Patrick Clarke

Anxiety vulnerability and dysfunction are characterized by an attentional bias to threat. Cognitive training procedures designed to modify selective attentional responding to threat originally were developed to test the hypothesis that this attentional bias causally contributes to anxious disposition. The capacity of attentional bias modification (ABM) training to alleviate dysfunctional anxiety has since attracted growing interest, and the present article reviews studies that have evaluated this therapeutic potential. When intended ABM training has successfully reduced attention to threat, it also has reduced anxiety vulnerability and symptomatology with a high degree of reliability. When the delivery of intended ABM training has not resulted in such anxiety reduction, this typically has reflected the failure to successfully modify attentional selectivity as required. We discuss ways in which ABM training procedures may be refined to optimize their capacity to reduce attentional bias to threat, to improve delivery of the resulting anxiolytic benefits.

Attentional bias modification (ABM) represents one of a number of cognitive bias modification techniques which are beginning to show promise as therapeutic interventions for emotional pathology. Numerous studies with both clinical and non-clinical populations have now demonstrated that ABM can reduce emotional vulnerability. However, some recent studies have failed to achieve change in either selective attention or emotional vulnerability using ABM methodologies, including a recent randomised controlled trial by Carlbring et al. Some have sought to represent such absence of evidence as a sound basis not to further pursue ABM as an online intervention. While these findings obviously raise questions about the specific conditions under which ABM procedures will produce therapeutic benefits, we suggest that the failure of some studies to modify selective attention does not challenge the theoretical and empirical basis of ABM. The present paper seeks to put these ABM failures in perspective within the broader context of attentional bias modification research. In doing so it is apparent that the current findings and future prospects of ABM are in fact very promising, suggesting that more research in this area is warranted, not less.

A considerable volume of research has demonstrated an anxiety-linked attentional bias characterized by selective processing of threat stimuli. The last decade has seen growing interest in identifying the precise attentional mechanisms which underlie such selective processing to advance both theoretical and etiological models of anxiety. This research has particularly focused on the roles of spatial engagement and disengagement of attention. The relative contribution of these attentional components to selective processing of threat in anxious individuals remains unclear however. Moreover, we argue here that many of the tasks employed to examine these mechanisms, may not be capable of indexing the attentional processes that they claim to measure. In this article, we provide a methodological review, critically evaluating the adequacy of previous tasks employed to measure biased attentional engagement and disengagement. Based on a number of concerns raised about the ability of such tasks to differentiate these component attentional processes, we detail three task criteria that we believe are essential to be confident that a task will accurately index biased attentional engagement with, and disengagement from threat in anxious participants.