Alcohol-related attentional biases in recently detoxified inpatients with severe alcohol use disorder: an eye-tracking approach.

BACKGROUND: Dominant theoretical models consider that attentional biases (AB) towards alcohol-related stimuli play a key role in the development and maintenance of alcohol use disorder (AUD). Their assessment has however showed high inconsistencies and has been mostly based on unreliable behavioral measures. This study evaluated the presence and extent of alcohol-related AB in recently detoxified inpatients with severe AUD by combining the visual probe task (VPT) paradigm with eye-tracking measures, known to improve the VPT reliability in subclinical populations. METHODS: We recruited 24 patients and 27 matched healthy controls. They performed the VPT (measuring reaction time when processing visual targets preceded by alcoholic and matched non-alcoholic pictures) combined with eye-tracking measures (dwell time, first fixation direction/duration, second fixation direction) during two sessions. Estimates of internal consistency, split-half reliability, and test-retest reliability were measured. RESULTS: Patients showed shorter dwell time for alcohol cues (p = .004, d=.853) and reduced number of fixations towards alcohol after a first fixation on non-alcohol cues (p = .012, d=.758) compared to controls. These findings suggest the presence of alcohol-related avoidance AB in detoxified patients with severe AUD. The VPT achieved excellent reliability for these eye-tracking measures. Reaction times and first fixation measures did not indicate any AB pattern and showed poor reliability. CONCLUSIONS: The VPT, when combined with dwell time and second fixation direction, constitutes a reliable method for assessing AB in detoxified patients. It showed the presence of an alcohol-related avoidance bias in this clinical population, in contradiction with the approach bias predicted by theoretical models.

Spatial anticipatory attentional bias for threat: Reliable individual differences with RT-based online measurement.

Cues that predict the future location of emotional stimuli may evoke an anticipatory form of automatic attentional bias. The reliability of this bias towards threat is uncertain: experimental design may need to be optimized or individual differences may simply be relatively noisy in the general population. The current study therefore aimed to determine the split-half reliability of the bias, in a design with fewer factors and more trials than in previous work. A sample of 63 participants was used for analysis, who performed the cued Visual Probe Task online, which aims to measure an anticipatory attentional bias. The overall bias towards threat was tested and split-half reliability was calculated over even and odd blocks. Results showed a significant bias towards threat and a reliability of around 0.7. The results support systematic individual differences in anticipatory attentional bias and demonstrate that RT-based bias scores, with online data collection, can be reliable.

Internet-delivered attentional bias modification training (iABMT) for the management of chronic musculoskeletal pain: a protocol for a randomised controlled trial.

INTRODUCTION: Chronic musculoskeletal pain is a complex medical condition that can significantly impact quality of life. Patients with chronic pain demonstrate attentional biases towards pain-related information. The therapeutic benefits of modifying attentional biases by implicitly training attention away from pain-related information towards neutral information have been supported in a small number of published studies. Limited research however has explored the efficacy of modifying pain-related biases via the internet. This protocol describes a randomised, double-blind, internet-delivered attentional bias modification intervention, aimed to evaluate the efficacy of the intervention on reducing pain interference. Secondary outcomes are pain intensity, state and trait anxiety, depression, pain-related fear, and sleep impairment. This study will also explore the effects of training intensity on these outcomes, along with participants' perceptions about the therapy. METHODS AND ANALYSIS: The study is a double-blind, randomised controlled trial with four arms exploring the efficacy of online attentional bias modification training versus placebo training theorised to offer no specific therapeutic benefit. Participants with chronic musculoskeletal pain will be randomised to one of four groups: (1) 10-session attentional modification group; (2) 10-session placebo training group; (3) 18-session attentional modification group; or (4) 18-session placebo training group. In the attentional modification groups, the probe-classification version of the visual-probe task will be used to implicitly train attention away from threatening information towards neutral information. Following the intervention, participants will complete a short interview exploring their perceptions about the online training. In addition, a subgroup analysis for participants aged 16-24 and 25-60 will be undertaken. ETHICS AND DISSEMINATION: This study has been approved by the University of Southampton Research Ethics Committee. Results will be published in peer-reviewed journals, academic conferences, and in lay reports for pain charities and patient support groups. TRIAL REGISTRATION NUMBER: NCT02232100; Pre-results.

