Visual attention to emotional faces in adolescents with social anxiety disorder receiving cognitive behavioral therapy


Autoři: Jens Högström aff001;  Martina Nordh aff001;  Miriam Larson Lindal aff002;  Ebba Taylor aff002;  Eva Serlachius aff001;  Johan Lundin Kleberg aff001
Působiště autorů: Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Stockholm County Council, CAP Research Center, Gävlegatan, Stockholm, Sweden aff001;  Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden aff002;  Uppsala Child and Baby Lab, Department of Psychology, Uppsala University, Uppsala, Sweden aff003
Vyšlo v časopise: PLoS ONE 14(11)
Kategorie: Research Article
doi: 10.1371/journal.pone.0225603

Souhrn

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.

Klíčová slova:

Adolescents – Attention – Emotions – Children – Social anxiety disorder – Social systems – Vigilance – Vigilance (psychology)


Zdroje

1. Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE. Lifetime prevalence and age-of-onset distributions of dsm-iv disorders in the national comorbidity survey replication. Arch Gen Psychiat. 2005; 62(6):593–602. doi: 10.1001/archpsyc.62.6.593 15939837

2. Halldorsson B, Creswell C. Social anxiety in pre-adolescent children: What do we know about maintenance? Behav Res Ther. 2017; 99:19–36. doi: 10.1016/j.brat.2017.08.013 28881221

3. Clark DM, Wells A. A cognitive model of social phobia. In Liebowitz M, Heimberg RG, editors. Social phobia: Diagnosis, assessment, and treatment. New York: Guilford Press; 1995. p. 69–93.

4. Rapee RM, Heimberg RG. A cognitive-behavioral model of anxiety in social phobia. Behav Res Ther. 1997; 35(8):741–56. doi: 10.1016/s0005-7967(97)00022-3 9256517

5. Spence SH, Rapee RM. The etiology of social anxiety disorder: An evidence-based model. Behav Res Ther. 2016; 86:50–67. doi: 10.1016/j.brat.2016.06.007 27406470

6. MacLeod C, Mathews A, Tata P. Attentional bias in emotional disorders. J Abnorm Psychol. 1986; 95(1):15. doi: 10.1037//0021-843x.95.1.15 3700842

7. Clarke PJF, MacLeod C, Guastella AJ. Assessing the role of spatial engagement and disengagement of attention in anxiety-linked attentional bias: a critique of current paradigms and suggestions for future research directions. Anxiety Stress Copin. 2013; 26(1):1–19.

8. Chen NTM, Clarke PJF. Gaze-based assessments of vigilance and avoidance in social anxiety: A review. Curr Psychiat Rep. 2017; 19(9):59.

9. Petersen SE, Posner MI. The attention system of the human brain: 20 years after. In: Hyman SE, editor. Annu Rev Neurosci. 2012; 35:73–89. doi: 10.1146/annurev-neuro-062111-150525 22524787

10. Duchowski AT. A breadth-first survey of eye-tracking applications. Behav Res Meth Instr. 2002; 34(4):455–70.

11. Armstrong T, Olatunji BO. Eye tracking of attention in the affective disorders: A meta-analytic review and synthesis. Clin Psychol Rev. 2012; 32(8):704–23. doi: 10.1016/j.cpr.2012.09.004 23059623

12. Bar-Haim Y, Lamy D, Pergamin L, Bakermans-Kranenburg MJ, van IJzendoorn MH. Threat-related attentional bias in anxious and nonanxious individuals: a meta-analytic study. Psychol Bull. 2007; 133(1):1–24. doi: 10.1037/0033-2909.133.1.1 17201568

13. Dudeney J, Sharpe L, Hunt C. Attentional bias towards threatening stimuli in children with anxiety: A meta-analysis. Clin Psychol Rev. 2015; 40:66–75. doi: 10.1016/j.cpr.2015.05.007 26071667

14. Kleberg JL, Thorup E, Falck-Ytter T. Reduced visual disengagement but intact phasic alerting in young children with autism. Autism Res. 2017; 10(3):539–45. doi: 10.1002/aur.1675 27696688

15. Buckner J, Maner J, Schmidt N. Difficulty disengaging attention from social threat in social anxiety. Cognitive Ther Res. 2010; 34(1):99–105.

