Hypervigilance and avoidance in visual attention in children with social phobia

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.

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.

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.

Social anxiety does not impair attention inhibition: An emotion anti-saccade task

BACKGROUND AND OBJECTIVES

Attention avoidance and attention vigilance are two typical attentional biases in individuals with social anxiety disorder (SAD). Attention inhibition is a type of attention control, which may be the key factor affecting attention vigilance and attention avoidance. However, previous studies have not examined the difference between the attention inhibition in individuals with SAD and healthy controls.

METHODS

To further explore this question, the current study used the single anti-saccade task with emotional facial stimuli to assess attention inhibition in 27 individuals with SAD and 22 healthy controls.

RESULTS

Regardless of the emotional valence of the facial stimuli, error rates in the social anxiety group were lower than that of the healthy control group, but there was no significant group difference in the saccade latency.

LIMITATIONS

This research only examined the attentional inhibition process highly related to attention avoidance and attention vigilance. Future research may benefit from adopting different research paradigms for more robust and generalizable conclusions.

CONCLUSIONS

Results suggest that individuals with SAD have better attention inhibition abilities than healthy control. Such enhanced attention inhibition may underlie their avoidance of threatening social cues.

Cognitive processing features of elementary school children with mathematical anxiety: Attentional control theory-based explanation

A growing body of research suggests that mathematical anxiety (MA) seriously affects an individual's math achievement. However, few studies have focused on the cognitive mechanisms of MA in elementary school children. Based on attention control theory (ACT), this research aimed to explore the cognitive mechanism of MA in elementary school children using two studies. In Study 1, the dual-task paradigm of number memory and computation span was used to investigate the difference in processing efficiency between the high-mathematical anxiety (HMA) group and the low-mathematical anxiety (LMA) group. In total, 59 students with HMA and 54 students with LMA participated in Study 1. The results showed that students with HMA had lower processing efficiency in dealing with high-load math tasks. To further investigate the underlying mechanism of low processing efficiency for students with HMA, Study 2 explored the attention bias toward math-related stimuli of students with HMA using the Posner paradigm. In total, 48 students with HMA and 49 students with LMA participated in Study 2. The results showed that math trials put children with HMA in a state of heightened vigilance in general, which might be related to the low processing efficiency in dealing with high-load math tasks. These findings support the ACT and further reveal the mechanism of MA in elementary school children from a cognitive perspective.

Relationships between attention to emotion and anxiety among a community sample of adolescents

BACKGROUND

Attentional bias to threat has been implicated as a cognitive mechanism in anxiety disorders for youth. Yet, prior studies documenting this bias have largely relied on a method with questionable reliability (i.e. dot-probe task) and small samples, few of which included adolescents. The current study sought to address such limitations by examining relations between anxiety - both clinically diagnosed and dimensionally rated - and attentional bias to threat.

METHODS

The study included a community sample of adolescents and employed eye-tracking methodology intended to capture possible biases across the full range of both automatic (i.e. vigilance bias) and controlled attentional processes (i.e. avoidance bias, maintenance bias). We examined both dimensional anxiety (across the full sample; n = 215) and categorical anxiety in a subset case-control analysis (n = 100) as predictors of biases.

RESULTS

Findings indicated that participants with an anxiety disorder oriented more slowly to angry faces than matched controls. Results did not suggest a greater likelihood of initial orienting to angry faces among our participants with anxiety disorders or those with higher dimensional ratings of anxiety. Greater anxiety severity was associated with greater dwell time to neutral faces.

CONCLUSIONS

This is the largest study to date examining eye-tracking metrics of attention to threat among healthy and anxious youth. Findings did not support the notion that anxiety is characterized by heightened vigilance or avoidance/maintenance of attention to threat. All effects detected were extremely small. Links between attention to threat and anxiety among adolescents may be subtle and highly dependent on experimental task dimensions.

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.

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.

Whole-Brain Resting-State Functional Connectivity Patterns Associated With Pediatric Anxiety and Involuntary Attention Capture

BACKGROUND

Pediatric anxiety disorders are linked to dysfunction in multiple functional brain networks, as well as to alterations in the allocation of spatial attention. We used network-level analyses to characterize resting-state functional connectivity (rs-fc) alterations associated with 1) symptoms of anxiety and 2) alterations in stimulus-driven attention associated with pediatric anxiety disorders. We hypothesized that anxiety was related to altered connectivity of the frontoparietal, default mode, cingulo-opercular, and ventral attention networks and that anxiety-related connectivity alterations that include the ventral attention network would simultaneously be related to deviations in stimulus-driven attention.

