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Cognitive Therapy and Research

, Volume 40, Issue 2, pp 245–255 | Cite as

The Effects of Attention Training on Health Anxiety: An Experimental Investigation

  • Julia SchwindEmail author
  • Maria Gropalis
  • Michael Witthöft
  • Florian Weck
Original Article

Abstract

According to cognitive-behavioural theories, attentional biases, especially increased symptom-focused attention, are crucial for the maintenance of health anxiety. Therefore, the attention training technique (ATT) seems to be a promising approach in reducing body-focused attention and hypochondriacal fears in people with high health anxiety. However, previous research has never implemented ATT on its own but always in combination with psychoeducation. The present study experimentally investigates the isolated impact of ATT on self-reported body-focused attention, health anxiety, and attentional bias towards health threatening stimuli. Fifty-four students with elevated health anxiety were randomised into the following conditions: attention training group (ATG), which received ATT; ATGbody, which received a variation of ATT that focused on training attention towards the body; and a control group without intervention. The ATG and ATGbody spent 1 week actively practicing the trainings. Before and after the training phase, we assessed the self-report measures, and attentional bias by using the Emotional Stroop Task. The ATG displayed no effects on self-report measures of body-focused attention or health anxiety. Against our expectations, the ATGbody experienced a significant decrease in the attentional bias (p = .001, Cohen’s d = 0.93). Attention training towards the body in people with elevated health anxiety might, therefore, be beneficial in reducing illness-related attentional bias.

Keywords

Attention training Attention training technique (ATT) Health anxiety Attentional bias Body-focused attention Emotional Stroop Task 

Notes

Acknowledgments

We would like to thank Christine Kloos, MSc, and Steffen Schiele, BSc, for their help with the data collection. There has been no funding or financial support. The article has not been presented elsewhere.

Compliance with Ethical Standards

Conflict of Interest

Julia Schwind, Maria Gropalis, Michael Witthöft, and Florian Weck declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Animal Rights

No animals were used in the current study.

