The Attentional Bias Modification Technique: characteristics and uses.

A promising treatment for Social Anxiety Disorder? Let's see what is known about it.

Although there are multiple theories, to date there is still no clear and universal definition of the concept of attention. 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 explain the repercussion that the technique of Attentional Bias Modification is havinga new attentional psychological technique designed for the treatment of social anxiety disorder or social phobia.

Attention and the treatment of mental disorders.

As Shechner et al. (2012) point out, 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 a person's development, since attention is the basis of memory and learning.. You can only learn and memorize experiences to which you are paying attention.

According to the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders), social phobia is characterized by an "intense fear or anxiety in one or more social situations in which the individual is exposed to possible examination by others".

The person feels fear when behaving in a certain way that may be negatively valued by those around him/her. That is to say, he/she is afraid of being judged by others and of being rejected for his/her behavior. in a situation involving several people. These situations can range from giving a talk to a large audience, to having a simple conversation with someone they know.

Najmi, Kuckertz and Amir (2011), showed that people with anxiety selectively attend to elements of the environment that they consider threatening, neglecting the rest of the environment, in which they could find neutral or positive elements. This attentional bias usually generates wrong value judgments that result in increased anxiety and persistence of the disorder in the long term.

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 a cell phone and two others were talking to each other, the speaker would only notice the latter actions, interpreting that his performance was being catastrophic and boring, leading to an increase in anxiety and, therefore, to an increase in the probability of making mistakes and worsening their actual performance, 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, the behavior of these four individuals would possibly go unnoticed, and they would interpret it as a lack of sleep and/or interest in the subject of those particular people and not in their own performance.

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 fast as possible and trying not to make a mistake by 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: one face with a neutral expression and one with anA face with a neutral expression and a face with an expression of disgust or rejection. In 80% of the trials, the letter "e" or "f" always appears where the neutral face was located moments before. In this way, although no explicit order is given not to pay attention to the faces of rejection, the person unconsciously learns not to pay attention to the stimuli he/she fears.

Despite the simplicity of the technique, these authors achieved, in 8 sessions of 20 minutes during 4 weeks, that 50% of the patients with social phobia reduced their symptomatology so much that they could not 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 real bias in anxiety disorders, and specifically social anxiety, is not to be hypervigilant to threatening stimuli (rejection faces)-since detecting those things that can potentially harm us is a bias that all humans share and that has helped us to survive for thousands of years-but rather that Once these threats have been detected, they cannot be ignored by the individual..

Therefore, the bias that causes the persistence of the disorder is the impossibility of "disengaging" attention from the threat, and the modification of the attentional bias would act by eliminating this impossibility.

However, recent evidence suggests that the picture is much more complicated than it might be. is much more complicated than it might at first appear.. Klump and Amir (2010) found that designing the task to attend to threatening rather than neutral faces also resulted in a decrease in anxiety. Yao, Yu, Qian, and Li (2015) conducted the same experiment, but using geometric figures instead of emotional stimuli and also observed a decrease in participants' subjective distress.

Cudeiro (2016), tried to measure attentional engagement 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.

In short, it is still it is not yet clear what the underlying mechanism(s) of action of this technique are.. Future research will have to be directed at replicating efficacy studies and determining these possible mechanisms of action.

Bibliographic references:

• 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? Behaviour research and therapy, 41(11), 1325-1335.
• Amir, N., Beard, C., Taylor, C. T., Klumpp, H., Elias, J., Burns, M. y 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, E. A., Browning, M., MacLeod, C., ... y Carlbring, P. (2013). Internet-based attention bias modification for social anxiety: a randomised controlled comparison of training towards negative and training towards positive cues. PLoS One, 8(9), e71760. doi: 10.1371/journal.pone.0071760.
• Cudeiro González, J. A. (2016). Modificación del sesgo atencional en trastornos de ansiedad: un acercamiento a los mecanismos explicativos. Minerva, 1-40
• Klumpp, H. y 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, N. B., Richey, J. A., Buckner, J. D. y Timpano, K. R. (2009). Attention training for generalized social anxiety disorder. Journal of abnormal psychology, 118(1), 5-14.
• Shechner, T., Britton, J. C., Pérez-Edgar, K., Bar‐Haim, Y., Ernst, M., Fox, N. A., ... y Pine, D. S. (2012). Attention biases, anxiety, and development: toward or away from threats or rewards?. Depression and anxiety, 29(4), 282-294.