Attentional Bias in Children with Social Anxiety Disorder

Early hypervigilance and sustained attention for the eye region in adolescents with social anxiety disorder

Social anxiety disorder (SAD) is a highly prevalent and debilitating affliction that typically manifests during childhood and adolescence. While theoretical models of adult SAD emphasize the role of attentional biases, little is known about maintaining factors during childhood and adolescence. The objective of our eye-tracking study was to determine whether youth with SAD exhibit a hypervigilance-avoidance pattern of visual attention for faces. To this end, we used a free-viewing paradigm to present angry, happy, and neutral faces, and non-social object stimuli to three groups of adolescents aged 10-15 years: SAD (n = 57), specific phobia (SP; n = 41), and healthy controls (HC; n = 65). A screen-based eye tracker recorded gaze behavior and pupil dilation. Among participants, only older adolescents with SAD exhibited shorter latencies of first fixation to the eye region compared to HC. Contrary to our expectations, there were no differences in duration of first fixation to the eye region among the groups. Instead, compared to HC, older adolescents with SAD showed longer dwell times on the eye region during the first 1000 - 3000 ms of stimulus presentation. No significant differences among the groups were found regarding scanpath length or pupillary reactivity. Taken together, our findings suggest early hypervigilance followed by sustained attention to the eye region in older adolescents with SAD, which may indicate difficulties in disengaging attention. We discuss the theoretical and practical implications in detail.

Attentional biases for dynamic stimuli in emerging adults with anxiety: A preliminary eye-tracking study

While attentional biases towards negative stimuli have previously been linked to the development and maintenance of anxiety disorders, a current limitation of this research involves the use of static images for stimuli, as they cannot adequately depict the dynamic nature of real-life interactions. Since attentional biases in those with elevated anxiety remain understudied using more naturalistic stimuli, such as dynamic social videos, the purpose of this explorative study was to use novel dynamic stimuli and modern eye-tracking equipment to further investigate negative attentional biases in anxious emerging, female adults. Non-clinical participants (N = 62; mean age = 20.44 years; biologically female) completed validated questionnaires regarding their anxiety symptoms and completed a free-viewing task by watching 30-s video clips while having their eye movements tracked. The video clips were shown in side-by-side pairs (i.e., positive-neutral, negative-neutral, and positive-negative) on a split screen without audio. Overall, participants fixated more quickly on emotional videos (i.e., positive and negative) over neutral ones, with more anxious participants orienting their gaze faster to the videos, regardless of content. Moreover, individuals with greater self-reported anxiety spent more time gazing at negative videos in negative-neutral pairings, highlighting that emerging female adults with increased anxiety symptoms may show a negative attention bias when viewing social interactions. Importantly, by incorporating novel, dynamic stimuli, we expand upon prior research on attentional biases, with the potential to adapt this approach for novel interventions that may ultimately help those suffering from anxiety.

Social stress task with parental support or self-instruction decreases negative cognitions in children with social anxiety disorder

Social anxiety disorder (SAD) is highly prevalent in childhood, yet research on cognitive processes in children with SAD is limited. This study examined anticipatory rumination (AR), self-focused attention (SFA), and post-event processing (PEP) in children with SAD and healthy controls (HC), and the impact of possible influencing factors (two conditions: parental support, self-instruction). Based on adult cognitive models, we hypothesized that children with SAD would report more negative and similar positive AR, more internal SFA, similar external focus, more negative and similar positive PEP compared to HCs. We predicted that both conditions would reduce negative AR, internal SFA, and negative PEP, with stronger effects in HCs. Participants (ages 9-14; SAD: n = 43, HC: n = 48) completed two speech tasks (T1, T2) in front of a peer audience. Children with SAD reported more negative AR, internal SFA, and negative PEP than HCs in both sessions. All children reported more negative AR, internal SFA, and negative PEP in T1 than T2. Surprisingly, these effects were equally strong in both groups. Condition effects were comparable across groups, with reduced negative cognitive processes in T2. These findings highlight cognitive biases in childhood SAD and the need for further research on their modifiability.