References

  1. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: American Psychiatric Association.Google Scholar
  2. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: American Psychiatric Association.Google Scholar
  3. Anderson, A. K. (2005). Affective influences on the attentional dynamics supporting awareness. Journal of Experimental Psychology: General, 134(2), 258–281.CrossRefGoogle Scholar
  4. Bar-Haim, Y. (2010). Research review: Attention bias modification (ABM): A novel treatment for anxiety disorders. Journal of Child Psychology and Psychiatry, 51(8), 859–870. doi: 10.1111/j.1469-7610.2010.02251.x.CrossRefPubMedGoogle Scholar
  5. Bar-Haim, Y., Lamy, D., Pergamin, L., Bakermans-Kranenburg, M. J., & van Ijzendoorn, M. H. (2007). Threat-related attentional bias in anxious and nonanxious individuals: A meta-analytic study. Psychological Bulletin, 133(1), 1–24. doi: 10.1037/0033-2909.133.1.1.CrossRefPubMedGoogle Scholar
  6. Beard, C., Sawyer, A. T., & Hofmann, S. G. (2012). Efficacy of attention bias modification using threat and appetitive stimuli: A meta-analytic review. Behavior Therapy, 43(4), 724–740. doi: 10.1016/j.beth.2012.01.002.CrossRefPubMedPubMedCentralGoogle Scholar
  7. Bleichhardt, G., & Weck, F. (2010). Kognitive Verhaltenstherapie bei Hypochondrie und Krankheitsangst (2nd ed.). Heidelberg: Springer.CrossRefGoogle Scholar
  8. Boulet, J., & Boss, M. W. (1991). Reliability and validity of the Brief Symptom Inventory. Psychological Assessment, 3(3), 433–437. doi: 10.1037/1040-3590.3.3.433.CrossRefGoogle Scholar
  9. Broday, S. F. (1991). Internal consistency of the Brief Symptom Inventory for counseling-center clients. Psychological Reports, 68(1), 94. doi: 10.2466/PR0.68.1.94-94.CrossRefPubMedGoogle Scholar
  10. Buwalda, F. M., Bouman, T. K., & Duijn, M. A. J. (2008). The effect of a psychoeducational course on hypochondriacal metacognition. Cognitive Therapy and Research, 32(5), 689–701. doi: 10.1007/s10608-007-9176-4.CrossRefGoogle Scholar
  11. Buwalda, F. M., Bouman, T. K., & van Duijn, M. A. J. (2006). Psychoeducation for hypochondriasis: A comparison of a cognitive-behavioural approach and a problem-solving approach. Behaviour Research and Therapy, 45(5), 887–899. doi: 10.1016/j.brat.2006.08.004.CrossRefPubMedGoogle Scholar
  12. Cattell, R. B., & Warburton, F. W. (1967). Objective personality and motivation tests. Urbana: University of Illinois Press.Google Scholar
  13. Cisler, J. M., & Koster, E. H. (2010). Mechanisms of attentional biases towards threat in anxiety disorders: An integrative review. Clinical Psychology Review, 30(2), 203–216. doi: 10.1016/j.cpr.2009.11.003.CrossRefPubMedPubMedCentralGoogle Scholar
  14. de Houwer, J. (2006). What are implicit measures and why are we using them. In R. W. Wiers & A. W. Stacy (Eds.), The handbook of implicit cognition and addiction (pp. 11–28). Thousand Oaks, CA: Sage.CrossRefGoogle Scholar
  15. de Houwer, J., & Moors, A. (2010). Implicit measures: Similarities and differences. In B. Garwonski & K. Payne (Eds.), Handbook of implicit social cognition: Measurement, theory, and application (pp. 176–193). New York: Guilford Press.Google Scholar
  16. de Houwer, J., Teige-Mocigemba, S., Spruyt, A., & Moors, A. (2009). Implicit measures: A normative analysis and review. Psychological Bulletin, 135(3), 347–368. doi: 10.1037/a0014211.CrossRefPubMedGoogle Scholar
  17. Derogatis, L. R., & Melisaratos, N. (1983). The Brief Symptom Inventory: An introductory report. Psychological Medicine, 13(3), 595–605. doi: 10.1017/S0033291700048017.CrossRefPubMedGoogle Scholar
  18. Enock, P. M., Hofmann, S. G., & McNally, R. J. (2014). Attention bias modification training via smartphone to reduce social anxiety: A randomized, controlled multi-session experiment. Cognitive Therapy and Research, 38(2), 200–216. doi: 10.1007/s10608-014-9606-z.CrossRefGoogle Scholar
  19. Eysenck, M. W., Derakshan, N., Santos, R., & Calvo, M. G. (2007). Anxiety and cognitive performance: Attentional control theory. Emotion, 7(2), 336–353.CrossRefPubMedGoogle Scholar
  20. Faul, F., Erdfelder, E., Lang, A. G., & Buchner, A. (2007). G*Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behavior Research Methods, 39(2), 175–191.CrossRefPubMedGoogle Scholar
