Alterations of the attentional networks in patients with anxiety disorders

Characterizing the functioning of the attentional networks in state and trait anxiety: the role of affective information

Introduction

The aim of the present research was to examine the role of affective information in the functioning of attentional networks in individuals with high vs. low trait or state anxiety. Previous studies suggest that anxiety can influence attentional processes, but the impact of affective information, such as alerting emotional stimuli, on these attentional networks remains unclear.

Methods

We conducted a set of experiments using negative or neutral faces as alerting stimuli, presented either alone or together with a neutral sound, within a modified version of the Attention Network Test-Interactions (ANT-I). Additionally, data from previous experiments with similar anxiety groups and without affective manipulations of alertness were analyzed for comparative insights (378 participants in total).

Results

Results showed three main effects on the functioning of attentional networks when affective alerting signals were introduced: (1) the alertness effect is increased, (2) the interference effect is increased, and (3) the orienting effect is decreased. These effects occurred regardless of the valence of the alerting stimuli on a given trial. Importantly, the presence of affective information on some trials eliminated the group differences regarding the functioning of the attentional networks that are usually found when no affective information is presented. Specifically, the larger interference effect commonly observed in individuals with high trait-anxiety and the larger alertness and orienting effects seen in those with high state-anxiety, disappeared when emotional alerting stimuli were included.

Discussion

The findings suggest that emotional information can significantly impact the functioning of attentional networks, particularly in relation to anxiety. The presence of affective stimuli seems to modulate attentional biases associated with anxiety, potentially neutralizing the usual effects seen in individuals with high trait or state anxiety. The role of affective information on the functioning of the attentional networks is discussed within the framework of anxiety and attention.

Stochastic resonance is not required for pink noise to have beneficial effects on ADHD-related performance? The moderate brain arousal model challenged

OBJECTIVE

Random noise, such as white or pink noise, has been shown to have beneficial effects on the performance of individuals with (elevated traits of) ADHD. Both the state regulation deficit (SRD) account and the moderate brain arousal (MBA) model argue that this effect is due to enhanced cognitive arousal. The MBA model specifically attributes this to random noise affecting dopaminergic (DA) transmission via stochastic resonance (SR). However, he requirement of SR and the role of DA have not yet been properly examined. To test this, proper control conditions are needed.

METHOD

To examine the requirement of SR, 60 neurotypical adults with varying levels of ADHD traits performed a slow two-choice reaction time (S1-S2) task in three auditory conditions: pink (random) noise, a pure 100 Hz tone (non-random noise), and silence. All participants also completed the Attention Network Test (ANT) in two conditions (pink noise and silence) to inspect the effect on executive network efficiency which may serve as a proxy measure of DA. ADHD traits were assessed via self-report.

RESULTS

Auditory stimulation improved performance on the S1-S2 task in participants with elevated ADHD traits, however this was the case for both pink noise and the pure tone. Pink noise did not affect executive network efficiency, irrespective of ADHD traits.

CONCLUSIONS

Our results suggest that stochastic resonance is not required for pink noise to have a beneficial effect on ADHD-related performance. Pink noise did not affect our DA proxy measure, however this negative finding should be interpreted with caution. Our results cast doubt on the tenets of the MBA model, warranting further research.

Differential correlates of fear and anxiety in salience perception: A behavioral and ERP study with adolescents

Anxiety disorders are the most common psychopathologies among adolescents. Their diagnostic criteria include both fear and anxiety symptomatology, although according to the literature, we can find evidence for some distinction between these two emotions. The present study contribute to this distinction, exploring the effects of trait fear and trait anxiety on behavioral and neural correlates. Thirty-two participants (aged 11-16 years) performed two experimental tasks of salient target detection, including visual stimuli that were manipulated to become salient, while reaction times and EEG were recorded. Results of both tasks revealed differential effects of trait fear and trait anxiety assessed through the Fear Survey Schedule for Children-Revised and the Youth Anxiety Measure for DSM-5 on reaction times and ERP components amplitudes. Specifically, higher symptoms from Separation Anxiety Disorder increased early neural visual processing and decreased reaction times for more salient stimuli. Also, trait fear reduced later neural visual processing of salient stimuli. These findings may provide a significant contribution to guiding psychological interventions, especially with adolescents presenting higher levels of anxiety-related symptomatology.

The impact of threat of shock-induced anxiety on alerting, orienting, and executive function in women: an ERP study

The present study used a combination of the Threat-of-Shock paradigm and the Attention Network Test (ANT) to investigate how induced anxiety affects alerting, orienting, and executive control and whether individual differences in threat sensitivity moderate these effects. Forty-two female subjects completed the ANT task in alternation under shock-threat and no-shock ("safe") conditions while event-related potentials (ERPs) were recorded. The results showed that anxiety induced by the threat of shock had a significant impact on alerting and executive control functions at the neural level. Specifically, alerting-related N1 and stimulus-preceding negativity (SPN) differences between double cue and no cue conditions were greater in the threat versus safe state, suggesting that the induced anxiety promoted the early perception of cues and preparation for the target. Moreover, executive control-related P3 and sustained potential (SP) differences between incongruent and congruent trials were greater in the threat versus safe state, indicating that the induced anxiety might improve the attentional allocation efficiency and stimulate subjects to recruit more cognitive resources to resolve conflicts. However, orienting-related ERPs were not affected by the threat of shock, but the threat of shock promoted the processing efficiency of spatial-cue at the behavioral level. Analysis of individual differences revealed that trait anxiety moderated the attentional allocation efficiency when performing executive control related tasks in the threat versus safe state. Our findings demonstrate the adaptive significance of the threat of shock-induced anxiety in that being in an anxious state can enhance individuals' alerting, orienting, and executive functions.