16. Schofield CA, Johnson AL, Inhoff AW, Coles ME. Social anxiety and difficulty disengaging threat: evidence from eye-tracking. Cognition Emotion. 2012; 26(2):300–11. doi: 10.1080/02699931.2011.602050 21970428

17. Pergamin-Hight L, Naim R, Bakermans-Kranenburg MJ, van IJzendoorn MH, Bar-Haim Y. Content specificity of attention bias to threat in anxiety disorders: a meta-analysis. Clin Psychol Rev. 2015; 35:10–8. doi: 10.1016/j.cpr.2014.10.005 25462110

18. Seefeldt WL, Kramer M, Tuschen-Caffier B, Heinrichs N. Hypervigilance and avoidance in visual attention in children with social phobia. J Behav Ther Exp Psy. 2014; 45(1):105–12.

19. Waters AM, Mogg K, Bradley BP, Pine DS. Attention bias for angry faces in children with social phobia. J Exp Psychopathol. 2011; 2(4):jep. 018111.

20. Schmidtendorf S, Wiedau S, Asbrand J, Tuschen-Caffier B, Heinrichs N. Attentional bias in children with social anxiety disorder. Cognitive Ther Res. 2018; 42(3):273–88.

21. Mogg K, Bradley B, Miles F, Dixon R. Time course of attentional bias for threat scenes: Testing the vigilance‐avoidance hypothesis. Cognition Emotion. 2004; 18(5):689–700.

22. Mogg K, Bradley BP. Time course of attentional bias for fear-relevant pictures in spider-fearful individuals. Behav Res Ther. 2006; 44(9):1241–50. doi: 10.1016/j.brat.2006.05.003 16870133

23. Steinman SA, Gorlin EI, Teachman BA. Cognitive biases among individuals with social anxiety. In: Weeks JW, editor. The Wiley Blackwell handbook of social anxiety disorder. Hoboken, NJ: Wiley-Blackwell; 2014. p. 321–43.

24. Wieser MJ, Pauli P, Weyers P, Alpers GW, Mühlberger A. Fear of negative evaluation and the hypervigilance-avoidance hypothesis: An eye-tracking study. J Neural Transm. 2009; 116(6):717–23. doi: 10.1007/s00702-008-0101-0 18690409

25. Gamble AL, Rapee RM. The time-course of attentional bias in anxious children and adolescents. J Anxiety Disord. 2009; 23(7):841–7. doi: 10.1016/j.janxdis.2009.04.001 19447004

26. Scaini S, Belotti R, Ogliari A, Battaglia M. A comprehensive meta-analysis of cognitive-behavioral interventions for social anxiety disorder in children and adolescents. J Anxiety Disord. 2016; 42:105–12. doi: 10.1016/j.janxdis.2016.05.008 27399932

27. Andersson G. Using the Internet to provide cognitive behaviour therapy. Behav Res Ther. 2009; 47(3):175–80. doi: 10.1016/j.brat.2009.01.010 19230862

28. Nordh M, Vigerland S, Öst LG, Ljótsson B, Mataix-Cols D, Serlachius E, et al. Therapist-guided internet-delivered cognitive-behavioural therapy supplemented with group exposure sessions for adolescents with social anxiety disorder: a feasibility trial. BMJ Open. 2017; 7(12):e018345. doi: 10.1136/bmjopen-2017-018345 29247101

29. Tillfors M, Andersson G, Ekselius L, Furmark T, Lewenhaupt S, Karlsson A, et al. A randomized trial of internet-delivered treatment for social anxiety disorder in high school students. Cogn Behav Therapy. 2011; 40(2):147–57.

