Top

Current Psychiatry Reports

Published in:

01-09-2017 | Anxiety Disorders (A Pelissolo, Section Editor)

Gaze-Based Assessments of Vigilance and Avoidance in Social Anxiety: a Review

Authors: Nigel T. M. Chen, Patrick J. F. Clarke

Published in: Current Psychiatry Reports | Issue 9/2017

Abstract

Purpose of Review

A broad base of research has sought to identify the biases in selective attention which characterize social anxiety, with the emergent use of eye tracking-based methods. This article seeks to provide a review of eye tracking studies examining selective attention biases in social anxiety.

Recent Findings

Across a number of contexts, social anxiety may be associated with a mix of both vigilant and avoidant patterns of attention with respect to the processing of emotional social stimuli. Socially anxious individuals may additionally avoid maintaining eye contact and may exhibit a generalized vigilance via hyperscanning of their environment.

Summary

The findings highlight the utility of eye tracking methods for increasing understanding of the gaze-based biases which characterize social anxiety disorder, with promising avenues for future research.

In this study, the latency to saccade away from a given stimulus following initial orienting was examined. While this was termed attentional maintenance by the authors, it is consistent with the present manuscript’s definition of attentional disengagement.

Kessler RC, Petukhova M, Sampson NA, Zaslavsky AM, Wittchen HU. Twelve-month and lifetime prevalence and lifetime morbid risk of anxiety and mood disorders in the United States. Int J Methods Psychiatr Res. 2012;21(3):169–84. doi:10.1002/mpr.1359.CrossRefPubMedPubMedCentral

Ruscio AM, Brown TA, Chiu WT, Sareen J, Stein MB, Kessler RC. Social fears and social phobia in the USA: results from the National Comorbidity Survey Replication. Psychol Med. 2008;38(1):15–28. doi:10.1017/s0033291707001699.CrossRefPubMed

Clark DM, Wells A. A cognitive model of social phobia. In: Heimberg R, Liebowitz M, Hope DA, Schneier FR, editors. Social phobia: diagnosis, assessment and treatment. New York: Guilford Press; 1995. p. 69–93.

Wittchen HU, Stein MB, Kessler RC. Social fears and social phobia in a community sample of adolescents and young adults: prevalence, risk factors and co-morbidity. Psychol Med. 1999;29(2):309–23.CrossRefPubMed

Deater-Deckard K. Annotation: recent research examining the role of peer relationships in the development of psychopathology. J Child Psychol Psychiatry. 2001;42(5):565–79.CrossRefPubMed

Salkovskis PM. The importance of behaviour in the maintenance of anxiety and panic: a cognitive account. Behav Psychother. 2009;19(1):6–19. doi:10.1017/S0141347300011472.CrossRef

Hofmann SG. Cognitive factors that maintain social anxiety disorder: a comprehensive model and its treatment implications. Cogn Behav Ther. 2007;36(4):193–209. doi:10.1080/16506070701421313.CrossRefPubMedPubMedCentral

Clark DM. A cognitive perspective on social phobia. In: Crozier WR, Alden LE, editors. International handbook of social anxiety: concepts, research and interventions relating to the self and shyness. New York, NY: John Wiley; 2001. p. 405–30.

Rapee RM, Heimberg RG. A cognitive-behavioral model of anxiety in social phobia. Behav Res Ther. 1997;35(8):741–56. doi:10.1016/S0005-7967(97)00022-3.CrossRefPubMed

10.

•• Heimberg RG, Brozovich FA, Rapee RM. A cognitive-behavioral model of social anxiety disorder: update and extension. In: Hofmann SG, PM DB, editors. Social anxiety (third edition). San Diego: Academic Press; 2014. p. 705–28. An important theoretical model of social anxiety.

11.

Mansell W, Clark DM, Ehlers A, Chen YP. Social anxiety and attention away from emotional faces. Cogn Emot. 1999;13(6):673–90. doi:10.1080/026999399379032.CrossRef

12.

Chen YP, Ehlers A, Clark DM, Mansell W. Patients with generalized social phobia direct their attention away from faces. Behav Res Ther. 2002;40(6):677–87.CrossRefPubMed

13.

Asmundson GJG, Stein MB. Selective processing of social threat in patients with generalized social phobia: evaluation using a dot-probe paradigm. J Anxiety Disord. 1994;8(2):107–17. doi:10.1016/0887-6185(94)90009-4.CrossRef

14.

