Attentional bias modification in social anxiety disorder: Physiological effects, alternative mechanisms of change, and genetic moderation



Grant no. PCE-ID-2012-4-0498

Contract no. 60/02.09.2013


Research team:
Andrei C. Miu, PhD (PI)
Romana Vulturar , MD, PhD
Marius Cioară, PhD
Mihai Cărnuță , PhD Student
Liviu G. Crișan , PhD Student
Mihaela Neamț, PhD Student


Social anxiety is defined as a spectrum that spans from ordinary shyness and mild social anxiety symptoms to functionally impairing social fears such as social anxiety disorder (SAD). SAD is the second most common psychiatric disorder, with a lifetime prevalence of 12.1%. Psychological theories have explained the development and maintenance of SAD through the interaction of several psychological factors, including exaggerated attention to threat. Attentional bias modification (ABM) is a novel approach based on the idea that cognitive tasks can be used to implicitly manipulate attention biases and reduce anxiety symptoms. With systematic repetitions of hundreds of such trials, an implicitly learned bias away from threat and toward neutral stimuli is gradually induced. Critical perspectives on the rapidly developing field of ABM emphasized that more randomized clinical trials are needed in psychiatric conditions (e.g., SAD), in which there is only preliminary support for the efficacy of ABM. It has been recommended that these trials examine: (a) alternative mediators of ABM’s efficacy; (b) moderators, including genetic influences; and (c) anxiety-related outcomes, across subjective, behavioral, and physiological systems. In light of the increasing focus on emotion regulation difficulties that characterize SAD, this project will investigate for the first time whether secondary changes in access to emotion regulation strategies contribute to the efficacy of ABM in SAD. Moreover, we will extend previous results on genetic moderators of ABM, including functional polymorphisms in the serotonin transporter gene and the brain-derived neurotrophic factor gene. Finally, this project will assess the effects of ABM on autonomic, neuroendocrine and psychoneuroimmunological markers of anxiety in SAD patients.


Aims (download official document with Aims [in Romanian]):


Aim 1: Creating a new version of attention al bias modification (ABM) with faces and words; piloting the ABM tasks with physiological recordings (i.e., cardiovascular, respiratory, salivary cortisol).
• Timeframe: 2013
• Stage: Completed (download Scientific Report [in Romanian]; download presentation of results [in English])


Aim 2: Investigating genetic moderators (e.g., 5-HTTLPR/rs25531, COMT Val158Met, BDNF Val166Met) of attentional bias modification malleability in healthy volunteers 

• Timeframe: 2014
• Stage: Completed (download Scientific Report [in Romanian])


Aim 3: Testing an ABM intervention in social anxiety (sample 1)
• Timeframe: 2015
• Stage: Completed


Aim 4: Testing an ABM intervention in social anxiety (sample 2)
• Timeframe: 2016
• Stage: Completed.


Fig. 1 Illustration of attention bias modification task (320 trials/session: faces and words, horizontal and vertical presentation)


Scientific Report 2013: in Romanian (download); in English (download)
Scientific Report 2014: in Romanian (download); in English (download)
Scientific Report 2015: in Romanian (download); in English (download)
Scientific Report 2016: in Romanian (download); in English (download)




Conferences and publications


Vălenaș, S., Szentágotai-Tătar, A., Miu, A. C., Grafton, B., Notebaert, L., MacLeod, C. (2016). Prediction of pre-exam state anxiety from ruminative disposition: The mediating role of impaired attentional disengagement from negative information. Revision requested by Behaviour Research and Therapy.
Crișan, L. G., Vulturar, R., Miclea, M., & Miu, A. C. (2016) Reactivity to Social Stress in Subclinical Social Anxiety: Emotional Experience, Cognitive Appraisals, Behavior, and Physiology.  Front. Psychiatry 7:5.  doi: 10.3389/fpsyt.2016.00005
Miu, A. C. (2016). Genetic influences on emotion regulation. In A. C. Miu, J. Homberg, & K.-P. Lesch (Eds.): Genes, Brain and Emotions: From resilience to psychopathology (In press). Oxford University Press, Oxford.
Cândea, D., Miu, A. C., & Szentágotai-Tătar, A. (2016). Shame-proneness as a significant predictor of social anxiety symptoms above and beyond classical cognitive constructs. 46th European Association of Behavioural and Cognitive Therapies Congress, Stockholm, Sweden.
Cărnuță, M., & Miu, A. C. (2016). Attachment in adults, emotion regulation difficulties and social anxiety symptoms. Manuscript in preparation.
Miu, A. C. (2015). Genetics of attentional biases and their malleability. Research Meeting "Developments in the measurement/modification of cognitive biases", Oxford Centre for Emotions and Affective Neuroscience, Oxford, UK.
Bîlc, M., Vulturar, R., Chiș, A., Prodan, A., Cioară, M., & Miu, A. C. (2015). Reappraisal ability predicts exam stress in students. 8th International Congress of Clinical Psychology, Granada, Spain.
Bîlc, M., & Miu, A. C. (2015). Emoțiile și decizia în condiții de risc. In C. Hăvârneanu, G. Havârneanu (Eds.): Psihologia riscului (pp. 37-48). Polirom, Iași.
Crișan, L. G., Chiș, A., Vulturar, R., MacLeod, C., & Miu, A. C. (2014). Attentional bias modification in social anxiety: Psychophysiological evidence. Invited paper in the symposium “From vulnerability to resilience: Individual differences in cognitive processes and their contributions to psychological well-being” at the 28th International Congress of Applied Psychology, Paris, France.
Crișan, L. G., Vulturar, R., Miclea, M., MacLeod, C., & Miu, A. C. (2014). Attention bias modification in social anxiety: Effects on neuroendocrine and autonomic stress reactivity. 35th Conference of the Stress and Anxiety Research Society (STAR), Cluj-Napoca, Romania.
Miu, A. C., Crişan, L. G., & MacLeod, C. (2013). Autonomic, neuroendocrine and immune changes associated with attentional bias modification in social anxiety. Invited paper in the symposium “Biological Approaches to Cognitive Bias Modification” at the 7th World Congress for Behavioural and Cognitive Therapies, Lima, Peru.
Crișan, L. G., Vulturar, R., MacLeod, C., & Miu, A. C. (2013). Autonomic and neuroendocrine effects of attentional bias modification in social anxiety. Invited paper in the symposium on “Genes, brain and emotions” at the 4th Conference of the National Neuroscience Society of Romania (SNN), Bucharest, Romania.
Miu, A. C., Crișan, L. G., & Vulturar, R. (2013). Psychophysiological effects of attentional bias modification in social anxiety. Expert Research Meeting on the Cognitive and Genetic Basis of Emotional Vulnerability, University of Western Australia, Australia.