METHODS

A sample of children (n = 61; mean = 10.6 years of age), approximately half of whom met criteria for a current anxiety disorder, completed a clinical assay, an attention task, and rs-fc magnetic resonance imaging scans. Network-level analyses examined whole-brain rs-fc patterns associated with clinician-rated anxiety and with involuntary capture of attention. Post hoc analyses controlled for comorbid symptoms.

RESULTS

Elevated clinician-rated anxiety was associated with altered connectivity within the cingulo-opercular network, as well as between the cingulo-opercular network and the ventral attention, default mode, and visual networks. Connectivity between the ventral attention and cingulo-opercular networks was associated with variation in both anxiety and stimulus-driven attention.

CONCLUSIONS

Pediatric anxiety is related to aberrant connectivity patterns among several networks, most of which include the cingulo-opercular network. These results help clarify the within- and between-network interactions associated with pediatric anxiety and its association with altered attention, suggesting that specific network connections could be targeted to improve specific altered processes associated with anxiety.

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.

Vigilant or avoidant? Children's temperamental shyness, patterns of gaze, and physiology during social threat

Temperamental shyness is characterized by fear, wariness, and the perception of threat in response to social novelty. Previous work has been inconsistent regarding attentional patterns to social threat among shy children, with evidence for both avoidance and vigilance. We examined relations between children's shyness and gaze aversion during the approach of a stranger (i.e., a context of social novelty), and tested whether these patterns of gaze moderated relations between shyness and autonomic reactivity and recovery. Participants included 152 typically-developing children (M_age  = 7.82 years, SD = 0.44 years) who had their respiratory sinus arrhythmia (RSA) recorded during baseline, social novelty, and recovery. Children's shyness correlated with increases in self-reported nervousness from baseline to social novelty, providing support for perceived threat. Results revealed that children's proportion of gaze aversion from social novelty was related to shyness in a U-shape pattern such that both low levels of gaze aversion (i.e., attentional vigilance) and high levels of gaze aversion (i.e., attentional avoidance) were related to higher levels of shyness. Further, we found that children's shyness was directly related to decreases in RSA from baseline to social novelty, whereas quadratic gaze to social novelty moderated the relation between shyness and RSA recovery. Specifically, shyness was related to greater RSA recovery among children who exhibited attentional vigilance during the novel social interaction. Our findings provide support for both avoidance of, and vigilance to, social threat among different shy children, and these gaze strategies may be differentially related to physiological regulation during novel social encounters.

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.

Attention Alterations in Pediatric Anxiety: Evidence From Behavior and Neuroimaging

BACKGROUND

Pediatric anxiety disorders involve greater capture of attention by threatening stimuli. However, it is not known if disturbances extend to nonthreatening stimuli, as part of a pervasive disturbance in attention-related brain systems. We hypothesized that pediatric anxiety involves greater capture of attention by salient, nonemotional stimuli, coupled with greater activity in the portion of the inferior frontal gyrus (IFG) specific to the ventral attention network (VAN).

METHODS

A sample of children (n = 129, 75 girls, mean 10.6 years of age), approximately half of whom met criteria for a current anxiety disorder, completed a task measuring involuntary capture of attention by nonemotional (square boxes) and emotional (angry and neutral faces) stimuli. A subset (n = 61) completed a task variant during functional magnetic resonance imaging. A priori analyses examined activity in functional brain areas within the right IFG, supplemented by a whole-brain, exploratory analysis.

RESULTS

Higher clinician-rated anxiety was associated with greater capture of attention by nonemotional, salient stimuli (F1,125 = 4.94, p = .028) and greater activity in the portion of the IFG specific to the VAN (F1,57 = 10.311, p = .002). Whole-brain analyses confirmed that the effect of anxiety during capture of attention was most pronounced in the VAN portion of the IFG, along with additional areas of the VAN and the default mode network.

CONCLUSIONS

The pathophysiology of pediatric anxiety appears to involve greater capture of attention to salient stimuli, as well as greater activity in attention-related brain networks. These results provide novel behavioral and brain-based targets for treatment of pediatric anxiety disorders.

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.