Psychological Outcomes and Mechanisms of Mindfulness-Based Training for Generalised Anxiety Disorder: A Systematic Review and Meta-Analysis

This systematic review aimed to identify 1) the effect of mindfulness training on pre-post measures of anxiety and attention among adults experiencing high levels of generalised anxiety; and 2) the impact of predictors, mediators and moderators on post-intervention changes in anxiety or attention. Trait mindfulness and distress measures were included as secondary outcomes. A systematic search was conducted in November 2021 in electronic databases using relevant search terms. Eight articles comprising four independent studies were included (N = 334). All studies included participants diagnosed with generalised anxiety disorder (GAD) who participated in an 8-week manualised program. The meta-analysis indicated that mindfulness training had a large effect on anxiety symptoms (g = -1.92, 95%CI[-3.44, -0.40]) when compared to inactive (i.e., care as usual, waitlist) or non-specified (i.e., condition not defined) controls. However, a significant effect was not found when compared to active controls. Effects for depression, worry and trait mindfulness did not reach statistical significance, despite small-large effect sizes favouring mindfulness compared to inactive/non-specified controls. Our narrative review found evidence that changes in aspects of trait mindfulness mediate anxiety reduction following mindfulness training. However, a small number of studies were available for inclusion in the review, with high risk of bias and low certainty of evidence present. Overall, the findings support the use of mindfulness training programs for GAD and indicate mechanisms that may differ from those involved in other cognitive therapy approaches. Further RCTs with evidence-based controls are needed to clarify techniques most beneficial for generalised anxiety to support individually tailored treatment.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12144-023-04695-x.

Norepinephrine system at the interface of attention and reward

Reward learning is key to survival for individuals. Attention plays an important role in the rapid recognition of reward cues and establishment of reward memories. Reward history reciprocally guides attention to reward stimuli. However, the neurological processes of the interplay between reward and attention remain largely elusive, due to the diversity of the neural substrates that participate in these two processes. In this review, we delineate the complex and differentiated locus coeruleus norepinephrine (LC-NE) system in relation to different behavioral and cognitive substrates of reward and attention. The LC receives reward related sensory, perceptual, and visceral inputs, releases NE, glutamate, dopamine and various neuropeptides, forms reward memories, drives attentional bias and selects behavioral strategies for reward. Preclinical and clinical studies have found that abnormalities in the LC-NE system are involved in a variety of psychiatric conditions marked by disturbed functions in reward and attention. Therefore, we propose that the LC-NE system is an important hub in the interplay between reward and attention as well as a critical therapeutic target for psychiatric disorders characterized by compromised functions in reward and attention.

The relationship between anxiety and smartphone addiction in the context of Covid-19: The mediating effect of attentional control and executive dysfunction

In the context of Covid-19, the present study examined the relationship between anxiety and smartphone addiction and tested the mediation role of attentional control and executive dysfunction. Four hundred and twenty-one Chinese undergraduate students completed anxiety, attentional control, executive dysfunction, and smartphone addiction measures. The findings of correlation analysis indicated that anxiety was negatively associated with attentional control, and positively with executive dysfunction and smartphone addiction. The results of structural equation model showed that attentional control and executive dysfunction played a mediation role between anxiety and smartphone addiction in series. Moreover, anxiety did not directly predict smartphone addiction in the final model including attentional control and executive dysfunction as mediators, suggesting that attentional control and executive dysfunction were full mediators in the relation between anxiety and smartphone addiction.

Anxious Brains: A Combined Data Fusion Machine Learning Approach to Predict Trait Anxiety from Morphometric Features

Trait anxiety relates to the steady propensity to experience and report negative emotions and thoughts such as fear and worries across different situations, along with a stable perception of the environment as characterized by threatening stimuli. Previous studies have tried to investigate neuroanatomical features related to anxiety mostly using univariate analyses and thus giving rise to contrasting results. The aim of this study is to build a predictive model of individual differences in trait anxiety from brain morphometric features, by taking advantage of a combined data fusion machine learning approach to allow generalization to new cases. Additionally, we aimed to perform a network analysis to test the hypothesis that anxiety-related networks have a central role in modulating other networks not strictly associated with anxiety. Finally, we wanted to test the hypothesis that trait anxiety was associated with specific cognitive emotion regulation strategies, and whether anxiety may decrease with ageing. Structural brain images of 158 participants were first decomposed into independent covarying gray and white matter networks with a data fusion unsupervised machine learning approach (Parallel ICA). Then, supervised machine learning (decision tree) and backward regression were used to extract and test the generalizability of a predictive model of trait anxiety. Two covarying gray and white matter independent networks successfully predicted trait anxiety. The first network included mainly parietal and temporal regions such as the postcentral gyrus, the precuneus, and the middle and superior temporal gyrus, while the second network included frontal and parietal regions such as the superior and middle temporal gyrus, the anterior cingulate, and the precuneus. We also found that trait anxiety was positively associated with catastrophizing, rumination, other- and self-blame, and negatively associated with positive refocusing and reappraisal. Moreover, trait anxiety was negatively associated with age. This paper provides new insights regarding the prediction of individual differences in trait anxiety from brain and psychological features and can pave the way for future diagnostic predictive models of anxiety.

Reducing anxiety and attentional bias with reward association learning and attentional bias modification

The current study examined the effects of a reward associative learning procedure and the traditional threat-avoidance ABM paradigm on anxiety and attentional bias. In reward training, participants were given high rewards for correct responses to neutral target and low rewards for correct responses to negative target. In reward control training, participants received no cues of rewards after their responses. High trait anxious individuals (N = 76) first completed a session of reward training or reward control training, followed by four sessions of ABM training or ABM control training. Generalized anxiety disorder symptom (GAD-7) and attentional bias in a dot-probe task were assessed during pre-and post-training. Results indicated that the effect of ABM training on reducing anxiety was only obtained in the reward training condition. Participants who received reward training showed significantly less attentional bias compared with those receiving reward control training. There was no significant training effect of ABM on atttentiona bias. Results suggested that reward training reduced general anxiety and attentional bias. Traditional ABM training reduced anxiety only when combined with reward training. Attentional bias in anxiety are modifiable through reward training.

Attention impairment in patients with cervical dystonia: An attention network test study

Objective

The purpose of this study was to investigate attentional network functional characteristics in patients with cervical dystonia (CD).

