The influence of self-focused attention on emotional picture processing: An ERP study.

Research has documented neurophysiological indicators of anticipation (Stimulus Preceding Negativity [SPN]) and perception (Late Positive Potential [LPP]) of threat, yet little is known as to how self-focused attention manipulations influence emotion processing within the context of cued picture viewing. With self-referent attention moderating attention to external stimuli, it is necessary to document how self-focused attention impacts attention and the ability to emotionally process external threat. The goal of the present study was to evaluate the impact of self-focused attention on the anticipation and perceptual processing of unpleasant pictures within a cued-picture viewing paradigm among 33 participants. Overall, the results suggest that the self-focused attention manipulations disrupted anticipation but not processing of pictures, as indexed by the SPN and LPP respectively. Self-focused attention appears to disrupt the preparatory attention for upcoming unpleasant stimuli, potentially through loading cognitive resources or activation of associative defensive responding. Collectively, these findings demonstrate the impact of self-focused attention within the context of emotional picture processing and suggest further areas of investigation.

Culturally Centered Implementation of Video Telehealth for Rural Native Veterans.

Introduction: Native American Veterans are the most rural and experience heightened risk for mental health (MH) challenges while facing significant health care inequities and access barriers. Rural Native Veterans (RNVs) have experienced historical loss and racial discrimination, contributing to mistrust of Veterans Health Administration (VHA) and other Federal systems. Telemedicine, including video telehealth (VTH), can improve access to MH care for RNVs by addressing barriers. Understanding the cultural context and existing community resources can improve engagement and implementation efforts with RNVs. Objective: This article describes a model of culturally centered MH care and a flexible implementation approach, Personalized Implementation of Virtual Treatments for Rural Native Veterans (PIVOT-RNV), used to disseminate the model. Methods: Participants included four VHA sites serving large RNV populations where PIVOT-RNV was applied to expand the availability of virtual solutions, including VTH, for RNVs. A mixed methods formative evaluation tracked VTH utilization and used provider and RNV feedback to inform iterative process improvements. Results: Where PIVOT-RNV was used, number of providers using VTH with RNVs, number of unique RNVs receiving MH care through VTH, and number of VTH encounters with RNVs grew annually. Provider and RNV feedback highlighted the importance of addressing the unique barriers and cultural context of RNVs. Conclusions: PIVOT-RNV demonstrates promise for improving implementation of virtual treatments and access to MH care for RNVs. The integration of implementation science within a cultural safety framework helps address specific barriers to adoption of virtual treatments for RNVs. Next steps include expanding PIVOT-RNV efforts at additional sites.

Independent Psychometric Evaluation and Predictive Utility of The Social Anxiety Questionnaire.

The Social Anxiety Questionnaire (SAQ) is a 10-item measure of social anxiety developed to comprehensively and concisely target the mechanisms described in Clark and Wells' model of social anxiety and address the breadth of social anxiety symptoms which may not all be encompassed in existing questionnaires. The aim of the current studies is to independently investigate the factor structure of the SAQ (i.e., Study 1 and 2) and determine its predictive validity and utility (i.e., Study 3 and 4). Data were collected across 4 studies to evaluate the factor structure and utility. Overall, the results suggest that a total summed score of the SAQ appeared to capture unique aspects of social anxiety that may not be captured using a single measure and appears to provide utility in experimental manipulations of theoretical maintenance factors. The current study was limited by a convenience sample and future research should continue to document the psychometric properties and clinical utility of this novel measure of social anxiety. The SAQ may show promise in both correlational and experimental research but future research should consider further evaluation of its utility.

Neural indices of orienting, discrimination, and conflict monitoring after contextual fear and safety learning.

Investigations of fear conditioning have recently begun to evaluate contextual factors that affect attention-related processes. However, much of the extant literature does not evaluate how contextual fear learning influences neural indicators of attentional processes during goal-directed activity. The current study evaluated how early attention for task-relevant stimuli and conflict monitoring were affected when presented within task-irrelevant safety and threat contexts after fear learning. Participants (N = 72) completed a Flanker task with modified context before and after context-dependent fear learning. Flanker stimuli were presented in the same threat and safety contexts utilized in the fear learning task while EEG was collected. Results indicated increased early attention (N1) to flankers appearing in threat contexts and later increased neural indicators (P2) of attention to flankers appearing in safety contexts. Results of this study indicate that contextual fear learning modulates early attentional processes for task-relevant stimuli that appear in the context of safety and threat. Theoretical and clinical implications are discussed.

Assessing the psychometric properties of the Attentional Style Questionnaire.

Attentional control has grown in importance within theoretical and predictive models of psychopathology over past decades. The Attentional Style Questionnaire (ASQ) is a novel measure of internal and external attentional control. However, no study has independently validated this questionnaire. Two studies assessed the factor structure for the ASQ within an English-speaking population (Study 1), evaluated the construct and content validity, and assessed incremental predictability (Study 2). Results of Study 1 observed two factors that could be characterised as distractibility/cognitive avoidance and focusing, whereas the original study had observed factors defined as internal and external. Results of Study 2 confirmed the factor structure of Study 1, in addition to providing evidence for the ASQ's predictability for anxiety, depression and worry behaviours above established measures of attentional control. Overall, these results indicated that the ASQ measures factors of attentional control which provides incremental utility for predicting psychopathology. Implications on psychopathology and discrepancies to previous findings are discussed.

