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Cited by 59Anxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesMental Health Research TopicsChild and Adolescent Psychosocial and Emotional Development

Attentional bias and emotional reactivity as predictors and moderators of behavioral treatment for social phobia

Open access
Niles, Andrea N., Mesri, Bita, Burklund, Lisa J., Lieberman, Matthew D., Craske, Michelle G.·2013·Behaviour Research and Therapy
DOI 10.1016/j.brat.2013.06.005PMC PMC3825738
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Abstract

Cognitive behavioral therapy (CBT) is a well-established treatment for anxiety disorders, and evidence is accruing for the effectiveness of acceptance and commitment therapy (ACT). Little is known about factors that relate to treatment outcome overall (predictors), or who will thrive in each treatment (moderators). The goal of the current project was to test attentional bias and negative emotional reactivity as moderators and predictors of treatment outcome in a randomized controlled trial comparing CBT and ACT for social phobia. Forty-six patients received 12 sessions of CBT or ACT and were assessed for self-reported and clinician-rated symptoms at baseline, post treatment, 6, and 12 months. Attentional bias significantly moderated the relationship between treatment group and outcome with patients slow to disengage from threatening stimuli showing greater clinician-rated symptom reduction in CBT than in ACT. Negative emotional reactivity, but not positive emotional reactivity, was a significant overall predictor with patients high in negative emotional reactivity showing the greatest self-reported symptom reduction. © 2013 Elsevier Ltd.

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Crossref · 10.1016/j.brat.2013.06.005

Cites

71 of 71 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

16 of 67 cited sources checked · 11 supported · 0 flagged · accuracy not yet measured

  • Premisecitation

    In adults with social phobia, threat vigilance predicted a better CBT response than threat avoidance.

    “Using a similar method, Price, Tone, and Anderson (2011) found that adults with social phobia who were vigilant to threat responded more favorably to CBT than those who were avoidant of threat.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Price, Tone, and Anderson (2011) source
  • Premisecitation

    People with social phobia report stronger negative affect while looking at negative pictures from the IAPS.

    “In terms of emotional reactivity, individuals with social phobia report more negative affect when viewing negative images from the international affective picture system (Goldin, Manber, Hakimi, Canli, & Gross, 2009)”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites Goldin, Manber, Hakimi, Canli, & Gross, 2009 source

      The Results (Emotional Reactivity, page not provided) report higher negative-emotion ratings in the social anxiety disorder group than in healthy controls while viewing the study’s images. But the Methods (Stimuli, page not provided) describe actor-produced faces and violent scenes collected from internet sites, not images from the International Affective Picture System. (LLM, conf=0.90)

      Experimental — accuracy not yet measured
  • Premisecitation

    Subsequent studies have provided support for the disengagement account of anxious attentional bias.

    “A number of studies have since supported this hypothesis (Amir, Elias, Klumpp, & Przeworski, 2003; Fox, Russo, & Dutton, 2002; Georgiou et al., 2005).”
    Quote in the paperSubstantial claim2 of 3 sources checked
    • cites Amir, Elias, Klumpp, & Przeworski, 2003 source
    • cites Fox, Russo, & Dutton, 2002 source
    • cites Georgiou et al., 2005 source
  • Premisecitation

    Both attentional biases and emotional reactivity have been proposed as factors contributing to the onset and persistence of social phobia.

    “Attentional biases and emotional reactivity each have been implicated as important factors in the development and maintenance of social phobia (Campbell-Sills & Barlow, 2007; Clark & Wells, 1995; Rapee & Heimberg, 1997).”
    Quote in the paperSubstantial claim2 of 3 sources checked
    • cites Campbell-Sills & Barlow, 2007 source

      The cited paper, “Acceptability and suppression of negative emotion in anxiety and mood disorders,” returned no full-text snippets for either of two searches about attentional bias and emotional reactivity in social phobia. A different paper, “Attentional bias and emotional reactivity as predictors and moderators of behavioral treatment for social phobia,” yielded a relevant snippet (score 0.806) discussing both factors, but it does not establish that the cited paper makes—or does not make—the claim. Because the cited paper’s text is unavailable in these results, the evidence does not meet the threshold for misattribution. (LLM, conf=0.66)

      Experimental — accuracy not yet measured
    • cites Clark & Wells, 1995

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites Rapee & Heimberg, 1997 source