Attention to Peer Feedback Through the Eyes of Adolescents with a History of Anxiety and Healthy Adolescents

During adolescence, youth may experience heightened attention bias to socially relevant stimuli; however, it is unclear if attention bias toward social threat may be exacerbated for adolescents with a history of anxiety. This study evaluated attentional bias during the Chatroom-Interact task with 25 adolescents with a history of anxiety (18F, Mage = 13.6) and 22 healthy adolescents (13F, Mage = 13.8). In this task, participants received feedback from fictional, virtual peers who either chose them (acceptance) or rejected them (rejection). Overall, participants were faster to orient toward and spent longer time dwelling on their own picture after both rejection and acceptance compared to non-feedback cues. Social feedback was associated with greater pupillary reactivity, an index of cognitive and emotional neural processing, compared to non-feedback cues. During acceptance feedback (but not during rejection feedback), anxious youth displayed greater pupil response compared to healthy youth, suggesting that positive feedback from peers may differentially influence youth with a history of an anxiety disorder.

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.

Stationary and ambulatory attention patterns are differentially associated with early temperamental risk for socioemotional problems: Preliminary evidence from a multimodal eye-tracking investigation

Behavioral Inhibition (BI) is a temperament type that predicts social withdrawal in childhood and anxiety disorders later in life. However, not all BI children develop anxiety. Attention bias (AB) may enhance the vulnerability for anxiety in BI children, and interfere with their development of effective emotion regulation. In order to fully probe attention patterns, we used traditional measures of reaction time (RT), stationary eye-tracking, and recently emerging mobile eye-tracking measures of attention in a sample of 5- to 7-year-olds characterized as BI (N = 23) or non-BI (N = 58) using parent reports. There were no BI-related differences in RT or stationary eye-tracking indices of AB in a dot-probe task. However, findings in a subsample from whom eye-tracking data were collected during a live social interaction indicated that BI children (N = 12) directed fewer gaze shifts to the stranger than non-BI children (N = 25). Moreover, the frequency of gazes toward the stranger was positively associated with stationary AB only in BI, but not in non-BI, children. Hence, BI was characterized by a consistent pattern of attention across stationary and ambulatory measures. We demonstrate the utility of mobile eye-tracking as an effective tool to extend the assessment of attention and regulation to social interactive contexts.

Anxiety-Linked Attentional Bias: Is It Reliable?

There is substantial evidence that heightened anxiety vulnerability is characterized by increased selective attention to threatening information. The reliability of this anxiety-linked attentional bias has become the focus of considerable recent interest. We distinguish between the potential inconsistency of anxiety-linked attentional bias and inconsistency potentially reflecting the psychometric properties of the assessment approaches used to measure it. Though groups with heightened anxiety vulnerability often exhibit, on average, elevated attention to threat, the evidence suggests that individuals are unlikely to each display a stable, invariant attentional bias to threat. Moreover, although existing assessment approaches can differentiate between groups, they do not exhibit the internal consistency or test-retest reliability necessary to classify individuals in terms of their characteristic pattern of attentional responding to threat. We discuss the appropriate uses of existing attentional bias assessment tasks and propose strategies for enhancing classification of individuals in terms of their tendency to display an attentional bias to threat.

An integrative review of the vigilance-avoidance model in pediatric anxiety disorders: Are we looking in the wrong place?

Enduring cognitive models of anxiety posit that negative biases in information processing are implicated in the etiology, maintenance, and recurrence of anxiety disorders in youth and adults. Specifically, the vigilance-avoidance model of attention is an influential hypothesis proposed to explain anxious individuals' attentional patterns. The vigilance-avoidance model posits that anxious individuals, relative to nonanxious individuals, initially orient more quickly to threatening stimuli and then later avoid threatening stimuli. However, a large body of empirical research examining attentional mechanisms in anxious individuals uses paradigms that do not allow the measurement of the time course of attention. Furthermore, existing reviews that examine the time course of attention only include studies with adults. We systematically review in depth the literature that compares anxious and non-anxious children that takes advantage of research designs that allow the examination of the time course of attention. Across studies, there is not robust support for the vigilance-avoidance model in samples of anxious youth. Future research examining attention biases across time should employ tasks that more directly measure multiple stages of attention, in order to assess if vigilance-avoidance patterns emerge based on sample characteristics or task variables, and to inform intervention efforts.