Gilboa-Schechtman E, Foa EB, Amir N. Attentional biases for facial expressions in social phobia: the face-in-the-crowd paradigm. Cogn Emot. 1999;13(3):305–18. doi:10.1080/026999399379294.CrossRef

15.

Mogg K, Philippot P, Bradley BP. Selective attention to angry faces in clinical social phobia. J Abnorm Psychol. 2004;113(1):160–5. doi:10.1037/0021-843x.113.1.160.CrossRefPubMed

16.

Mogg K, Bradley BP. Selective orienting of attention to masked threat faces in social anxiety. Behav Res Ther. 2002;40(12):1403–14.CrossRefPubMed

17.

Mogg K, Bradley BP, Miles F, Dixon R. Time course of attentional bias for threat scenes: testing the vigilance-avoidance hypothesis. Cogn Emot. 2004;18(5):689–700. doi:10.1080/02699930341000158.CrossRef

18.

Bradley BP, Mogg K, Millar NH. Covert and overt orienting of attention to emotional faces in anxiety. Cogn Emot. 2000;14(6):789–808. doi:10.1080/02699930050156636.CrossRef

19.

Rayner K. Eye movements in reading and information processing: 20 years of research. Psychol Bull. 1998;124(3):372–422. doi:10.1037/0033-2909.124.3.372.CrossRefPubMed

20.

Duchowski AT. A breadth-first survey of eye-tracking applications. Behav Res Methods Instr Comput. 2002;34(4):455–70. doi:10.3758/bf03195475.CrossRef

21.

Carpenter RHS. Frontal cortex: choosing where to look. Curr Biol. 1994;4(4):341–3. doi:10.1016/S0960-9822(00)00074-9.CrossRef

22.

Hutton SB, Ettinger U. The antisaccade task as a research tool in psychopathology: a critical review. Psychophysiology. 2006;43(3):302–13. doi:10.1111/j.1469-8986.2006.00403.x.CrossRefPubMed

23.

Posner MI, Inhoff AW, Friedrich FJ, Cohen A. Isolating attentional systems—a cognitive-anatomical analysis. Psychobiology. 1987;15(2):107–21. doi:10.3758/BF03333099.

24.

Posner MI, Petersen SE. The attention system of the human brain. Annu Rev Neurosci. 1990;13:25–42. doi:10.1146/annurev.ne.13.030190.000325.CrossRefPubMed

25.

Buckner JD, Maner JK, Schmidt NB. Difficulty disengaging attention from social threat in social anxiety. Cogn Ther Res. 2010;34(1):99–105. doi:10.1007/s10608-008-9205-y.CrossRef

26.

Richards HJ, Benson V, Donnelly N, Hadwin JA. Exploring the function of selective attention and hypervigilance for threat in anxiety. Clin Psychol Rev. 2014;34(1):1–13. doi:10.1016/j.cpr.2013.10.006.CrossRefPubMed

27.

Green MJ, Williams LM, Davidson D. In the face of danger: specific viewing strategies for facial expressions of threat? Cogn Emot. 2003;17(5):779–86. doi:10.1080/02699930302282.CrossRef

28.

• Chen NTM, Thomas LM, Clarke PJF, Hickie IB, Guastella AJ. Hyperscanning and avoidance in social anxiety disorder: the visual scanpath during public speaking. Psychiatry Res. 2015;225(3):667–72. doi:10.1016/j.psychres.2014.11.025. This study examines the selective attention biases which operate in SAD during a social-evaluative speech task CrossRefPubMed

29.

Seefeldt WL, Kramer M, Tuschen-Caffier B, Heinrichs N. Hypervigilance and avoidance in visual attention in children with social phobia. J Behav Ther Exp Psychiatry. 2014;45(1):105–12. doi:10.1016/j.jbtep.2013.09.004.CrossRefPubMed

30.

Shechner T, Jarcho JM, Britton JC, Leibenluft E, Pine DS, Nelson EE. Attention bias of anxious youth during extended exposure of emotional face pairs: an eye-tracking study. Depress Anxiety. 2013;30(1):14–21. doi:10.1002/da.21986.CrossRefPubMed

31.

Stevens S, Rist F, Gerlach AL. Eye movement assessment in individuals with social phobia: differential usefulness for varying presentation times? J Behav Ther Exp Psychiatry. 2011;42(2):219–24. doi:10.1016/j.jbtep.2010.11.001.CrossRefPubMed

32.