The effects of cognitive load on attention control in subclinical anxiety and generalised anxiety disorder.

Poor regulation of emotions may involve impaired attention control. In the current paper, we report the results of two studies examining the interaction of anxiety, attention control and cognitive load. In Study I, using a performance-based task to assess attention control, we examined whether anxiety is associated with impaired attention control, and whether these effects are influenced by working memory load. In Study II, we examined these effects in patients with a diagnosis of generalised anxiety disorder (GAD) compared to non-anxious control (NAC) participants. Results of Study I showed that high anxiety was associated with increased attention control, that is decreased interference from distractors, but only under high cognitive load. These results were replicated in Study II such that individuals with GAD showed increased attention control relative to NACs, but only under high cognitive load. These results help clarify previous predictions regarding the effect of anxiety on attention control.

Rural-Urban Disparities in Video Telehealth Use During Rapid Mental Health Care Virtualization Among American Indian/Alaska Native Veterans.

Importance: American Indian/Alaska Native veterans experience a high risk for health inequities, including mental health (MH) care access. Rapid virtualization of MH care in response to the COVID-19 pandemic facilitated care continuity across the Veterans Health Administration (VHA), but the association between virtualization of care and health inequities among American Indian/Alaska Native veterans is unknown. Objective: To examine differences in video telehealth (VTH) use for MH care between American Indian/Alaska Native and non-American Indian/Alaska Native veterans by rurality and urbanicity. Design, Setting, and Participants: In this cohort study, VHA administrative data on VTH use among a veteran cohort that received MH care from October 1, 2019, to February 29, 2020 (prepandemic), and April 1 to December 31, 2020 (early pandemic), were examined. Exposures: At least 1 outpatient MH encounter during the study period. Main Outcomes and Measures: The main outcome was use of VTH among all study groups (ie, American Indian/Alaska Native, non-American Indian/Alaska Native, rural, or urban) before and during the early pandemic. American Indian/Alaska Native veteran status and rurality were examined as factors associated with VTH utilization through mixed models. Results: Of 1 754 311 veterans (mean [SD] age, 54.89 [16.23] years; 85.21% male), 0.48% were rural American Indian/Alaska Native; 29.04%, rural non-American Indian/Alaska Native; 0.77%, urban American Indian/Alaska Native; and 69.71%, urban non-American Indian/Alaska Native. Before the pandemic, a lower percentage of urban (b = -0.91; SE, 0.02; 95% CI, -0.95 to -0.87; P < .001) and non-American Indian/Alaska Native (b = -0.29; SE, 0.09; 95% CI, -0.47 to -0.11; P < .001) veterans used VTH. During the early pandemic period, a greater percentage of urban (b = 1.37; SE, 0.05; 95% CI, 1.27-1.47; P < .001) and non-American Indian/Alaska Native (b = 0.55; SE, 0.19; 95% CI, 0.18-0.92; P = .003) veterans used VTH. There was a significant interaction between rurality and American Indian/Alaska Native status during the early pandemic (b = -1.49; SE, 0.39; 95% CI, -2.25 to -0.73; P < .001). Urban veterans used VTH more than rural veterans, especially American Indian/Alaska Native veterans (non-American Indian/Alaska Native: rurality b = 1.35 [SE, 0.05; 95% CI, 1.25-1.45; P < .001]; American Indian/Alaska Native: rurality b = 2.91 [SE, 0.38; 95% CI, 2.17-3.65; P < .001]). The mean (SE) increase in VTH was 20.34 (0.38) and 15.35 (0.49) percentage points for American Indian/Alaska Native urban and rural veterans, respectively (difference in differences [DID], 4.99 percentage points; SE, 0.62; 95% CI, 3.77-6.21; t = -7.999; df, 11 000; P < .001), and 12.97 (0.24) and 11.31 (0.44) percentage points for non-American Indian/Alaska Native urban and rural veterans, respectively (DID, 1.66; SE, 0.50; 95% CI, 0.68-2.64; t = -3.32; df, 15 000; P < .001). Conclusions and Relevance: In this cohort study, although rapid virtualization of MH care was associated with greater VTH use in all veteran groups studied, a significant difference in VTH use was seen between rural and urban populations, especially among American Indian/Alaska Native veterans. The findings suggest that American Indian/Alaska Native veterans in rural areas may be at risk for VTH access disparities.

Documenting the late positive potential towards self-imagery within social anxiety.

