A Search for Specificity: Attentional Bias in Anxiety, Depression, and Borderline Personality Disorder

Distractions by emotional stimuli have been studied in non-clinical and clinical populations to identify attentional biases that may provide information relevant to assessing and treating emotional disorders. These studies of attentional bias have frequently employed the emotional Stroop and dot probe tasks. However, results from studies on attentional bias in emotional disorders that have used these tasks have been varied and it remains unclear if disorder-specific biases exist. A dimensional study, utilizing both measures of broad psychopathology constructs and more specific subcomponents, was conducted to investigate these inconsistencies. Results suggest that while the relationship of attentional bias to the broad, disorder based constructs of anxiety, depression, and BPD is unclear, research which focuses on more specific aspects of these psychopathologies may provide clearer answers as to the specificity of attentional bias. Greater understanding of the relationship between attentional bias and facets of psychopathology promises to benefit clinical treatment through the use of attentional bias modification training. Specificity in Attentional Bias 2 A Search for Specificity: Attentional bias in Anxiety, Depression, and Borderline Personality Disorder Cognition and Attention The broad concept of cognition involves many cognitive processes such as perception, memory, cognitive control, and attention. Attention itself, using a component-processes approach, can be broken down into simpler component processes such as early and late attentional processes. (Sanislow, et al., 2010). Of particular importance to the study of attention is the concept of selective attention: the complex process involved when individuals select what to attend to and further process from the vast number of stimuli in their internal and external environment According to the biased competition model of attention, individuals have a limited capacity for sensory perception and further processing and therefore are limited in what they are able to pay further attention (Mueller-Pfeiffer, et al., 2010). Researchers and theorists who examine selection tendencies of individuals or groups have used the term attentional bias, which will be used in this paper. This term refers to the systematic tendency to allocate attention to a particular type of group of stimuli (Harvey, Watkins, Mansell, & Shafran, 2004). Attentional bias can be a tendency to attend to a particular group or a tendency to avoid a particular group (attentional avoidance). The tendency to attend to threatening stimuli in particular is called hypervigilance. These tendencies can occur in both early and late perceptual processes. It has been theorized that some groups of individuals are characterized by specific and distinct attentional biases and much work has been done to find evidence for the existence of attentional biases in anxiety disorders, depression, eating Specificity in Attentional Bias 3 disorders, the elderly, etc. Research in the area usually attempts to find differences in measures of attention to certain types of stimuli between certain groups. The presence of a bias in attention towards certain stimuli can be explained from an evolutionary perspective. For instance, sensitivity towards items indicating nourishment, such as food, or towards stimuli indicating danger, such as a threatening animal, would both prove beneficial to an individual’s survival. However, in the wrong context or when overdeveloped, it appears that this bias may be too strong to remain beneficial or may have negative impacts on an individual’s functioning and mental health. It is hypothesized that these malfunctioning biases are related to mental health problems including anxiety and mood disorders. Several assumptions must be made to explain this hypothesis, the foremost of which is the idea that cognitions can have a role in the maintenance of disorders through cognitive biases, as these biases cause individuals to focus on negative information or ignore positive information (Andrews, Charney, Sirovatka, & Regier, 2009). There is also an assumption that this tendency to focus on information relevant to the given disorder increases vulnerability to developing that disorder. As discussed, the biased competition model of attention theorizes that attending to one class of stimulus decreases the amount of cognitive resources, including attention, that may be focused on other classes of stimuli (Mueller-Pfeiffer, et al., 2010). For example, attentional biases in the allocation of perceptual resources may cause individuals to miss information that would contradict the problematic beliefs they have developed because it causes them to attend only to information consistent with their concerns. Specificity in Attentional Bias 4 Cognitive Theories of Psychopathology Many specific cognitive theories have been developed in an effort to explain how cognition may interact with emotional affect to cause difficulties. Cognitive theorists have proposed that an individual’s or group’s ways of attending to, interpreting, and remembering events may contribute to the development and maintenance of psychopathology(Teasdale, 1988). Although explanations may sometimes come from dysfunctions in memory or interpretation, they have often drawn upon the process of attention in an attempt to explain the cause or maintenance of disorders. Attention is an important and early process in the cognitive system and therefore differences in the material that individuals pay attention to and accumulate have implications for different emotional disorders. Anxiety. Most cognitive models of psychopathology posit that the types of stimuli that are the focus of attentional biases are disorder specific (Hankin, Gibb, Abela, & Flory, 2010). Attentional bias is most often used to explain the etiology and maintenance of anxiety disorders. It is hypothesized that these disorders involve an attentional bias to environmental cues that goes beyond the attention necessary for survival, resulting in heightened anxiety. Specifically, cognitive theories suggest that these disorders as a whole are characterized by a heightened attention to threat-related information. This heightened attention might manifest as an increased awareness of possible threats in the environment, or may result in a bias for interpreting ambiguous stimuli or situations in a threatening manner. Most research on attentional bias in this group has involved the former explanation, but some research has also investigated responses to ambiguous words that have a possible threat meaning (Andrews, et al., Specificity in Attentional Bias 5 2009). The increased attention to, or perception of, threatening stimuli may cause individuals to experience increased physiological symptoms of anxiety and therefore to generate excessive worry (Mueller-Pfeiffer, et al., 2010). Depression. Though cognitively based hypotheses about depression have been less frequent, some cognitive theorists have tried to provide a possible explanation for depression. In these explanations, depression is characterized by biases to stimuli that convey negative emotions such as hopelessness or loss (Hankin, et al., 2010). This dysfunctional attentional allocation is believed to represent significant vulnerability for developing depression (Gotlib & Krasnoperova, 1998). Beck’s theory of depression ascribes much of the onset of depression to cognitive biases, while emphasizing the influence of negative schemas (Teasdale, 1988). In his model, individuals who experience loss or failure in their childhood develop negative schemas concerning these situations. These schemas become reactivated when an individual experiences similar situations later in life, becoming rigid beliefs about the world and the self through which stimuli and events are filtered This attention to schema-congruent negative materials causes the individual to accumulate negative material in their memories as well as reactivate previous negative memories. Due to their filters, individuals interpret information from the environment in ways that are consistent with their personal schemas including: selectively avoiding positive information, interpreting neutral information as negative, or selectively attending to the negative information available (Gotlib & Krasnoperova, 1998). The result is an attentional bias towards stimuli that express or emphasize sad emotions. There is some evidence that attentional bias to sad faces characterizes both formerly Specificity in Attentional Bias 6 depressed participants (Fritzsche, et al., 2010) as well as individuals at risk for depression (Fritzsche, et al., 2010; Joormann & Gotlib, 2007; Joormann, Talbot, & Gotlib, 2007). This research supports the idea that these biases have an effect on and/or indicate vulnerability to depression. However, the evidence for attentional biases in depressed individuals is not as consistent or abundant as the evidence for anxiety disorders; while some researchers have found evidence for depression specific biases, others have not (Mobini & Grant, 2007). Early investigations did not find evidence for an attention bias in depression, but some later studies that used longer stimulus duration times have demonstrated a bias (Gotlib, Kasch, et al., 2004). This is consistent with the theory that there is an attentional bias specific to depression, but that it occurs later on in information processing than the biases seen in individuals with anxiety disorders. Some researchers in the field believe that rather than biases in attention, individuals with depression are better characterized by biases in the information that is placed into memory, or available for recall (Harvey, et al., 2004). Although more evidence exists for enhanced memory of negative emotional material that is depression-relevant, research using certain paradigms (including dichotic listening and emotional Stroop tasks) has