Cognitive Therapy and Research

, Volume 43, Issue 5, pp 884–892 | Cite as

Components of Attentional Bias to Threat in Clinically Anxious Children: An Experimental Study Using the Emotional Spatial Cueing Paradigm

  • Andreas BlicherEmail author
  • Marie Louise Reinholdt-Dunne
Original Article


Attentional bias to threat is believed to play a key role in the development and maintenance of anxiety disorders. However, the underlying attentional mechanisms related to anxiety are not well understood. The aim of the present study was to investigate the effect of cognitive therapy on the engagement and disengagement components of attentional bias to threat in clinically anxious children using the emotional spatial cueing paradigm. Anxiety was diagnosed using the Anxiety Disorders Interview Schedule and the Revised Child Anxiety and Depression Scale. Results from 27 clinically anxious children and 27 control children (7–13 years old) indicated that clinically anxious children showed significantly faster engagement to angry faces than control children. Results also indicated that clinically anxious children showed significantly faster disengagement from angry faces before treatment in comparison to control children and significantly slower disengagement from angry faces after treatment than they did before treatment. Findings suggests that cognitive therapy reduces attentional avoidance of threat in clinically anxious children and challenges the assumption that results can be generalized from subclinical to clinical samples.


Engagement Disengagement Attentional bias Anxiety disorder Children Spatial cueing 



We wish to thank participating children and parents for partaking in the study as well as all staff and psychology students who have assisted the process.


This study was funded by the Tryg Foundation, Grant Number 7-12-0702, Sygekassernes Helse Foundation, Grant Number 2011A613, and Augustinus Foundation, Grant Number 12-01-019.

Compliance with Ethical Standards

Conflict of Interest

Andreas Blicher and Marie Louise Reinholdt-Dunne declare that they have no conflict of interest.

Ethical Approval

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

Informed Consent

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

Supplementary material

10608_2019_10008_MOESM1_ESM.sav (9 kb)
Supplementary material 1 (SAV 8 KB)