Threat-related Attention Bias in Socioemotional Development: A Critical Review and Methodological Considerations

Cross-sectional evidence suggests that attention bias to threat is linked to anxiety disorders and anxiety vulnerability in both children and adults. However, there is a lack of developmental evidence regarding the causal mechanisms through which attention bias to threat might convey risks for socioemotional problems, such as anxiety. Gaining insights into this question demands longitudinal research to track the complex interplay between threat-related attention and socioemotional functioning. Developing and implementing reliable and valid assessments tools is essential to this line of work. This review presents theoretical accounts and empirical evidence from behavioral, eye-tracking, and neural assessments of attention to discuss our current understanding of the development of normative threat-related attention in infancy, as well as maladaptive threat-related attention patterns that may be associated with the development of anxiety. This review highlights the importance of measuring threat-related attention using multiple attention paradigms at multiple levels of analysis. In order to understand if and how threat-related attention bias in real-life, social interactive contexts can predict socioemotional development outcomes, this review proposes that future research cannot solely rely on screen-based paradigms but needs to extend the assessment of threat-related attention to naturalistic settings. Mobile eye-tracking technology provides an effective tool for capturing threat-related attention processes in vivo as children navigate fear-eliciting environments and may help us uncover more proximal bio-psycho-behavioral markers of anxiety.

Subclinically Anxious Adolescents Do Not Display Attention Biases When Processing Emotional Faces - An Eye-Tracking Study

Recent research suggests that early difficulties with emotion regulation go along with an increased risk for developing psychiatric disorders, such as anxiety disorders for example. Adolescent anxiety is often referred to as a gateway disorder, due to its high predictability for lifelong persistent mental health problems. It has been shown that clinically anxious adolescents exhibit attention biases toward negative stimuli, yet whether these biases can also be found in the subclinical range of subclinically anxious adolescents is currently unclear. In this study, we set out to investigate this question by combining an emotional Go-Nogo task with eye-tracking techniques to assess attention biases for emotional faces in a subclinical sample of 23 subclinically anxious adolescent girls. This combined approach allowed us to look at both, behavioral and covert attention biases. Using both traditional and Bayesian hypothesis testing, we found no evidence for a bias toward negative, threat-relevant stimuli in the behavioral level or eye-tracking data. We believe that the results can help close a gap in the current literature by showing that like low-anxious adolescents, subclinically anxious adolescents do not exhibit attention biases when viewing de-contextualized emotional stimuli in the Overlap task. Together with previous research findings in clinically anxious participants which have reported high levels of attention biases, our results seem to suggest that attention biases do no increase linearly as a function of individual anxiety level. Future research is now needed to explore the contribution of additional factors, such as depression for example.

Children with social anxiety disorder show blunted pupillary reactivity and altered eye contact processing in response to emotional faces: Insights from pupillometry and eye movements

Cognitive models and adult research associate social anxiety disorder (SAD) with hypervigilant-avoidant processing of social information, such as eye contact. However, processing biases in childhood SAD remain mostly unexplored. We examined 10- to 13-year-old children's eye contact processing and pupil dilation in response to happy, neutral, and angry faces in three groups: SAD (n = 31), mixed anxiety disorders (MAD; n = 30), and healthy controls (HC; n = 32). Compared to HC, SAD children showed faster first fixations on the eye region of neutral faces and shorter first fixation durations on the eye region of all faces. No differences between the two clinical groups emerged in eye movement results. SAD girls showed reduced pupil dilation in response to happy and angry faces compared to MAD and to happy faces compared to HC. SAD boys showed reduced pupil dilation in response to neutral faces compared to HC. Dimensionally, reduced pupil dilation was linked to social anxiety severity while eye movements were correlated with mixed anxiety and depressive severity. Results suggest that hypervigilant-avoidant eye contact processing and a blunted pupillary reactivity characterize children with SAD. Both transdiagnostic and disorder-specific processing biases are relevant for the understanding of childhood SAD.