Methods

A total of 29 patients with CD and 26 healthy controls (HCs) were recruited. All subjects participated in the study and underwent the Attention Network Test (ANT), which evaluated the efficiencies of three independent attention networks (alerting, orienting, and executive control), as well as reaction time (RT) and accuracy.

Results

Significant differences between CD patients (9.86 ± 27.95 ms) and HCs (33.62 ± 23.41 ms) were observed in the alerting network (t = −3.40, p < 0.05). In contrast, the orienting network (t = 0.26, p = 0.79), executive control network (Z = −0.55, p = 0.58), total mean reaction time (t = −2.6, p = 0.79), and total accuracy rate (Z = −1.67, p = 0.09) showed no significant differences between the two groups.

Conclusion

Patients with CD showed a significant deficit in the alerting network. However, they did not show any deficits in the orienting or executive control network. In addition, the alerting, orienting, and executive control network functions of CD patients were all affected by the severity of torticollis, especially the alerting network function.

The Attention Network Test in Parkinson and Lewy Body Disease: A Systematic Review

BACKGROUND

The Attention Network Test (ANT) is a well-established measure of efficiency for the alerting, orienting, and executive attentional networks. However, its novel application in Parkinson disease (PD) and Lewy body dementia (LBD) research more broadly has yet to be evaluated systematically.

OBJECTIVE

To compare and consolidate the outcomes of studies reporting use of the ANT in PD and LBD groups and to identify the methodological considerations for the conduct of such studies.

METHOD

We performed a systematic literature search for articles exploring attention in PD and LBD groups using the ANT. We excluded articles on the basis of irrelevant scope, non-English, and groups other than PD and LBD. Once the full text articles were identified, we extracted the data and assessed the studies' quality.

RESULTS

The final sample included 16 articles ranging from low to moderate quality. Behavioral findings suggested a general slowing of responses yet preserved accuracy from the PD group compared with controls. Overall, the evidence was inconclusive regarding the state of the alerting network in the PD and LBD groups, mostly supportive of an intact orienting network, and strongly suggestive of an impaired executive network. Differences in sample stratification, patient symptomatology, and dopaminergic medication levels were identified as influential factors in the attentional results across studies.

CONCLUSION

Although sparse, the existing evidence indicates that the ANT is a viable option for measuring attention in PD; it can also be harnessed to explore the impact of symptoms and medications on attentional networks in PD and LBD groups.

Attentional networks in co-occurring generalized anxiety disorder and major depression disorder: Towards a staging approach to the executive control deficits

INTRODUCTION

Major Depression Disorder (MDD) and Generalized Anxiety Disorder (GAD) often co-occur, but the neurocognitive mechanisms of this co-occurrence remain unknown. Prominent views have pointed to attentional processes as potent mechanisms at play in MDD and GAD, respectively. Yet uncertainty remains regarding the very nature of attentional impairments in patients with co-occurring MDD and GAD.

METHODS

Inspired by contemporary models of attentional networks, we compared the three main attentional networks, namely the orienting, alerting, and executive networks of the Attention Network Task's model, in four groups of patients with, respectively, co-occurring DSM-5 MDD and GAD (n = 30), DSM-5 MDD only (n = 30), DSM-5 GAD only (n = 30), or free from any DSM-5 diagnosis (n = 30). To capture the multivariate nature of our data, we examined between-group differences in the attentional networks through a multivariate analysis of variance.

RESULTS

Patients with co-occurring MDD and GAD exhibited more severe impairments in the executive control network than those with only one of the disorders. Although patients with MDD or GAD solely did not differ in terms of attentional impairments, both groups showed significantly more impairments in the executive control network than those free from any DSM-5 diagnosis (all Bonferonni-corrected post-hoc ps < 0.05).

CONCLUSIONS

Our findings align with a longstanding staging approach to comorbidity whereby, via synergistic effects, co-occurring disorders produce more damages than the sum of each disorder. Here, for the first time, we extended this approach to the executive network of attention in the context of the co-occurrence between MDD and GAD.

Lessons unlearned: A conceptual review and meta-analysis of the relationship between the Attention Control Scale and Objective Attention Control

Attention control is central to many models of emotion. Among the most common measures of attention, control is the Attention Control Scale (ACS), which has exerted considerable influence in terms of the volume and breadth of research findings, with its use in cognitive-experimental research continuing to increase in recent years. However, there are growing concerns about whether the ACS genuinely indexes attention control. The present paper considers the context and development of the ACS, reviews and meta-analyses the available evidence regarding its association with objective measures of attention control. Meta-analytic results from nine studies (total n = 1274) indicated that the full-scale ACS was not significantly associated with behavioural measures of attentional control (r = .067, p = .093, N = 1274, 95% CI: -.011, .145). Findings indicated likely missing studies with lower correlations suggesting the true association may be smaller. Limited evidence of shared variance between subjective and objective measures of attention control contrasts with considerable evidence that the scale is closely correlated with dispositional traits (e.g. anxiety, agreeableness) that could plausibly influence responding. Thus, on the balance of current findings, we conclude that there is little compelling evidence that responding on the ACS reflects genuine attention control abilities.

Neurovisceral integration in the executive control network: A resting state analysis

Neurovisceral integration models emphasize the role of frontal lobes in cognitive, behavioral, and emotional regulation. Two candidate hubs for the regulation of cardio-autonomic control, anxiety, and executive attention are the dorsolateral prefrontal cortex (DLPFC) and middle frontal gyrus (MFG). Two-hundred and seventy-one adults (62.9 % female) aged 18-85 years were selected from the NKI-Rockland Sample. Resting state functional imaging data was preprocessed, and seeds extracted from bilateral DLPFC and MFG to test 4 regression models predicting connectivity with high frequency HRV (HF-HRV), trait anxiety (TA), and reaction time on an executive attention task. After controlling for age, sex, body mass index and head motion, the right DLPFC-MFG seed pair provided strongest support for neurovisceral integration indexed by HF-HRV, low TA and shorter reaction time on the attention network task. This hemispheric effect may underlie the inhibitory role of right PFC in the regulation of cardio-autonomic function, emotion, and executive attention.

