Accepted Manuscript

Title: The contribution of attentional bias to worry:

Distinguishing the roles of selective engagement and
disengagement

Authors: Colette R. Hirsch, Colin MacLeod, Andrew

Mathews, Oneet Sandher, Amruti Siyani, Sarra Hayes

PII: S0887-6185(10)00195-7
DOI: doi:10.1016/j.janxdis.2010.09.013
Reference: ANXDIS 1204

To appear in: Journal of Anxiety Disorders

Received date: 5-7-2010

Revised date: 16-9-2010
Accepted date: 25-9-2010

Please cite this article as: Hirsch, C. R., MacLeod, C., Mathews, A., Sandher, O.,
Siyani, A., & Hayes, S., The contribution of attentional bias to worry: Distinguishing
the roles of selective engagement and disengagement, Journal of Anxiety Disorders
(2010), doi:10.1016/j.janxdis.2010.09.013

This is a PDF file of an unedited manuscript that has been accepted for publication.
As a service to our customers we are providing this early version of the manuscript.
The manuscript will undergo copyediting, typesetting, and review of the resulting proof
before it is published in its final form. Please note that during the production process
errors may be discovered which could affect the content, and all legal disclaimers that
apply to the journal pertain.
*Research Highlights

* Two variants of a novel attention modification paradigm were developed

* Attention to threat meaning was modified rather than just its location

* One variant modified attentional engagement and the other

disengagement from threat

t
* Only attentional engagement training significantly influenced worry

ip
* Attentional engagement with threat meanings may causally contribute to

cr
worry

us
an
M
ed
pt
ce
Ac

Page 1 of 25
 Attentional engagement and disengagement modification: Effects on worry 1

Running Head: ATTENTIONAL ENGAGEMENT AND DISENGAGEMENT

MODIFICATION: EFFECTS ON WORRY

t
ip
The contribution of attentional bias to worry: Distinguishing

cr
the roles of selective engagement and disengagement.

us
an
Colette R. Hirsch a*, Colin MacLeod b, Andrew Mathews c, Oneet Sandher d, Amruti Siyani d,
M
& Sarra Hayes d
d

a
King‟s College London, Institute of Psychiatry, UK; and University of Western Australia,
te

Australia.
b
p

University of Western Australia, Australia.

c
University of California, Davis, USA.
ce

d
King‟s College London, Institute of Psychiatry, UK.
Ac

* Author for correspondence: Dr. Colette Hirsch, PO 77, King‟s College London, Institute of

Psychiatry, De Crespigny Park, London, SE5 8AF, U.K. Tel: +442078480697; Fax:

+442078485006; Email: colette.hirsch@kcl.ac.uk

Page 2 of 25
 Attentional engagement and disengagement modification: Effects on worry 2

Abstract

This study investigated the effect on worry of biased attentional engagement and disengagement.

Variants of a novel attention modification paradigm were developed, designed to induce a group

t
difference either in participants‟ tendency to selectively engage with, or disengage from,

ip
threatening meanings. An index of threat bias, reflecting relative speeding to process threat word

cr
compared to non-threat word content, confirmed that both procedures were effective in inducing

us
differential attentional bias. Importantly, when the induced group difference in attentional bias

followed the procedure designed to influence selective engagement with threat meanings, it also

an
gave rise to a corresponding group difference in worry. This was not the case when it was

induced by the procedure designed to influence selective disengagement from threat meanings.
M
These findings suggest that facilitated attentional engagement with threat meanings may causally

contribute to variability in worry.

d
te

Keywords: attention; attentional engagement; attentional disengagement; worry; cognitive bias

p

modification; anxiety.
ce
Ac

Page 3 of 25
 Attentional engagement and disengagement modification: Effects on worry 3

1. Introduction

Worry is a central cognitive symptom of anxiety observed across many anxiety disorders, and

uncontrollable worry is the key defining feature of generalised anxiety disorder (GAD; American

Psychiatric Association, 1994). Heightened anxiety vulnerability is characterised by a selective

t
ip
attentional bias favouring threatening information, which some clinical theorists contend makes a

causal contribution to anxiety symptomology, such as excessive worry (cf. Mathews & MacLeod,

cr
1994; 2005). This attentional bias has been demonstrated using a range of different tasks,

us
including the emotional Stroop task (cf., Williams et al., 1997), and the dot-probe task (e.g.,

MacLeod, Mathews & Tata, 1986; MacLeod & Mathews, 1988; Mogg, Mathews, & Eysenck,

1992).

an
There has been recent debate concerning whether elevated anxiety vulnerability reflects
M
facilitated attentional engagement with, or impaired subsequent disengagement from, threatening
d

information. Some evidence suggests that such vulnerability is associated with speeded
te

attentional engagement with the locus of threatening information (Koster, Crombes, Verschuere,

Damme, & Wiersema, 2006; Garner, Mogg & Bradley, 2006). However, there also is evidence
p

that it is associated with a slowing to disengage attention from the locus of such information
ce

(Fox, Russo, Bowles & Dutton, 2001; Yiend & Mathews, 2001; Amir, Elias, Klumpp &
Ac

Przeworski, 2003; Koster, Crombez, Verschuere, & De Houwer, 2004; Salemink, van den Hout

& Kindt, 2007). On occasions, researchers have found evidence of both attentional effects in

anxious participants (Mathews, Fox, Yiend & Calder, 2003). While this suggests that facilitated

engagement with threat, and impaired disengagement from threat, may both be associated with

anxiety vulnerability, such findings do not reveal whether the engagement bias, the

disengagement bias, or both, contribute causally to anxiety symptoms such as worry.

