Subtypes of Attentional Bias within Social Anxiety Disorder: Evaluating Changes following Cognitive Behavioral Therapy

Prominent theories of social anxiety disorder (SAD) describe the role of attentional bias in the disorder's etiology and maintenance; some models implicate bias toward social threats (e.g., Rapee & Heimberg, 1997) and others implicate bias to avoid them (e.g., Clark & Wells, 1995). The present investigation examined: 1) whether a clinical sample of individuals with SAD comprises two distinct groups based on attention bias for social threat (vigilant, avoidant), and 2) group-specific changes in attention bias following cognitive behavioral therapy (CBT) for SAD. Consistent with predictions, results yielded evidence of two pre-treatment groups (vigilant and avoidant). After eight weeks of treatment, the direction of change in attention bias differed between groups, such that the vigilant group became less vigilant, and the avoidant group became less avoidant, with the avoidant group showing a significant change in attention bias from pre-to post-treatment. These findings provide preliminary support for the hypothesis that SAD comprises subgroups with both threat vigilant and threat avoidant attentional styles and change in different directions following treatment. Implications for how individuals who exhibit one attentional bias or the other may differentially respond to treatment are discussed. To whom it may concern: We have attached an original research article entitled " Subtypes of Attentional Bias within Social Anxiety Disorder: Evaluating Changes following Cognitive Behavioral Therapy " for your consideration for publication in Journal of Anxiety Disorders. In this manuscript, we report findings that suggest a novel way to refine conceptualizations of Social Anxiety Disorder (SAD) and to better target treatment for affected individuals. Specifically, our findings provide preliminary support for the idea that individuals with SAD constitute two distinct subgroups with differing attentional styles and whose respective threat bias patterns change in different ways following Cognitive Behavioral Therapy for SAD. We are confident that this study will be particularly meaningful to the readership of Journal of Anxiety Disorders. We trust that you will agree and will give this submission due consideration. Acknowledgements: This project was supported by a National Institutes of Mental Health grant (P50 MH 68036) awarded to the last author and an Anxiety Disorders Association of American grant (H07532) awarded to the second and last authors.