Variations in the Visual Probe Paradigms for Attention Bias Modification for Substance Use Disorders.

Advances in experimental psychology have provided evidence for the presence of attentional and approach biases in individuals with substance use disorders. Traditionally, reaction time tasks, such as the Stroop or the Visual Probe Task, are commonly used in the assessment of attention biases. The Visual Probe Task has been criticized for its poor reliability, and other research has highlighted that variations remain in the paradigms adopted. However, a gap remains in the published literature, as there have not been any prior studies that have reviewed stimulus timings for different substance use disorders. Such a review is pertinent, as the nature of the task might affect its effectiveness. The aim of this paper was in comparing the different methods used in the Visual Probe Task, by focusing on tasks that have been used for the most highly prevalent substance disorders-that of opiate use, cannabis use and stimulant use disorders. A total of eight published articles were identified for opioid use disorders, three for cannabis use disorders and four for stimulant use disorders. As evident from the synthesis, there is great variability in the paradigm adopted, with most articles including only information about the nature of the stimulus, the number of trials, the timings for the fixation cross and the timings for the stimulus set. Future research examining attentional biases among individuals with substance use disorders should take into consideration the paradigms that are commonly used and evaluate the optimal stimulus and stimulus-onset asynchrony timings.

Intergenerational transmission of attentional bias and anxiety.

Earlier evidence has revealed a bi-directional causal relationship between anxiety and attention biases in adults and children. This study investigated the prospective and concurrent relations between anxiety and attentional bias in a sample of 89 families (mothers, fathers, and first-born children). Parents' and children's attentional bias was measured when children were 7.5 years old, using both a visual probe task and visual search task with angry versus happy facial expressions. Generalized and social anxiety symptoms in parents and children were measured when children were 4.5 and 7.5 years old. Anxiety in parents and children was prospectively (but not concurrently) related to their respective attentional biases to threat: All participants showed a larger attentional bias to threat in the visual search (but not in the visual probe) task if they were more anxious at the 4.5 (but not at the 7.5) year measurement. Moreover, parents' anxiety levels were prospectively predictive of the visual search attentional bias of their children after controlling for child anxiety. More anxiety in mothers at 4.5 years was related to a faster detection of angry among happy faces, while more anxiety in fathers predicted a faster detection of happy among angry faces in children at 7.5 years. We found no direct association between parental and child attentional biases. Our study contributes to the recently emerging literature on attentional biases as a potential mechanism in the intergenerational transmission of anxiety by showing that parents' anxiety rather than parents' attentional bias contributes to the intergenerational transmission of risk for child anxiety.

Chewing Stimulation Reduces Appetite Ratings and Attentional Bias toward Visual Food Stimuli in Healthy-Weight Individuals.

Based on the theory of incentive sensitization, the exposure to food stimuli sensitizes the brain's reward circuits and enhances attentional bias toward food. Therefore, reducing attentional bias to food could possibly be beneficial in preventing impulsive eating. The importance of chewing has been increasingly implicated as one of the methods for reducing appetite, however, no studies to investigate the effect of chewing on attentional bias to food. In this study, we investigated whether chewing stimulation (i.e., chewing tasteless gum) reduces attentional bias to food as well as an actual feeding (i.e., ingesting a standardized meal) does. We measured reaction time, gaze direction and gaze duration to assess attentional bias toward food images in pairs of food and non-food images that were presented in a visual probe task (Experiment 1, n = 21) and/or eye-tracking task (Experiment 2, n = 20). We also measured appetite ratings using visual analog scale. In addition, we conducted a control study in which the same number of participants performed the identical tasks to Experiments 1 and 2, but the participants did not perform sham feeding with gum-chewing/actual feeding between tasks and they took a rest. Two-way ANOVA revealed that after actual feeding, subjective ratings of hunger, preoccupation with food, and desire to eat significantly decreased, whereas fullness significantly increased. Sham feeding showed the same trends, but to a lesser degree. Results of the visual probe task in Experiment 1 showed that both sham feeding and actual feeding reduced reaction time bias significantly. Eye-tracking data showed that both sham and actual feeding resulted in significant reduction in gaze direction bias, indexing initial attentional orientation. Gaze duration bias was unaffected. In both control experiments, one-way ANOVAs showed no significant differences between immediately before and after the resting state for any of the appetite ratings, reaction time bias, gaze direction bias, or gaze duration bias. In conclusion, chewing stimulation reduced subjective appetite and attentional bias to food, particularly initial attentional orientation to food. These findings suggest that chewing stimulation, even without taste, odor, or ingestion, may affect reward circuits and help prevent impulsive eating.

