Anxiety and threat-related attention: Cognitive-motivational framework and treatment

Abstract

Research in experimental psychopathology and cognitive theories of anxiety highlight threat-related attention biases (ABs) and underpin the development of a computer-delivered treatment for anxiety disorders: attention-bias modification (ABM) training. Variable effects of ABM training on anxiety and ABs generate conflicting research recommendations, novel ABM training procedures, and theoretical controversy. This article summarises an updated cognitive-motivational framework, integrating proposals from cognitive models of anxiety and attention, as well as evidence of ABs. Interactions between motivational salience-driven and goal-directed influences on multiple cognitive processes (e.g., stimulus evaluation, inhibition, switching, orienting) underlie anxiety and the variable manifestations of ABs (orienting towards and away from threat; threat-distractor interference). This theoretical analysis also considers ABM training as cognitive skill training, describes a conceptual framework for evaluating/developing novel ABM training procedures, and complements network-based research on reciprocal anxiety-cognition relationships. Research in experimental psychopathology has led to the development of ABM training as a potential computer-delivered treatment for anxiety disorders.Conventional ABM threat-avoidance training encourages anxious individuals to orient attention away from threat, but has variable effects on anxiety and threat-related ABs.Differing explanations for mixed outcomes of ABM training, and theoretical controversy about the causes of anxiety and ABs, encourage the development of alternative novel ABM training methods.Development of effective attention-based treatments for anxiety would be advanced by better theoretical understanding of the cognitive processes underlying anxiety and ABs, and by using more refined and comprehensive assessments of threat-related attention and associated cognitive and neural functioning.

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