Models of social anxiety propose that negative self-imagery is a maintenance factor of psychopathology, yet the mechanisms of this relationship are unclear. One proposed mechanism is attention towards self-images. However, self-image creation does not occur in isolation and is likely influenced by other mechanisms, such as anticipatory processing (AP). The current study aimed to investigate how trait social anxiety and AP influence motivated attention during self-imagery (i.e., late-positive potential; LPP). Participants (N = 40) with a mean age of 18.95 (SD = 1.22) completed AP manipulations and a self-imagery task. Results revealed that participants with high levels of social anxiety who engaged in AP demonstrated blunted LPP activity in the late time window (6000-10,000 ms) relative to those who engaged in Distraction. These results suggest that motivated attention towards self-imagery may be impacted by anticipatory processing, but less influenced by the valence of self-imagery. Given previous research has been limited in methodology, this study expands upon current research by documenting the neural mechanisms of self-imagery manipulations within social anxiety.

Cognitive mechanisms influence the relationship between social anxiety and depression among college students.

OBJECTIVE: Social anxiety and depression are commonly comorbid and cause significant impairment in college students. Past research suggests that both poor attentional control and increased rumination are related to these disorders and independently mediate their relationship. Theory suggests that social anxiety loads working memory, thus decreasing attentional control, which influences rumination and depression. The current study aimed to investigate the potential combined influence of attention control and rumination on social anxiety and depression. Participants: Participants (80) were recruited from a large Midwestern university in September 2017. Methods: Participants completed questionnaires regarding social anxiety, attentional control, rumination, and depression and data were analyzed using bias-corrected bootstrapping analyses. Results: Results demonstrate a significant indirect relationship between social anxiety and depression through attentional control and rumination. Conclusions: Results indicated that college students with social anxiety may be at risk for depression due to decreased attentional control and increased rumination. Clinical implications are discussed.

Examination of evaluative threat in worry: Insights from the Error-Related Negativity (ERN).

Recent research suggests atypical error-monitoring is important to understanding pathological anxiety. Because uncertainty is a transdiagnostic factor associated with anxiety and related disorders, recent research has begun to examine the influence of uncertainty in error-monitoring. Moreover, task irrelevant threat has been shown to influence cognitive performance in individuals with maladaptive anxiety. The current study aims to merge these literatures by examining the influence of task-irrelevant uncertain evaluative threat on error-monitoring using an event-related brain potential, the error-related negativity (ERN). Considering extensive literature indicating a relationship between worry and the ERN, worry was included as a continuous predictor in the analyses. Participants were randomly assigned to either a condition of negative or uncertain evaluative threat to determine their influence on error-monitoring in a Flankers task. Results for the ERN suggest that the ERN was significantly reduced only for the uncertain evaluative threat condition. The current study suggests that uncertain evaluative threat distractors result in a subsequent reduction in error-monitoring. This is consistent with literature suggesting that anxiety impairs inhibition of attentional processing of task irrelevant threatening information. This study adds to the burgeoning literature on the malleability of the ERN. Future research is needed to determine the mechanisms underlying this effect.

Trait attentional control influences the relationship between repetitive negative thinking and psychopathology symptoms.

Repetitive negative thinking (RNT) has been implicated in several disorders (e.g., Clark (2005)). However, little research has examined how RNT influences other risk factors of psychopathology, such as attentional control. This study used prospective methodology to determine if relationships among various RNT styles and symptoms of psychological disorders are indirectly influenced by facets of attentional control. The sample included 376 participants who completed measures of RNT (worry, rumination, anticipatory processing, obsessions, intrusive thoughts and panic cognitions), psychopathology (generalized anxiety disorder, depression, social anxiety, obsessive-compulsive disorder, posttraumatic stress disorder, and panic disorder), and attentional control at two time points. Several relationships between RNT forms and symptom levels were indirectly predicted by the focusing subscale of attentional control; however, the patterns of these relationships differed based on the disorder. The shifting subscale did not indirectly predict any relationship. Therefore, it appears that low focusing may be a particular risk factor for the development of later RNT and/or psychopathology symptoms.

Electrocortical Evidence of Enhanced Performance Monitoring in Social Anxiety.

Self-focused attention is thought to be a key feature of social anxiety disorder. Yet few studies have used event-related potentials (ERPs) to examine whether socially anxious individuals display greater monitoring of their performance and attention to their errors. Similarly, only a few studies have used ERPs to examine how social anxiety is related to processing of performance feedback. Individuals with high (n=26) and low (n=28) levels of social anxiety completed a trial-and-error learning task. Self-focus was manipulated using false heart-rate feedback during a random subset of trials. Performance feedback was given using emotional and neutral faces in a positive context (correct=happy face; incorrect=neutral face) and negative context (correct=neutral face; incorrect=disgust face) in order to investigate biased interpretation and attention to feedback. Socially anxious subjects displayed enhanced amplitude of the ERN and CRN, suggesting greater response monitoring, and enhanced Pe amplitude, suggesting greater processing of errors relative to the low social anxiety group. No group differences were observed with respect to feedback processing. Before learning stimulus-response mappings in the negative context, the FRN was larger for self-focus compared to standard trials and marginally larger for socially anxious subjects compared to controls. These findings support cognitive models and suggest avenues for future research.