  21. Ferguson, E. (2009). A taxometric analysis of health anxiety. Psychological Medicine, 39(2), 277–285. doi: 10.1017/S0033291708003322.CrossRefPubMedGoogle Scholar
  22. Foa, E. B., & Kozak, M. J. (1986). Emotional processing of fear: Exposure to corrective information. Psychological Bulletin, 99(1), 20–35.CrossRefPubMedGoogle Scholar
  23. Fox, E., Zougkou, K., Ashwin, C., & Cahill, S. (2015). Investigating the efficacy of attention bias modification in reducing high spider fear: The role of individual differences in initial bias. Journal of Behavior Therapy and Experimental Psychiatry, 49(Pt A), 84–93. doi: 10.1016/j.jbtep.2015.05.001.CrossRefPubMedPubMedCentralGoogle Scholar
  24. Franke, G. H. (2000). Brief Symptom Inventory von L. R. Derogatis (Kurzform der SCL-90-R)Deutsche Version. Manual [Short version of the SCL-90-R - German version]. Göttingen: Beltz Test GmbH.Google Scholar
  25. Gropalis, M., Bleichhardt, G., Hiller, W., & Witthöft, M. (2013). Specificity and modifiability of cognitive biases in hypochondriasis. Journal of Consulting and Clinical Psychology, 81(3), 558–565. doi: 10.1037/a0028493.CrossRefPubMedGoogle Scholar
  26. Hadjistavropoulos, H. D., Hadjistavropoulos, T., & Quine, A. (2000). Health anxiety moderates the effects of distraction versus attention to pain. Behaviour Research and Therapy, 38(5), 425–438. doi: 10.1016/S0005-7967(99)00044-3.CrossRefPubMedGoogle Scholar
  27. Hakamata, Y., Lissek, S., Bar-Haim, Y., Britton, J. C., Fox, N. A., Leibenluft, E., & Pine, D. S. (2010). Attention bias modification treatment: A meta-analysis toward the establishment of novel treatment for anxiety. Biological Psychiatry, 68(11), 982–990. doi: 10.1016/j.biopsych.2010.07.021.CrossRefPubMedPubMedCentralGoogle Scholar
  28. Hiller, W., & Rief, W. (2004). Internationale Skalen für Hypochondrie Deutschsprachige Adaptation des Whiteley-Index (WI) und der Illness Attitude Scales (IAS). Bern: Huber.Google Scholar
  29. Hiller, W., Rief, W., & Fichter, M. M. (2002). Dimensional and categorical approaches to hypochondriasis. Psychological Medicine, 32(4), 707–718. doi: 10.1017/S0033291702005524.CrossRefPubMedGoogle Scholar
  30. Höfling, V., & Weck, F. (2013). Assessing bodily preoccupations is sufficient: Clinically effective screening for hypochondriasis. Journal of Psychosomatic Research, 75(6), 526–531. doi: 10.1016/j.jpsychores.2013.10.011.CrossRefPubMedGoogle Scholar
  31. Inquisit. (2008). Inquisit. Seattle, WA: Millisecond software.Google Scholar
  32. Karademas, E. C., Christopoulou, S., Dimostheni, A., & Pavlu, F. (2008). Health anxiety and cognitive interference: Evidence from the application of a modified Stroop task in two studies. Personality and Individual Differences, 44(5), 1138–1150. doi: 10.1016/j.paid.2007.11.007.CrossRefGoogle Scholar
  33. Kellner, R. (1986). Somatization and hypochondriasis. New York: Praeger-Greenwood Publishers.Google Scholar
  34. Kerstner, T., Witthöft, M., Mier, D., Diener, C., Rist, F., & Bailer, J. (2015). A diary-based modification of symptom attributions in pathological health anxiety: Effects on symptom report and cognitive biases. Journal of Consulting and Clinical Psychology, 83(3), 578–589. doi: 10.1037/a0039056.CrossRefPubMedGoogle Scholar
  35. Krautwurst, S., Gerlach, A. L., Gomille, L., Hiller, W., & Witthöft, M. (2014). Health anxiety—An indicator of higher interoceptive sensitivity? Journal of Behavior Therapy and Experimental Psychiatry, 45(2), 303–309. doi: 10.1016/j.jbtep.2014.02.001.CrossRefPubMedGoogle Scholar
  36. Lecci, L., & Cohen, D. J. (2002). Perceptual consequences of an illness-concern induction and its relation to hypochondriacal tendencies. Health Psychology, 21(2), 147–156. doi: 10.1037//0278-6133.21.2.147.CrossRefPubMedGoogle Scholar
  37. Lecci, L., & Cohen, D. (2007). Altered processing of health threat words as a function of hypochondriacal tendencies and experimentally manipulated control beliefs. Cognition and Emotion, 21(1), 211–224. doi: 10.1080/02699930600625248.CrossRefGoogle Scholar
  38. Longley, S. L., Broman-Fulks, J. J., Calamari, J. E., Noyes, R., Wade, M., & Orlando, C. M. (2010). A taxometric study of hypochondriasis symptoms. Behavior Therapy, 41(4), 505–514. doi: 10.1016/j.beth.2010.02.002.CrossRefPubMedGoogle Scholar
