The Effects of Attention Training on Health Anxiety: An Experimental Investigation
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.
KeywordsAttention training Attention training technique (ATT) Health anxiety Attentional bias Body-focused attention Emotional Stroop Task
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.
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 was obtained from all individual participants included in the study.
No animals were used in the current study.
- American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: American Psychiatric Association.Google Scholar
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: American Psychiatric Association.Google Scholar
- Cattell, R. B., & Warburton, F. W. (1967). Objective personality and motivation tests. Urbana: University of Illinois Press.Google Scholar
- 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
- 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
- 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
- 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
- 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
- Inquisit. (2008). Inquisit. Seattle, WA: Millisecond software.Google Scholar
- 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
- Kellner, R. (1986). Somatization and hypochondriasis. New York: Praeger-Greenwood Publishers.Google Scholar
- 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
- 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
- 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.
- Wells, A., & Matthews, G. (1994). Attention and emotion: A clinical perspective. Hove: Lawrence Erlbaum.Google Scholar
- 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
- Witthöft, M. (2011). Besonderheiten der Aufmerksamkeitsregulation bei Gesundheitsängsten. In W. Hoefert & C. Klotter (Eds.), Gesundheitsängste (pp. 285–303). Heidelberg: Springer.Google Scholar
- 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
- 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