30. Waters AM, Mogg K, Bradley BP. Direction of threat attention bias predicts treatment outcome in anxious children receiving cognitive-behavioural therapy. Behav Res Ther. 2012; 50(6):428–34. doi: 10.1016/j.brat.2012.03.006 22542533

31. Waters AM, Potter A, Jamesion L, Bradley BP, Mogg K. Predictors of treatment outcomes in anxious children receiving group cognitive-behavioural therapy: pretreatment attention bias to threat and emotional variability during exposure tasks. Behav Change. 2015; 32(3):143–58.

32. Price M, Tone EB, Anderson PL. Vigilant and avoidant attention biases as predictors of response to cognitive behavioral therapy for social phobia. Depress Anxiety. 2011; 28(4):349–53. doi: 10.1002/da.20791 21308888

33. Legerstee JS, Tulen JH, Dierckx B, Treffers PD, Verhulst FC, Utens EM. CBT for childhood anxiety disorders: differential changes in selective attention between treatment responders and non‐responders. J Child Psychol Psyc. 2010; 51(2):162–72.

34. Byrow Y, Peters L. The influence of attention biases and adult attachment style on treatment outcome for adults with social anxiety disorder. J Affect Disorders. 2017; 217:281–8. doi: 10.1016/j.jad.2017.04.018 28441619

35. Waters AM, Wharton TA, Zimmer-Gembeck MJ, Craske MG. Threat-based cognitive biases in anxious children: comparison with non-anxious children before and after cognitive behavioural treatment. Behav Res Ther. 2008; 46(3):358–74. doi: 10.1016/j.brat.2008.01.002 18304519

36. Davis ML, Rosenfield D, Bernstein A, Zvielli A, Reinecke A, Beevers CG, et al. Attention bias dynamics and symptom severity during and following CBT for social anxiety disorder. J Consult Clin Psych. 2016; 84(9):795.

37. Pishyar R, Harris LM, Menzies RG. Responsiveness of measures of attentional bias to clinical change in social phobia. Cognition Emotion. 2008; 22(7):1209–27.

38. Sheehan DV, Lecrubier Y, Sheehan KH, Amorim P, Janavs J, Weiller E, et al. The Mini International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM- IV and ICD- 10. J Clin Psychiat. 1998; 59(Supplement 20):22–33.

39. Albano AM, DiBartolo PM. Cognitive-behavioral therapy for social phobia in adolescents: Stand up, speak out therapist guide. New York: Oxford University Press; 2007.

40. Beidel DC, Turner SM, Morris TL. Behavioral treatment of childhood social phobia. J Consult Clin Psych. 2000; 68(6):1072.

41. Albano AM, Silverman WK. Anxiety disorders interview schedule for DSM-IV-child version: Clinician manual. San Antonio, TX: Psychological Corporation; 1996.

42. Guy W. ECDEU assessment manual for psychopharmacology. US Department of Health, and Welfare. 1976: 534–7.

43. Beidel DC, Turner SM, Morris TL. A new inventory to assess childhood social anxiety and phobia: The social phobia and anxiety inventory for children. Psychol Assessment. 1995; 7(1):73–9.

44. Wechsler D. Wechsler intelligence scale for children—Fourth edition. San Antonio, TX: Harcourt; 2003.

45. Wechsler D. Wechsler adult intelligence scale—Fourth edition. San Antonio, TX: Pearson Assessment; 2008.

46. Csibra G, Johnson MH, Tucker LA. Attention and oculomotor control: a high-density ERP study of the gap effect. Neuropsychologia. 1997; 35(6):855–65. doi: 10.1016/s0028-3932(97)00016-x 9204490

47. Kleberg JL, Högström J, Nord M, Bölte S, Serlachius E, Falck-Ytter T. Autistic traits and symptoms of social anxiety are differentially related to attention to others' eyes in social anxiety disorder. J Autism Dev Disord. 2017; 47(12):3814–21. doi: 10.1007/s10803-016-2978-z 28000078

48. Van der Stigchel S, Hessels RS, van Elst JC, Kemner C. The disengagement of visual attention in the gap paradigm across adolescence. Exp Brain Res. 2017; 235(12):3585–92. doi: 10.1007/s00221-017-5085-2 28884226

49. Moriya J, Tanno Y. The time course of attentional disengagement from angry faces in social anxiety. J Behav Ther Exp Psy. 2011; 42(1):122–128.

