Haunted by Pino Grigio
I decided to go t-total in January. As a person who enjoys a glass of vino regularly, I knew this was going to be a challenge. Now, one week into 2018, I feel like I am being haunted by Pino Grigio. Everywhere I look my attention seems to be grabbed by some tempting alcoholic beverage. I seem to have developed an attentional bias for wine!
I am not overly concerned as I know we all preferentially attend to information that is temporarily salient or personally meaningful. However, whilst this rather flippant example of attentional bias is doing me no real harm (other than testing my resolve), in certain situations attentional biases can and do become problematic.
Cognitive biases, anxiety and depression
A cognitive bias is the tendency to notice, interpret, or remember only certain aspects of the environment. For example, when speaking in a group, someone who is particularly socially anxious may overly attend to negative facial expressions (e.g., anger and disgust) rather than neutral expressions. They may also be more likely to interpret a negative facial expression as indicating a disapproval or dislike of them, rather than the context of their conversation. This habit of selectively attending (attention bias) and interpreting (interpretation bias) creates a vicious cycle in which an ambiguous world is experienced as threatening.
Several decades of research in clinical psychology has identified that these types of cognitive biases play a central role in the onset and maintenance of anxiety and depression. Clinical psychologists have led research in this field, developing computerized experimental methods to tap into how people implicitly process salient, emotive and threatening information. Researchers are now refining procedures to modify these cognitive biases –called cognitive bias modification (CBM) (MacLeod & Mathews, 2012).
CBM aims to modify the attention or interpretation bias, by repeatedly training attention towards more positive or benign information. CBM can test the causal relationship between cognitive biases and symptoms by experimentally manipulating the bias and measuring any associated change in symptoms.
Though CBM techniques are in their relative infancy, they have shown some promise as a clinical tool (Hakamata, et al., 2010) and as an adjunct to conventional forms of psychological interventions (Williams, et al., 2013).
Cognitive biases and health behaviours
Traditional health psychology models have largely focused on the role of reflective, intentioned action and beliefs (Sheeran et al., 2013), such as weighing up the pros and cons of my dry January. Attention (excuse the pun) is also now being paid to more habitual or automatic drivers of behaviour, such as my increased perception of alcohol cues.
For example, attentional biases towards food has been identified in eating disorders (Shafran, Lee, Cooper, Palmer, & Fairburn, 2007), for cigarettes in smokers (Ehrman, et al. 2002), and for, you guessed it, alcohol in alcohol use (Townshend & Duka, 2001).
Building upon this basic science research, a growing number of studies have employed CBM techniques to attempt to shift these cognitive biases. In addiction, there is some evidence that CBM may be effective as an ‘add-on’ to traditional, behavioural interventions. For example, a study of a CBM with people with alcohol addiction, called alcohol-avoidance training, found that trained alcoholic patients showed less relapse at one-year follow-up than control patients (Wiers et al., 2011). A further study replicated this result, and found that a shift in the attentional bias mediated this effect (Wiers et al., 2013).
Cognitive biases and symptom experience
Experimental research has also begun to explore the role cognitive biases may play in how people experience physical symptoms, such as pain. Research has shown that if a person is expecting pain or they are particularly fearful and catastrophic about the experience of pain, they have a lower threshold of perception for pain. Thus, vague, commonplace pains may more readily capture attention and may be interpreted as indicating damage or disease (Keogh, Ellery, Hunt, & Hannent, 2001; Keogh, Thompson, & Hannent, 2003).
These types of illness-specific cognitive biases have been identified in chronic pain (Crombez, Van Ryckeghem, Eccleston, & Van Damme, 2013; Schoth & Liossi, 2016), chronic fatigue syndrome (Hughes, Hirsch, Chalder, & Moss-Morris, 2016) and irritable bowel syndrome (Afzal, Potokar, Probert, & Munafò, 2006; Chapman & Martin, 2011; Tkalcic, Domijan, Pletikosic, Setic, & Hauser, 2014).
CBM work in this area is just beginning. Several CBM studies in chronic pain suggest that training people to direct attention away from pain-related information (i.e. reducing an attentional bias) is associated with reduced anxiety and pain related fear (Carleton, Richter, & Asmundson, 2011; Schoth, Georgallis, & Liossi, 2013; Sharpe, et al., 2012). However, as yet, mediation has not been established in these studies.
Experimental health psychology
The potential for experimental research to contribute to health psychology is substantial. CBM research can help establish if cognitive biases drive certain health behaviours or help maintain symptoms and distress in certain conditions. Our interventions may be optimized by targeting these implicit cognitive processes. For example, reducing attentional biases to food cues may in turn reduce impulsivity and thereby help regulate impulsive eating. There may also be a role for implicit processing in coping. For example, if survivors of breast cancer have persistent attentional bias for cancer related information and tend to interpret ambiguous information as cancer related, they may consequently experience increased anxiety and fear of recurrence.
Experimental research within health psychology is small but growing. However, in order for this research to be fruitful, experimental methods must be tailored and adapted appropriately for the population being studied. *For a guide to developing illness-specific materials for experimental research see Hughes, A. M., Gordon, R., Chalder, T., Hirsch, C. R., & Moss‐Morris, R. (2016). Maximizing potential impact of experimental research into cognitive processes in health psychology: A systematic approach to material development. British Journal of Health Psychology, 21(4), 764-780.
I hope this article encourages you to consider the role implicit processes may play in your area of research and to explore how you might conduct experimental research to assess these hypotheses. This post was written by Alicia Hughes and edited by Jowinn Chew. Thanks for reading our post. Hoping to leave you healthily psyched for more until our next edition in February.
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