Wieser MJ, Pauli P, Weyers P, Alpers GW, Muhlberger A. Fear of negative evaluation and the hypervigilance-avoidance hypothesis: an eye-tracking study. J Neural Transm. 2009;116(6):717–23. doi:10.1007/s00702-008-0101-0.CrossRefPubMed

33.

Garner M, Mogg K, Bradley BP. Orienting and maintenance of gaze to facial expressions in social anxiety. J Abnorm Psychol. 2006;115(4):760–70. doi:10.1037/0021-843x.115.4.760.CrossRefPubMed

34.

Byrow Y, Broeren S, de Lissa P, Peters L. Anxiety, attachment & attention: the influence of adult attachment style on attentional biases of anxious individuals. J Exp Psychopathol. 2016;7(1):110–28. doi:10.5127/jep.046714.

35.

Byrow Y, Chen NTM, Peters L. Time course of attention in socially anxious individuals: investigating the effects of adult attachment style. Behav Ther. 2016;47(4):560–71. doi:10.1016/j.beth.2016.04.005.CrossRefPubMed

36.

Gamble AL, Rapee RM. The time-course of attentional bias in anxious children and adolescents. J Anxiety Disord. 2009;23(7):841–7. doi:10.1016/j.janxdis.2009.04.001.CrossRefPubMed

37.

Chen NTM, Clarke PJF, MacLeod C, Guastella AJ. Biased attentional processing of positive stimuli in social anxiety disorder: an eye movement study. Cogn Behav Ther. 2012;41(2):96–107. doi:10.1080/16506073.2012.666562.CrossRefPubMed

38.

Schofield CA, Inhoff AW, Coles ME. Time-course of attention biases in social phobia. J Anxiety Disord. 2013;27(7):661–9. doi:10.1016/j.janxdis.2013.07.006.CrossRefPubMed

39.

Singh JS, Capozzoli MC, Dodd MD, Hope DA. The effects of social anxiety and state anxiety on visual attention: testing the vigilance-avoidance hypothesis. Cogn Behav Ther. 2015;44(5):377–88. doi:10.1080/16506073.2015.1016447.CrossRefPubMed

40.

Lazarov A, Abend R, Bar-Haim Y. Social anxiety is related to increased dwell time on socially threatening faces. J Affect Disord. 2016;193:282–8. doi:10.1016/j.jad.2016.01.007.CrossRefPubMed

41.

Liang CW, Tsai JL, Hsu WY. Sustained visual attention for competing emotional stimuli in social anxiety: an eye tracking study. J Behav Ther Exp Psychiatry. 2017;54:178–85. doi:10.1016/j.jbtep.2016.08.009.CrossRefPubMed

42.

Lange WG, Heuer K, Langner O, Keijsers GPJ, Becker ES, Rinck M. Face value: eye movements and the evaluation of facial crowds in social anxiety. J Behav Ther Exp Psychiatry. 2011;42(3):355–63. doi:10.1016/j.jbtep.2011.02.007.CrossRefPubMed

43.

Shechner T, Jarcho JM, Wong S, Leibenluft E, Pine DS, Nelson EE. Threats, rewards, and attention deployment in anxious youth and adults: an eye tracking study. Biol Psychol. 2017;122:121–9. doi:10.1016/j.biopsycho.2015.10.004.CrossRefPubMed

44.

Armstrong T, Olatunji BO. Eye tracking of attention in the affective disorders: a meta-analytic review and synthesis. Clin Psychol Rev. 2012;32(8):704–23. doi:10.1016/j.cpr.2012.09.004.CrossRefPubMedPubMedCentral

45.

Schofield CA, Johnson AL, Inhoff AW, Coles ME. Social anxiety and difficulty disengaging threat: evidence from eye-tracking. Cogn Emot. 2012;26(2):300–11. doi:10.1080/02699931.2011.602050.CrossRefPubMed

46.

• Çek D, Sánchez A, Timpano KR. Social anxiety-linked attention bias to threat is indirectly related to post-event processing via subjective emotional reactivity to social stress. Behav Ther. 2016;47(3):377–87. doi:10.1016/j.beth.2016.02.007. This study provides an interesting investigation into how attentional bias may influence other cognitive and emotional aspects of social anxiety CrossRefPubMed

47.

Macatee RJ, Albanese BJ, Schmidt NB, Cougle JR. Attention bias towards negative emotional information and its relationship with daily worry in the context of acute stress: an eye-tracking study. Behav Res Ther. 2017;90:96–110. doi:10.1016/j.brat.2016.12.013.CrossRefPubMed

48.