Relations of emotion-related temperamental characteristics to attentional biases and social functioning

The current study examined whether an important temperamental characteristic, effortful control (EC), moderates the associations between dispositional anger and sadness, attention biases, and social functioning in a group of preschool-aged children (N = 77). Preschoolers' attentional biases toward angry and sad facial expressions were assessed using eye-tracking, and we obtained teachers' reports of children's temperament and social functioning. Associations of dispositional anger and sadness with time looking at relevant negative emotional stimuli were moderated by children's EC, but relations between time looking at emotional faces and indicators of social functioning, for the most part, were direct and not moderated by EC. In particular, time looking at angry faces (and low EC) predicted high levels of aggressive behaviors, whereas longer time looking at sad faces (and high EC) predicted higher social competence. Finally, latency to detect angry faces predicted aggressive behavior under conditions of average and low levels of EC. Findings are discussed in terms of the importance of differentiating between components of attention biases toward distinct negative emotions, and implications for attention training. (PsycINFO Database Record

Social content and emotional valence modulate gaze fixations in dynamic scenes

Previous research has shown that low-level visual features (i.e., low-level visual saliency) as well as socially relevant information predict gaze allocation in free viewing conditions. However, these studies mainly used static and highly controlled stimulus material, thus revealing little about the robustness of attentional processes across diverging situations. Secondly, the influence of affective stimulus characteristics on visual exploration patterns remains poorly understood. Participants in the present study freely viewed a set of naturalistic, contextually rich video clips from a variety of settings that were capable of eliciting different moods. Using recordings of eye movements, we quantified to what degree social information, emotional valence and low-level visual features influenced gaze allocation using generalized linear mixed models. We found substantial and similarly large regression weights for low-level saliency and social information, affirming the importance of both predictor classes under ecologically more valid dynamic stimulation conditions. Differences in predictor strength between individuals were large and highly stable across videos. Additionally, low-level saliency was less important for fixation selection in videos containing persons than in videos not containing persons, and less important for videos perceived as negative. We discuss the generalizability of these findings and the feasibility of applying this research paradigm to patient groups.

Canine companionship is associated with modification of attentional bias in posttraumatic stress disorder

Attentional bias towards aversive stimuli has been demonstrated in the anxiety disorders and in posttraumatic stress disorder, and attentional bias modification has been proposed as a candidate treatment. This study rigorously assessed attentional bias towards aversive and pleasant visual imagery associated with the presence or absence of a familiar service canine in 23 veterans with chronic military-related posttraumatic stress disorder. Participants were repeatedly tested with and without their service canines present on two tasks designed to elicit spontaneous visual attention to facial and scenic image pairs, respectively. Each stimulus contrasted an emotive image with a neutral image. Via eye-tracking, the difference in visual attention directed to each image was analyzed as a function of the valence contrast and presence/absence of the canine. Across both tasks, the presence of a familiar service canine attenuated the normative attentional bias towards aversive image content. In the facial task, presence of the service canine specifically reduced attention toward angry faces. In that task, as well, accumulated days with the service canine similarly modulated attention toward facial emotion. The results suggest that the presence of a familiar service canine is associated with attenuation of attentional bias to aversive stimuli in chronic military-service-related posttraumatic stress disorder. Questions remain regarding the generalization of such effects to other populations, their dependence on the familiarity, breed, and training of the canine, and on social context.

Gaze-Based Assessments of Vigilance and Avoidance in Social Anxiety: a Review

PURPOSE OF REVIEW

A broad base of research has sought to identify the biases in selective attention which characterize social anxiety, with the emergent use of eye tracking-based methods. This article seeks to provide a review of eye tracking studies examining selective attention biases in social anxiety.

RECENT FINDINGS

Across a number of contexts, social anxiety may be associated with a mix of both vigilant and avoidant patterns of attention with respect to the processing of emotional social stimuli. Socially anxious individuals may additionally avoid maintaining eye contact and may exhibit a generalized vigilance via hyperscanning of their environment. The findings highlight the utility of eye tracking methods for increasing understanding of the gaze-based biases which characterize social anxiety disorder, with promising avenues for future research.

Annual Research Review: An expanded account of information-processing mechanisms in risk for child and adolescent anxiety and depression

BACKGROUND

Anxiety and depression occurring during childhood and adolescence are common and costly. While early-emerging anxiety and depression can arise through a complex interplay of 'distal' factors such as genetic and environmental influences, temperamental characteristics and brain circuitry, the more proximal mechanisms that transfer risks on symptoms are poorly delineated. Information-processing biases, which differentiate youth with and without anxiety and/or depression, could act as proximal mechanisms that mediate more distal risks on symptoms. This article reviews the literature on information-processing biases, their associations with anxiety and depression symptoms in youth and with other distal risk factors, to provide direction for further research.