Page 4 of 25
 Attentional engagement and disengagement modification: Effects on worry 4

Though not resolving this specific issue, the recent use of cognitive bias modification

procedures has established that biased attention does contribute to worry. Recent studies using

moderate and high level worriers (Krebs, Hirsch, & Mathews, 2010; Hayes, Hirsch, & Mathews,

2010) employed an attention modification approach, based on that introduced by MacLeod,

t
ip
Rutherford, Campbell, Ebsworthy and Holker (2002), to demonstrate that attentional bias

causally impacts on worry. For example, Hayes et al (2010) randomly assigned high worriers to

cr
either a training condition in which they repeatedly directed their attention away from the source

us
of worry-related information and towards benign information, or to a control condition not

designed to modify attention. This procedure served to induce a group difference in attentional

an
bias, such that the former participants came to display significantly less evidence of selective

attention to threat than did the latter. All participants then reported on thought intrusions while
M
focusing on their breathing, before and after an instructed worry period (Borkovec, Robinson,
d

Pruzinsky, & De Pree, 1983; Ruscio & Borkovec, 2004). Again a significant group difference
te

was evident, with those individuals exposed to benign attentional training reporting less negative

thought intrusions than control participants.

p

While these findings suggest that attentional bias makes a causal contribution to worry,
ce

they do not reveal whether it is enhanced attentional engagement with threat, impaired attentional
Ac

disengagement from threat, or both, that exerts this causal impact. To address this issue, it would

be necessary to examine whether inducing a group difference in attentional engagement with

threat, or inducing a group difference in attentional disengagement from threat, each serve to

produce a corresponding group difference in negative thought intrusions, during a subsequent

worry assessment task.

It is important to note that attention to the spatial locus of a threat stimulus is not

necessarily the same as attention to the threatening meaning of this stimulus, and it is selective

Page 5 of 25
 Attentional engagement and disengagement modification: Effects on worry 5

attention to threat meanings that is assumed to be the critical causal factor in anxiety. Moving

attention toward a given spatial locus does not ensure the semantic processing of stimuli in that

region, just as moving attention away from a previously attended spatial locus does not preclude

the continued semantic processing of information presented there. For example, non-anxious

t
ip
individuals may avoid focusing on the threatening meaning of a spatially-attended stimulus,

while anxious individuals may not only process the threat meaning but continue to focus on it

cr
even after shifting attention away from the stimulus location. In this way, an external threat cue

us
could trigger worry, involving attention to internally-maintained threatening meanings, which

then continues long after disengagement from the location of the original cue.

an
To determine the contribution to worry made by biased attention to threat meanings, a

methodology is required that can influence the ease with which attention can be shifted
M
selectively towards or away from processing threatening meanings. In the present study, this was
d

achieved using a novel procedure that required participants to switch between two different types
te

of decision concerning the same stimulus word; an affective decision requiring semantic access

(good or bad?), and a non-semantic structural decision (upper or lower case letters?).
p

By employing two alternative variants of this procedure, we sought to induce a group

ce

difference in selective attention to threat in either one of two quite different ways. One approach
Ac

was designed to induce such a difference through training biased selective attentional

engagement with threat meanings. This involved participants repeatedly switching from

structural to affective decisions for one particular valence of stimuli, with some participants being

required to consistently make this switch only for threat words (to encourage selective

engagement with threat meanings), and others being required to consistently make this switch

only for non-threat words (to discourage selective engagement with threat meanings). The other

approach was designed to induce a group difference in selective attention to threat through

Page 6 of 25
 Attentional engagement and disengagement modification: Effects on worry 6

training biased attentional disengagement from threat meanings. This involved participants

repeatedly switching from affective to structural decisions for one particular valence of stimuli,

with some participants being required to consistently make this switch only for threat words (to

encourage selective disengagement from threat meanings), and others being required to

t
ip
consistently make the switch only for non-threat words (to discourage selective disengagement

from threat meanings).