Attentional bias to unhealthy food in individuals with severe obesity and binge eating.

Attentional bias is an implicit cognition relevant to development and maintenance of obesity, but little is known of how binge eating modulates attentional bias in severe obesity. This study investigated attentional bias towards unhealthy foods at different stages of attentional processing in a clinical sample, comparing obese patients (Body Mass Index, BMI>35 kg/m2) with and without binge eating behaviors. Participants were separated into two groups according to their score on the Binge Eating Scale (BES): no binge eating (NB; score ≤17; n = 23) and binge eating (BE; score > 17; n = 19). Participants performed a computerized visual probe task designed to evaluate attentional bias in different stages of attentional process; matching pairs of unhealthy food and matching non-food pictures concealed a target for 100, 500 or 2000 ms. Reduced reaction times to targets following food-related images are indicative of attentional bias towards food images. BE group exhibited a greater bias towards food than NB. Both groups showed positive attentional bias to food in the initial orientation stage (100 ms), whereas bias was close to zero in the maintenance of attention stage (2000 ms), suggesting ambivalent approach-avoidance responses to food stimuli. Only the BE group showed a bias towards food images when displayed for 500 ms, indicating disengaging from food-related stimuli was faster in NB group. Although both groups were ambivalent about attending to food cues, slower attentional disengagement from unhealthy food might be a cognitive marker of binge eating behavior in severe obesity.

Attentional biases in patients with alcohol dependence: influence of coexisting psychopathology.

OBJECTIVE: The effects of coexisting psychopathology on disorder-specific attentional biases in patients with alcohol dependence are uncertain. We undertook a cross-sectional study assessing attentional biases to alcohol-, depression-, and anxiety- related stimuli using the visual probe task in patients with alcohol dependence, attending a community alcohol service. METHODS: Using the visual probe task, we presented disorder-specific words (relating to alcohol, anxiety, and depression) for 500 ms and measured reaction times. RESULTS: Participants demonstrated a significant attentional bias towards alcohol-related cues (mean 8.5, p = 0.03) but significant avoidance of depression-related cues (mean -8.4, p = 0.01). The subgroup of participants who were recently abstinent (n = 70) showed greatest avoidance of depression-related cues (t(69) = 2.68, p < 0.01) but no significant vigilance towards alcohol or anxiety cues, whereas those still drinking (n = 43) showed attentional biases towards alcohol-related (t(42) = 2.70, p = 0.01) and social anxiety-related cues (t(42) = 2.84, p < 0.01). In the whole sample, the magnitude of attentional bias to alcohol was not correlated with length of drinking history, number of comorbid conditions, or severity of anxiety/depression. CONCLUSIONS: In a clinical sample of alcohol-dependent patients, further investigation is required to explore whether these attentional biases reflect current drinking status or factors indicating prognosis.

Alcohol Administration Increases Cocaine Craving But Not Cocaine Cue Attentional Bias.