Specificity of trait anxiety in anxiety and depression: Meta-analysis of the State-Trait Anxiety Inventory

The State-Trait Anxiety Inventory - Trait version (STAI-T) was developed to measure an individual's tendency to experience anxiety, but it may lack discriminant evidence of validity based on strong observed relationships with measures of depression. The present series of meta-analyses compares STAI-T scores among individuals with depressive disorders, anxiety disorders, and nonclinical comparison groups, as well as correlations with measures of anxiety and depressive symptom severity, in order to further examine discriminant and convergent validity. A total of 388 published studies (N = 31,021) were included in the analyses. Individuals with an anxiety disorder and those with a depressive disorder displayed significantly elevated scores on the STAI-T compared to nonclinical comparison groups. Furthermore, anxiety and depressive symptom severity were similarly strongly correlated with the STAI-T (mean r = .59 - .61). However, individuals with a depressive disorder had significantly higher STAI-T scores than individuals with an anxiety disorder (Hedges's g = 0.27). Given these findings, along with previous factor analyses that have observed a depression factor on the STAI-T, describing the scale as a measure of 'trait anxiety' may be a misnomer. It is proposed that the STAI-T be considered a non-specific measure of negative affectivity rather than trait anxiety per se.

Shall We Dance? Dancing Modulates Executive Functions and Spatial Memory

BACKGROUND

Aging is generally considered to be related to physical and cognitive decline. This is especially prominent in the frontal and parietal lobes, underlying executive functions and spatial memory, respectively. This process could be successfully mitigated in certain ways, such as through the practice of aerobic sports. With regard to this, dancing integrates physical exercise with music and involves retrieval of complex sequences of steps and movements creating choreographies.

METHODS

In this study, we compared 26 non-professional salsa dancers (mean age 55.3 years, age-range 49-70 years) with 20 non-dancers (mean age 57.6 years, age-range 49-70 years) by assessing two variables: their executive functions and spatial memory performance.

RESULTS

results showed that dancers scored better that non-dancers in our tests, outperforming controls in executive functions-related tasks. Groups did not differ in spatial memory performance.

CONCLUSIONS

This work suggests that dancing can be a valid way of slowing down the natural age-related cognitive decline. A major limitation of this study is the lack of fitness assessment in both groups. In addition, since dancing combines multiple factors like social contact, aerobic exercise, cognitive work with rhythms, and music, it is difficult to determine the weight of each variable.

Emotion regulation and intervention in adults with autism spectrum disorder: a synthesis of the literature

Purpose

Emotion regulation is an ongoing multiprocess phenomenon and is a challenging developmental task to acquire in individuals with autism spectrum disorder (ASD) who have different neurobiological profiles and emotion regulation problems. The purpose of this paper is to review recent literature to understand the neurobiological and psychological perspective of emotion regulation in ASD, while converging themes of psychosocial interventions and existing best practices on emotion regulation within this heterogeneous population are reviewed and discussed in consideration of intellectual disability (ID).

Design/methodology/approach

Review of recent literature and common empirically supported interventions addressing emotional regulation implemented in individuals with and without ASD, and with and without ID were included in the electronic database search through PubMed, EBSChost, Science Direct, Wiley Online Library, GALE and SAGE. Search terms used included autism, ID, cognitive control, executive function, sensory processing/intervention, emotion regulation, cognitive behavior therapy, mindfulness, social stories, positive behavior support and behavior therapy.

Findings

Neural systems governing emotion regulation can be divided into “top-down” and “bottom-up” processing. Prefrontal cortex, cognitive and attentional control are critical for effective emotion regulation. Individuals with ASD, and with ID show impairments in these areas have problems with emotion regulation. Targeted psychosocial intervention need to consider bottom-up and top-down processes of emotion regulation, and that standardized interventions require adaptations.

Originality/value

There are limited studies looking into understanding the neurobiological and psychological perspective of emotion regulation in ASD and linking them to interventions. This review highlights psychosocial interventions that are important for further research, investigation and development as treatment in this population is limited.

Neural Mechanisms of Spatial Attention Deficits in Trauma

BACKGROUND

Survival requires effective shifting of attention from one stimulus to another as goals change. It has been consistently demonstrated that posttraumatic stress disorder (PTSD) is associated with both faster orienting of attention toward and slower disengagement of attention from affective stimuli. Prior work, however, suggests that attention abnormalities in PTSD may extend beyond the affective domain.

METHODS

We used the Attention Network Test-modified to include invalid spatial cues-in conjunction with functional magnetic resonance imaging to examine the neurocognitive underpinnings of visuospatial attention in participants with PTSD (n = 31) and control participants who were (n = 20) and were not (n = 21) exposed to trauma.

RESULTS

We observed deficits in the utilization of spatial information in the group with PTSD. Specifically, compared with the non-trauma-exposed group, participants with PTSD showed a smaller reaction time difference between invalidly and validly cued targets, demonstrating that they were less likely to use spatial cues to inform subsequent behavior. We also found that in both the PTSD and trauma-exposed control groups, utilization of spatial information was positively associated with activation of attentional control regions (e.g., right precentral gyrus, inferior and middle frontal gyri) and negatively associated with activation in salience processing regions (e.g., right insula).

CONCLUSIONS

This pattern suggests that both trauma exposure and psychopathology may be associated with alterations of spatial attention. Overall, our findings suggest that both attention- and salience-network abnormalities may be related to altered attention in trauma-exposed populations. Treatments that target these neural networks could therefore be a new avenue for PTSD research.