A comparison of the social cognition and neurocognitive characteristics of adolescents with suicide behavior, adolescent with depression and healthy controls

INTRODUCTION

Deficits in neurocognition and social-cognition have been suggested to be an endophenotype for suicidal behavior. We aimed to compare the social-cognition and neurocognitive characteristics of adolescents diagnosed with depression with and without suicidal behavior and to investigate whether these functions predict suicide.

METHOD

Adolescents diagnosed with Major Depressive Disorder (MDD) with suicidal behavior (n = 42); MDD without suicidal behavior (n = 44) and age- and sex-matched controls (n = 43) were included. The University of Pennsylvania Computerized Neurobehavioral Test Battery and Autism Spectrum Screening Questionnaire (ASSQ) were used to evaluate social-cognition and neurocognitive characteristics.

RESULTS

Several neurocognitive domain values of MDD groups, were significantly different from the control group. Neutral emotion recognition task (p = 0.025) and ASSQ scores were found to be significantly impaired in the patient groups (p < 0.001). Logistic regression analysis showed that, only the increase in the Suicide Probability Scale score was found to be significant as a risk factor predicting suicide (p = 0.007, OR: 1.246).

CONCLUSION

While the neurocognitive and social-cognitive performances of adolescents with MDD were significantly lower than the control group, these performances in the two depression groups were similar. When the predictors of suicidal behavior were examined, it was found that only the increase in suicidal ideation scores predicted suicide.

Assessing Visual Avoidance of Faces During Real-Life Social Stress in Children with Social Anxiety Disorder: A Mobile Eye-Tracking Study

This study measured visual attention (fixation count, dwell time) during two real-life social stress tasks using mobile eye-tracking glasses in children (9-13 years) diagnosed with social anxiety disorder (SAD; n = 25) and a healthy control group (HC; n = 30). The influence of state anxiety on attention allocation and negative self-evaluation biases regarding gaze behavior were also examined. Compared to the HC group, children with SAD showed visual avoidance (i.e., fewer fixations) of the faces of interaction partners during the second social stress task. While visual avoidance in HC children decreased with declining state anxiety from the first to the second social stress task, no such effect was found in children with SAD. A negative self-evaluation bias regarding gaze behavior in children with SAD was not found. In sum, measuring visual attention during real-life social situations may help enhance our understanding of social attention in childhood SAD.

Behavioural inhibition and early neural processing of happy and angry faces interact to predict anxiety: a longitudinal ERP study

Limited prospective research has examined whether attention biases to emotion moderate associations between Behavioural Inhibition (BI) and anxiety in preschool-aged children. Furthermore, there has been an over-reliance on behavioral measures in previous studies. Accordingly, we assessed anxiety in a sample of preschool-aged children (3-4 years) at baseline, and again approximately 6 and 11 months later, after they started school. At baseline, children completed an assessment of BI and an EEG task where they were presented with angry, happy, and neutral faces. EEG analyses focused on ERPs (P1, P2, N2) associated with specific stages of attention allocation. Interactions between BI and emotion bias (ERP amplitude for emotional versus neutral faces) were found for N2 and P1. For N2, BI was significantly associated with higher overall anxiety when an angry bias was present. Interestingly for P1, BI was associated with higher overall anxiety when a happy bias was absent. Finally, interactions were found between linear time and happy and angry bias for P1, with a greater linear decrease in anxiety over time when biases were high. These results suggest that attention to emotional stimuli moderates the BI-anxiety relationship across early development.

Autistic Children Quickly Orient Away from Both Eyes and Mouths During Face Observation

Studies have supported two different hypotheses of reduced eye gaze in people with ASD; gaze avoidance and gaze indifference, while less is known about the role of anxiety. We tested these hypotheses using an eye-tracking paradigm that cued the eyes or mouth of emotional faces. Autistic children (n = 12, mean age 7 years) looked faster away from both eyes and mouths than controls (n = 22). This effect was not explained by anxiety symptoms. No difference was found in latency towards either area. These results indicate that attentional avoidance of autistic children is not specific to eyes, and that they do not show attentional indifference to eyes compared to controls. Atypicalities in visual scanning in ASD are possibly unrelated to specific facial areas.

