Understanding Anxiety Through the Constructs of Attentional Bias and Attentional Scope by Mengran Xu A thesis presented to the University of Waterloo in fulfillment of the thesis requirement for the degree of Doctor of Philosophy in Psychology Waterloo, Ontario, Canada, 2017 ©Mengran Xu 2017 Examining Committee Membership The following served on the Examining Committee for this thesis. The decision of the Examining Committee is by majority vote. External Examiner: Dr. Judith Laposa Supervisor: Dr. Christine Purdon Internal Member: Dr. Michael Dixon Dr. Daniel Smilek Internal-external Member: Dr. Mathieu Doucet ii Author’s Declaration I hereby declare that I am the sole author of this thesis. This is a true copy of the thesis, including any required final revisions, as accepted by my examiners. I understand that my thesis may be made electronically available to the public. iii Abstract Anxiety disorders are common and debilitating, and there are substantial research efforts to better understand and treat them. These efforts are characterized by two leading trends: an emphasis on the role of attentional biases in their development and persistence, and an emphasis on mindfulness as a means of ameliorating them. However, there are substantial problems with both lines of research. Fist, research on attentional biases to threat (ABT) has yielded highly inconsistent findings with respect to the nature of the biases and when they occur. Most studies to date have failed to account for factors that influence attentional deployment, such as motivation to approach vs. avoid threat, and almost no studies have examined attentional biases that occur when people are occupied with an attentionally demanding task, which far more resembles what happens in real life when faced with a threat. There is emerging evidence showing that visual attention to threat varies substantially according to motivation, and that clinically significant anxiety may be characterized more by ambivalence about where to deploy attention in face of threat. Second, mindfulness is now widely recommended as a treatment for anxiety disorders despite the absence of a viable theory as to the mechanism of action by which it is effective. This is especially concerning given the current hype about its effects. Research has clearly demonstrated that anxiety is associated with a narrow scope of attention (the one frowning face in an audience) as opposed to a broad scope of attention (the entire crowd). New theories proposed that a function of mindfulness is to broaden perspective, which may explain how mindfulness ameliorates anxiety. This program of research aimed to address these issues in three studies. The first study was designed to assess the impact of motivation to attend to vs. avoid attending to an external threat (a live tarantula) in people who were high in spider fear, while they completed a competing attentionally demanding task. The second study was designed to better iv understand ambivalent motivation by selecting a sample and stimuli that may yield a high degree of approach-avoidance conflict; in this study, individuals who self-identified as restrained eaters underwent a passive viewing task in which they were exposed to high calorie food vs. neutral images while their eye movements were tracked. The third study examined the extent to which a brief mindfulness intervention influenced the scope of perceptual attention, conceptual attention, and thought-action repertoires. Results from Studies 1 and 2 revealed a significant impact of motivation on attentional deployment, such that different motivational groups demonstrated different patterns of attentional biases to threat. This calls into question the conceptualization of ATB as a homogenous construct, as it would seem anxious individuals may engage in different types of attentional deployment when confronting threat. Results also revealed that individuals who showed high motivation to both look at and to avoid looking at the tarantula (that is, participants who were ambivalent) did not show a decrease in fear of the