Cognitive-behavioral therapy effects on alerting network activity and effective connectivity in panic disorder

Given the particular relevance of arousal and alerting in panic disorder (PD), here the alerting network was investigated (1) contrasting patients with PD and healthy controls, (2) as a function of anxiety sensitivity constituting a dimensional measure of panic-related anxiety, and (3) as a possible correlate of treatment response. Using functional magnetic resonance imaging (fMRI), 45 out-patients with PD (f = 34) and 51 matched healthy controls were investigated for brain activation patterns and effective connectivity (Dynamic Causal Modeling, DCM) while performing the Attention Network Task (ANT). Anxiety sensitivity was ascertained by the Anxiety Sensitivity Index (ASI). Forty patients and 48 controls were re-scanned after a 6 weeks cognitive-behavioral treatment (CBT) or an equivalent waiting time, respectively. In the alerting condition, patients showed decreased activation in fronto-parietal pathways including the middle frontal gyrus and the superior parietal lobule (MFG, SPL). In addition, ASI scores were negatively correlated with connectivity emerging from the SPL, the SFB and the LC and going to the MFG in patients but not in healthy controls. CBT resulted in an increase in middle frontal and parietal activation along with increased connectivity going from the MFG to the SPL. This change in connectivity was positively correlated with reduction in ASI scores. There were no changes in controls. The present findings point to a pathological disintegration of the MFG in a fronto-parietal pathway in the alerting network in PD which was observed to be reversible by a successful CBT intervention.

Anxiety and Brain Networks of Attentional Control

Advances in the study of brain networks can be applied to our understanding of anxiety disorders (eg, generalized anxiety, obsessive-compulsive, and posttraumatic stress disorders) to enable us to create targeted treatments. These disorders have in common an inability to control thoughts, emotions, and behaviors related to a perceived threat. Here we review animal and human imaging studies that have revealed separate brain networks related to various negative emotions. Research has supported the idea that brain networks of attention serve to control emotion networks as well as the thoughts and behaviors related to them. We discuss how attention networks can modulate both positive and negative affect. Disorders arise from both abnormal activation of negative affect and a lack of attentional control. Training attention has been one way to foster improved attentional control. We review attention training studies as well as efforts to generally improve attention networks through stimulation in self-regulation.

Does rumination mediate the relationship between attentional control and symptoms of depression?

BACKGROUND AND OBJECTIVES

It has been suggested that impaired attentional control (AC) promotes the use of maladaptive emotional regulation strategies, such as rumination, with subsequent increase in risk of depression.

METHOD

This study examined this hypothesis in a healthy community sample. Questionnaire measures of depression, anxiety, rumination and self-reported AC (shifting and focusing) were used, as well as an attention performance task (Attention Network Task; ANT).

RESULTS

While self-report and performance measures of AC were not significantly related, both depression and rumination were associated with reduced self-reported AC. Depression was specifically associated with poorer attentional shifting. Depression and brooding were also associated with better performance on the conflict component of the ANT. Importantly, the relationships of ANT conflict and self-reported AC to depression were mediated by brooding.

LIMITATIONS

The current study used a community sample, and it is unclear if results would generalise to a clinical population. All measures were taken concurrently and so it is not possible to confidently ascertain causality or direction of effects.

CONCLUSIONS

These results are consistent with the suggestion that impaired AC, particularly a narrow and inflexible attentional focus, may increase risk of depression by promoting ruminative thinking. The results highlight the importance of considering both self-report and performance measures of AC, as well as different components of attentional performance.

Unfolding the Complex Dynamic Interplay Between Attentional Processes and Anxiety: A Commentary on Ghassemzadeh, Rothbart, and Posner

Theories about the involvement of attention in feelings of fear and anxiety have been debated in philosophical circles since long before the foundation of experimental psychology and cognitive neuroscience. In this issue, Ghassemzadeh, Rothbart, and Posner (2019) provide a much-needed historical and conceptual review of the relations between attention and anxiety disorders. Throughout their paper, they argue that insights from the study of brain networks of attention offer a particularly viable prospect for best clarifying the complex relations between attentional processes and anxiety. We fully share this view. Moreover, we believe that the computational and conceptual tools of network analysis (also known as graph theory) can enable researchers to move even closer to elucidating the complex dynamic interplay between those phenomena. In this commentary, we explain why and how to use network analysis for this purpose.

Home-delivered attention bias modification training via smartphone to improve attention control in sub-clinical generalized anxiety disorder: A randomized, controlled multi-session experiment

BACKGROUND

Mogg and Bradley (2016) proposed that attentional bias (to threat stimuli) among patients with generalized anxiety disorder (GAD) may be associated with the top-down attention control process. Additionally, some scholars (e.g., Enock & McNally, 2013) have designed mobile applications to enable patients to engage in home-delivered attentional bias modification (HD-ABM); however, many problems related to these training systems have not yet been addressed.

METHOD

A total of 82 participants (61 women, mean age = 21.47 y) who received GAD diagnoses were randomly assigned to an HD-ABM (n = 30), placebo training (n = 30), or waiting list (n = 22) group. Both the HD-ABM and placebo groups were trained with the attention training application (through Android phones three times a day for four weeks).

RESULTS

(1) All measures of participants' self-reported symptoms (except for trait anxiety) were significantly lower in Week 4 and in the follow-up. (2) Attentional network test (ANT) results demonstrated that all participants' alerting scores significantly increased by Week 4. (3) Participants in the HD-ABM and placebo groups demonstrated significant increases in their self-reported attention control scores, decreases in their attention bias index (ABI) scores, and progress in their executive control abilities.

LIMITATIONS

Self-report scales may have been insufficient for measuring effectiveness in the present study.

CONCLUSIONS

This study helps to elucidate the mechanism underlying changes in attention processes after HD-ABM training implemented through a mobile application in GAD.