      Semantic Scholar returned no full-text snippets for Rapee and Heimberg’s 1997 paper across two searches, so the attributed claim could not be checked against its text. An unscoped search found a related passage in “Attentional bias and emotional reactivity as predictors and moderators of behavioral treatment for social phobia” (score 0.806), discussing attentional bias, emotional reactivity, and anxiety maintenance. That match does not establish that the claim originated there or that Rapee and Heimberg did not propose it; the evidence is insufficient for a misattribution verdict. (LLM, conf=0.62)

      Experimental — accuracy not yet measured
  • Premisecitation

    Burklund and colleagues (2007) reported that rejection-sensitive individuals had stronger dorsal anterior cingulate responses to disapproving faces than to angry or disgusted faces.

    “In a recent study, Burklund, Eisenberger, and Lieberman (2007) found that individuals high in rejection sensitivity showed greater dorsal anterior cingulate cortex activity (an area activated in response to social distress) while viewing disapproving facial expressions compared to angry or disgusted expressions.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Burklund, Eisenberger, and Lieberman (2007) source
  • Classified as probably not a substantial claim. 50
  • May combine two claims. 16
  • Borderline: one of the tests for a substantial claim is unclear. 1
  • The quote only partly states this claim. 1

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    ACT is gaining support as an effective treatment for anxiety disorders.

    “Other behavioral treatments, such as Acceptance and Commitment therapy (ACT; Hayes, Strosahl, & Wilson, 1999) are garnering support as well (Arch et al., 2012; Craske et al., 2013; Meuret, Twohig, Rosenfield, Hayes, & Craske, 2012).”
    Quote in the paperNot a substantial claim2 of 3 sources checked
    • cites Arch et al., 2012 source
    • cites Craske et al., 2013

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites Meuret, Twohig, Rosenfield, Hayes, & Craske, 2012 source
      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    CBT is an established treatment for anxiety disorders.

    “The efficacy of Cognitive Behavioral Therapy (CBT) for treatment of anxiety disorders is well established (Butler, Chapman, Forman, & Beck, 2006; Norton & Price, 2007; Tolin, 2010).”
    Quote in the paperNot a substantial claim2 of 3 sources checked
    • cites Butler, Chapman, Forman, & Beck, 2006 source
      Experimental — accuracy not yet measured
    • cites Norton & Price, 2007 source
      Experimental — accuracy not yet measured
    • cites Tolin, 2010 source

  • May combine two claims.

    Premisecitation

    Both CBT and ACT increase perceived control over emotions.

    “Although ACT does not explicitly aim to regulate emotions, emotion regulation is an outcome from ACT (Arch & Craske, 2008), and both CBT and ACT increase perceived control over emotions (Arch et al., 2012).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Arch et al., 2012 source

      The Discussion (Primary Outcomes; page unavailable) reports that both treatments improved anxiety outcomes and psychological flexibility, but does not report perceived control over emotions. A search of the Methods outcome measures and treatment descriptions also found no assessment or finding that both CBT and ACT increased perceived emotional control. (LLM, conf=0.72)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Prior studies have found that vigilance toward threat predicts better outcomes in CBT.

    “Prior studies have similarly found that vigilance toward threat predicts better outcomes in CBT (Price et al., 2011; Waters et al., 2012).”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites Price et al., 2011 source
    • cites Waters et al., 2012 source

  • Classified as probably not a substantial claim.

    Premisecitation

    Models of emotional arousal and learning suggest that the greater the emotional arousal during exposure, the greater the learning.

    “Models of emotional arousal and learning (Cahill, Gorski, & Le, 2003) also suggest that the greater the emotional arousal during exposure, the greater the learning.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Cahill, Gorski, & Le, 2003 source

      The Discussion (page unavailable) says that arousal at encoding affects later memory consolidation, and the Results report better recall of arousing slides after post-learning stress. But the paper does not establish the general rule that greater arousal during exposure means greater learning: the enhancement depended on post-learning stress, and control subjects recalled fewer details from arousing than neutral slides. (LLM, conf=0.86)

      Experimental — accuracy not yet measured

  • Borderline on S3 (load-bearing), S4 (based): unclear from the text. May combine two claims.

    Findingnone given

    Positive affect while viewing positive images did not significantly moderate or predict either outcome.