BACKGROUND: Alcohol consumption is a known antecedent to cocaine relapse. Through associative conditioning, it is hypothesized that alcohol increases incentive motivation for cocaine and thus the salience of cocaine-related cues, which are important in maintaining drug-taking behavior. Cocaine-using individuals display a robust cocaine cue attentional bias as measured by fixation time during the visual probe task. The purpose of this study was to evaluate the influence of alcohol administration on cocaine cue attentional bias using eye-tracking technology to directly measure attentional allocation. METHODS: Twenty current cocaine users completed a double-blind, placebo-controlled, within-subjects study that tested the effect of 3 doses of alcohol (0.00, 0.325, and 0.65 g/kg) on cocaine cue attentional bias using the visual probe task with eye-tracking technology. The participant-rated and physiological effects of alcohol were also assessed. RESULTS: Participants displayed a robust cocaine cue attentional bias following both placebo and alcohol administration as measured by fixation time, but not response time. Alcohol administration did not influence cocaine cue attentional bias, but increased craving for cocaine in a dose-dependent manner. Alcohol produced prototypic psychomotor and participant-rated effects. CONCLUSIONS: Alcohol administration increases cocaine craving but not cocaine cue attentional bias. Alcohol-induced cocaine craving suggests that alcohol increases incentive motivation for cocaine but not the salience of cocaine-related cues.

Mood & alcohol-related attentional biases: New considerations for gender differences and reliability of the visual-probe task.

INTRODUCTION: Alcohol-related attentional biases are positively associated with drinking history and may represent a mechanism by which alcohol use behavior is maintained over time. This study was designed to address two unresolved issues regarding alcohol-related attention biases. Specifically, this study tested whether acute changes in positive and negative mood increase attentional biases toward alcohol cues and whether coping and enhancement drinking motives moderate these effects. METHODS: Participants were 100 college students aged 18-25, who drank alcohol at least once in the last 90 days. In a 2 × 3 mixed design, participants were randomized to one of three mood conditions (neutral, negative, or positive) and completed visual-probe tasks pre- and post-mood-induction. RESULTS: Attentional biases toward alcohol cues were significantly associated with alcohol consumption among men, but not women. Although the mood manipulation was highly successful, attentional biases did not vary as a function of mood condition and hypothesized moderating effects of drinking motives were not significant. CONCLUSIONS: The largely null findings of the experiment are discussed in light of the fact that the visual probe task had poor reliability. Issues related to the reliability of visual-probe task are discussed, as more research is needed to evaluate and improve the psychometrics of this method.

Less than meets the eye: reappraising the clinical relevance of attentional bias in addiction.

Recent years have seen an explosion of interest in attentional bias in addiction, particularly its clinical relevance. Specifically, numerous articles claimed to demonstrate either that (1) attentional bias measured in treatment settings could predict subsequent relapse to substance use, or (2) direct modification of attentional bias reduced substance use and improved treatment outcomes. In this paper, we critically evaluate empirical studies that investigated these issues. We show that the evidence regarding both of these claims is decidedly mixed, and that many of the studies that appear to yield positive findings have serious methodological and statistical limitations. We contend that the available literature suggests that attentional bias for drug cues fluctuates within individuals because it is an output of the underlying motivational state at that moment in time, but there is no convincing evidence that it exerts a causal influence on substance use. Future research should make use of experience sampling methodology to characterise the clinical significance of fluctuations in attentional bias over time.

Attentional bias to food cues in youth with loss of control eating.

Emerging data indicate that adults with binge eating may exhibit an attentional bias toward highly palatable foods, which may promote obesogenic eating patterns and excess weight gain. However, it is unknown to what extent youth with loss of control (LOC) eating display a similar bias. We therefore studied 76 youth (14.5 ± 2.3 years; 86.8% female; BMI-z 1.7 ± .73) with (n = 47) and without (n = 29) reported LOC eating. Following a breakfast to reduce hunger, youth participated in a computerized visual probe task of sustained attention that assessed reaction time to pairs of pictures consisting of high palatable foods, low palatable foods, and neutral household objects. Although sustained attentional bias did not differ by LOC eating presence and was unrelated to body weight, a two-way interaction between BMI-z and LOC eating was observed (p = .01), such that only among youth with LOC eating, attentional bias toward high palatable foods versus neutral objects was positively associated with BMI-z. These findings suggest that LOC eating and body weight interact in their association with attentional bias to highly palatable foods cues, and may partially explain the mixed literature linking attentional bias to food cues with excess body weight.

Fixation time is a sensitive measure of cocaine cue attentional bias.