Does Change in Attention Control Mediate the Impact of tDCS on Attentional Bias for Threat? Limited Evidence from a Double-blind Sham-controlled Experiment in an Unselected Sample

Neurocognitive models of attentional bias for threat posit that attentional bias may result from a decreased activation of the left prefrontal cortex, and especially of its dorsolateral part (dlPFC), resulting in an impaired attention control. Consequently, a transient increase of neural activity within the left dlPFC via non-invasive brain stimulation reduces attentional bias among both anxious and nonanxious participants. Yet, it is still unclear whether the impact of dlPFC activation on attentional bias is mediated by improvement in attention control. In this experiment, we sought to test this hypothesis in an unselected sample (n = 20). Accordingly, we adopted a double-blind within-subject protocol in which we delivered a single-session of anodal versus sham transcranial Direct Current Stimulation (tDCS) over the left dlPFC during the completion of a task assessing attention control. We also assessed its subsequent impact on attentional bias. Neither attention control nor attentional bias did significantly improve following anodal tDCS. Although our results do not support our main hypothesis, we believe the present null results to be particularly useful for future meta-research in the field. We also formulated a series of methodological recommendations for future research aiming at testing the tDCS-induced modification of attentional bias.

An examination of the association between prenatal cocaine exposure and brain activation measures of arousal and attention in young adults: An fMRI study using the Attention Network Task

Prenatal drug exposure, including cocaine, alcohol, marijuana, and tobacco, is associated with deficits in behavioral regulation and attention. Using fMRI, the objective of this study was to characterize the association between prenatal cocaine exposure (PCE) and the underlying neural substrates associated with behavioral outcomes of attention. Forty-seven young adults were recruited for this study from the ongoing Maternal Health Practices and Child Development (MHPCD) Project, a longitudinal study of the effects of PCE on growth, behavior, and cognitive function. Three groups were compared: 1) prenatal exposure to cocaine, alcohol, marijuana, and tobacco (CAMT, n = 15), 2) prenatal exposure to alcohol, marijuana, and tobacco (AMT, n = 17), and 3) no prenatal exposure to drugs (Controls, n = 15). Subjects were frequency matched on gender, race, handedness, and 15-year IQ. This study used the theoretical model proposed by Posner and Peterson (1990), which posits three dissociable components of attention: alerting, orienting, and executive attention. Subjects completed a functional MRI (fMRI) scan while performing the Attention Network Task, a validated neuroimaging measure of the 3-network model of attention. Behavioral and fMRI data revealed no associations between PCE and task accuracy, speed of processing, or activation in key brain regions associated with each of the attention networks. The results of this study show that any subtle differences in brain function associated with PCE are not detectable using the ANT task and fMRI. These results should be interpreted in the context of other studies that have found associations between PCE and arousal with emotionally arousing stimuli, compared to this study that found no associations using emotionally neutral stimuli.

Attentional Control and Fear Extinction in Subclinical Fear: An Exploratory Study

Attentional control (AC) and fear extinction learning are known to be involved in pathological anxiety. In this study we explored whether individual differences in non-emotional AC were associated with individual differences in the magnitude and gradient of fear extinction (learning and recall). In 50 individuals with fear of spiders, we collected measures of non-emotional AC by means of self-report and by assessing the functioning of the major attention networks (executive control, orienting, and alerting). The participants then underwent a paradigm assessing fear extinction learning and extinction recall. The two components of the orienting network functioning (costs and benefits) were significantly associated with fear extinction gradient over and above the effects of trait anxiety. Specifically, participants with enhanced orienting costs (i.e., difficulties in disengaging attention from cues not relevant for the task) showed faster extinction learning, while those with enhanced orienting benefits (i.e., attention facilitated by valid cues) exhibited faster extinction recall as measured by fear-potentiated startle and Unconditioned Stimulus expectancies, respectively. Our findings suggest that, in non-emotional conditions, the orienting component of attention may be predictive of fear extinction. They also show that the use of fear extinction gradients and the exploration of individual differences in non-emotional AC (using performance-based measures of attentional network functioning) can provide a better understanding of individual differences in fear learning. Our findings also may help to understand differences in exposure therapy outcomes.

Reward processing and mood-related symptoms: An RDoC and translational neuroscience perspective

BACKGROUND

Two objectives of the NIMH Research Domain Criteria (RDoC) initiative are to identify (a) mechanisms that are common to multiple psychiatric disorders, and (b) mechanisms that are unique to specific psychiatric symptoms, and that reflect markers of differential risk for these symptoms. With respect to these objectives, a brain-behavior dimension that has received considerable attention and that is directly relevant to the Positive Valence Systems domain of the RDoC initiative involves reward processing.

METHODS

The present review paper first examines the relationship between reward processing and mood-related symptoms from an RDoC perspective. We then place this work in a larger context by examining the relationship between reward processing abnormalities and psychiatric symptoms defined broadly, including mood-related symptoms, schizophrenia, and addiction.

RESULTS

Our review suggests that reward hyposensitivity relates to a subtype of anhedonia characterized by motivational deficits in unipolar depression, and reward hypersensitivity relates to a cluster of hypo/manic symptoms characterized by excessive approach motivation in the context of bipolar disorder. Integrating this perspective with research on reward processing abnormalities in schizophrenia and addiction, we further argue that the principles of equifinality and multifinality may be preferable to a transdiagnostic perspective for conceptualizing the relationship between reward processing and psychiatric symptoms defined broadly.

CONCLUSION

We propose that vulnerability to either motivational anhedonia or approach-related hypo/manic symptoms involve extreme and opposite profiles of reward processing. We further propose that an equifinality and multifinality perspective may serve as a useful framework for future research on reward processing abnormalities and psychiatric symptoms.

Behavior characteristics of the attention network of military personnel with high and low trait anxiety

Converging evidence reveals significant increase in both state anxiety and trait anxiety during the past 2 decades among military servicemen and servicewomen in China. In the present study, we employed the Chinese version of the State-trait Anxiety Inventory (STAI) to examine trait and state anxiety in Chinese military servicemen and servicewomen. We further evaluated orienting, alerting and execution inhibition using the attention network test.Healthy military servicemen and servicewomen were recruited for the present study. The STAI was used to measure both state and trait anxiety and the attention network test was done to determine reaction time and accuracy rate.Fifty-seven subjects were eligible for the study. Their mean STAI score was 3.2 ± 2.8 (range, 1-17) and 29 (50.9%) subjects were categorized into the high trait anxiety group and 28 (49.1%) subjects into the low trait anxiety group. The reaction time of the high trait anxiety group to incongruent, congruent, and neutral target was significantly longer than that of the low trait anxiety group (P < .05). Moreover, the accurate rate of the high trait anxiety group for incongruent, congruent, and neutral target was significantly higher than that of the low trait anxiety group (P < .05). Repeated analysis of variance showed marked effect of trait anxiety, cue types, and target types on reaction time. There was significant interaction among trait anxiety, target types, and cue types. Trait anxiety and target types also had marked effect on the accurate rate. Multivariate analysis showed no marked effect of trait anxiety on the alerting, orienting, and execution inhibition subnetwork.The present study has demonstrated that military service personnel with high trait anxiety requires more time for cognitive processing of external information but exhibits enhanced reaction accuracy rate compared to those with low trait anxiety. Our findings indicate that interventional strategies to improve the psychological wellbeing of military service personnel should be implemented to improve combat mission performance.