    “Positive affect while viewing positive images did not significantly moderate or predict either outcome (ps > .126).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Disapproving faces were rated more negatively than neutral faces.

    “There was a significant effect of face type on valence (F(2,84) = 255.62, p < .001) with angry faces rated as more negative than disapproving faces and neutral faces, and disapproving faces rated as more negative than neutral faces (ps < .001) (see Table 2).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Angry faces received more negative ratings than neutral faces.

    “There was a significant effect of face type on valence (F(2,84) = 255.62, p < .001) with angry faces rated as more negative than disapproving faces and neutral faces, and disapproving faces rated as more negative than neutral faces (ps < .001) (see Table 2).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Arousal ratings were higher for angry faces than for disapproving faces.

    “There was also a significant effect of face type on arousal (F(2,84) = 72.69, p < .001) with angry faces rated as more arousing than disapproving and neutral faces, and disapproving faces rated as more arousing than neutral faces (ps < .001).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Arousal ratings for angry faces exceeded those for neutral faces.

    “There was also a significant effect of face type on arousal (F(2,84) = 72.69, p < .001) with angry faces rated as more arousing than disapproving and neutral faces, and disapproving faces rated as more arousing than neutral faces (ps < .001).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Disapproving faces received higher arousal ratings than neutral faces.

    “There was also a significant effect of face type on arousal (F(2,84) = 72.69, p < .001) with angry faces rated as more arousing than disapproving and neutral faces, and disapproving faces rated as more arousing than neutral faces (ps < .001).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Ratings for angry faces were more negative than those for disapproving faces.

    “There was a significant effect of face type on valence (F(2,84) = 255.62, p < .001) with angry faces rated as more negative than disapproving faces and neutral faces, and disapproving faces rated as more negative than neutral faces (ps < .001) (see Table 2).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Affect ratings for positive and negative images were comparable across the first and second presentations of each image type.

    “Positive and negative affect ratings did not significantly differ between blocks 1 and 2 (ps > .06).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The accuracy rate for disapproving faces was 44.2%.

    “Accuracy rates for angry, disapproving, and neutral faces were 68.9%, 44.2%, and 80.0% respectively (see Table 2).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Error rate did not differ between angry faces and objects.

    “Tests of simple effects with a Bonferroni correction revealed that error rate was significantly higher for disapproving faces than angry faces (corrected p < .001) and objects (corrected p = .009), but did not differ between angry faces and objects (corrected p = 1.0).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    For average response time, there were no significant interaction or main effects.

    “For average response time, there were no significant interaction or main effects (ps > .54).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The accuracy rate for neutral faces was 80.0%.

    “Accuracy rates for angry, disapproving, and neutral faces were 68.9%, 44.2%, and 80.0% respectively (see Table 2).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Raters identified disapproving faces as confused on 28.7% of occasions.

    “Disapproving faces were rated as confused 28.7% of the time.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The accuracy rate for angry faces was 68.9%.

    “Accuracy rates for angry, disapproving, and neutral faces were 68.9%, 44.2%, and 80.0% respectively (see Table 2).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Negative affect while viewing neutral images did not significantly moderate or predict either outcome.

    “Negative affect while viewing neutral images did not significantly moderate or predict either outcome (ps > .088).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Positive emotional reactivity did not predict or moderate treatment outcome.

    “In addition, positive emotional reactivity did not predict or moderate treatment outcome.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    No evidence indicates that patients with social phobia differ from controls in amygdala or insula response to positive images.

    “there is no evidence for differential amygdala or insula activation in response to positive images in patients with social phobia compared to controls (Shah et al., 2009).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Shah et al., 2009

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    According to cognitive models of social phobia, preferential attention to external social threats raises anxiety, fosters maladaptive cognition, and sustains poor social functioning.

    “Cognitive theories of social phobia posit that selectively attending to external social threats increases anxiety, promotes maladaptive thinking, and maintains ineffective social behavior in social situations (Clark & Wells, 1995).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Clark & Wells, 1995

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Classified as probably not a substantial claim. May combine two claims.

    Premisereasoning

    Anxious people are slower to identify probes replacing neutral faces, which suggests attention remains on the threatening face.