  39. Longley, S. L., Watson, D., & Noyes, R. (2005). Assessment of the hypochondriasis domain: The multidimensional inventory of hypochondriacal traits (MIHT). Psychological Assessment, 17(1), 3–14. doi: 10.1037/1040-3590.17.1.3.CrossRefPubMedGoogle Scholar
  40. MacLeod, C., Mathews, A., & Tata, P. (1986). Attentional bias in emotional disorders. Journal of Abnormal Psychology, 95(1), 15–20. doi: 10.1037/0021-843X.95.1.15.CrossRefPubMedGoogle Scholar
  41. Marcus, D. K., Gurley, J. R., Marchi, M. M., & Bauer, C. (2007). Cognitive and perceptual variables in hypochondriasis and health anxiety: A systematic review. Clinical Psychology Review, 27(2), 127–139. doi: 10.1016/j.cpr.2006.09.003.CrossRefPubMedGoogle Scholar
  42. Martin, A., & Jacobi, F. (2006). Features of hypochondriasis and illness worry in the general population in Germany. Psychosomatic Medicine, 68(5), 770–777. doi: 10.1097/01.psy.0000238213.04984.b0.CrossRefPubMedGoogle Scholar
  43. Martínez, M. P., & Belloch, A. (2004). Efectos de un tratamiento cognitivo-conductual para la hipocondría en los sesgos atencionales. International Journal of Clinical Health Psychology, 4(2), 299–311.Google Scholar
  44. McEvoy, P. M., & Perini, S. J. (2009). Cognitive behavioral group therapy for social phobia with or without attention training: A controlled trial. Journal of Anxiety Disorders, 23(4), 519–528. doi: 10.1016/j.janxdis.2008.10.008.CrossRefPubMedGoogle Scholar
  45. Mogg, K., & Bradley, B. P. (1998). A cognitive-motivational analysis of anxiety. Behaviour Research and Therapy, 36(9), 809–848. doi: 10.1016/S0005-7967(98)00063-1.CrossRefPubMedGoogle Scholar
  46. Mogoaşe, C., David, D., & Koster, E. H. W. (2014). Clinical efficacy of attentional bias modification procedures: An updated meta-analysis. Journal of Clinical Psychology, 70(12), 1133–1157. doi: 10.1002/jclp.22081.CrossRefPubMedGoogle Scholar
  47. Owens, K. M. B., Asmundson, G. J. G., Hadjistavropoulos, T., & Owens, T. J. (2004). Attentional bias toward illness threat in individuals with elevated health anxiety. Cognitive Therapy and Research, 28(1), 57–66. doi: 10.1023/B:COTR.0000016930.85884.29.CrossRefGoogle Scholar
  48. Papageorgiou, C., & Wells, A. (1998). Effects of attention training on hypochondriasis: A brief case series. Psychological Medicine, 28(1), 193–200. doi: 10.1017/S0033291797005825.CrossRefPubMedGoogle Scholar
  49. Papageorgiou, C., & Wells, A. (2000). Treatment of recurrent major depression with attention training. Cognitive and Behavioral Practice, 7(4), 407–413. doi: 10.1016/S1077-7229(00)80051-6.CrossRefGoogle Scholar
  50. Raymond, J. E., Shapiro, K. L., & Arnell, K. M. (1992). Temporary suppression of visual processing in an RSVP task: An attentional blink? Journal of Experimental Psychology: Human Perception and Performance, 18(3), 849–860. doi: 10.1037/0096-1523.18.3.849.PubMedGoogle Scholar
  51. Sirri, L., Grandi, S., & Fava, G. A. (2008). The illness attitude scales. A clinimetric index for assessing hypochondriacal fears and beliefs. Psychotherapy and Psychosomatics, 77(6), 337–350. doi: 10.1159/000151387.CrossRefPubMedGoogle Scholar
  52. Valmaggia, L. R., Bouman, T. K., & Schuurman, L. (2007). Attention training with auditory hallucinations: A case study. Cognitive and Behavioral Practice, 14(2), 127–133. doi: 10.1016/j.cbpra.2006.01.009.CrossRefGoogle Scholar
  53. Warwick, H. M. C., & Salkovskis, P. M. (1990). Hypochondriasis. Behaviour Research and Therapy, 28(2), 105–117. doi: 10.1016/0005-7967(90)90023-C.CrossRefPubMedGoogle Scholar
  54. Weck, F., Bleichhardt, G., & Hiller, W. (2009). Stellen Erfahrungen mit Krankheiten einen spezifischen Risikofaktor für Krankheitsängste dar? Zeitschrift für Klinische Psychologie und Psychotherapie, 38(2), 89–99. doi: 10.1026/1616-3443.38.2.89.CrossRefGoogle Scholar
  55. Weck, F., Bleichhardt, G., & Hiller, W. (2010). Screening for hypochondriasis with the Illness Attitude Scales. Journal of Personality Assessment, 92(3), 260–268. doi: 10.1080/00223891003670216.CrossRefPubMedGoogle Scholar