cr
If group differences in attention to threat can be successfully induced in each of these two

us
ways then, by comparing such groups in terms of subsequently reported negative thought

intrusions, it will be possible to determine whether differential attentional engagement with

an
threat, and/or differential attentional disengagement from threat, causally contribute to

differential worry.
M
2. Method
d

2.1 Design
te

The study involved two consecutive phases: an attentional bias induction phase and a
p

worry assessment phase. Participants were assigned at random either to a training procedure
ce

designed to induce a group difference in engagement bias, or to a training procedure designed to

induce a group difference in disengagement bias. In each case, half the participants were exposed
Ac

to a condition intended either to encourage, or to discourage, the selective processing of

threatening meanings. Thus, participants were randomly allocated to one of the four attentional

bias induction conditions: (1) increase threat processing by encouraging selective engagement

with threat meanings; (2) increase threat processing by discouraging selective disengagement

from threat meanings; (3) decrease threat processing by discouraging selective engagement with

threat meanings; or (4) decrease threat processing by encouraging selective disengagement from

Page 7 of 25
 Attentional engagement and disengagement modification: Effects on worry 7

threat meanings. In all cases, participants were required to make two consecutive decisions about

each target word, either concerning its structure (i.e. upper or lower case of the letters) or its

semantic content (affective valence), but these decisions varied according to attentional bias

induction condition (see Table 1).

t
ip
Following the attention bias induction phase, all participants completed Hayes et al.‟s

(2010) worry task, which involved categorising the valence of thought intrusions that occurred

cr
before and after an instructed worry period. Participants subsequently provided expanded

us
descriptions of these thought intrusions, enabling an assessor, who was not informed of group

allocation, to categorise their valence.

2.2 Participants

an
Sixty-four student participants were selected based on their scores on the Penn State
M
Worry Questionnaire (PSWQ; Meyer, Miller, Metzger, & Borkovec, 1990). Due to the concern
d

that inducing selective attention to threat meanings might have adverse effects on very high trait
te

worriers, only participants who scored 55 or below on the PSWQ were invited to take part in the

study (Molina & Borkovec, 1994). Of the 64 volunteers, 16 were randomly allocated to each of
p

the following training conditions: i. encourage selective engagement with threat meanings (3
ce

males and 13 females); ii. discourage selective disengagement from threat meanings (9 males and
Ac

7 females); iii. discourage selective engagement with threat meanings (7 males and 9 females);

and iv. encourage selective disengagement from threat meanings (4 males and 12 females). Note

that conditions i and ii both are designed to induce attentional bias that favours the processing of

threat meanings, while conditions iii and iv instead are designed to induce attentional bias that

compromises processing of threat meanings. The ratio of males to females selected for each

group did not significantly differ, χ²(3, N=64)=6.18, ns. Groups also did not differ significantly in

scores on the PSWQ (M=41.7; SD=7.3; F(3, 60)=2.20, ns.) or State-Trait Anxiety Inventory Trait

Page 8 of 25
 Attentional engagement and disengagement modification: Effects on worry 8

version (STAI-T; Spielberger, Gorsuch, Lushene, Vagg, & Jacobs, 1983; M=39.3; SD=5.9; F<1).

Average age was 19.5 (SD=2.7), with no significant age difference between groups, F<1.

2.3Materials

2.3.1. Experimental stimuli. A set of 96 words (48 threat and 48 non-threat) was selected from an

t
ip
initial pool of 377 words, based on ratings provided by ten independent judges. These judges

rated each item on a 7-point scale (1=very positive, 7=very negative). The threat words selected

cr
for use all had a mean rating above 6.00 (M=6.44, SD=0.70), while the non-threat words all had a

us
mean rating below 3.00 (M=1.76, SD=0.77). Of the final set of 96 words, 64 were assigned to

attention modification trials and 32 to test trials.

2.3.2 Emotional Assessment Instruments.

an
Trait worry level was measured using the Penn State

Worry Questionnaire (PSWQ; Meyer et al., 1990), a 16-item measure consisting of statements
M
about worry (e.g., “Once I start worrying, I can‟t stop”), each with a 5-point answer scale ranging
d

from 1 (not at all typical of me) to 5 (very typical of me) yielding a total score ranging from 16 to
te

80, with higher scores indicating greater worry levels. The PSWQ has good psychometric

properties in student, community, and clinical samples, with studies reporting high internal
p

consistency, short-term retest reliability, and convergent and criterion related validity (Brown,
ce

Antony, & Barlow, 1992; Davey, 1993).

Ac

Trait anxiety was measured using the State-Trait Anxiety Inventory (STAI-T; Spielberger,

et al., 1983), consisting of 20 anxiety symptoms that participants rate for frequency of

occurrence. Scores range between 20 and 80, with a higher score indicating greater anxiety. The

STAI-T has good internal consistency (.89) and test-retest reliability (.88; Barnes, Harp, & Jung,

2002).