    “Anxious individuals tend to take longer to identify probes that appear in place of neutral faces, suggesting that their attention is on the threatening face.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    A substantial proportion of patients fail to respond to behavioral treatments, discontinue treatment, or relapse during follow-up.

    “However, many patients do not respond to behavioral treatments, drop out of treatment or show a return of symptoms at follow-up (Loerinc, Meuret, Twohig, Rosenfield, & Craske, 2013).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Loerinc, Meuret, Twohig, Rosenfield, & Craske, 2013

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Premisecitation

    Attentional bias and negative emotional reactivity are closely linked, as experimentally induced anxiety increases bias toward threat.

    “Attentional bias and negative emotional reactivity are strongly related since induction of negative affect in the form of anxiety enhances attentional bias to threat (Chen, 1996; MacLeod & Mathews, 1988; Mogg, Bradley, & Hallowell, 1994).”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites Chen, 1996 source
    • cites MacLeod & Mathews, 1988 source
    • cites Mogg, Bradley, & Hallowell, 1994 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Training attention away from threat reduces self-reported anxiety in a naturalistic stressor.

    “and training attention away from threatening stimuli lowers self-reported anxiety to a naturalistic stressor (MacLeod & Bridle, 2009).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites MacLeod & Bridle, 2009

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Classified as probably not a substantial claim.

    Premisecitation

    Other studies report that socially anxious people direct attention away from threatening cues.

    “some studies have found that socially anxious individuals avoid threatening stimuli (Chen, Ehlers, Clark, & Mansell, 2002; Mansell, Clark, Ehlers, & Chen, 1999).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Chen, Ehlers, Clark, & Mansell, 2002 source
    • cites Mansell, Clark, Ehlers, & Chen, 1999 source

  • Classified as probably not a substantial claim.

    Premisecitation

    Fox and colleagues (2001) concluded that anxious attentional bias reflects difficulty disengaging from threat more than rapid orienting to it.

    “Using the Spatial Cueing paradigm, Fox, Russo, Bowles, and Dutton (2001) identified that the attentional bias in anxiety is more likely explained by difficulty disengaging from threat rather than faster orienting toward threat.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Fox, Russo, Bowles, and Dutton (2001) source

  • Classified as probably not a substantial claim.

    Premisecitation

    According to meta-analytic evidence, anxious people display vigilance toward threat.

    “Although metaanalyses show that anxious individuals are vigilant to threat, some studies have found that socially anxious individuals avoid threatening stimuli (Chen, Ehlers, Clark, & Mansell, 2002; Mansell, Clark, Ehlers, & Chen, 1999).”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Social phobia is linked to low positive affect.

    “Although social phobia has been linked to low positive affect (Brown et al., 1998; Watson, Clark, & Carey, 1988)”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Brown et al., 1998 source
    • cites Watson, Clark, & Carey, 1988 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The National Institute of Mental Health advocated for personalized medicine to determine the most effective treatment for particular conditions.

    “The National Institute of Mental Health has called for a focus on personalized medicine to identify which treatment under what conditions will be most effective (National Institute of Mental Health, 2010).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites National Institute of Mental Health, 2010

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Classified as probably not a substantial claim.

    Premisecitation

    Waters and colleagues (2012) examined threatening-face attentional bias as a predictor of CBT outcome among 35 children diagnosed with generalized anxiety disorder or social phobia.

    “Waters, Mogg, and Bradley (2012) assessed attentional bias for threatening faces as a predictor of response to CBT in 35 children with generalized anxiety disorder or social phobia.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Waters, Mogg, and Bradley (2012) source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The SPS correlates highly with other measures of social phobia.

    “The scale demonstrates good internal consistency (α = .91) and correlates highly with other measures of social phobia (Osman et al., 1998).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Osman et al., 1998 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The LSAS-SR has good test-retest reliability (r = .83).

    “The measure shows good test-retest reliability (r = .83), internal consistency (α = .95) and convergent validity, and is sensitive to change following treatment (Baker, Heinrichs, Kim, & Hofmann, 2002).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Baker et al., 2002 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Inter-rater reliability on the principal diagnosis was 100%.

    “Inter-rater reliability on the principal diagnosis was 100%.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    The two treatments had equal numbers of exposure-focused sessions.

    “ACT and CBT were matched on number of sessions devoted to exposure but differed in framing of the intent of exposure.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    These constructs were not simply indicators of disorder severity and provided additional information about treatment response over and above disorder severity.