Scary in the eye of the beholder: Attentional bias and attentional retraining for social anxiety

Consistent with cognitive models of social anxiety, socially anxious individuals show cognitive biases that magnify their perceived level of threat in the environment.

OBJECTIVES

The first objective was to determine whether attentional bias for socially threatening stimuli occurs after concomitant depression has been controlled. The second objective was to test the effectiveness of the Attention Control Training Program for Social Anxiety (ACTP-SA) for reducing social anxiety attentional bias and improving therapeutic indices in people with social anxiety.

METHOD

In the first study, socially anxious (N = 30) and non-anxious individuals (N = 30) completed the Beck Depression Inventory-II, Spielberger's State-Trait Anxiety Inventory, Conner's Social Phobia Inventory, a social-anxiety Stroop test, and a clinical interview. In the second study, individuals with social anxiety (N = 30) were randomly assigned to an experimental group that received 4 sessions of ACTP-SA, or to a sham-intervention control condition. At the post-test and a 3-month follow-up, both groups completed the same measures as in Study 1.

RESULTS

In Study 1, socially anxious individuals showed higher attentional bias for threatening stimuli than the controls, after depression had been controlled for. In Study 2, participants in the experimental group, compared with the controls, showed greater reductions in attentional bias, social anxiety, and trait anxiety at post-test and follow-up.

CONCLUSIONS

The results underscore the importance of information processing biases in social anxiety and the benefits of attentional bias training as a complementary intervention for modifying symptoms of social anxiety.

Auditory and cross-modal attentional bias toward positive natural sounds: Behavioral and ERP evidence

Recently, researchers have expanded the investigation into attentional biases toward positive stimuli; however, few studies have examined attentional biases toward positive auditory information. In three experiments, the present study employed an emotional spatial cueing task using emotional sounds as cues and auditory stimuli (Experiment 1) or visual stimuli (Experiment 2 and Experiment 3) as targets to explore whether auditory or visual spatial attention could be modulated by positive auditory cues. Experiment 3 also examined the temporal dynamics of cross-modal auditory bias toward positive natural sounds using event-related potentials (ERPs). The behavioral results of the three experiments consistently demonstrated that response times to targets were faster after positive auditory cues than they were after neutral auditory cues in the valid condition, indicating that healthy participants showed a selective auditory attentional bias (Experiment 1) and cross-modal attentional bias (Experiment 2 and Experiment 3) toward positive natural sounds. The results of Experiment 3 showed that N1 amplitudes were more negative after positive sounds than they were after neutral sounds, which further provided electrophysiological evidence that positive auditory information enhances attention at early stages in healthy adults. The results of the experiments performed in the present study suggest that humans exhibit an attentional bias toward positive natural sounds.

The Longitudinal Interplay Between Attention Bias and Interpretation Bias in Social Anxiety in Adolescents

Background

Cognitive biases are found to play a role in the onset and maintenance of social anxiety. However, particularly in adolescence, the link between different biases and their role in predicting social anxiety is far from clear. This study therefore investigated the interplay between attention bias and interpretation bias in relation to social anxiety in adolescence across three years.

Methods

816 adolescents in grade 7 to 9 participated at three yearly waves (52.8% boys, Mage grade7 = 12.60). Social anxiety was measured with a self-report questionnaire. Attention bias was measured with a visual search task with emotional faces. Textual vignettes assessed interpretation bias.

Results

Cross-lagged models showed that negative interpretation bias at grade 7 predicted an increase in social anxiety at grade 8. This effect was not found from grade 8 to 9. Attention bias did not predict social anxiety. Attention bias and interpretation bias were not longitudinally related to each other, nor did they interact with each other in predicting social anxiety.