Differential impairments across attentional networks in binge drinking

RATIONALE

The cognitive deficits observed in young binge drinkers have been largely documented during the last decade. Yet, these earlier studies have mainly focused on high-level cognitive abilities (particularly memory and executive functions), and uncertainty thus still abounds regarding the integrity of less complex cognitive processes in binge drinking. This is particularly true for attentional abilities, which play a crucial role in behavior regulation and are impaired in other alcohol-related disorders.

OBJECTIVES AND METHODS

To specify the attentional deficits associated with binge drinking, two groups of university students (40 binge drinkers and 40 matched controls) performed the Attention Network Task, a theoretically grounded test assessing three independent attentional networks: alerting, orienting, and executive control.

RESULTS

Binge drinkers displayed preserved orienting performance but impaired alerting and executive control. Binge drinking is thus not related to a general attentional impairment but rather to specific impairments of the alerting and executive control networks.

CONCLUSIONS

These results underline that, beyond the already explored high-level deficits, binge drinking is also related to impairments for attentional abilities. In view of the role played by attentional impairments in alcohol dependence, the present data also suggest that rehabilitation programs should be developed to improve attentional abilities at the early stages of alcohol-related disorders.

Functional neuroanatomy in panic disorder: Status quo of the research

AIM

To provide an overview of the current research in the functional neuroanatomy of panic disorder.

METHODS

Panic disorder (PD) is a frequent psychiatric disease. Gorman et al (1989; 2000) proposed a comprehensive neuroanatomical model of PD, which suggested that fear- and anxiety-related responses are mediated by a so-called "fear network" which is centered in the amygdala and includes the hippocampus, thalamus, hypothalamus, periaqueductal gray region, locus coeruleus and other brainstem sites. We performed a systematic search by the electronic database PubMed. Thereby, the main focus was laid on recent neurofunctional, neurostructural, and neurochemical studies (from the period between January 2012 and April 2016). Within this frame, special attention was given to the emerging field of imaging genetics.

RESULTS

We noted that many neuroimaging studies have reinforced the role of the "fear network" regions in the pathophysiology of panic disorder. However, recent functional studies suggest abnormal activation mainly in an extended fear network comprising brainstem, anterior and midcingulate cortex (ACC and MCC), insula, and lateral as well as medial parts of the prefrontal cortex. Interestingly, differences in the amygdala activation were not as consistently reported as one would predict from the hypothesis of Gorman et al (2000). Indeed, amygdala hyperactivation seems to strongly depend on stimuli and experimental paradigms, sample heterogeneity and size, as well as on limitations of neuroimaging techniques. Advanced neurochemical studies have substantiated the major role of serotonergic, noradrenergic and glutamatergic neurotransmission in the pathophysiology of PD. However, alterations of GABAergic function in PD are still a matter of debate and also their specificity remains questionable. A promising new research approach is "imaging genetics". Imaging genetic studies are designed to evaluate the impact of genetic variations (polymorphisms) on cerebral function in regions critical for PD. Most recently, imaging genetic studies have not only confirmed the importance of serotonergic and noradrenergic transmission in the etiology of PD but also indicated the significance of neuropeptide S receptor, CRH receptor, human TransMEMbrane protein (TMEM123D), and amiloride-sensitive cation channel 2 (ACCN2) genes.

CONCLUSION

In light of these findings it is conceivable that in the near future this research will lead to the development of clinically useful tools like predictive biomarkers or novel treatment options.

Relationships among attention networks and physiological responding to threat

Although researchers have long hypothesized a relationship between attention and anxiety, theoretical and empirical accounts of this relationship have conflicted. We attempted to resolve these conflicts by examining relationships of attentional abilities with responding to predictable and unpredictable threat - related but distinct motivational process implicated in a number of anxiety disorders. Eighty-one individuals completed a behavioral task assessing efficiency of three components of attention - alerting, orienting, and executive control (Attention Network Test - Revised). We also assessed startle responding during anticipation of both predictable, imminent threat (of mild electric shock) and unpredictable contextual threat. Faster alerting and slower disengaging from non-emotional attention cues were related to heightened responding to unpredictable threat, whereas poorer executive control of attention was related to heightened responding to predictable threat. This double dissociation helps to integrate models of attention and anxiety and may be informative for treatment development.

Executive Dysfunctions: The Role in Attention Deficit Hyperactivity and Post-traumatic Stress Neuropsychiatric Disorders