    “Therefore, these constructs were not simply indicators of disorder severity, and provided additional information about treatment response over and above that of disorder severity.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    In pre/post designs, including pre-treatment scores as covariates more fully equates groups on baseline levels of the outcome and minimizes variance in outcomes.

    “In pre/post designs, pre-treatment scores can be included as covariates rather than as one of the repeated measures because including covariates more fully equates groups on baseline levels of the outcome and minimizes the variance in the outcomes (Tabachnick & Fidell, 2006).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Tabachnick & Fidell, 2006

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Premisecitation

    Evidence for attentional bias in social phobia is not unequivocal, and effect sizes are small to moderate.

    “However, evidence for attentional bias in social phobia is not unequivocal, and effect sizes are small to moderate (Bar-Haim et al., 2007).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Bar-Haim et al., 2007 source

  • Classified as probably not a substantial claim.

    Premisecitation

    Amygdala activation while viewing negative stimuli was interpreted to represent deficits in emotion regulation.

    “Such amygdala activation was interpreted to represent deficits in emotion regulation (Siegle et al., 2006).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Siegle et al., 2006 source

  • Classified as probably not a substantial claim.

    Study design and conductown data

    Participants with social phobia were randomized to ACT or CBT.

    “Sixty-two participants who met DSM-IV criteria for a principal or co-principal diagnosis of social phobia, generalized type were randomized to ACT (n = 29) or CBT (n = 33).”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The SIAS has good internal consistency (α = .90).

    “The scale demonstrates good internal consistency (α = .90) and correlates highly with other measures of social phobia (Osman, Gutierrez, Barrios, Kopper, & Chiros, 1998).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Osman et al., 1998 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    In full multi-level models, residuals were normally distributed across all models.

    “In full multi-level models, level one and two residuals were examined for normality. Residuals were normally distributed across all models.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Inter-rater agreement on dimensional CSR ratings across all anxiety disorders was .65.

    “Inter-rater agreement on dimensional CSR ratings across all anxiety disorders was .65 with a single-measure, one-way mixed intraclass correlation6 coefficient.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). The quote only partly states this claim.

    Study design and conductown data

    In the current sample, fear and avoidance ratings alphas ranged from .88 to .96 across all time points.

    “In the current sample, as ranged from .88 to .96 across all time points.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The LSAS-SR is sensitive to change following treatment.

    “The measure shows good test-retest reliability (r = .83), internal consistency (α = .95) and convergent validity, and is sensitive to change following treatment (Baker, Heinrichs, Kim, & Hofmann, 2002).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Baker et al., 2002 source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Baseline analysis included all randomized participants, while follow-up analysis included only treatment completers.

    “Analysis of baseline data included all participants who were randomized. Analysis of follow-up data included only participants who completed treatment (n = 24 ACT, n = 22 CBT).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The LSAS-SR has convergent validity.

    “The measure shows good test-retest reliability (r = .83), internal consistency (α = .95) and convergent validity, and is sensitive to change following treatment (Baker, Heinrichs, Kim, & Hofmann, 2002).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Baker et al., 2002 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The total number of studies of attentional bias using the spatial cueing paradigm in anxiety research is small.

    “In addition, the total number of studies of attentional bias using the spatial cueing paradigm in anxiety research is small (Bar-Haim et al., 2007), and further research is necessary to identify whether evidence for delayed disengagement from threat is consistently found using the spatial cueing paradigm.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Bar-Haim et al., 2007 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    In the current sample, LSAS-SR alphas ranged from .94 to .97 across all time points.

    “Alphas ranged from .94 to .97 across all time points.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The LSAS-SR has good internal consistency (α = .95).

    “The measure shows good test-retest reliability (r = .83), internal consistency (α = .95) and convergent validity, and is sensitive to change following treatment (Baker, Heinrichs, Kim, & Hofmann, 2002).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Baker et al., 2002 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    In the current sample, SIAS alphas ranged from .93 to .96 across all time points.

    “In the current sample, as ranged from .93 to .96 across all time points.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    According to theories of extinction, the greater the salience of the stimulus, the more learning that occurs.

    “According to theories of extinction (a purported mechanism of exposure therapy; Craske et al., 2008; Craske et al., 2012), the greater the salience of the stimulus, the more learning that occurs (Mackintosh, 1975).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Mackintosh, 1975 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The SIAS correlates highly with other measures of social phobia.

