a chicken-and-egg problem: Does anxiety cause a negative
attention bias, or does the bias cause anxiety? “It’s kind of like a
feedback loop, where the fears feed into the cognitive biases and
those cognitive biases may maintain or even exacerbate the fears
over time,” says Brad Schmidt, PhD, who directs the anxiety and
behavioral health clinic at Florida State University.
Intriguingly, though, studies show that by altering the bias,
one can dial emotional vulnerability up or down. Most of these
studies simply use a modified version of the dot-probe test. In
a 2002 study, for instance, MacLeod and colleagues used a dot-
probe task to train students either to attend to or avoid negative
of active treatment — 72 percent of patients in the treatment
group no longer met diagnostic criteria for social anxiety
disorder, compared with 11 percent of patients in the control
group. Even more startling, the diagnostic differences were still
evident at a follow-up exam four months later.
Other studies have also had positive results. A 2010 meta-
analysis of 12 studies (Biological Psychiatry, Vol. 68, No. 11)
concluded that attention-bias modification “shows promise”
as a treatment for anxiety. “When we look at the studies
collectively, we see that attentional bias modification really
seems to work for anxiety disorders,” says study co-author Yair
A definite buzz is emerging around CBM. Still, it’s
not yet known how CBM stacks up against current
treatments or how best to deliver it as therapy.
words. Seeing the probes flash repeatedly in particular areas of
the screen, the subjects learned where to focus their attention
— either on or away from the negative stimuli. Later, subjects
were given a stressful anagram task to complete. Immediately
following the stress test, the students who were trained to
focus on negative stimuli showed increased anxiety compared
with the students trained to avoid them (Journal of Abnormal
Psychology, Vol. 111, No. 1).
“That was the start of showing this could be useful,”
MacLeod says, not only as a treatment, but also as a tool to
study the cognitive roots of anxiety and other mental health
conditions. “We can modify one facet of attention or another
specifically so we can see which have an emotional impact in
the laboratory,” he says.
Moving beyond anxiety
Of course, CBM also has considerable appeal as a potential
therapy. Most studies so far have been small, but initial
results are positive. In a 2009 study described in the Journal of
Abnormal Psychology (Vol. 118, No. 1), Schmidt and colleagues
tested attention bias in 36 people with social anxiety disorder.
Half completed a repetitive dot-probe task designed to train
attention away from images of disgusted faces. By repeatedly
flashing probes in the locations where neutral faces had
appeared, Schmidt reasoned, the subjects would learn to focus
their attention away from the negative images. Meanwhile,
participants in the control group were shown probes that
replaced neutral and disgusted faces with equal frequency.
After just eight 15-minute sessions — a mere two hours
Bar-Haim, PhD, a clinical psychologist and neuroscientist at Tel
As far as cognitive bias goes, anxiety has been studied much
more thoroughly than any other condition, Bar-Haim says. Still,
it’s not the only condition in which such habits of thought are
believed to play a role. He’s currently exploring the connection
between attention biases and post-traumatic stress disorder
in soldiers. On the battlefield, being tuned in to threats is
advantageous. “That’s how you survive,” he says. “But eventually,
when you come back home, these biases are not adaptive.” The
research isn’t published yet, but so far, he says, there appears to be
a “rather clear link” between PTSD and negative attention bias.
Negative bias has also been implicated in depression, though
the association isn’t quite as clear as it is for anxiety. “It remains
to be determined whether extended attentional bias training
is beneficial in depression,” MacLeod says. Interpretation bias
(rather than attention bias) probably plays a stronger role in
depression, he says. Indeed, depressed individuals are more
likely to interpret ambiguous information in a negative way
(Cognition and Emotion, Vol. 16, No. 3).
Compared with attention bias, interpretation bias has
thus far received less research focus, he adds. Still, some early
studies have indicated that depressed people may be good
candidates for CBM. A small study by Holmes and her Oxford
colleague Simon Blackwell, PsyD, found four of seven depressed
volunteers had improvements in mood and/or mental health
after one week of CBM training in their homes (Applied
Cognitive Psychology, Vol. 24, No. 3).
Meanwhile, other investigators are beginning to apply CBM