A promising treatment for Social Anxiety Disorder? Let’s see what is known about it.
Although there are multiple theories, today there is still no clear and universal definition of the concept of care. However, what is known with absolute certainty is that this basic cognitive process is of paramount importance in the origin and maintenance of mental disorders and, in particular, in anxiety disorders.
In the following lines we will expose the repercussion that the Attention Bias Modification technique is having, a new attentional psychological technique designed for the treatment of social anxiety disorder or social phobia.
The care and treatment of mental disorders
As Shechner et al. (2012), attention is a basic process that encompasses different cognitive functions that allow the brain to prioritize the processing of certain information. The fact of attending or not to certain stimuli or information can affect the development of the person, since attention is the basis of memory and learning. You can only learn and memorize experiences towards which you are attending.
According to the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders), social phobia is characterized by “intense fear or anxiety in one or more social situations in which the individual is exposed to possible examination by other people” .
The person is afraid of behaving in a certain way that can be negatively valued by those around him. In other words, she is afraid of being judged by others and of being rejected for her performance in a situation that involves several people. These situations can range from giving a talk to a large audience, to having a simple conversation with someone you know.
Najmi, Kuckertz and Amir (2011), showed that people with anxiety selectively attend to elements of the environment that they consider threatening, ceasing to attend to the rest of the environment, in which they could find neutral or positive elements. This attentional bias often generates wrong value judgments that result in increased anxiety and long-term persistence of the disorder.
For example, if a person with social anxiety disorder were giving an oral presentation to an audience of 20 people, although 16 people were paying attention to the presentation and showing interest, if one person was yawning, another was playing with the mobile and others two talking to each other, the speaker would only look at these last actions, interpreting that their execution is being catastrophic and boring, leading to an increase in anxiety and, therefore, an increase in the probability of making mistakes and worsening their execution of truth, accompanied by a greater persistence of fear of public speaking in the future.
On the contrary, if the person did not suffer from social anxiety, possibly the behavior of these four individuals would go unnoticed, and he would interpret it as lack of sleep and / or interest in the subject of those people in particular and not because of his own execution.
Modification of attentional bias
In this context, Amir et al. (2009) created a virtual technique in order to correct this attentional bias. The patient is instructed to stand in front of a computer and determine the appearance of the letters “e” or “f” as quickly as possible and trying not to make mistakes using the mouse (“e” left button, “f” right button ) during multiple trials.
The key is that, during all attempts, before the appearance of the letter, two images of faces are presented : a face with a neutral expression and a face with an expression of disgust or rejection. In 80% of the attempts, the letter “e” or “f” always appears where moments before the neutral face was located. In this way, even if an explicit order is not given not to attend to the faces of rejection, the person unconsciously learns not to pay attention to the stimuli that they fear.
Despite the simplicity of the technique, these authors achieved, in 8 sessions of 20 minutes over 4 weeks, that 50% of patients with social phobia reduced both the symptoms and not being able to be diagnosed according to the DSM criteria. Other authors such as Boettcher et al. (2013) and Schmidt et al. (2009) obtained similar results in their experiments.
This technique is not without controversy
According to Amir, Elias, Klumpp and Przeworski (2003), the true bias in anxiety disorders, and specifically social anxiety, is not being hypervigilant in the face of threatening stimuli (rejecting faces) – since detecting those things that can potentially harm us is a bias that all humans share and that has helped us survive for thousands of years – but once these threats are detected, they cannot be ignored by the person.
Therefore, the bias that causes the persistence of the disorder is the impossibility of “disengaging” the attention from the threat, and the modification of the attention bias would act to eliminate this impossibility.
However, recent evidence suggests that the picture is much more complicated than it might initially appear. Klump and Amir (2010) found that designing the task to attend to threatening faces instead of neutral ones also produces a decrease in anxiety. Yao, Yu, Qian and Li (2015) performed the same experiment, but using geometric figures instead of emotional stimuli, and they also observed a decrease in subjective distress of the participants.
Cudeiro (2016) tried to measure attentional hooking bias through an experimental eye movement paradigm and did not obtain conclusive evidence that the bias actually existed or at least could be measured empirically.
Ultimately, it is still not clear what or what are the mechanisms of action underlying this technique. Future research will have to be directed at replicating efficacy studies and determining these possible mechanisms of action.
- Amir, N., Elias, J., Klumpp, H. and Przeworski, A. (2003). Attentional bias to threat in social phobia: facilitated processing of threat or difficulty disengaging attention from threat? Behavior research and therapy, 41 (11), 1325-1335.
- Amir, N., Beard, C., Taylor, CT, Klumpp, H., Elias, J., Burns, M. and Chen, X. (2009). Attention training in individuals with generalized social phobia: A randomized controlled trial. Journal of consulting and clinical psychology, 77 (5), 961-973.
- Boettcher, J., Leek, L., Matson, L., Holmes, EA, Browning, M., MacLeod, C., … and Carlbring, P. (2013). Internet-based attention bias modification for social anxiety: a randomized controlled comparison of training towards negative and training towards positive cues. PLoS One, 8 (9), e71760. doi: 10.1371 / journal.pone.0071760.
- Cudeiro González, JA (2016). Modification of attentional bias in anxiety disorders: an approach to explanatory mechanisms. Minerva, 1-40
- Klumpp, H. and Amir, N. (2010). Preliminary study of attention training to threat and neutral faces on anxious reactivity to a social stressor in social anxiety. Cognitive Therapy and Research, 34 (3), 263-271.
- Schmidt, NB, Richey, JA, Buckner, JD and Timpano, KR (2009). Attention training for generalized social anxiety disorder. Journal of abnormal psychology, 118 (1), 5-14.
- Shechner, T., Britton, JC, Pérez-Edgar, K., Bar-Haim, Y., Ernst, M., Fox, NA, … and Pine, DS (2012). Attention biases, anxiety, and development: toward or away from threats or rewards ?. Depression and anxiety, 29 (4), 282-294.