    “The scale demonstrates good internal consistency (α = .90) and correlates highly with other measures of social phobia (Osman, Gutierrez, Barrios, Kopper, & Chiros, 1998).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Osman et al., 1998 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The LSAS clinician administered measure is well validated as a clinician administered measure of social phobia.

    “Of the 13 situations, 10 overlap with those in the LSAS clinician administered measure, which is well validated as a clinician administered measure of social phobia (Heimberg et al., 1999).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Heimberg et al., 1999 source

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    Exposure practices may have proven more salient and more arousing for patients high in negative emotional reactivity, thereby enhancing extinction learning and eventual symptom improvements.

    “Exposure practices may have proven more salient and more arousing for patients high in negative emotional reactivity, thereby enhancing extinction learning and eventual symptom improvements.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The SPS has good internal consistency (α = .91).

    “The scale demonstrates good internal consistency (α = .91) and correlates highly with other measures of social phobia (Osman et al., 1998).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Osman et al., 1998 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    In the current sample, SPS alphas ranged from .90 to .93 across all time points.

    “In the current sample, as ranged from .90 to .93 across all time points.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductreasoning

    The sample size was relatively small, which resulted in limited power to consistently detect significant findings.

    “Most importantly, the sample size was relatively small, which resulted in limited power to consistently detect significant findings.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductown data

    Rates of correct identification of angry and disapproving faces (69% and 44% respectively) were low compared to validated stimuli sets such as NimStim, which may have limited our ability to detect delayed disengagement in our anxious sample.

    “Although an independent sample validated the images, rates of correct identification of angry and disapproving faces (69% and 44% respectively) were low compared to validated stimuli sets such as NimStim, which may have limited our ability to detect delayed disengagement in our anxious sample.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Interpretationreasoning

    Greater negative emotion to generic negative stimuli represents deficits in emotion regulation that are directly targeted by behavioral treatments or is a proxy for greater fearful reactivity within exposure therapy.

    “Our explanations of this finding are that greater negative emotion to generic negative stimuli represents deficits in emotion regulation that are directly targeted by behavioral treatments or is a proxy for greater fearful reactivity within exposure therapy.”
    Quote in the paperNot a substantial claim
62 of 62

  • The paper relies on this without support.

    Knowledge is limited regarding general predictors of treatment outcome and moderators of response to each treatment.

    “Little is known about factors that relate to treatment outcome overall (predictors), or who will thrive in each treatment (moderators).”

  • The paper relies on this without support.

    Only a small number of studies have tested attentional bias and emotional reactivity as treatment-response predictors.

    “However, very few studies have examined attentional bias and emotional reactivity as predictors of treatment response.”

  • The paper relies on this without support.

    To the authors' knowledge, no prior work has used subjective positive or negative affect reactions to valenced images to predict treatment response.

    “To our knowledge, no studies have examined subjective report of positive or negative affect in response to positive and negative images respectively as predictors of treatment response.”

  • The paper relies on this without support.

    Moderation by attentional bias and emotional reactivity had not been investigated before.

    “Because the question of moderation by attentional bias and emotional reactivity had not been previously been examined, we had no a priori hypotheses.”

  • The paper relies on this without support.

    This is the first investigation of self-reported emotional reactivity as a predictor of treatment response for social phobia or any anxiety disorder.

    “To our knowledge, this is the first investigation of self-reported emotional reactivity as a predictor of treatment response for social phobia or any anxiety disorder.”

  • The paper relies on this without support.

    CBT directly targets emotion regulation through skills such as cognitive restructuring and somatic control techniques.

    “Clearly, CBT directly targets emotion regulation through skills such as cognitive restructuring and somatic control techniques.”

  • The paper relies on this without support.

    Attempts to identify moderators and predictors of treatment response in social phobia have yielded few consistent results.

    “In conclusion, despite significant variability in treatment response in patients with social phobia, attempts to identify moderators and predictors have yielded few consistent results.”

  • The paper relies on this without support.

    This study is the first to suggest that patients who are particularly slow to disengage from social stimuli may do better in CBT than in ACT.