50. Lundqvist D, Flykt A, Öhman A. The Karolinska Directed Emotional Faces-KDEF [CD-ROM]. Department of Clinical Neuroscience, Psychology section, Karolinska Institutet, Stockholm, Sweden, 1998.

51. Raftery AE. Bayesian model selection in social research. Sociol Methodol. 1995;25:111–64.

52. Wagenmakers E-J. A practical solution to the pervasive problems of p values. Psychon B Rev. 2007; 14(5):779–804.

53. Field AP, Lester KJ. Is there room for "development" in developmental models of information processing biases to threat in children and adolescents? Clin Child Fam Psych. 2010; 13(4):315–32.

54. Kindt M, Van Den Hout M. Selective attention and anxiety: A perspective on developmental issues and the causal status. J Psychopathol Behav. 2001; 23(3):193–202.

55. Calvo MG, Avero P. Time course of attentional bias to emotional scenes in anxiety: Gaze direction and duration. Cognition Emotion. 2005; 19(3):433–51. doi: 10.1080/02699930441000157 22686651

56. Rohner J-C. The time-course of visual threat processing: High trait anxious individuals eventually avert their gaze from angry faces. Cognition Emotion. 2002; 16(6):837–44.

57. Legerstee JS, Tulen JH, Kallen VL, Dieleman GC, Treffers PD, Verhulst FC, et al. Threat-related selective attention predicts treatment success in childhood anxiety disorders. J Amer Acad Child Psy. 2009; 48(2):196–205.

58. Bögels SM, Mansell W. Attention processes in the maintenance and treatment of social phobia: hypervigilance, avoidance and self-focused attention. Clin Psychol Rev. 2004; 24(7):827–56. doi: 10.1016/j.cpr.2004.06.005 15501558

59. Naim R, Kivity Y, Bar-Haim Y, Huppert JD. Attention and interpretation bias modification treatment for social anxiety disorder: A randomized clinical trial of efficacy and synergy. J Behav Ther Exp Psy. 2018; 59:19–30.

60. Fitzgerald A, Rawdon C, Dooley B. A randomized controlled trial of attention bias modification training for socially anxious adolescents. Behav Ther. 2016; 84:1–8.

61. Pergamin-Hight L, Pine DS, Fox NA, Bar-Haim Y. Attention bias modification for youth with social anxiety disorder. J Child Psychol Psyc. 2016; 57(11):1317–25.

62. Amir N, Beard C, Taylor CT, Klumpp H, Elias J, Bums M, Chen X. Attention training in individuals with generalized social phobia: A randomized controlled trial. J Consult Clin Psych. 2009; 77(5):961–73.

63. Heeren A, Reese HE, McNally RJ, Philippot P. Attention training toward and away from threat in social phobia: Effects on subjective, behavioral, and physiological measures of anxiety. Behav Res Ther. 2012; 50(1):30–9. doi: 10.1016/j.brat.2011.10.005 22055280

64. In-Albon T, Schneider S. Does the vigilance-avoidance gazing behavior of children with separation anxiety disorder change after cognitive-behavioral therapy? J Abnorm Child Psych. 2012; 40(7):1149–56.

65. Chen NTM, Thomas LM, Clarke PJF, Hickie IB, Guastella AJ. Hyperscanning and avoidance in social anxiety disorder: the visual scanpath during public speaking. Psychiat Res. 2015; 225(3):667–672.

66. Kleberg JL, Hanqvist C, Serlachius E, Högström J. Pupil dilation to emotional expressions in adolescent social anxiety disorder is related to treatment outcome. J Anxiety Disord. 2019; 65:26–33. doi: 10.1016/j.janxdis.2019.04.006 31136877


Článek vyšel v časopise

PLOS One


2019 Číslo 11