2.3.3 Attentional bias induction tasks. These tasks required participants to switch attention

between the structure and the semantic content of words, by making two sequential decisions

Page 9 of 25
 Attentional engagement and disengagement modification: Effects on worry 9

about every word relating either to the form of the letters in which it was written (i.e. whether the

word was presented in “big letters”/ “upper case” or “small letters”/ “lower case”), or to its

emotional meaning (i.e. whether the word was “positive”/ “good” or “negative”/ “bad” in

meaning)1.

t
ip
On each trial a fixation cross appeared in the centre of the screen for 1500 ms, after which

the first question appeared (e.g., „Big?‟). After 1000 ms this was replaced by a target word (e.g.,

cr
CANCER) that appeared for 400 ms. Participants were instructed to quickly answer the first

us
question correctly, by pressing the corresponding “y” (yes) or “n” (no) key. Incorrect responses

were signaled by a short error tone. Immediately following registration of the participant‟s

an
response, the second question about the word appeared (e.g., „Positive?‟). The next trial

commenced 1500 ms after the participant responded to the second question.

M
The exact sequence of events within trials varied according to participant group (see Table
d

1 for a summary of the different bias induction conditions). Half the participants were exposed to
te

a procedure designed to induce a group difference in selective attentional engagement with threat

meanings. For these participants the first decision always concerned the structure of the word, to
p

ensure that initially attention was focused on this non-semantic aspect of the stimulus. The
ce

participant then was immediately required to make a second judgment about the stimulus, which
Ac

could concern either structure again, or semantic content. For the subset of such participants

exposed to the condition designed to encourage selective engagement with threat meanings, this

second decision always concerned valence when the target word was threatening, and structure

when it was non-threatening. Thus, making this second decision required these participants to

move attention from stimulus structure to selectively engage with the meanings of threatening,

1
Two sets of labels were used for each question type, such that two sequential questions concerning structure (or
valence) always differed even if they related to the same concept (e.g., “big letters?” followed by “upper case?”, or
“positive?” followed by “good?”).

Page 10 of 25
 Attentional engagement and disengagement modification: Effects on worry 10

but not non-threatening words. For the other subset of such participants, who were exposed to the

condition designed to discourage selective engagement with threat meanings, the second decision

always concerned valence when the target word was non-threatening, and structure when it was

threatening. Thus, making this second decision required these participants to move attention from

t
ip
stimulus structure to selectively engage with the meanings of non-threatening, but not threatening

words.

cr
The remaining participants were assigned to a procedure designed to induce a group

us
difference in selective attentional disengagement from threat meanings. These participants always

were required to make their first decision about the valence of each word, to ensure that attention

an
was initially focused on stimulus meaning. For the subset exposed to the condition designed to

discourage selective disengagement from threat meanings, the second decision always concerned
M
stimulus valence when the word was threatening, and structure when the word was non-
d

threatening. Thus, making this second decision required selective disengagement from the
te

content of non-threatening words, but not from the content of threat words. Finally, for those

participants exposed to the condition designed to encourage selective disengagement from threat
p

meanings, the second decision concerned structure when the word was threatening, and valence
ce

when the word was non-threatening. Thus, making this second decision required these
Ac

participants to selectively disengage attention from the content of threat words, but not from the

content of non-threatening words.

The task delivered a total of 256 attention bias induction trials, across four consecutive

blocks of 64 such trials, with each word presented once per block in random order. Participants

were offered a rest break after each block. Participants also completed 32 attentional bias

assessment trials, 16 using new threat words and 16 using new non-threat words. In these

assessment trials, although the first decision about each stimulus was of the type required in the

Page 11 of 25
 Attentional engagement and disengagement modification: Effects on worry 11

bias induction trials completed by the participant, the second decision always concerned stimulus

valence. The degree to which participants were relatively faster to make this content decision on

threat words, compared to non-threat words, on these assessment trials, provided an index of

attentional preference for threat meanings. This made it possible to determine whether the bias

t
ip
induction procedures did induce a group differences in attentional bias.

2.4 Filler task

cr
The Speed of Comprehension Test (Version A; Baddeley, Emslie, & Nimmo-Smith, 1992)

us
was administered as a filler to reduce the likelihood of differences in mood prior to the worry

task. Participants decided whether 100 sentences were true or false for two minutes. To minimize

an
anxiety instructions emphasized that speed was not important.

2.5 Worry task

M
This task was based on that adopted by Hayes, et al. (2010), itself based on the method
d

developed by Borkovec, et al. (1983). There were three phases: a 5 minute pre-worry induction
te

breathing focus period, which assessed tendency to worry prior to its active experimental

induction; a 5 minute period of worrying; and a further 5 minute post-worry induction breathing
p

focus period, which assessed the persistence of the induced worry. During each breathing focus
ce

period participants were instructed to focus their attention on their breathing. Twelve tones were
Ac

presented at random intervals of 20-30 seconds (Donaldson, 2004), signaling participants to

report if their attention was focused on their breathing, or if they were experiencing a thought

intrusion. If the latter, they indicated whether it was positive, benign, or negative, and provided a

brief description (e.g., “positive – going on holiday”).

