Two studies conducted in Iran discovered that the tendency to scan for potential social threats, a prominent feature of social anxiety, is independent of depression. Moreover, the research demonstrated that individuals with anxiety can undergo training to decrease their attentional focus on threat detection. The findings were published in the Journal of Psychiatric Research.
Anxiety disorders are a group of mental health conditions characterized by excessive and persistent feelings of fear and worry that significantly and adversely impact a person’s daily life. Social anxiety disorder is the most common type of these disorders. It is the third most frequent psychiatric among adults and adolescents.
Also known as social phobia, social anxiety disorder is characterized by an intense and persistent fear of social situations and being scrutinized or judged by others. People with this disorder typically experience a strong fear of embarrassment, humiliation, or negative evaluation in social interactions. This fear often leads them to avoid social situations altogether.
Studies have revealed that individuals with social anxiety tend to pay increased attention to potential social threats (i.e., situations that may lead to scrutiny, embarrassment, and similar adverse developments). This magnifies their perceived level of threat in the environment leading to the exacerbation of symptoms. Anxiety disorders are commonly coupled with depression.
Study author Javad S. Fadardi and his colleagues wanted to determine whether this attentional bias, the tendency to pay increased attention to potential social threats and constantly scan for them, is related to depression or is it a specificity of social anxiety disorder. They also wanted to test the effectiveness of a program called Attention Control Training program for Social Anxiety (ATCP-SA for short) in teaching individuals with social anxiety disorder to reduce the attentional bias to social threats, thus improving the effects of therapy in such individuals.
Participants of the first study were 60 students of the Ferdowsi University of Mashad, Iran. Thirty of them met the diagnostic criteria for social anxiety and 30 of them did not meet this criterion and served as a control group. The general state anxiety levels of the control group were similar to that of the experimental group. Most of the participants (77%) in the experimental group and in the control group (89%) were female.
Participants completed assessments of social anxiety symptoms (the Conner’s Social Phobia Inventory), anxiety as a trait and as a state (the Spielberger’s State-Trait Anxiety Inventory), depression (the Beck Depression Inventory-Second Edition), and attentional bias for disorder related stimuli (an emotional Stroop test).
The 30 participants with social anxiety from the first study also participated in the second one. Researchers randomly assigned them into two groups. One was to undergo the Attention Control Training program for Social Anxiety, while the other would undergo a sham treatment.
Both groups completed four training sessions lasting 45 minutes each. There were two training sessions per week. After completing the trainings, participants completed the same assessments that they did at the start of the first study. They completed them again 3-months later (follow-up).
The Attention Control Training program for Social Anxiety was a modified version of the computerized Alcohol Attention-Control Training program. The goal of the training was to modify participants’ excessive and automatic attention for socially threatening stimuli, reduce the time it takes to turn their attention away from these stimuli, and alter their cognitive processes so that they seek out and choose neutral stimuli instead.
The training itself consists of presenting a mixture of neutral and socially threatening pictures and training participants to pay equal attention to both types, thus reducing the tendency to completely focus on the threatening ones.
Results of the first study showed that participants with social anxiety disorder indeed displayed higher attentional bias for relevant stimuli and for stimuli related to life goals (on the emotional Stroop test) compared to the control group. This difference remained even when depression was controlled for. This indicated that the tendency to overly focus attention on socially threatening stimuli is not due to depression.
Results of study two showed that the group that underwent the Attention Control Training program for Social Anxiety had somewhat lower symptoms of social anxiety after the intervention and particularly in the follow-up. Participants in this group also showed a strong reduction in the attentional bias, both at posttest and follow-up.
“Socially anxious individuals’ rapid distraction by threatening stimuli manifests itself as attentional bias. Moreover, focusing on the threatening stimuli might cause these individual’s level of anxiety and alertness for these stimuli to increase. Reducing attentional bias for threatening stimuli and focusing instead on neutral stimuli can break the vicious cycle. Breaking this cycle at any stage will, in turn, decrease individuals’ vulnerability for social anxiety,” the study authors concluded.
The study makes an important contribution to the scientific understanding of the psychological mechanisms underpinning the social anxiety disorder. However, it also has limitations that need to be taken into account. Notably, all of the participants were students and volunteers, thus self-selected for participation. It is possible that results on other age groups and on participants who are not as enthusiastic about the treatment as the participants of this study might not be the same.
The study, “Scary in the eye of the beholder: Attentional bias and attentional retraining for social anxiety“, was authored by Javad S. Fadardi, Sepideh Memarian, John Parkinson, W. Miles Cox, and Alan W. Stacy.