spider whereas all other participants did. In Study 2, individuals who reported high motivation to both look at and to avoid looking at high calorie food endorsed more restrained eating behaviours and stronger pathological beliefs, such that even looking at food could make one gain weight. Thus, ambivalent motivation may be a characteristic of greater psychopathology. In Study 3, it was found that for participants whose baseline attentional scope was narrow, mindfulness was associated with the broadening of attentional scope and an improvement in mood state. Theoretical and clinical implications for understanding and treating anxiety were discussed. v Acknowledgments First of all, I am most grateful to my supervisor, Dr. Christine Purdon, for her invaluable support for this program of research and her excellent mentorship in my professional career. Without the assistant from my supervisor, I wouldn’t have been able to embark on this wonderful career. Besides, I would like to thank my committee members, Drs. Dan Smilek and Mike Dixon for the expertise they have brought into my dissertation research and their many suggestions during the revision process. I am also grateful to Dr. Erik Woody for his generous guidance with some of the data analysis. Support for this research was received from the Ontario Government and the University of Waterloo through an Ontario Graduate Scholarship Award and an International Doctoral Student Award. Recruiting hundreds of participants and coding massive eye tracking data would not have been possible without my dedicated research assistants. I would like to thank Elizabeth Kalles, Patricia Philip, Ryan Yeung, Talia Hashmani, Sarika Soomal, and Jay Solanki for their diligent work and thoughtful contribution. I am also grateful for my family, friends, and colleagues for their continuous support and understanding. A very special thank goes to my wife Katelyn Rowe for her support and encouragement during this very challenging yet meaningful phase of my life. vi Table of Contents Examining Committee Membership…………………………………………………….…….ii Author’s Declaration………………………………………………………………………….iii Abstract……………………………………………………………………………………….iv Acknowledgements…………………………………………………………………………...vi Table of Contents…………………………………………………………………………….vii List of Figures………………………………………………………………………………..xii List of Tables………………………………………………………………………………..xiii Chapter 1. Anxiety and Attentional Biases to Threat.................................................................1 1.1 Introduction……………………………………………………………………………..1 1.2 Defining Attentional Biases to Threat…………………………………………………..3 1.3 Attentional Biases to Threat: Empirical Findings………………………………………4 1.3.1 Experimental Tasks……………………………………………………………...4 1.3.2 Anxiety Diagnoses………………………………………………………………7 1.3.3 Anxiety Treatment……………………………………………………………….8 1.4 Attentional Biases to Threat in Anxiety: Theoretical Models…………………………10 1.4.1 Williams, Watts, MacLeod, and Matthews, 1988……………………………...10 1.4.2 Beck and Clark, 1997…………………………………………………………..10 1.4.3 Mogg and Bradley, 1998……………………………………………………….11 1.4.4 Matthews and Mackintosh, 1998………………………………………………12 1.4.5 Eyesenck, Derekshan, Santos, and Calvo, 2007……………………………….12 1.4.6 Bar-Haim, Lamy, Pergamin, Bakermans-Kranenburg, and van IJzendoorn, 2007…………………………………………………………………………….13 1.4.7 Cisler and Koster, 2010………………………………………………………...14 1.5 Attentional Biases to Threat in Spider-Related Anxiety………………………………14 vii 1.6 Attentional Biases to Threat in Eating-Related Anxiety………………………………16 1.7 Summary………………………………………………………………………………19 Chapter 2. Motivation and Anxiety…………………………………………………………..21 2.1 Introduction……………………………………………………………………………21 2.2 A Two-Factor Model: Approach and Avoidance Motivation…………………………22 2.3 Approach and Avoidance Motivation in Anxiety: Theoretical Models……………….23 2.4 Approach and Avoidance Motivation in Spider-Related Anxiety…………………….25 2.5 Approach and Avoidance Motivation in Eating-Related Anxiety………………….…26 2.6 Summary………………………………………………………………………………28 Chapter 3. Integrating Attentional Biases to Threat and Motivation in Anxiety…….