Conclusions

Thus, no evidence was found for the Combined Cognitive Bias Hypothesis in social anxiety in adolescents. Instead, our results suggest that interpretation bias rather than attention bias contributes to the increase of social anxiety over time.

Eye-tracking to assess anxiety-related attentional biases among a large sample of preadolescent children

A considerable body of research in adults has demonstrated that anxiety disorders are characterised by attentional biases to threat. Findings in children have been inconsistent. The present study examined anxiety-related attention biases using eye tracking methodology in 463 preadolescents between 10 and 12 years of age, of whom 92 met criteria for a DSM-5 anxiety disorder and 371 did not. Preadolescent's gaze was recorded while they viewed adolescent face pairs depicting angry-neutral and happy-neutral expressions with each face pair presented for 5000 ms. No group differences were observed across any eye tracking indices including probability of first fixation direction, latency to first fixation, first fixation duration and dwell time. The sample overall showed faster initial attention towards threat cues, followed by a later broadening of attention away from threat. There is a need to identify the types of threats and the developmental period during which visual attention patterns of anxious and non-anxious youth diverge to inform more developmentally sensitive treatments.

Neural responses associated with attentional engagement and disengagement from threat in high socially anxious children: Evidence from temporal-spatial PCA

BACKGROUND

Cognitive models indicated that social anxiety disorder (SAD) would be caused and maintained by a biased attentional processing of threatening information. This study investigates whether socially anxious children may present impaired attentional engagement and disengagement from negative emotional faces, as well as their underlying event-related potential responses.

METHODS AND FINDINGS

Fifteen children with high levels of social anxiety (HSA; 9 boys; mean age = 9.99y; SD = 1.14) and twenty low socially anxious children (LSA; 16 boys; mean age = 10.47y; SD = 1.17) participated in a spatial cueing task in which they had to detect targets following neutral/disgusted faces in a valid or invalid location. No group effect was reported on reaction times [p>.05]. However, electrophysiological data showed lower P3a amplitude in HSA children compared with the LSA group when processing facial stimuli. They also reported larger N2 amplitudes for valid-disgusted targets and a larger P3a amplitude for the invalid-disgusted ones.

CONCLUSION

In terms of electrophysiological data, our results validated, the hypothesis of attentional disengagement difficulties in SAD children. We also confirm the idea that high levels of social anxiety are associated with cognitive control impairments and have a greater impact on the processing efficiency than on the performance effectiveness.

Frozen with Fear? Attentional Mechanisms in Children with Selective Mutism

Background

Children with selective mutism (SM) are consistently unable to speak in certain social situations. Due to an overlap between SM and social anxiety disorder (SAD) in children, similar mechanisms could apply to both disorders. Especially biased attentional processing of threat and fear-induced reduced visual exploration (referred to as attentive freezing) appear promising in SM.

Methods

A total of N = 84 children (8–12 years, SM: n = 28, SAD: n = 28, typical development (TD): n = 28) participated in an eye-tracking paradigm with videos of a social counterpart expressing a question, a social evaluation or a neutral statement. We investigated gaze behavior towards the social counterpart’s eye-region and the extent of visual exploration (length of scanpath), across conditions.

Results

There were no group differences regarding gaze behavior on the eye region. Neither gaze behavior with respect to the eye region nor visual exploration were dependent on the video condition. Compared to children with TD, children with SM generally showed less visual exploration, however children with SAD did not.

Conclusion

Reduced visual exploration might be due to the mechanism of attentive freezing, which could be part of an extensive fear response in SM that might also affect speech-production. Interventions that counteract the state of freezing could be promising for the therapy of SM.

