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Cognitive Bias Modification of Attention is Less Effective Under Working Memory Load


Cognitive bias modification for attentional bias (CBM-A) attempts to alleviate anxiety by training an attentional bias away from threat. Several authors have argued that CBM-A in fact trains top-down, reactive counteraction of the tendency to orient towards threat. Imposing a working memory (WM) load during training should therefore limit its efficacy, since WM resources are required for goal-driven control of attention. Twenty-eight subclinical high-anxious participants completed two sessions of CBM-A or placebo training: one under a high WM load, and one under a low WM load. Attentional bias was assessed after each training. CBM-A produced an attentional bias away from threat under low load, but not under high load. These results suggest CBM-A trains top-down counteraction of orienting to threat. It also suggests the administration of CBM-A in the home environment may be affected by everyday worries and distractions.

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  1. Amir, N., Beard, C., Burns, M., & Bomyea, J. (2009). Attention modification program in individuals with generalized anxiety disorder. Journal of Abnormal Psychology, 118, 28–33. doi:10.1037/a0012589.

    PubMed Central  PubMed  Article  Google Scholar 

  2. Amir, N., & Taylor, C. T. (2012). Combined computerized home-based treatments for generalized anxiety disorder: An attention modification program and cognitive behavioral therapy. Behavior Therapy, 43, 546–559.

    PubMed Central  PubMed  Article  Google Scholar 

  3. Attwood, A. S., O’Sullivan, H., Leonards, U., Mackintosh, B., & Munafò, M. R. (2008). Attentional bias training and cue reactivity in cigarette smokers. Addiction, 103, 1875–1882. doi:10.1111/j.1360-0443.2008.02335.x.

    PubMed  Article  Google Scholar 

  4. Baert, S., De Raedt, R., Schacht, R., & Koster, E. H. W. (2010). Attentional bias training in depression: therapeutic effects depend on depression severity. Journal of Behavior Therapy and Experimental Psychiatry, 41, 265–274. doi:10.1016/j.jbtep.2010.02.004.

    PubMed  Article  Google 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, 1–24. doi:10.1037/0033-2909.133.1.1.

    PubMed  Article  Google Scholar 

  6. Booth, R. W. (2014). Uncontrolled avoidance of threat: Vigilance-avoidance, executive control, inhibition and shifting. Cognition and Emotion. doi:10.1080/02699931.2014.882294.

  7. Braver, T. S., Cohen, J. D., Nystrom, L. E., Jonides, J., Smith, E. E., & Noll, D. C. (1997). A parametric study of prefrontal cortex involvement in human working memory. Neuroimage, 5, 49–62. doi:10.1006/nimg.1996.0247.

    CAS  PubMed  Article  Google Scholar 

  8. Brosan, L., Hoppitt, L., Shelfer, L., Sillence, A., & Mackintosh, B. (2011). Cognitive bias modification for attention and interpretation reduces trait and state anxiety in anxious patients referred to an out-patient service: Results from a pilot study. Journal of Behavior Therapy and Experimental Psychiatry, 42, 258–264. doi:10.1016/jjbtep201012006.

    PubMed  Article  Google Scholar 

  9. Browning, M., Holmes, E. A., & Harmer, C. J. (2010a). The modification of attentional bias to emotional information: A review of the techniques, mechanisms, and relevance to emotional disorders. Cognitive, Affective, & Behavioral Neuroscience, 10, 8–20. doi:10.3758/CABN.10.1.8.

    Article  Google Scholar 

  10. Browning, M., Holmes, E. A., Murphy, S. E., Goodwin, G. M., & Harmer, C. J. (2010b). Lateral prefrontal cortex mediates the cognitive modification of attentional bias. Biological Psychiatry, 67, 919–925. doi:10.1016/j.biopsych.2009.10.031.

    PubMed Central  PubMed  Article  Google Scholar 

  11. Carlbring, P., Apelstrand, M., Sehlin, H., Amir, N., Rousseau, A., Hofmann, S. G., et al. (2012). Internet-delivered attention bias training in individuals with social anxiety disorder–a double blind randomized controlled trial. BMC Psychiatry, 12, 66. doi:10.1186/1471-244X-12-66.

    PubMed Central  PubMed  Article  Google Scholar 

  12. Cohen, J. D., Perlstein, W. M., Braver, T. S., Nystrom, L. E., Noll, D. C., Jonides, J., et al. (1997). Temporal dynamics of brain activation during a working memory task. Nature, 386, 604–608. doi:10.1038/386604a0.

    CAS  PubMed  Article  Google Scholar 

  13. 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, 200–216. doi:10.1007/s10608-014-9606-z.

    Article  Google Scholar 

  14. Field, M., Duka, T., Tyler, E., & Schoenmakers, T. (2009). Attentional bias modification in tobacco smokers. Nicotine & Tobacco Research, 11, 812–822. doi:10.1093/ntr/ntp067.

    Article  Google Scholar 

  15. Fox, E., Russo, R., & Dutton, K. (2002). Attentional bias for threat: Evidence for delayed disengagement from emotional faces. Cognition and Emotion, 16, 355–379. doi:10.1080/02699930143000527.