Weeks JW, Howell AN. The bivalent fear of evaluation model of social anxiety: further integrating findings on fears of positive and negative evaluation. Cogn Behav Ther. 2012;41(2):83–95. doi:10.1080/16506073.2012.661452.CrossRefPubMed

49.

Weeks JW, Heimberg RG, Rodebaugh TL. The fear of positive evaluation scale: assessing a proposed cognitive component of social anxiety. J Anxiety Disord. 2008;22(1):44–55. doi:10.1016/j.janxdis.2007.08.002.CrossRefPubMed

50.

Weeks JW, Heimberg RG, Rodebaugh TL, Norton PJ. Exploring the relationship between fear of positive evaluation and social anxiety. J Anxiety Disord. 2008;22(3):386–400. doi:10.1016/j.janxdis.2007.04.009.CrossRefPubMed

51.

Horley K, Williams LM, Gonsalvez C, Gordon E. Social phobics do not see eye to eye: a visual scanpath study of emotional expression processing. J Anxiety Disord. 2003;17(1):33–44. doi:10.1016/S0887-6185(02)00180-9.CrossRefPubMed

52.

Horley K, Williams LM, Gonsalvez C, Gordon E. Face to face: visual scanpath evidence for abnormal processing of facial expressions in social phobia. Psychiatry Res. 2004;127(1–2):43–53. doi:10.1016/j.psychres.2004.02.016.CrossRefPubMed

53.

Moukheiber A, Rautureau G, Perez-Diaz F, Jouvent R, Pelissolo A. Gaze behaviour in social blushers. Psychiatry Res. 2012;200(2–3):614–9. doi:10.1016/j.psychres.2012.07.017.CrossRefPubMed

54.

Moukheiber A, Rautureau G, Perez-Diaz F, Soussignan R, Dubal S, Jouvent R, et al. Gaze avoidance in social phobia: objective measure and correlates. Behav Res Ther. 2010;48(2):147–51. doi:10.1016/j.brat.2009.09.012.CrossRefPubMed

55.

Weeks JW, Howell AN, Goldin PR. Gaze avoidance in social anxiety disorder. Depress Anxiety. 2013;30(8):749–56. doi:10.1002/da.22146.CrossRefPubMed

56.

• Howell AN, Zibulsky DA, Srivastav A, Weeks JW. Relations among social anxiety, eye contact avoidance, state anxiety, and perception of interaction performance during a live conversation. Cogn Behav Ther. 2016;45(2):111–22. doi:10.1080/16506073.2015.1111932. This study provides an interesting use of eye tracking in the assessment of eye contact during a live social interaction CrossRefPubMed

57.

Boll S, Bartholomaeus M, Peter U, Lupke U, Gamer M. Attentional mechanisms of social perception are biased in social phobia. J Anxiety Disord. 2016;40:83–93. doi:10.1016/j.janxdis.2016.04.004.CrossRefPubMedPubMedCentral

58.

Brunet PM, Heisz JJ, Mondloch CJ, Shore DI, Schmidt LA. Shyness and face scanning in children. J Anxiety Disord. 2009;23(7):909–14. doi:10.1016/j.janxdis.2009.05.009.CrossRefPubMed

59.

Van Dillen LF, Enter D, Peters LPM, van Dijk WW, Rotteveel M. Moral fixations: the role of moral integrity and social anxiety in the selective avoidance of social threat. Biol Psychol. 2017;122:51–8. doi:10.1016/j.biopsycho.2016.01.016.CrossRefPubMed

60.

Terburg D, Syal S, Rosenberger LA, Heany SJ, Stein DJ, van Honk J. Testosterone abolishes implicit subordination in social anxiety. Psychoneuroendocrinology. 2016;72:205–11. doi:10.1016/j.psyneuen.2016.07.203.CrossRefPubMed

61.

Myllyneva A, Ranta K, Hietanen JK. Psychophysiological responses to eye contact in adolescents with social anxiety disorder. Biol Psychol. 2015;109:151–8. doi:10.1016/j.biopsycho.2015.05.005.CrossRefPubMed

62.

Schneier FR, Rodebaugh TL, Blanco C, Lewin H, Liebowitz MR. Fear and avoidance of eye contact in social anxiety disorder. Compr Psychiatry. 2011;52(1):81–7. doi:10.1016/j.comppsych.2010.04.006.CrossRefPubMed

63.

