Research paperThe influence of attention biases and adult attachment style on treatment outcome for adults with social anxiety disorder

- Eye-tracking technology was used to measure both vigilance towards and difficulty disengaging from threat.
- Those initially avoidant of threat become more vigilant towards threat following CBT for social anxiety disorder.
- Attention bias towards threatening stimuli and difficulty disengaging from happy stimuli predicts treatment outcome.

BackgroundAttention biases figure prominently in CBT models of social anxiety and are thought to maintain symptoms of social anxiety disorder (SAD). Studies have shown that individual differences in pre-treatment attention biases predict cognitive behavioural therapy (CBT) outcome. However, these findings have been inconsistent as to whether vigilance towards threat predicts better or poorer treatment outcome. Adult attachment style is an individual characteristic that may influence the relationship between attention bias and SAD. This study investigates the relationship between attention biases and CBT treatment outcome for SAD. Furthermore, we examined the influence of adult attachment style on this relationship.MethodParticipants with a primary diagnosis of SAD completed a passive viewing (measuring vigilance towards threat) and a novel difficulty to disengage (measuring difficulty to disengage attention) eye-tracking task prior to attending 12 CBT group sessions targeting SAD. Symptom severity was measured at pre- and post-treatment. Regression analyses were conducted on a sample of 50 participants.ResultsGreater vigilance for threat than avoidance of threat at pre-treatment predicted poorer treatment outcomes. Greater difficulty disengaging from happy faces, compared to neutral faces, predicted poorer treatment outcomes. Attachment style did not moderate these relationships.LimitationsThe associations between attention biases and specific components of CBT treatment were not examined. The novel findings regarding difficulty to disengage attention require replication.ConclusionsThe findings have implications for the theoretical models of SAD and for the treatment of SAD.