    PubMed Central  PubMed  Article  Google Scholar 

  16. Hakamata, Y., Lissek, S., Bar-Haim, Y., Britton, J. C., Fox, N. A., Leibenluft, E., et al. (2010). Attentional bias modification treatment: A meta-analysis toward the establishment of novel treatment for anxiety. Biological Psychiatry, 68, 982–990. doi:10.1016/j.biopsych.2010.07.021.

    PubMed Central  PubMed  Article  Google Scholar 

  17. Hallion, L. S., & Ruscio, A. M. (2011). A meta-analysis of the effect of cognitive bias modification on anxiety and depression. Psychological Bulletin, 137, 940–958. doi:10.1037/a0024355.

    PubMed  Article  Google Scholar 

  18. Koster, E. H. W., Baert, S., Bockstaele, M., & De Raedt, R. (2010). Attentional retraining procedures: Manipulating early or late components of attentional bias? Emotion, 10, 230–236. doi:10.1037/a0018424.

    PubMed  Article  Google Scholar 

  19. Larson, C. L., Schaefer, H. S., Siegle, G. J., Jackson, C. A. B., Anderle, M. J., & Davidson, R. J. (2006). Fear is fast in phobic individuals: Amygdala activation in response to fear-relevant stimuli. Biological Psychiatry, 60, 410–417. doi:10.1016/j.biopsych.2006.03.079.

    PubMed  Article  Google Scholar 

  20. Lavie, N., Hirst, A., de Fockert, J. W., & Viding, E. (2004). Load theory of selective attention and cognitive control. Journal of Experimental Psychology: General, 133, 339–354. doi:10.1037/0096-3445.133.3.339.

    Article  Google Scholar 

  21. MacLeod, C., Mackintosh, B., & Vujic, T. (2009). Does the explicit communication of the training contingency enhance the efficacy of cognitive bias modification (CBM)? Paper presented at the special meeting on cognitive bias modification in emotional disorders and addiction: New developments, Ghent, Belgium.

  22. MacLeod, C., Mathews, A., & Tata, P. (1986). Attentional bias in emotional disorders. Journal of Abnormal Psychology, 95, 15–20.

    CAS  PubMed  Article  Google Scholar 

  23. MacLeod, C., Rutherford, E., Campbell, L., Ebsworthy, G., & Holker, L. (2002). Selective attention and emotional vulnerability: Assessing the causal basis of their association through the experimental manipulation of attentional bias. Journal of Abnormal Psychology, 111, 107–123. doi:10.1037//0021-843X.111.1.107.

    PubMed  Article  Google Scholar 

  24. Mobini, S., & Grant, A. (2007). Clinical implications of attentional bias in anxiety disorders: An integrative literature review. Psychotherapy: Theory, Research, Practice, Training, 44, 450–462. doi:10.1037/0033-3204.44.4.450.

    Article  Google Scholar 

  25. Öner, N., & LeCompte, A. (1985). Durumluluk-Süreklilik Kaygı Envanteri elkitabı [in Turkish]. Istanbul: Boğaziçi University Press.

  26. Redick, T. S., & Engle, R. W. (2006). Working memory capacity and attention network test performance. Applied Cognitive Psychology, 20, 713–721. doi:10.1002/acp.1224.

    Article  Google Scholar 

  27. See, J., MacLeod, C., & Bridle, R. (2009). The reduction of anxiety vulnerability through the modification of attentional bias: A real-world study using a home-based cognitive bias modification procedure. Journal of Abnormal Psychology, 118, 65–75. doi:10.1037/a0014377.

    PubMed  Article  Google Scholar 

  28. Spielberger, C. D., Gorsuch, R. L., & Lushene, R. E. (1970). Manual for the State-Trait Anxiety Inventory. Palo Alto, CA: Consulting Psychologist Press.

    Google Scholar 

  29. Tekcan, Aİ., & Göz, İ. (2005). Türkçe kelime normları [in Turkish]. Istanbul: Boğaziçi University Press.

  30. Waters, A. M., Pittaway, M., Mogg, K., Bradley, B. P., & Pine, D. S. (2013). Attention training towards positive stimuli in clinically anxious children. Developmental Cognitive Neuroscience, 4, 77–84. doi:10.1016/j.dcn.2012.09.004.

    PubMed Central  PubMed  Article  Google Scholar 

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This work is supported by a BAP grant (11B101) from Işık University. We are grateful to Fulya Mücaviroğlu, Sirem Özen, Püren D. Şenyuva and S. Aslıhan Tüzün for their assistance with data collection.

Conflict of Interest

Robert W. Booth, Bundy Mackintosh, Sirous Mobini, Pinar Oztop, and Samantha Nunn declare that they have no conflict of interest.

Informed Consent

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000 (5). Informed consent was obtained from all participants for being included in the study.

Animal Rights

No animal studies were carried out by the authors for this article.

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Correspondence to Robert W. Booth.

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Booth, R.W., Mackintosh, B., Mobini, S. et al. Cognitive Bias Modification of Attention is Less Effective Under Working Memory Load. Cogn Ther Res 38, 634–639 (2014).

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  • Cognitive bias modification
  • Attentional bias
  • Anxiety
  • Working memory