Attentional processes during emotional face perception in social anxiety disorder: A systematic review and meta-analysis of eye-tracking findings

Background In recent years, a growing body of eye-tracking research has investigated gaze behavior in individuals with social anxiety during the visual perception of emotional stimuli. The aim of this article was to review and synthesize studies examining attention orientation in patients with clinical social anxiety by means of eye-tracking methodology. Methods Through a systematic search, 30 articles were identified, including 11 studies in which single emotional faces were used as stimuli and seven eligible studies in which threatening faces were paired with neutral stimuli. Meta-analyses were conducted to compare prolonged eye-contact behavior and early attentional biases to threats in individuals with social anxiety disorder (SAD) and healthy controls. Results Moderate group differences were revealed for single face viewing studies, with SAD patients showing significantly reduced eye contact with negative (Hedges' g = -0.67) and positive emotional faces (g = -0.49) compared to that of healthy participants. Type of task and duration of stimulus presentation were (marginally) significant moderators of between-study variance in effect size. Small but significant group differences were found for early attentional biases toward angry faces versus neutral stimuli (g = 0.21) but not toward happy faces versus neutral stimuli (g = 0.05). Preliminary evidence for a hyperscanning strategy in SAD patients relative to healthy controls emerged (g = 0.42). Limitations The number of included studies with face pairings was low, and two studies were excluded due to unavailable data. Conclusions Our results suggest that eye contact avoidance with emotional faces is a prominent feature in SAD patients. Patients might benefit from guidance to learn to make adequate eye contact during therapeutic interventions, such as exposure therapy. SAD patients demonstrated slightly heightened attention allocation toward angry faces relative to that of healthy participants during early processing stages. Threat biases can be potential targets for attention modification training as an adjuvant to other treatments. Future research on early attentional processes may benefit from improved arrangements of paired stimuli to increase the psychometric properties of initial attention indices.

Überprüfung der Konstrukt-‍, Kriteriumsvalidität und Messinvarianz eines Instruments zur Messung von sozialer Unsicherheit

Zusammenfassung. Soziale Unsicherheit bei Kindern zeichnet sich durch ein subjektives Unwohlsein in sozialen Situationen und die Sorge vor einer negativen Bewertung durch andere aus. Falls möglich, werden soziale Situationen vermieden oder auf ein Minimum beschränkt. Aufgrund der Unzuverlässigkeit von Fremdurteilen durch Erziehungsberechtigte oder Lehrkräfte haben Selbstbeurteilungsfragebögen in der Diagnostik von sozialer Unsicherheit einen besonderen Stellenwert. Die Social Anxiety Scale for Children (SASC-R-D; Melfsen & Florin, 1997 ) ist hierbei ein häufig eingesetztes Instrument, deren Validität bisher aber unzureichend untersucht wurde. Die vorliegende Studie untersucht daher anhand von Daten von 997 Kindern die Konstrukt- und Kriteriumsvalidität sowie Messinvarianz über das Geschlecht der Skala. Die Ergebnisse legen nah, dass es sich um ein valides Instrument handelt, wobei die differenzielle Nützlichkeit der einzelnen Subskalen fragwürdig bleibt. Die Ergebnisse und ihre Implikationen für die praktische Verwendung des Fragebogens werden diskutiert.

Initial Maintenance of Attention to Threat in Children with Social Anxiety Disorder? Findings from an Eye-Tracking Experiment

Background

Attentional biases are assumed to be a core feature in the etiology and maintenance of clinical anxiety. The present study focuses on initial maintenance of attention to threat, one of three attentional components investigated the least, particularly in child anxiety.

Methods

Angry and neutral facial expressions were presented in a free-viewing task, while eye-movements were recorded. Participants were N = 96 school-aged children, with n = 50 children with a clinical social anxiety disorder (SAD) and n = 46 healthy control children (HC). Prior to the task, social stress was induced in half of participating children to investigate the impact of increased levels of distress on initial attention allocation.

Results

The length of first fixation to angry faces in children with SAD neither differed from the length of first fixation to neutral faces nor the length of first fixation to angry faces in HC children. Furthermore, this variable was not affected by a stress induction procedure. However, children with SAD initially fixated longer on faces than HC children.

Conclusion

Our findings provide evidence for difficulties disengaging attention from faces. This may indicate that attention allocation is determined by the social nature of the stimuli rather than by the specific emotional valence.

