A multilevel examination of attention in social anxiety disorder

/ABSTRACT Social anxiety disorder (SAD) is one of the most prevalent psychiatric conditions worldwide, with a lifetime prevalence of 12.1%. SAD is associated with immense societal burden, including poorer educational and occupational outcomes and reduced quality of life. A sizeable subset of SAD patients (~1/6) do not respond to evidence-based treatments, and even more (17-60%) experience relapse following effective treatment. Accordingly, there is a pressing need to identify novel mechanisms that may be effectively targeted in treatment to improve patient outcomes. Biases in the attentional system may hold promise for future translational work. Attentional bias (AB) describes the preferential allocation of attentional resources to certain types of stimuli over others. In SAD, an AB to external, social-evaluative threats (i.e., angry/disgusted faces) has been reliably observed in the laboratory. However, interventions targeting this bias do not meaningfully reduce SAD symptoms, suggesting that ABs to external threats may represent a disease correlate, not cause. A more meaningful form of AB in SAD may be the extent to which individuals attend internally vs. externally in social situations. Indeed, excessive internally focused attention (i.e., on one’s anxiety-laden thoughts, emotions, and interoceptive sensations) is reliably linked to SAD severity and may contribute to disorder maintenance by increasing perceptions of threat and thus triggering anxious responding across multiple levels. However, researchers have not yet identified if, how, and for whom excessive internally focused attention plays a causal role in SAD maintenance, which is essential to know to inform optimized interventions. The proposed research will utilize an ecological momentary assessment-delivered experimental manipulation to compare the role of internally vs. externally focused attention in the maintenance of SAD. Outcomes will be explored longitudinally across self-report, behavioral, and cognitive levels of analysis, and mechanisms (i.e., threat detection, state anxiety) and moderators (i.e., attentional control) of the effects will be tested. The overarching goal of this project is to identify patterns of attention that play a causal role in the maintenance of SAD to inform novel treatment targets. Specific training goals include conducting experimental psychopathology research from an RDoC-informed framework, acquiring a deeper knowledge of the theory, assessment, and modeling of cognitive systems, applying advanced quantitative methods, and developing professional skills needed for a successful career in clinical science. By integrating theory and methods from multiple areas of basic and clinical science, the PI will acquire a strong foundation for building an impactful program of translational research that investigates the role of cognitive systems in the maintenance of anxiety disorders. Project Number: 1F31MH139139-01A1 | Fiscal Year: 2025 | NIH Institute/Center: National Institute of Mental Health (NIMH) | Principal Investigator: Alexandra Adamis | Institution: VANDERBILT UNIVERSITY, Nashville, TN | Award Amount: $42,246 | Activity Code: F31 | Study Section: Special Emphasis Panel[ZRG1 F16-D (20)] View on NIH RePORTER: https://reporter.nih.gov/project-details/11236562