    “In addition, this study is the first to suggest that patients who are particularly slow to disengage from social stimuli may do better in CBT than in ACT.”
8 of 8

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Moderation was found only at the 12-month follow-up.

    “Moderation was found only at the 12-month follow-up, which replicated our prior studies in the same and different samples (Craske et al., 2014; Niles et al., 2013; Wolitzky-Taylor et al., 2012).”

    From Public speaking avoidance as a treatment moderator for social anxiety disorder. (2017) · cites this paper as Niles et al., 2013

    The Results (Attentional bias; page unavailable) report a significant interaction between reaction time to negative faces and treatment group in predicting clinician-rated fear and avoidance. The Statistical approach section (page unavailable) says time was dropped when it did not significantly interact with the moderator and group; the reported moderation is not confined to the 12-month follow-up. (LLM, conf=0.85)

    Checked by a reasoning model — may be wrong.

    Experimental — accuracy not yet measured

  • Niles et al. (2013) found that attentional bias significantly moderated the relationship between treatment group and outcome, with patients slow to disengage from threatening stimuli showing greater clinician-rated symptom reduction in CBT than in ACT.

    “Attentional bias significantly moderated the relationship between treatment group and outcome with patients slow to disengage from threatening stimuli, showing greater clinician-rated symptom reduction in CBT than in ACT.”

    From The role of the acceptance and commitment therapy in the treatment of social anxiety: An updated scoping review. (2022) · cites this paper as Niles et al. (2013)

Statistics recomputed

Every reported test result, recomputed from its test statistic and degrees of freedom. A result shows as not adding up only once an independent check has confirmed it.

  • ConsistentF(2, 84) = 255.62reported p < .001 · recomputed p < .001

    “F(2,84) = 255.62, p < .001”

  • ConsistentF(2, 84) = 72.69reported p < .001 · recomputed p < .001

    “F(2,84) = 72.69, p < .001”

  • ConsistentF(1, 76) = 112.19reported p < .001 · recomputed p < .001

    “F(1, 76) = 112.19, p < .001”

  • ConsistentF(1, 77) = 4.34reported p = .041 · recomputed p = .041

    “F(1, 77) = 4.34, p = .041”

  • ConsistentF(2, 212) = 5.17reported p = .007 · recomputed p = .006

    “F(2, 212) = 5.17, p = .007”

    The paper states a correction for multiple tests

  • Consistentz = 2.83reported p = .005 · recomputed p = .005

    “(z = 2.83, p = .005”

  • Consistentz = 3.11reported p = .002 · recomputed p = .002

    “(z = 3.11, p = .002”

  • Consistentz = 2.18reported p = .029 · recomputed p = .029

    “(z = 2.18, p = .029”

8 of 8

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Self-check results appear here once an independent check has confirmed them.

Cites

Flagged first, then by citations

7 of the 78 references couldn’t be matched to a known paper.

Cited by

Sorted by citations

Related

Authors
Niles, A. N., Mesri, B., Burklund, L. J., Lieberman, M. D., & Craske, M. G.
Affiliations
University of California, Los Angeles (US)
Corresponding author
Craske, Michelle G.
ORCID
Venue
Behaviour Research and Therapy
Publisher
Elsevier BV
Published
2013-10
Volume
51
Issue
10
Pages
669-679
ISSN
0005-7967 (ISSN-L)
DOI
10.1016/j.brat.2013.06.005
PMC
PMC3825738
OpenAlex
W2152129343
Cited by
59
References
78
Citations by year
2026: 2 · 2025: 3 · 2024: 3 · 2023: 5 · 2022: 2 · 2021: 3 · 2020: 5 · 2019: 5 · 2018: 4 · 2017: 5 · 2016: 5 · 2015: 10 · 2014: 5 · 2013: 1
FWCI
6.42
Type
journal article
Language
en
Open access
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Behaviour Research and Therapy (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (submittedVersion)
  • eScholarship (California Digital Library) (submittedVersion, cc-by-nd)
Topics
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Mental Health Research Topics
  • Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
Keywords
attentional bias, negative emotional reactivity, social anxiety disorder, cognitive behavioral therapy, acceptance and commitment therapy, treatment outcome predictors, anxiety disorders
MeSH terms
Adolescent, Adult, Attention, Emotions, Female, Humans, Male

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-09-28.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-09-28.

Cited sources are checked by gpt-6-sol.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

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