………29 3.1 Introduction……………………………………………………………………………29 3.2 The Modulating Effect of Motivation on Attentional Biases to Threat……………….30 3.3 Integrating Approach and Avoidance Motivation in Anxiety…………………………32 3.4 Going Beyond Avoidance Motivation in Anxiety: Theoretical Models………………34 3.5 Going Beyond Avoidance Motivation in Anxiety: Empirical Findings………………35 3.6 Integrating Attentional Biases and Motivation: Spider-Related Anxiety……………..36 3.7 Integrating Attentional Biases and Motivation: Eating-Related Anxiety……………..37 3.8 Current Program of Research: Study 1 and Study 2…………………………………..39 Chapter 4. Attentional Scope and the Broadening Effect of Mindfulness…………………...41 4.1 Introduction……………………………………………………………………………41 4.2 Defining Attentional Scope……………………………………………………………41 4.3 Attentional Scope and Anxiety………………………………………………………..45 4.4 Mindfulness: Definition and Treatment for Anxiety………………………………….46 4.5 Mindfulness as a Strategy for Broadening Attentional Scope………………………...48 4.6 Current Program of Research: Study 3………………………………………………..51 viii Chapter 5. Study 1: Attentional Biases to Threat and Motivation in Spider-related Anxiety..53 5.1 Introduction……………………………………………………………………………53 5.2 Methods………………………………………………………………………………..56 5.2.1 Participants………………………………………………………………………..56 5.2.2 Self-Report Measures……………………………………………………………..57 5.2.3 Metronome Response Task Measures……………………………………….……58 5.2.4 Materials and Stimuli……………………………………………………………..60 5.2.5 Eye Movement Measures…………………………………………………………61 5.2.6 Procedures………………………………………………………………………...63 5.3 Results…………………………………………………………………………………64 5.3.1 Do Spider-Fearful Individuals Experience Significant Differences in Their Motivation to Attend to Vs. Avoid Attending to the Spider?.................................64 5.3.2 Do Spider-Fearful Individuals Exhibit Significant Differences in Their Attentional Biases to Threat? …………………………………………………………………66 5.3.3 Do Ambivalent Individuals Experience More Persistent Spider Fear and More Negative Mood State at the End of the Study? ………………………………..…75 5.3.4 Do Ambivalent Individuals Report More Spider-related Thoughts and Show Greater Performance Disruption During the MRT? ……………………..………82 5.4 Discussion…………………………………………………………………………..84 Chapter 6. Study 2: Attentional Biases to Threat and Motivation in Eating-Related Anxiety…….……………………………………………………………………...91 6.1 Introduction……………………………………………………………………………91 6.2 Methods…………….……………………………………………………………….…94 6.2.1 Participants…………………………………………………………………….….94 6.2.2 Self-Report Measures………………………………………………………….….95 ix 6.2.3 Materials and Stimuli……………………………………………………………..96 6.2.4 Eye Movement Measures…………………………………………………………97 6.2.5 Motivation Measures……………………………………………………………...99 6.2.6 Procedures…………………………………………………………………….…100 6.3 Results………………………………………………………………………………..101 6.3.1 Do Restrained Eaters Experience Significant Differences in Their Motivation to Attend to vs. Avoid Attending to Food Images…………………………………101 6.3.2 Do Restrained Eaters Exhibit Significant Differences in Their Attentional Biases to Threat?…………………………………………………………………………...103 6.3.3 Do Ambivalent Individuals Report More Restrained Eating Behaviours, Thought- shape Fusion, and Negative Mood State? ………………………………………111 6.4 Discussion……………………………………………………………………………116 Chapter 7. Study 3: The Impact of Brief Mindfulness Training on Attentional Scope…….123 7.1 Introduction………………..…………………………………………………………123 7.2 Methods………………………………………………………………………………125 7.2.1 Participants………………………………………………………………………125 7.2.2 Self-Report Measures……………………………………………………………126 7.2.3 Cognitive Measures…………………………………………………….………..126 7.2.4 Intervention……………………………………………………………………...128 7.2.5 Procedures……………………………………………………………………….130 7.3 Results………………………………………………………………………………..131 7.3.1 Does Mountain Meditation Improve Mood State? ……………………………...131 7.3.2 Does Mountain Meditation Broaden the Scope of Perceptual Attention?............132 7.3.3 Does Mountain Meditation Broaden the Scope of Conceptual Attention?...........134 7.3.4 Does Mountain Meditation Broaden the Scope of Thought-Action x