Attention Deployment to the Eye Region of Emotional Faces among Adolescents with and without Social Anxiety Disorder

BACKGROUND

Avoidance of the eye region, especially of faces showing anger, may maintain social anxiety symptoms by negatively reinforcing expectations and fears associated with social situations. Eye-tracking research, however, has yet to explicitly examine differences in attention allocation to the eye region of emotional faces among adolescents with social anxiety disorder (SAD).

METHODS

Gaze patterns were explored in a sample of youth with and without SAD matched on age and sex.

RESULTS

Adolescents with SAD were quicker to fixate, and maintained their initial gaze longer, to the eye region, regardless of emotion, relative to teens without SAD. Group-level differences also emerged for initial fixation duration directed to the eye region of angry faces (when compared with happy faces).

CONCLUSIONS

These findings suggest that vigilance to the eye region of faces, especially angry faces, (when compared with happy faces) is characteristic of adolescents with SAD. Adolescents with SAD seem drawn to the eye region, more so than teens without SAD.

Restricted Visual Scanpaths During Emotion Recognition in Childhood Social Anxiety Disorder

Background: Social anxiety disorder (SAD) has its typical onset in childhood and adolescence. Maladaptive processing of social information may contribute to the etiology and maintenance of SAD. During face perception, individuals execute a succession of visual fixations known as a scanpath which facilitates information processing. Atypically long scanpaths have been reported in adults with SAD, but no data exists from pediatric samples. SAD has also been linked to atypical arousal during face perception. Both metrics were examined in one of the largest eye-tracking studies of pediatric SAD to date. Methods: Participants were children and adolescents with SAD (n = 61) and healthy controls (n = 39) with a mean age of 14 years (range 10-17) who completed an emotion recognition task. The visual scanpath and pupil dilation (an indirect index of arousal) were examined using eye tracking. Results: Scanpaths of youth with SAD were shorter, less distributed, and consisted of a smaller number of fixations than those of healthy controls. These findings were supported by both frequentist and Bayesian statistics. Higher pupil dilation was also observed in the SAD group, but despite a statistically significant group difference, this result was not supported by the Bayesian analysis. Conclusions: The results were contrary to findings from adult studies, but similar to what has been reported in neurodevelopmental conditions associated with social interaction impairments. Restricted scanpaths may disrupt holistic representation of faces known to favor adaptive social understanding.

Delayed gaze shifts away from others' eyes in children and adolescents with social anxiety disorder

BACKGROUND

Social anxiety disorder (SAD) is linked to atypical attention to other's eyes. Empirical literature about this phenomenon in childhood and adolescence is scarce. Previous studies in adults have suggested that SAD may be characterized by either rapid avoidance of eye contact, or by impaired shifting of attention away from eyes once eye contact has been established. SAD has also been linked to quick orienting towards eyes, indicating vigilant monitoring of perceived threat.

METHODS

In the largest eye-tracking study of youth with SAD to date, 10 to 17 year-olds with SAD (n = 88) and healthy controls (n = 62) were primed to look at either the eyes or the mouth of human faces. The latency and likelihood of a first gaze shift from, or to the eyes, was measured.

RESULTS

Individuals with SAD were slower to shift their gaze away from the eye region of faces than controls, but did not differ in orienting toward eyes.

LIMITATIONS

Participants were assessed once after the onset of SAD symptoms, meaning that the longitudinal predictive value of delayed gaze shifts from others' eyes could not be examined.

CONCLUSIONS

Youth with SAD may be impaired in shifting attention from other's eyes. This could contribute to the experience of eye contact as aversive, and may be a maintaining factor of childhood SAD.