After the pre-worry breathing focus period, participants identified a current worry topic

which was discussed briefly with the experimenter to ensure that it was related to a potentially

negative future situation. They were then asked to continue to silently worry about this topic for 5

Page 12 of 25
 Attentional engagement and disengagement modification: Effects on worry 12

minutes, and the experimenter left the room. After 5 minutes the experimenter returned and the

post-worry breathing focus period was completed.

Finally, participants were asked to expand on the thought intrusions reported during the

breathing focus periods. For each intrusion, the experimenter read aloud the participant‟s

t
ip
summary, and asked them to describe what was going through their minds at the moment they

originally had that thought. Descriptions were recorded for later rating by a psychologist, who

cr
assessed the valence of each intrusion. To assess reliability, a psychology student also rated 16

us
participants‟ thought expansions. Neither assessor was informed about group allocation, nor

when the intrusion occurred. Inter-rater reliability for assessors‟ valence ratings using Cohen‟s

Kappa statistic (k) was 0.89.

2.6 Procedure an
M
Participants initially completed the PSWQ and STAI-T. After instructions and 16
d

practice trials, the attentional bias induction task was administered. This was followed by
te

the filler task. Participants then received instructions for the worry task, practiced

focusing on their breathing and providing a capsule summary of their thoughts at three
p

random time intervals within 45 seconds. When it was clear that all instructions were
ce

understood, participants were administered the worry task. Finally participants were
Ac

debriefed and paid £15 ($22 USD) or given course credit.

3. Results

3.1 Data Analytic Plan. Data from the attentional bias induction task was first analyzed for

accuracy to determine if there were any group differences. Then the reaction time data from the

assessment trials were investigated in the following way. To determine whether the task was

successful in inducing differential attentional bias to threat as intended, the median response

Page 13 of 25
 Attentional engagement and disengagement modification: Effects on worry 13

latencies for the second (valence) decision were calculated for each participant. Then a threat bias

index was computed for each participant, reflecting relative speeding to make this content

decision on threat words compared to non-threat words (by subtracting median latency on threat

words from median latency on non-threat words). A higher score on this threat bias index reflects

t
ip
the facilitated processing of threat word content relative to non-threat word content, consistent

with selective attentional bias to threatening information. The threat bias index was analyzed by

cr
examining the effects of Modification Type (Engagement vs. Disengagement) and Modification

us
Direction (Increase Threat Processing vs. Decrease Threat Processing) to determine whether the

targeted attentional biases had been induced. Finally the negative thought intrusion data was

an
analyzed to determine the effects of Modification Type and Modification Direction, Time (Pre-

vs. Post-Worry Induction) and Rater (Participant vs. Assessor).

M
3.2 Attentional bias induction task
d

3.2.1 Accuracy. Accurate responses to target words averaged 95.8% (SD=2.8) on training
te

trials, and 96.1% (SD=2.7) on assessment trials, with no significant difference in accuracy

between the four groups (F<1; F(3,63)=1.03, ns). Hence, any group differences on assessment
p

trials could not be attributed to differential speed-accuracy trade-offs.

ce

3.2.2 Assessment trials. A two-way ANOVA was carried out on these threat bias index
Ac

scores, that considered the between-group factors: Modification Type (Engagement vs.

Disengagement); and Modification Direction (Increase Threat Processing vs. Decrease Threat

Processing). See Table 2 for means and standard deviations. As expected, this analysis revealed a

significant main effect of Modification Direction, F(1,60)=15.52, p<.001, f²=0.50. This reflected

the fact that participants in the Decrease Threat Processing groups obtained lower threat bias

index scores than did those in the Increase Threat Processing groups (M= -130.64, SD=166.54,

vs. M= 42.92, SD= 184.71). Therefore, as intended, the bias induction procedure did indeed

Page 14 of 25
 Attentional engagement and disengagement modification: Effects on worry 14

appear to induce group differences in selective attention to threat meanings. Importantly,

Modification Type did not influence attentional bias index scores, either as a main effect

F(1,60)=1.34, ns., f²=0.15, or in an interaction involving Modification Direction, F<1. Hence the

procedures designed to induce a group difference in attentional bias through the manipulation of

t
ip
selective engagement with, and selective disengagement from, threat meanings were equally

effective in inducing such a group difference in attentional bias. Indeed, t-tests on threat bias

cr
index scores, revealed similar effects of Modification Direction, in terms of the resulting

us
magnitude of group difference in attentional bias, whether the induction procedure targeted

engagement bias (t(30)=2.96, p<.01, d=1.08) or disengagement bias (t(30)=2.60, p<.05, d=0.95).