Gilbert P. Evolution and social anxiety—the role of attraction, social competition, and social hierarchies. Psychiatr Clin North Am. 2001;24(4):723–51.CrossRefPubMed

64.

Wieser MJ, Pauli P, Alpers GW, Muehlberger A. Is eye to eye contact really threatening and avoided in social anxiety?—an eye-tracking and psychophysiology study. J Anxiety Disord. 2009;23(1):93–103. doi:10.1016/j.janxdis.2008.04.004.CrossRefPubMed

65.

66.

• Chen NTM, Clarke PJF, MacLeod C, Hickie IB, Guastella AJ. Aberrant gaze patterns in social anxiety disorder: an eye movement assessment during public speaking. J Exp Psychopathol. 2016;7(1):1–17. doi:10.5127/jep.040313. This study examines the selective attention biases which operate in SAD during a social-evaluative speech task CrossRef

67.

Clarke PJF, Notebaert L, MacLeod C. Absence of evidence or evidence of absence: reflecting on therapeutic implementations of attentional bias modification. BMC Psychiatry. 2014;14(1):1–6. doi:10.1186/1471-244X-14-8.CrossRef

68.

MacLeod C, Clarke PJF. The attentional bias modification approach to anxiety intervention. Clin Psychol Sci. 2015;3(1):58–78. doi:10.1177/2167702614560749.CrossRef

69.

Price RB, Wallace M, Kuckertz JM, Amir N, Graur S, Cummings L, et al. Pooled patient-level meta-analysis of children and adults completing a computer-based anxiety intervention targeting attentional bias. Clin Psychol Rev. 2016;50:37–49. doi:10.1016/j.cpr.2016.09.009.CrossRefPubMed

70.

Boettcher J, Berger T, Renneberg B. Internet-based attention training for social anxiety: a randomized controlled trial. Cogn Ther Res. 2012;36(5):522–36. doi:10.1007/s10608-011-9374-y.CrossRef

71.

Neubauer K, von Auer M, Murray E, Petermann F, Helbig-Lang S, Gerlach AL. Internet-delivered attention modification training as a treatment for social phobia: a randomized controlled trial. Behav Res Ther. 2013;51(2):87–97. doi:10.1016/j.brat.2012.10.006.CrossRefPubMed

72.

Kuckertz JM, Amir N. Attention bias modification for anxiety and phobias: current status and future directions. Curr Psychiatry Rep. 2015;17(2):9. doi:10.1007/s11920-014-0545-x.CrossRefPubMed

73.

• Price RB, Greven IM, Siegle GJ, Koster EH, De Raedt R. A novel attention training paradigm based on operant conditioning of eye gaze: preliminary findings. Emotion. 2016;16(1):110–6. doi:10.1037/emo0000093. This study provides an innovative gaze-contingent approach to training the selective attention biases which maintain SAD CrossRefPubMed

74.

• Lazarov A, Pine DS, Bar-Haim Y. Gaze-contingent music reward therapy for social anxiety disorder: a randomized controlled trial. Am J Psychiatry. 2017:appi.ajp.2016.16080894. doi:10.1176/appi.ajp.2016.16080894. This study provides an innovative gaze-contingent approach to training the selective attention biases which maintain SAD.

Title: Gaze-Based Assessments of Vigilance and Avoidance in Social Anxiety: a Review
Authors: Nigel T. M. Chen
Patrick J. F. Clarke
Publication date: 01-09-2017
Publisher: Springer US
Published in: Current Psychiatry Reports / Issue 9/2017
Print ISSN: 1523-3812
Electronic ISSN: 1535-1645
DOI: https://doi.org/10.1007/s11920-017-0808-4

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Gaze-Based Assessments of Vigilance and Avoidance in Social Anxiety: a Review

Abstract

Purpose of Review

Recent Findings

Summary

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose of Review

Recent Findings

Summary

Please log in to get access to this content

Other articles of this Issue 9/2017

Psychosocial Issues in Patients with Head and Neck Cancer: an Updated Review with a Focus on Clinical Interventions

Valproic Acid in Women and Girls of Childbearing Age

A Skill Set for Supporting Displaced Children in Psychological Recovery After Disasters

Advances in Psychotherapy for Depressed Older Adults

Neurocognitive Treatments for Eating Disorders and Obesity

Effects of Antidepressants on Sleep