The role of emotion regulation in socially anxious children and adolescents: a systematic review

While numerous studies suggest that emotion dysregulation is important in maintaining social anxiety among adults, the role of emotion regulation in children and adolescents with social anxiety is not yet well understood. In this systematic review, we use the process model of emotion regulation as a framework for understanding emotion regulation in children and adolescents with social anxiety. We performed a systematic literature search in the electronic data bases Medline and PsycINFO. Additional studies were identified by hand search. We identified 683 studies, screened their titles and abstracts, viewed 142 studies, and included 55 of these. Study results indicate that children and adolescents with social anxiety disorder or high social anxiety show emotion dysregulation across all five domains of emotion regulation, such as enhanced social avoidance, more safety behaviors, repetitive negative thinking, biased attention and interpretation of social information, and reduced emotional expression. While enhanced social avoidance seems to be specific to childhood social anxiety, other maladaptive emotion regulation strategies, such as repetitive negative thinking, seem to occur transdiagnostically across different childhood anxiety disorders. Implications for current theory, interventions and future research are discussed.

A systematic review of visual avoidance of faces in socially anxious individuals: Influence of severity, type of social situation, and development

Although visual avoidance of faces is a hallmark feature of social anxiety disorder (SAD) on clinical and theoretical grounds, empirical support is equivocal. This review aims to clarify under which conditions socially anxious individuals display visual avoidance of faces. Through a systematic search in Web of Science and PubMed up to March 2019 we identified 61 publications that met the inclusion criteria. We discuss the influence of three factors on the extent to which socially anxious individuals avoid looking at faces: (a) severity of social anxiety symptoms (diagnosed SAD versus High Social Anxiety levels in community samples [HSA] or related characteristics [Shyness, Fear of Negative Evaluation]), (b) three types of social situation (computer facial-viewing tasks, speaking tasks, social interactions), and (c) development (age-group). Adults with SAD exhibit visual avoidance across all three types of social situations, whereas adults with HSA exhibit visual avoidance in speaking and interaction tasks but not in facial-viewing tasks. The relatively few studies with children and adolescents suggest that visual avoidance emerges during adolescence. The findings are discussed in the context of cognitive-behavioral and skills-deficit models. Suggestions for future research include the need for developmental studies and more fine-grained analyses of specific areas of the face.

Systematic Review and Meta-Analysis: Eye-Tracking of Attention to Threat in Child and Adolescent Anxiety

OBJECTIVE

Attention biases for threat may reflect an early risk marker for anxiety disorders. Yet questions remain regarding the direction and time-course of anxiety-linked biased attention patterns in youth. A meta-analysis of eye-tracking studies of biased attention for threat was used to compare the presence of an initial vigilance toward threat and a subsequent avoidance in anxious and nonanxious youths.

METHOD

PubMed, PsycARTICLES, Medline, PsychINFO, and Embase were searched using anxiety, children and adolescent, and eye-tracking-related key terms. Study inclusion criteria were as follows: studies including participants ≤18 years of age; reported anxiety using standardized measures; measured attention bias using eye tracking with a free-viewing task; comparison of attention toward threatening and neutral stimuli; and available data to allow effect size computation for at least one relevant measure. A random effects model estimated between- and within-group effects of first fixations toward threat and overall dwell time on threat.

RESULTS

Thirteen eligible studies involving 798 participants showed that neither youths with or without anxiety showed significant bias in first fixation to threat versus neutral stimuli. However anxious youths showed significantly less overall dwell time on threat versus neutral stimuli than nonanxious controls (g = -0.26).

CONCLUSION

Contrasting with adult eye-tracking data and child and adolescent data from reaction time indices of attention biases to threat, there was no vigilance bias toward threat in anxious youths. Instead, anxious youths were more avoidant of threat across the time course of stimulus viewing. Developmental differences in brain circuits contributing to attention deployment to emotional stimuli and their relationship with anxiety are discussed.

Validating a mobile eye tracking measure of integrated attention bias and interpretation bias in youth

Introduction

This study sought to validate a real-world speech task designed to assess attention and interpretation bias in an integrated and ecologically valid manner.

Methods

Thirty adolescent girls gave a speech in front of an emotionally ambiguous judge and a positive judge while wearing mobile eye tracking glasses to assess how long they looked at each judge (i.e., attention bias). They also reported their interpretations of the ambiguous judge and distress associated with the task (i.e., interpretation bias).