3.3 Worry Task

an
The number of negative thought intrusions recorded during each breathing focus period,
M
as categorized by participants and assessor, are presented in Table 3. These data were analyzed in
d

a mixed-model ANOVA with two between-participants factors, Modification Type and

te

Modification Direction, and two repeated measures factors, Time (Pre- vs. Post-Worry Induction)

and Rater (Participant vs. Assessor). This analysis revealed a main effect of Time, F(1,60)=9.89,
p

p<.005, f²=0.40, with more negative thought intrusions Post- than Pre-Worry induction (M=1.95
ce

vs. M=1.35). There was also a main effect of Rater, F(1,30)=4.76, p<.05, f²=0.28, with
Ac

participants themselves identifying more negative thought intrusions than the assessor (M=1.76

vs. M=1.55). More critically, a significant interaction now was obtained between Modification

Type and Modification Direction, F(1,60)=5.15, p<.05, f²=0.29, which was the only other

significant effect to emerge from the analysis. This interaction was not further qualified by Time

(F(1,30)=1.12, ns.), suggesting that the impact of modifying attentional selectivity was not

restricted to the persistence of worry only after it was experimentally induced, but was equally

evident on the measure of tendency to worry taken prior to the experimental worry induction. Nor

Page 15 of 25
 Attentional engagement and disengagement modification: Effects on worry 15

was it modified by Rater (F<1), indicating that it did not reflect the impact of bias induction on

participants‟ criteria for classifying the valence of thought intrusions.

The interaction between Modification Type and Modification Direction was investigated

further. For participants exposed to the procedure designed to create a group difference in

t
ip
attentional bias through inducing discrepant patterns of selective disengagement from threat,

there was no effect of Modification Direction on negative thought intrusions, with a similar

cr
number of such negative intrusions being evidenced across the conditions designed to decrease or

us
to increase threat processing (M=1.92, SD=1.38, vs. M=1.67, SD=1.76 t<1). In contrast, for

participants exposed to the procedure designed to create differential attentional bias through

an
inducing discrepant patterns of selective engagement with threat, there was a strong effect of

Modification Direction on negative thought intrusions. Specifically, the condition designed to

M
decrease threat processing (discourage engagement with threat meanings) now led to fewer
d

negative intrusions than did the condition designed to increase threat processing (encourage
te

engagement with threat meanings; M=0.83, SD=0.62 vs. M=2.19, SD=1.63; t(30)=3.12, p<.01,

d=1.14). Thus, when the bias induction procedure served to induce a group difference in selective
p

attention to threat through a contingency designed to affect attentional engagement with threat,
ce

then it also served to create a corresponding group difference in worry symptomatology, which
Ac

was not the case when differential attention to threat instead was induced through a contingency

designed to affect attentional disengagement from threat.

4. Discussion

This study introduces a novel attentional bias modification method, designed to induce group

differences in selective attention to threat meaning, rather than only to the spatial location of

threat stimuli. Participants who completed attentional induction procedures designed to decrease

Page 16 of 25
 Attentional engagement and disengagement modification: Effects on worry 16

processing of threat meanings were slower to process the semantic content of threat words

relative to non-threat words than were participants assigned to induction procedures designed to

increase threat processing. This effect was equally evident whether the bias induction procedure

involved training that targeted biased attentional engagement with, or biased attentional

t
ip
disengagement from, threat meanings. However, while these different induction bias procedures

were equally effective in inducing differential selective attention to threat meanings, they had

cr
quite different effects on subsequent patterns of worry.

us
When the attentional bias induction procedure encouraged selective attentional engagement

with threat meanings, the frequency of negative thought intrusions on the worry task was greater

an
than when the procedure was designed to discourage selective engagement with threat meanings.

In contrast, no such differences in negative thought intrusions were found between the attentional
M
bias induction procedures designed to encourage or discourage selective attentional
d

disengagement from threat meanings. These findings are not readily attributable to differences in
te

performance accuracy between the alternative attention induction tasks, since groups did not

differ in these respects. Rather, this pattern of results indicates that variability in selective
p

attentional engagement with threat, but not variability in attentional disengagement from threat,
ce

causally impacts on negative thought intrusions indicative of worry. Consequently we suggest

Ac

that biased attentional engagement with threat meanings influences the tendency to worry,

perhaps by affecting the degree to which selective attention is drawn towards those negative

aspects of the situation that serve to trigger negative thoughts.

Previous research has yielded evidence that elevated anxiety vulnerability is associated with

both biased attentional engagement with, and biased attentional disengagement from, the spatial

locus of threatening stimuli. As noted earlier, such patterns of attention to spatial loci need not

imply that anxiety vulnerability is characterized by both biased attentional engagement with, and

Page 17 of 25
 Attentional engagement and disengagement modification: Effects on worry 17

disengagement from, threat meanings. Furthermore, even if anxiety vulnerability is found to be

associated with both increased engagement with and impaired disengagement from threat

meanings, this would not permit the inference that each form of attentional bias contributes to

anxious symptomatology. Addressing this issue requires the development of procedures designed

t
ip
to induce either differential selective engagement with or disengagement from threatening

meanings, in order to reveal their respective effects on anxiety symptoms. The present research

cr
has adopted this approach and, at least with respect to worry, suggests that biased attentional

us
engagement with threatening meanings may be more critical than biased attentional

disengagement from such information in causally contributing to worry-related negative thought

an
intrusions. Future research should examine whether this remains true when people are already

engaged in worrying and in clients with Generalized Anxiety Disorder.