Executive functions (EFs) is an umbrella term for various cognitive processes controlled by a complex neural activity, which allow the production of different types of behaviors seeking to achieve specific objectives, one of them being inhibitory control. There is a wide consensus that clinical and behavioral alterations associated with EF, such as inhibitory control, are present in various neuropsychiatric disorders. This paper reviews the research literature on the relationship between executive dysfunction, frontal-subcortical neural circuit changes, and the psychopathological processes associated with attention deficit hyperactivity disorder (ADHD) and post-traumatic stress disorder (PTSD). A revision on the role of frontal-subcortical neural circuits and their presumable abnormal functioning and the high frequency of neuropsychiatric symptoms could explain the difficulties with putting effector mechanisms into action, giving individuals the necessary tools to act efficiently in their environment. Although, neuronal substrate data about ADHD and PTSD has been reported in the literature, it is isolated. Therefore, this review highlights the overlapping of neural substrates in the symptomatology of ADHD and PTSD disorders concerning EFs, especially in the inhibitory component. Thus, the changes related to impaired EF that accompany disorders like ADHD and PTSD could be explained by disturbances that have a direct or indirect impact on the functioning of these loops. Initially, the theoretical model of EF according to current neuropsychology will be presented, focusing on the inhibitory component. In a second stage, this component will be analyzed for each of the disorders of interest, considering the clinical aspects, the etiology and the neurobiological basis. Additionally, commonalities between the two neuropsychiatric conditions will be taken into consideration from the perspectives of cognitive and emotional inhibition. Finally, the implications and future prospects for research and interventions in the area will be outlined, with the intention of contributing scientific reference information that encompasses the knowledge and understanding of executive dysfunction and its relationship with these treated disorders.

Intolerance of uncertainty and attentional networks: Unique associations with alerting

The present study sought to extend our understanding as to how intolerance of uncertainty (IU) relates to information-processing by investigating associations between IU and attentional networks, including alerting, orienting, and executive attention. Based upon prior research, IU was expected to cluster with alerting. An unselected sample of college students (N=86; 79% women) completed self-report measures of IU and state anxiety, as well as the attention network test. Among the attentional networks, IU only shared a positive association with alerting and the association remained intact after statistically controlling for state anxiety. State anxiety did not moderate the association between IU and alerting. Although two IU dimensions (prospective and inhibitory) both shared a positive association with alerting, only prospective IU was associated with alerting after statistically controlling for state anxiety. The results provide evidence that IU relates to an overfunctioning of the alerting attentional network, which may suggest a role of hypervigilance and a greater influence of bottom-up processing in relation to IU. Implications for how these results advance our understanding of possible links between IU and anxiety disorders are discussed.

Attentional processes in posttraumatic stress disorder and the associated changes in neural functioning

Posttraumatic Stress Disorder (PTSD) is associated with alterations in attention at the behavioral and neural levels. However, there are conflicting findings regarding the specific type of attention impairments present in PTSD, as the commonly used tests of attention do not isolate the mechanisms behind attention abnormalities, and the constructs measured do not map onto the neurocircuits governing attention. Here, we review the literature on attention processing in PTSD and offer directions for future research to clarify these unanswered questions. First, using instruments that allow assessment of behavioral and neurophysiological attention components will be necessary to understand attention deficits in PTSD. Second, focus on intra-individual variability in addition to assessment of central tendency may help clarify some of the mixed findings. Third, longitudinal studies on attentional processes are warranted to determine how attention contributes to the development and maintenance of PTSD. Integration of behavioral and neural measures of attention will be useful in understanding the pathophysiology of PTSD.

Can auditory deviant stimuli temporarily suspend cognitive processing? Evidence from patients with anxiety

While anxiety is typically thought to increase distractibility, this notion mostly derives from studies using emotionally loaded distractors presented in the same modality as the target stimuli and tasks involving crosstalk interference. We examined whether pathological anxiety might also increase distractibility for emotionally neutral irrelevant sounds presented prior to target stimuli in a task where these stimuli do not compete for selection. Patients with anxiety and control participants categorized visual digits preceded by task-irrelevant sounds that changed on rare trials (auditory deviance). Both groups exhibited an equivalent increase in response times following a deviant sound but patients showed a reduction of response accuracy, which was entirely due to an increase in response omissions. We conclude that the involuntary capture of attention by unexpected stimuli may, in patients with anxiety, result in a temporary suspension of cognitive activity.

Executive Attention Impairment in Adolescents With Major Depressive Disorder

Neural network models that guide neuropsychological assessment practices are increasingly used to explicate depression, though a paucity of work has focused on regulatory systems that are under development in adolescence. The purpose of this study was to evaluate subsystems of attention related to executive functioning including alerting, orienting, and executive attention networks, as well as sustained attention with varying working memory load, in a sample of depressed and well adolescents. Neuropsychological functioning in 99 adolescents diagnosed with major depressive disorder (MDD) and 63 adolescent healthy controls (M = 16.6 years old) was assessed on the Attention Network Test (ANT) and the Continuous Performance Test, Identical Pairs. Adolescents with MDD, particularly those who were not medicated, were slower to process conflict (slower reaction time on the Executive Attention scale of the ANT) compared to controls, particularly for those who were not undergoing psychopharmacological treatment. Tentative evidence also suggests that within the MDD group, orienting performance was more impaired in those with a history of comorbid substance use disorder, and alerting was more impaired in those with a history of a suicide attempt. Adolescents with depression showed impaired executive attention, although cognitive performance varied across subgroups of patients. These findings highlight the importance of examining neurocognitive correlates associated with features of depression and suggest an avenue for future research to help guide the development of interventions.

Revisiting attentional processing of non-emotional cues in social anxiety: A specific impairment for the orienting network of attention

People with social anxiety disorder (SAD) exhibit an attentional bias for threat (AB). Nevertheless, the focus on AB for emotional stimuli has led to neglect the exploration of basic attention deficits for non-emotional material among SAD patients. This study aimed to investigate the integrity of the attentional system in SAD. The Attention Network Test was used to precisely explore attentional deficits, and centrally the differential deficit across the three attentional networks, namely alerting (allowing to achieve and maintain a state of alertness), orienting (allowing to select information from sensory input by engaging or disengaging attention to one stimulus among others and/or shifting the attentional resources from one stimulation to another), and executive control (involving the top-down control of attention and allowing to resolve response conflicts). Twenty-five patients with SAD were compared to 25 matched controls. SAD patients exhibited a specific impairment for the orienting network (p < 0.001) but preserved performance for the alerting and executive networks. Complementary analyses revealed that this impairment may result from a faster attentional engagement to task-irrelevant material. The orienting impairment was highly correlated with the intensity of the social anxiety symptoms, but did not correlate either with trait-anxiety, state-anxiety, or depressive symptoms.