BACKGROUND AND AIMS: Attentional bias has been demonstrated to a variety of substances. Evidence suggests that fixation time is a more direct measure of attentional bias than response time. The aims of this experiment were to demonstrate that fixation time during the visual probe task is a sensitive and stable measure of cocaine cue attentional bias in cocaine-using adults compared to controls. DESIGN: A between-subject, repeated-measures experiment. SETTING: An out-patient research unit. PARTICIPANTS: Fifteen cocaine using and 15 non-cocaine-using adults recruited from the community. MEASUREMENTS: Participants completed a visual probe task with eye tracking and a modified Stroop during two experimental sessions. FINDINGS: A significant interaction between cue type and group (F = 13.5; P < 0.05) indicated that cocaine users, but not controls, displayed an attentional bias to cocaine-related images as measured by fixation time. There were no changes in the magnitude of attentional bias across sessions (F = 3.4; P > 0.05) and attentional bias correlated with self-reported life-time cocaine use (r = 0.64, P < 0.05). Response time on the visual probe (F = 1.1; P > 0.05) as well as on the modified Stroop (F = 0.1; P > 0.05) failed to detect an attentional bias. CONCLUSIONS: Fixation time on cocaine-related stimuli (propensity to remain focused on the stimulus) is a sensitive and stable measure of cocaine cue attentional bias in cocaine-using adults.

Attentional bias modification encourages healthy eating.

The continual exposure to unhealthy food cues in the environment encourages poor dietary habits, in particular consuming too much fat and sugar, and not enough fruit and vegetables. According to Berridge's (2009) model of food reward, unhealthy eating is a behavioural response to biased attentional processing. The present study used an established attentional bias modification paradigm to discourage the consumption of unhealthy food and instead promote healthy eating. Participants were 146 undergraduate women who were randomly assigned to two groups: one was trained to direct their attention toward pictures of healthy food ('attend healthy' group) and the other toward unhealthy food ('attend unhealthy' group). It was found that participants trained to attend to healthy food cues demonstrated an increased attentional bias for such cues and ate relatively more of the healthy than unhealthy snacks compared to the 'attend unhealthy' group. Theoretically, the results support the postulated link between biased attentional processing and consumption (Berridge, 2009). At a practical level, they offer potential scope for interventions that focus on eating well.

Attention processes in chronic fatigue syndrome: attentional bias for health-related threat and the role of attentional control.

Cognitive behavioural models of chronic fatigue syndrome (CFS) propose that attention processes, specifically, enhanced selective attention to health-threat related cues, may play an important role in symptom maintenance. The current study investigated attentional bias towards health-threat stimuli in CFS. It also examined whether individuals with CFS have impaired executive attention, and whether this was related to attentional bias. 27 participants with CFS and 35 healthy controls completed a Visual Probe Task measuring attentional bias, and an Attention Network Test measuring executive attention, alerting and orienting. Participants also completed self-report measures of CFS and mood symptoms. Compared to the control group, the CFS group showed greater attentional bias for health-threat words than pictures; and the CFS group was significantly impaired in executive attention. Furthermore, CFS individuals with poor executive attention showed greater attentional bias to health-threat related words, compared not only to controls but also to CFS individuals with good executive attention. Thus, this study revealed a significant relationship between attentional bias and executive attention in CFS: attentional bias to threat was primarily evident in those with impaired executive attention control. Taking account of individual differences in executive attention control in current intervention models may be beneficial for CFS.

Attentional avoidance of smoking cues in former smokers.

It has been speculated that attentional bias (AB) to smoking cues is a permanent feature of addiction. The objective of the present study was to investigate if abstinence duration has an influence on AB. Performance on a visual probe task of three groups (recent, intermediate and prolonged) of ex-smokers (n=62, mean age 50±11 years) with different abstinence durations was compared. Target/Control images were presented at three stimulus onset asynchronies (SOAs: 200, 500, and 2000 ms) on a 17-inch monitor. Former smokers avoided target images (TIs). Mean reaction time to control images was shorter than to TIs, confirming the attentional avoidance of TIs. Attentional avoidance of TIs and the lower emotional valence of these stimuli may have been a strategy to avoid relapse. Sustained avoidance to smoking-related cues may be a predictor of long-term abstinence. Direct training of AB away from drug cues may improve the results of smoking cessation therapy.