M
In conclusion, we report the first attempt to induce differences in selective attentional
d

engagement with, and in selective attentional disengagement from, threat meanings, in order to
te

distinguish the causal contributions made by each pattern of attentional selectivity to worry. A

procedure designed to induce differential selective attentional engagement with threat meanings
p

served to influence negative thought intrusions, whereas a procedure designed to induce

ce

differential attentional disengagement from threat meanings did not, despite the fact that both
Ac

procedures succeeded equally in inducing differential attentional bias. It would appear that

enhanced attentional engagement with threat meanings may causally contribute to negative

thought intrusions indicative of worry.

Page 18 of 25
 Attentional engagement and disengagement modification: Effects on worry 18

5. References

American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders

(4th ed.). Washington, DC: Author.

Amir, N., Elias, J., Klumpp, H., & Przeworski, A. (2003). Attentional bias to threat in social

t
ip
phobia: Facilitated processing of threat or difficulty disengaging attention from threat?

Behaviour Research and Therapy, 41, 1325-1335.

cr
Baddeley, A., Emslie, H. & Nimmo-Smith, I. (1992). The Speed of Comprehension Test: Version

us
A. In Speed and Capacity of Language Processing Test. Suffolk, England: Thames Valley

Test Company.

an
Borkovec, T.D., Robinson, E., Pruzinsky, T., & DePree, J.A. (1983). Preliminary exploration of

worry: Some characteristics and processes. Behaviour Research Therapy, 21, 9-16.
M
Fox, E., Russo, R., Bowles R. J., & Dutton, K. (2001). Do Threatening Stimuli Draw or Hold
d

Visual Attention in Subclinical Anxiety? Journal of Experimental Psychology: General.

te

130, 681-700.

Garner, M., Mogg, K., & Bradley, B.P. (2006). Orienting and Maintenance of Gaze to Facial
p
ce

Expressions in Social Anxiety. Journal of Abnormal Psychology, 115, 760-770.

Hayes, S., Hirsch, C.R. & Mathews, A. (2010). Facilitating a benign attentional bias reduces
Ac

negative thought intrusions. Journal of Abnormal Psychology, 119, 235-240.

Koster, E.H.W., Crombez, G., Verschuere, B., De Houwer, J. (2004). Selective attention to threat

in the dot probe paradigm: Differentiating vigilance and difficulty to disengage.

Behaviour Research and Therapy, 42, 1183-1192.

Koster, E.H.W., Crombes, G., Verschuere, B., Van Damme, S., & Wiersema, J.R. (2006).

Components of attentional bias to threat in high trait anxiety: Facilitated engagement,

Page 19 of 25
 Attentional engagement and disengagement modification: Effects on worry 19

impaired disengagement, and attentional avoidance. Behaviour Research and Therapy,

44, 1757-1771.

Krebs, G., Hirsch, C.R., & Mathews, A. (2010). The effect of attention modification with explicit

vs. minimal instructions on worry. Behaviour Research and Therapy, 48(3), 251-256.

t
ip
MacLeod, C., & Mathews, A. M. (1988). Anxiety and the allocation of attention to threat.

cr
Quarterly Journal of Experimental Psychology: Human Experimental Psychology, 40A,

653–670.

us
MacLeod, C., Mathews, A., & Tata, P. (1986). Attentional bias in emotional disorders. Journal of

an
Abnormal Psychology, 95, 15-20.

MacLeod, C., Rutherford, E., Campbell, L., Ebsworthy, G., & Holker, L. (2002). Selective
M
attention and emotional vulnerability: Assessing the causal basis of their association

through the experimental manipulation of attentional bias. Journal of Abnormal

d

Psychology, 111, 107-123.

te

Mathews, A., Fox, E., Yiend, J. & Calder, A. (2003). The face of fear: Effects of eye gaze and
p

emotion on visual attention. Visual Cognition, 10, 823-836.

ce

Mathews, A. & MacLeod, C. (1994). Cognitive approaches to emotion and emotional disorders.

Annual Review of Psychology, 45, 25-50.

Ac

Mathews, A. & MacLeod, C. (2005). Cognitive vulnerability to emotional disorders. Annual

Review of Clinical Psychology, 1, 167-195.

Meyer, T.J., Miller, M.L., Metzger, R.L., & Borkovec, T.D. (1990). Development and validation

of the Penn State Worry Questionnaire. Behaviour Research and Therapy, 28, 487-495.

Mogg, K., Mathews, A., & Eysenck, M. (1992). Attentional bias to threat in clinical anxiety

states. Cognition & Emotion, 6, 149–159.