  56. Weck, F., Bleichhardt, G., Witthöft, M., & Hiller, W. (2011). Explicit and implicit anxiety: Differences between patients with hypochondriasis, patients with anxiety disorders, and healthy controls. Cognitive Therapy and Research, 35(4), 317–325.CrossRefGoogle Scholar
  57. Weck, F., & Höfling, V. (2014). Assessment of implicit health attitudes: A multitrait–multimethod approach and a comparison between patients with hypochondriasis and patients with anxiety disorders. Journal of Personality Assessment, 97(1), 1–11//55–65. doi: 10.1080/00223891.2014.913253.
  58. Weck, F., Neng, J. M. B., & Stangier, U. (2013). The effects of attention training on the perception of bodily sensations in patients with hypochondriasis: A randomized controlled pilot trial. Cognitive Therapy and Research, 37(3), 514–520. doi: 10.1007/s10608-012-9482-3.CrossRefGoogle Scholar
  59. Wells, A. (1990). Panic disorder in association with relaxation induced anxiety: An attentional training approach to treatment. Behavior Therapy, 21(3), 273–280. doi: 10.1016/S0005-7894(05)80330-2.CrossRefGoogle Scholar
  60. Wells, A. (2007). The attention training technique: Theory, effects, and a metacognitive hypothesis on auditory hallucinations. Cognitive and Behavioral Practice, 14(2), 134–138. doi: 10.1016/j.cbpra.2006.01.010.CrossRefGoogle Scholar
  61. Wells, A., & Matthews, G. (1994). Attention and emotion: A clinical perspective. Hove: Lawrence Erlbaum.Google Scholar
  62. Wells, A., White, J., & Carter, K. (1997). Attention training: Effects on anxiety and beliefs in panic and social phobia. Clinical Psychology and Psychotherapy, 4(4), 226–232. doi: 10.1002/(SICI)1099-0879(199712)4:4<226::AID-CPP129>3.0.CO;2-M.CrossRefGoogle Scholar
  63. Williams, J. M. G., Mathews, A., & MacLeod, C. (1996). The emotional Stroop task and psychopathology. Psychological Bulletin, 120(1), 3–24. doi: 10.1037/0033-2909.120.1.3.CrossRefPubMedGoogle Scholar
  64. Williams, P. G., Wasserman, M. S., & Lotto, A. J. (2003). Individual differences in self-assessed health: An information-processing investigation of health and illness cognition. Health Psychology, 22, 3–11.CrossRefPubMedGoogle Scholar
  65. Witthöft, M. (2011). Besonderheiten der Aufmerksamkeitsregulation bei Gesundheitsängsten. In W. Hoefert & C. Klotter (Eds.), Gesundheitsängste (pp. 285–303). Heidelberg: Springer.Google Scholar
  66. Witthöft, M., Haaf, A., Rist, F., & Bailer, J. (2010). Erfassung von Krankheitsangst mit dem Multidimensional Inventory of Hypochondriacal Traits (MIHT). Diagnostica, 56(1), 2–12. doi: 10.1026/0012-1924/a000005.CrossRefGoogle Scholar
  67. Witthöft, M., Kerstner, T., Ofer, J., Mier, D., Rist, F., Diener, C., & Bailer, J. (2015a). Cognitive biases in pathological health anxiety: The contribution of attention, memory, and evaluation processes. Clinical Psychological Science. doi: 10.1177/2167702615593474.Google Scholar
  68. Witthöft, M., Rist, F., & Bailer, J. (2008). Enhanced early emotional intrusion effects and proportional habituation of threat response for symptom and illness words in college students with elevated health anxiety. Cognitive Therapy and Research, 32(6), 818–842. doi: 10.1007/s10608-007-9159-5.CrossRefGoogle Scholar
  69. Witthöft, M., Weck, F., & Gropalis, M. (2015b). The multidimensional inventory of hypochondriacal traits (MIHT): Factor structure, specificity, reliability, and validity in patients with hypochondriasis. Assessment, 22(3), 261–376. doi: 10.1177/1073191114545489.CrossRefGoogle Scholar
  70. Yang, W., Ding, Z., Dai, T., Peng, F., & Zhang, J. X. (2015). Attention bias modification training in individuals with depressive symptoms: A randomized controlled trial. Journal of Behavior Therapy and Experimental Psychiatry, 49(Pt A), 101–111. doi: 10.1016/j.jbtep.2014.08.005.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Julia Schwind
    • 1
    Email author
  • Maria Gropalis
    • 2
  • Michael Witthöft
    • 2
  • Florian Weck
    • 2
  1. 1.Department of Clinical Psychology and Psychotherapy, Institute for PsychologyGoethe University FrankfurtFrankfurtGermany
  2. 2.Department of Clinical Psychology, Psychotherapy and Experimental PsychopathologyJohannes Gutenberg University MainzMainzGermany

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