not without controversy

According to Amir, Elias, Klumpp and Przeworski (2003), the true bias in anxiety disorders, and specifically social anxiety, is not to be hypervigilant in the face of threatening stimuli (rejection faces) - since to detect those things that can potentially harm us is a bias that all humans share and that has helped us survive for thousands of years-, but that once these threats are detected, they can not be ignored by the person .

Therefore, the bias that causes the persistence of the disorder is the impossibility of "disengaging" the attention from the threat, and the modification of the attentional bias would act to eliminate this impossibility.

However, recent evidence suggests that the outlook is much more complicated than it might seem at first . Klump and Amir (2010) found that by designing the task to address the threatening rather than the neutral faces there is also a decrease in anxiety. Yao, Yu, Qian and Li (2015) performed the same experiment, but using geometric figures instead of emotional stimuli and also observed a decrease in the subjective anguish of the participants.

Cudeiro (2016), tried to measure the attentive engagement bias through an experimental paradigm of eye movements and did not obtain conclusive evidence that the bias really existed or at least could be measured empirically.

In short, still it is not clear which one or which are the mechanisms of action underlying this technique . Future research will have to be directed to replicate the effectiveness studies and to determine these possible mechanisms of action.

Bibliographic references:

  • Amir, N., Elias, J., Klumpp, H. and Przeworski, A. (2003). Attentional bias to threat in social phobia: facilitating processing of threat or difficulty disengaging attention from threat? Behavior research and therapy, 41 (11), 1325-1335.
  • Amir, N., Beard, C., Taylor, C.T., Klumpp, H., Elias, J., Burns, M. and Chen, X. (2009). Attention training in individuals with generalized social phobia: A randomized controlled trial. Journal of consulting and clinical psychology, 77 (5), 961-973.
  • Boettcher, J., Leek, L., Matson, L., Holmes, E.A., Browning, M., MacLeod, C., ... and Carlbring, P. (2013). Internet-based attention bias modification for social anxiety: a randomized controlled comparison of training towards negative and training towards positive cues. PLoS One, 8 (9), e71760. doi: 10.1371 / journal.pone.0071760.
  • Cudeiro González, J. A. (2016). Modification of attention bias in anxiety disorders: an approach to explanatory mechanisms. Minerva, 1-40
  • Klumpp, H. and Amir, N. (2010). Preliminary study of attention to training and neutral faces on anxious reactivity to a social stressor in social anxiety. Cognitive Therapy and Research, 34 (3), 263-271.
  • Schmidt, N.B., Richey, J.A., Buckner, J.D. and Timpano, K.R. (2009). Attention training for generalized social anxiety disorder. Journal of abnormal psychology, 118 (1), 5-14.
  • Shechner, T., Britton, J.C., Perez-Edgar, K., Bar-Haim, Y., Ernst, M., Fox, N.A., ... and Pine, D.S. (2012). Attention biases, anxiety, and development: towards or away from threats or rewards ?. Depression and anxiety, 29 (4), 282-294.

Cognitive Distortions: Counselor Toolbox Episode 135 (March 2023).

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