Results

These task-based measures correlated with self-report of interpretation bias and mother-report of attentional control, demonstrating convergent validity. They did not correlate with frustration or high intensity pleasure, indicating discriminant validity. Task-based measures of interpretation bias also showed predictive and incremental validity in relation to child distress during the speech.

Discussion

This proof-of-concept study demonstrates the initial validity of a novel task designed to assess attention and interpretation bias as they manifest in real-world social interactions.

Visual attention to emotional faces in adolescents with social anxiety disorder receiving cognitive behavioral therapy

Social anxiety disorder (SAD) is a psychiatric condition that often onsets in childhood. Cognitive models underline the role of attention in the maintenance of SAD, but studies on youth populations are few, particularly those using eye tracking to measure attention. Cognitive behavioral therapy (CBT) for SAD includes interventions targeting attention, like exposure to eye contact, but the link between CBT and attention bias is largely unexplored. This study investigated attention bias in youth with SAD and the association with outcome from CBT. Latency to attend to pictures of faces with different emotions (vigilance) and latency to disengage from social stimuli (avoidance) was examined in N = 25 adolescents (aged 13–17) with SAD in relation to treatment outcome. Vigilance was operationalized as the time it took to relocate the gaze from a central position to a peripherally appearing social stimulus. The latency to disengage from a centrally located social stimulus, when a non-social stimulus appeared in the periphery, was used as a proxy for avoidance. Attention characteristics in the SAD group were compared to non-anxious (NA) controls (N = 22). Visual attention was measured using eye tracking. Participants in both the SAD and NA groups were vigilant towards angry faces, compared to neutral and happy faces. Similarly, both groups disengaged attention faster from angry faces. Adolescents with SAD who disengaged faster from social stimuli had less social anxiety after CBT. The results indicate that anxious youth display a vigilant-avoidant attention pattern to threat. However, partly inconsistent with previous research, the same pattern was observed in the NA group.

Pupil dilation to emotional expressions in adolescent social anxiety disorder is related to treatment outcome

Atypical attention to potential social threats, such as emotional faces, may be one of the core mechanisms underlying social anxiety disorder (SAD). Pupil dilation is an index of locus coreuleus-noradrenergic activity, and closely linked to attention. In the present study, pupil dilation was studied in adolescents with SAD (N = 26; 22 Female) before the onset of a 12-week cognitive behavioral treatment, and in healthy controls (N = 23). Stimuli were faces with angry or happy emotional expressions. Contrary to our hypothesis, the SAD group did not show hyper-responsiveness to angry compared to happy faces. Instead, an atypical time course of the pupil dilation response was found, resulting in an attenuated response during late time stages. Larger pupil dilation amplitude to happy faces before treatment was related to worse treatment response. These results contribute significantly to our understanding of the mechanisms underlying adolescent SAD.

Attentional disengagement from negative natural sounds for high-anxious individuals

BACKGROUND AND OBJECTIVES

Previous studies have not consistently concluded whether high-anxious persons exhibit attentional bias towards negative natural auditory stimuli. The present study explores whether auditory negative stimuli could induce attentional bias to negative sounds in real life and investigates the exact nature of these biases using an emotional spatial cueing task.

DESIGN

Experimental study with a mixed factorial design.

METHOD

We created two groups according to the state-trait anxiety scale, namely high and low trait anxiety. Participants (N = 68 undergraduate students) were required to respond to an auditory target after receiving a negative (aversive sounds from natural life) or neutral auditory stimuli.

RESULTS

A 2 (Validity: valid/invalid)   × 2 (Cue Valence: negative/neutral) × 2 (Anxiety Group: LA/HA) repeated-measures ANOVA on reaction times revealed that participants with high trait anxiety exhibited slower reaction times in invalid trials following negative cues than following neutral cues. Higher levels of trait anxiety were associated with more difficult attentional disengagement from negative auditory information.

CONCLUSIONS

The results demonstrate that impaired attentional disengagement was one of the mechanisms by which high-anxious participants exhibited auditory attentional bias to natural negative information.