  1. Amir, N., Elias, J., Klumpp, H., & 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.CrossRefGoogle Scholar
  2. 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.CrossRefGoogle Scholar
  3. Bar-Haim, Y., Morag, I., & Glickman, S. (2011). Training anxious children to disengage attention from threat: A randomized controlled trial. Journal of Child Psychology and Psychiatry, 52(8), 861–869.CrossRefGoogle Scholar
  4. Beck, A. T., & Clark, D. A. (1997). An information processing model of anxiety: Automatic and strategic processes. Behaviour Research and Therapy, 35(1), 49–58.CrossRefGoogle Scholar
  5. Chambless, D. L., & Ollendick, T. H. (2001). Empirically supported psychological interventions: Controversies and evidence. Annual Review of Psychology, 52, 685–716.CrossRefGoogle Scholar
  6. Chorpita, B. F., Yim, L., Moffitt, C., Umemoto, L. A., & Francis, S. E. (2000). Assessment of symptoms of DSM-IV anxiety and depression in children: A revised child anxiety and depression scale. Behaviour Research and Therapy, 38(8), 835–855.CrossRefGoogle Scholar
  7. 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.CrossRefGoogle Scholar
  8. Cisler, J. M., & Olatunji, B. O. (2010). Components of attentional biases in contamination fear: Evidence for difficulty in disengagement. Behaviour Research and Therapy, 48(1), 74–78.CrossRefGoogle Scholar
  9. Clarke, P. J., MacLeod, C., & Guastella, A. J. (2013). Assessing the role of spatial engagement and disengagement of attention in anxiety-linked attentional bias. Anxiety, Stress, & Coping, 26(1), 1–19.CrossRefGoogle Scholar
  10. Dudeney, J., Sharpe, L., & Hunt, C. (2015). Attentional bias towards threatening stimuli in children with anxiety: A meta-analysis. Clinical Psychology Review, 40, 66–75.CrossRefGoogle Scholar
  11. Ege, S., & Reinholdt-Dunne, M. L. (2016). Improving treatment response for paediatric anxiety disorders: An information-processing perspective. Clinical Child and Family Psychology Review, 19(4), 392–402.Google Scholar
  12. Eide, P., Kemp, A., Silberstein, R. B., Nathan, P. J., & Stough, C. (2002). Test-retest reliability of the emotional Stroop task: Examining the paradox of measurement change. The Journal of Psychology, 136(5), 514–520.CrossRefGoogle Scholar
  13. Ellenbogen, M. A., & Schwartzman, A. E. (2009). Selective attention and avoidance on a pictorial cueing task during stress in clinically anxious and depressed participants. Behaviour Research and Therapy, 47(2), 128–138.CrossRefGoogle Scholar
  14. Fox, E., Russo, R., Bowles, R., & Dutton, K. (2001). Do threatening stimuli draw or hold visual attention in subclinical anxiety? Journal of Experimental Psychology: General, 130(4), 681–700.CrossRefGoogle Scholar
  15. Fox, E., Russo, R., & Dutton, K. (2002). Attentional bias for threat: Evidence for delayed disengagement from emotional faces. Cognition and Emotion, 16(3), 355–379.CrossRefGoogle Scholar
  16. Koster, E. H., Crombez, G., Verschuere, B., Van Damme, S., & Wiersema, J. R. (2006). Components of attentional bias to threat in high trait anxiety. Behaviour Research and Therapy, 44(12), 1757–1771.CrossRefGoogle Scholar
  17. MacLeod, C., Mathews, A., & Tata, P. (1986). Attentional bias in emotional disorders. Journal of Abnormal Psychology, 95(1), 15–20.CrossRefGoogle Scholar
  18. Massar, S. A., Mol, N. M., Kenemans, J. L., & Baas, J. M. (2011). Attentional bias in high-and low-anxious individuals: Evidence for threat-induced effects on engagement and disengagement. Cognition and Emotion, 25(5), 805–817.CrossRefGoogle Scholar
  19. Mathews, A., & MacLeod, C. (1985). Selective processing of threat cues in anxiety states. Behaviour Research and Therapy, 23(5), 563–569.CrossRefGoogle Scholar
  20. Mogg, K., & Bradley, B. P. (1998). A cognitive-motivational analysis of anxiety. Behaviour Research and Therapy, 36(9), 809–848.CrossRefGoogle Scholar
  21. Mogg, K., Holmes, A., Garner, M., & Bradley, B. P. (2008). Effects of threat cues on attentional shifting, disengagement and response slowing in anxious individuals. Behaviour Research and Therapy, 46(5), 656–667.CrossRefGoogle Scholar
  22. Morales, S., Taber-Thomas, B. C., & Pérez-Edgar, K. E. (2016). Patterns of attention to threat across tasks in behaviorally inhibited children at risk for anxiety. Developmental Science, 20(2), e12391.CrossRefGoogle Scholar
  23. Polanczyk, G. V., Salum, G. A., Sugaya, L. S., Caye, A., & Rohde, L. A. (2015). Annual research review: A meta-analysis of the worldwide prevalence of mental disorders in children and adolescents. Journal of Child Psychology and Psychiatry, 56(3), 345–365.CrossRefGoogle Scholar
  24. Pollak, S. D., & Tolley-Schell, S. A. (2003). Selective attention to facial emotion in physically abused children. Journal of Abnormal Psychology, 112(3), 323–338.CrossRefGoogle Scholar
  25. Posner, M. I. (1980). Orienting of attention. Quarterly Journal of Experimental Psychology, 32(1), 3–25.CrossRefGoogle Scholar
  26. Reinholdt-Dunne, M. L., Mogg, K., Vangkilde, S. A., Bradley, B. P., & Esbjørn, B. H. (2015). Attention control and attention to emotional stimuli in anxious children before and after cognitive therapy. Cognitive Therapy and Research, 39(6), 785–796.CrossRefGoogle Scholar
  27. Seligman, L. D., & Ollendick, T. H. (2011). Cognitive therapy for anxiety disorders in youth. Child and Adolescent Psychiatric Clinics of North America, 20(2), 217–238.CrossRefGoogle Scholar
  28. Silverman, W. K., & Albano, A. M. (1996). Anxiety disorders interview schedule for DSM-IV-child version. Parent interview schedule (pp. 1–15). Oxford: Oxford University Press.Google Scholar
  29. Tobon, J. I., Ouimet, A. J., & Dozois, D. J. (2011). Attentional bias in anxiety disorders following cognitive behavioral treatment. Journal of Cognitive Psychotherapy, 25(2), 114–129.CrossRefGoogle Scholar
  30. Tottenham, N., Tanaka, J. W., Leon, A. C., McCarry, T., Nurse, M., Hare, T. A., Marcus, D. J., Westerlund, A., Casey, B. J., & Nelson, C. (2009). The NimStim set of facial expressions. Psychiatry Research, 168(3), 242–249.CrossRefGoogle Scholar
  31. Van Bockstaele, B., Verschuere, B., Tibboel, H., De Houwer, J., Crombez, G., & Koster, E. H. (2014). A review of current evidence for the causal impact of attentional bias on fear and anxiety. Psychological Bulletin, 140(3), 682–721.CrossRefGoogle Scholar
  32. Van Strien, J. W., & Valstar, L. H. (2004). The lateralized emotional stroop task: left visual field interference in women. Emotion, 4(4), 403.CrossRefGoogle Scholar
  33. Yiend, J., & Mathews, A. (2001). Anxiety and attention to threatening pictures. The Quarterly Journal of Experimental Psychology, 54(3), 665–681.CrossRefGoogle Scholar
  34. Yiend, J., Mathews, A., Burns, T., Dutton, K., Fernández-Martín, A., Georgiou, G. A., Luckie, M., Rose, A., Russo, R., & Fox, E. (2015). Mechanisms of selective attention in generalized anxiety disorder. Clinical Psychological Science, 3(5), 758–771.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of PsychologyUniversity of CopenhagenCopenhagenDenmark

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