METHODS

Based on strategic searches of the literature, we consider how youth with and without anxiety and/or depression vary in how they deploy attention to social-affective stimuli, discriminate between threat and safety cues, retain memories of negative events and appraise ambiguous information. We discuss how these information-processing biases are similarly or differentially expressed on anxiety and depression and whether these biases are linked to genetic and environmental factors, temperamental characteristics and patterns of brain circuitry functioning implicated in anxiety and depression.

FINDINGS

Biases in attention and appraisal characterise both youth anxiety and depression but with some differences in how these are expressed for each symptom type. Difficulties in threat-safety cue discrimination characterise anxiety and are understudied in depression, while biases in the retrieval of negative and overgeneral memories have been observed in depression but are understudied in anxiety. Information-processing biases have been studied in relation to some distal factors but not systematically, so relationships remain inconclusive.

CONCLUSIONS

Biases in attention, threat-safety cue discrimination, memory and appraisal may characterise anxiety and/or depression risk. We discuss future research directions that can more systematically test whether these biases act as proximal mechanisms that mediate other distal risk factors.

Attention allocation and social worries predict interpretations of peer-related social cues in adolescents

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Across scenes, increasing social anxiety was associated with greater endorsement of negative interpretations.

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Greater attentional deployment to peers predicted increased endorsements of negative interpretations.

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Self-relevant scenes yielded more negative interpretations.

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Older adolescents selected more benign interpretations.

Adolescence is a sensitive period for increases in normative but also debilitating social fears and worries. As the interpretation of interpersonal cues is pertinent to social anxiety, investigating mechanisms that may underlie biases in social cue appraisal is important.

Fifty-one adolescents from the community aged 14–19 were presented with self- and other-relevant naturalistic social scenes for 5 s and then required to rate either a negative or a positive interpretation of the scene. Eye-tracking data were collected during the free viewing period to index attentional deployment. Individual differences in social worries were measured via self-report.

Social anxiety levels significantly predicted biases in interpretation ratings across scenes. Additionally, cumulative attentional deployment to peer cues also predicted these interpretation biases: participants who spent more time on facial displays perceived more threat, i.e. endorsed more negative and less positive interpretations. Self-relevant scenes yielded greater tendencies to draw negative interpretations. Finally, older adolescents also selected more benign interpretations.

Social anxiety is associated with a bias in interpreting social cues; a cognitive bias that is also influenced by attentional deployment. This study contributes to our understanding of the possible attention mechanisms that shape cognitions relevant to social anxiety in this at-risk age group.

Sustained visual attention for competing emotional stimuli in social anxiety: An eye tracking study

BACKGROUND AND OBJECTIVES

Numerous studies have supported attentional biases toward social threats in socially anxious individuals. The aim of the present study was to investigate the time-course of sustained attention for multiple emotional stimuli using a free-viewing paradigm in social anxiety.

METHODS

Thirty-two socially anxious (SA) and 30 non-anxious (NA) participants completed the free-viewing task. Participants were presented with a face array composed of angry, sad, happy and neutral faces for 10 s in each trial. Eye movements were recorded throughout the trial to assess the time-course of attentional processing.

RESULTS

Although SA participants did not exhibit initial orienting bias, they had higher fixation probability for angry faces during the 250-1000 ms time intervals, relative to NA participants. SA participants also maintained their attention longer than NA participants did when angry faces were initially fixated upon. Moreover, NA participants showed higher fixation probability for happy faces during the 6-8 s after stimulus onset. We failed to observe attentional avoidance of threat in SA participants.

LIMITATIONS

First, this study used a non-clinical sample. Second, the stimuli used in this study were static.

CONCLUSIONS

The present findings suggest that, relative to non-anxious individuals, socially anxious individuals are characterized by enhanced engagement with social threat at an early stage of processing and difficulty in disengaging from social threat once their initial attention is located on it. Conversely, non-anxious individuals are characterized by enhanced engagement with positive stimuli at a later stage of processing.