Page 20 of 25
 Attentional engagement and disengagement modification: Effects on worry 20

Molina, S., & Borkovec, T. D. (1994). The Penn State Worry Questionnaire: Psychometric

properties and associated characteristics. In G. C. L. Davey & F. Tallis (Eds.),Worrying:

Perspectives on theory, assessment and treatment (pp. 265–283). Oxford, England:

Wiley.

t
ip
Ruscio, A.M., Borkovec, T.D. (2004). Experience and appraisal of worry among high worriers

with and without generalized anxiety disorder. Behaviour Research and Therapy, 42,

cr
1469-1482.

us
Salemink, E., van den Hout, M.A., & Kindt, M. (2007). Selective attention and threat: Quick

orienting versus slow disengagement and two versions of the dot probe task. Behaviour

Research and Therapy, 45, 607-615.

an
Spielberger, C.D., Gorsuch, R.C., Lushene, R.E., Vagg, P.R., & Jacobs, G.A. (1983). Manual for
M
the State Trait Anxiety Inventory. Palo Alto, CA: Consulting Psychologists Press.
d

Williams, J. M. G., Watts, F. N., MacLeod, C., & Mathews, A. (1997). Cognitive psychology and
te

emotional disorders (2nd ed). Chichester, UK: Wiley.

Yiend, J., & Mathews, A. (2001). Anxiety and attention to threatening pictures. The quarterly
p

Journal of Experimental Psychology: Human Experimental Psychology, 54A, 665–681.

ce
Ac

Page 21 of 25
 Attentional engagement and disengagement modification: Effects on worry 21

7. Acknowledgments

This research was supported by a Medical Research Council Grant and a Wellcome Trust

Grant to the first author. The authors would like to thank: Lucia Fung for helping with testing;

Gemma Perman for completing the assessor ratings; Sarah Radcliffe and Amy Smith for their

t
ip
contribution towards testing and ratings; and John Donaldson for writing the thought sampling

program.

cr
us
an
M
d
p te
ce
Ac

Page 22 of 25
 Attentional engagement and disengagement modification: Effects on worry 22

Table 1: Outline of the design showing the first and second decision task for threat and non-threat words

in each condition.

____________________________________________________________________
Bias Induction Condition Decision 1 Decision 2
Direction

t
_____________________________________________________________________

ip
Increase
threat processing

cr
Encourage threat Word structure Valence for threat
engagement: or
Structure for non-threat

us
Discourage threat Word valence Valence for threat
disengagement: or

an
Structure for non-threat

Decrease
threat processing
M
Discourage threat Word Structure Structure for threat
engagement: or
Valence for non-threat
d
te

Encourage threat Word valence Structure for threat

disengagement: or
Valence for non-threat
p

Note: The second decision (about its valence or structure) varied by word type (threat or non-threat).
ce

For example, the Encourage Threat Engagement condition involved an initial structural decision,
followed by an emotional valence decision (good or bad?) for threat words but a structural (e.g. upper or
lower case letters?) decision for non-threat words, thus requiring a shift to engagement with emotional
Ac

meaning for threat but not non-threat words.

___________________________________________________

Page 23 of 25
 Attentional engagement and disengagement modification: Effects on worry 23

Table 2: Median attention modification test trial response latencies and threat bias index for each

Condition (standard deviations in parentheses).

Modification Condition Trial Valence Threat

t
Direction Bias Index

ip
Non-threat Threat

cr
Increase threat
Processing
Encourage 1017.50 986.2500 31.25

us
Threat (225.47) (221.52) (180.65)
Engagement

an
Discourage 1007.53 952.94 54.59
Threat (237.41) (126.42) (193.87)
Disengagement
M
Decrease threat
Processing
Discourage 913.31 1083.34 -170.03
d

Threat
(142.89) (245.57) (202.86)
te

Engagement

Encourage 916.25 1007.50 -91.25

p

Threat (166.80) (162.87) (113.38)

Disengagement
ce
Ac

Page 24 of 25
 Attentional engagement and disengagement modification: Effects on worry 24

Table 3: Mean number of negative thought intrusions for each condition during the Worry Task
Pre-Worry and Post-Worry periods, as rated by Self and Assessor (standard deviations in
parentheses).

Modification Condition Pre-Worry Post-Worry

Direction
Self Assessor Self Assessor

t
ip
Increase
threat

cr
processing
Encourage 2.00 1.69 2.94 2.12

us
Threat (1.37) (1.19) (2.89) (2.42)
Engagement

an
Discourage 1.50 1.12 2.06 2.00
Threat (1.41) (1.50) (2.23) (2.22)
Disengagement
M
Decrease
threat
processing
d

Discourage 0.94 0.69 0.87 0.81

te

Threat (1.12) (0.70) (0.88) (0.98)

Engagement
p

Encourage 1.44 1.44 2.31 2.50

ce

Threat (1.31) (1.36) (1.74) (1.93)

Disengagement
Ac

Page 25 of 25