Although there are multiple theories, there is as yet 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 impact of the attention bias modification technique, A new attentional psychological technique designed for the treatment of social anxiety disorder or social phobia.
Care and treatment of mental disorders
Like 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. Whether or not dealing with certain stimuli or information can affect a person’s development as a attention is the basis of memory and learning. You can only learn and remember experiences that you pay attention to.
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 scrutiny by others. People “.
The person is afraid to behave in a certain way that can be appreciated negatively by those around him. In other words, that is to say she is afraid of being judged by others and being rejected for her performance in a situation involving several people. These situations can range from giving a talk to a large audience, to a simple conversation with someone you know.
Najmi, Kuckertz and Amir (2011) have shown that anxious people react selectively to elements of the environment that they consider threatening, by ignoring the rest of the environment, in which they may find neutral or positive elements. This attentional bias often leads to value judgment errors which results in increased anxiety and long-term persistence of the disorder.
For example, if a person with social anxiety disorder gave an oral presentation to an audience of 20 people, even though 16 people were paying attention to the paper and showing interest, if one person yawned, another played with the cell phone and others 2h00 talking to each other, the speaker would pay attention only to these last actions, interpreting that their execution is catastrophic and boring, leading to increased anxiety and, therefore, an increased likelihood of making mistakes and worsening their actual execution, accompanied by a greater persistence of fear of public speaking in the future.
Conversely, if the person did not suffer from social anxiety, the behavior of these four individuals might go unnoticed, and he would interpret it as a lack of sleep and / or of interest in the subject of these people. in particular and not for their own execution. .
Modification of attentional bias
In this context, Amir et al. (2009) created a virtual technique to correct this attentional bias. The patient is asked to stand in front of a computer and determine the appearance of the letters “i” or “f” as quickly as possible and try not to make a mistake using the mouse (“i” left button, “f »Right button) for several tries.
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. In 80% of attempts, the letter “i” or “f” always appears where the neutral face is. This way, even if no explicit command is given not to deal with the faces of rejection, the person subconsciously learns not to pay attention to the stimuli that they fear.
Despite the simplicity of the technique, these authors succeeded, in 8 sessions of 20 minutes for 4 weeks, that 50% of patients with social phobia both reduced symptoms and could not be diagnosed according to DSM criteria. Other authors such as Boettcher et al. (2013) and Schmidt et al. (2009) they got similar results in their experiments.
This technique is not without controversy
According to Amir, Elias, Klumpp and Przeworski (2003), the real bias in anxiety disorders, and in particular social anxiety, is not being hypervigilant in the face of threatening stimuli (faces of rejection) – because it senses things that can harm us is potentially a prejudice that all humans share that has helped us survive for thousands of years – but once these threats are detected, they cannot be ignored by the person.
Therefore, the bias that causes the disorder to persist is the inability to “disengage” the attention from the threat, and the modification of the attentional bias would work by eliminating this impossibility.
However, recent evidence suggests that the image it’s much more complicated than it seems at first glance. Klump and Amir (2010) found that designing the task to deal with threatening rather than neutral faces also results in decreased 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 participants’ subjective anxiety.
Cudeiro (2016), attempted to measure attentional attachment bias through an experimental eye movement paradigm and did not obtain conclusive evidence that the bias actually existed or at least could be measured empirically.
In short, again we do not know what or what are the mechanisms of action underlying this technique. Future research should aim to replicate efficacy studies and determine these possible mechanisms of action.
- Amir, N., Elias, J., Klumpp, H., and Przeworski, A. (2003). Attention-threatening bias in social phobia: ease of dealing with threats or difficulty in detaching attention from the threat? Behavioral Research and Therapy, 41 (11), 1325-1335.
- Amir, N., Beard, C., Taylor, CT, Klumpp, H., Elias, J., Burns, M., & Chen, X. (2009). Care education in people 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, EA, Browning, M., MacLeod, C., … and Carlbring, P. (2013). Changing the Internet-based Attention Bias for Social Anxiety: A Random-Controlled Comparison of Negative Indication Training and Positive Indication Training. PLoS One, 8 (9), e71760. doi: 10.1371 / journal.pone.0071760.
- Cudeiro González, JA (2016). Modification of attentional depression in anxiety disorders: an explanatory mechanisms approach. Minerva, 1-40
- Klumpp, H. and Amir, N. (2010). Preliminary study of attention training to threatened and neutral faces on anxiety reactivity to a social stressor in social anxiety. Cognitive Therapy and Research, 34 (3), 263-271.
- Schmidt, NB, Richey, JA, Buckner, JD and Timpano, KR (2009). Management of generalized social anxiety disorder. Journal of Abnormal Psychology, 118 (1), 5-14.
- Shechner, T., Britton, JC, Pérez-Edgar, K., Bar – Haim, Y., Ernst, M., Fox, NA, … and Pine, DS (2012). Attention, Anxiety and Developmental Bias: Towards or Far From Threats or Rewards ?. Depression and Anxiety, 29 (4), 282-294.