Stimulus-Driven Attention, Threat Bias, and Sad Bias in Youth with a History of an Anxiety Disorder or Depression

Attention biases towards threatening and sad stimuli are associated with pediatric anxiety and depression, respectively. The basic cognitive mechanisms associated with attention biases in youth, however, remain unclear. Here, we tested the hypothesis that threat bias (selective attention for threatening versus neutral stimuli) but not sad bias relies on stimulus-driven attention. We collected measures of stimulus-driven attention, threat bias, sad bias, and current clinical symptoms in youth with a history of an anxiety disorder and/or depression (ANX/DEP; n = 40) as well as healthy controls (HC; n = 33). Stimulus-driven attention was measured with a non-emotional spatial orienting task, while threat bias and sad bias were measured at a short time interval (150 ms) with a spatial orienting task using emotional faces and at a longer time interval (500 ms) using a dot-probe task. In ANX/DEP but not HC, early attention bias towards threat was negatively correlated with later attention bias to threat, suggesting that early threat vigilance was associated with later threat avoidance. Across all subjects, stimulus-driven orienting was not correlated with early threat bias but was negatively correlated with later threat bias, indicating that rapid stimulus-driven orienting is linked to later threat avoidance. No parallel relationships were detected for sad bias. Current symptoms of depression but not anxiety were related to decreased stimulus-driven attention. Together, these results are consistent with the hypothesis that threat bias but not sad bias relies on stimulus-driven attention. These results inform the design of attention bias modification programs that aim to reverse threat biases and reduce symptoms associated with pediatric anxiety and depression.

Anxiety and Attentional Bias in Preschool-Aged Children: An Eyetracking Study

Extensive research has examined attentional bias for threat in anxious adults and school-aged children but it is unclear when this anxiety-related bias is first established. This study uses eyetracking technology to assess attentional bias in a sample of 83 children aged 3 or 4 years. Of these, 37 (19 female) met criteria for an anxiety disorder and 46 (30 female) did not. Gaze was recorded during a free-viewing task with angry-neutral face pairs presented for 1250 ms. There was no indication of between-group differences in threat bias, with both anxious and non-anxious groups showing vigilance for angry faces as well as longer dwell times to angry over neutral faces. Importantly, however, the anxious participants spent significantly less time looking at the faces overall, when compared to the non-anxious group. The results suggest that both anxious and non-anxious preschool-aged children preferentially attend to threat but that anxious children may be more avoidant of faces than non-anxious children.

Attentional mechanisms of social perception are biased in social phobia

Previous studies of social phobia have reported an increased vigilance to social threat cues but also an avoidance of socially relevant stimuli such as eye gaze. The primary aim of this study was to examine attentional mechanisms relevant for perceiving social cues by means of abnormalities in scanning of facial features in patients with social phobia. In two novel experimental paradigms, patients with social phobia and healthy controls matched on age, gender and education were compared regarding their gazing behavior towards facial cues. The first experiment was an emotion classification paradigm which allowed for differentiating reflexive attentional shifts from sustained attention towards diagnostically relevant facial features. In the second experiment, attentional orienting by gaze direction was assessed in a gaze-cueing paradigm in which non-predictive gaze cues shifted attention towards or away from subsequently presented targets. We found that patients as compared to controls reflexively oriented their attention more frequently towards the eyes of emotional faces in the emotion classification paradigm. This initial hypervigilance for the eye region was observed at very early attentional stages when faces were presented for 150ms, and persisted when facial stimuli were shown for 3s. Moreover, a delayed attentional orienting into the direction of eye gaze was observed in individuals with social phobia suggesting a differential time course of eye gaze processing in patients and controls. Our findings suggest that basic mechanisms of early attentional exploration of social cues are biased in social phobia and might contribute to the development and maintenance of the disorder.

Threats, rewards, and attention deployment in anxious youth and adults: An eye tracking study

The current study examines anxiety and age associations with attention allocation and physiological response to threats and rewards. Twenty-two healthy-adults, 20 anxious-adults, 26 healthy-youth, and 19 anxious-youth completed two eye-tracking tasks. In the Visual Scene Task (VST), participants' fixations were recorded while they viewed a central neutral image flanked by two threatening or two rewarding stimuli. In the Negative Words Task (NWT), physiological response was measured by means of pupil diameter change while negative and neutral words were presented. For both tasks, no interaction was found between anxiety and age-group. In the VST, anxious participants avoided the threatening images when groups were collapsed across age. Similarly, adults but not adolescents avoided the threatening images when collapsed across anxiety. No differences were found for rewarding images. In NWT, all subjects demonstrated increase in pupil dilation after word presentation. Only main effect of age emerged with stronger pupil dilation in adults than children. Finally, maximum pupil change was correlated with threat avoidance bias in the scene task. Gaze patterns and pupil dilation show that anxiety and age are associated with attention allocation to threats. The relations between attention and autonomic arousal point to a complex interaction between bottom-up and top-down processes as they relate to attention allocation.