Cited by 1,753Anxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesNeural and Behavioral Psychology StudiesVisual Attention and Saliency Detection

Mechanisms of attentional biases towards threat in anxiety disorders: An integrative review

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Cisler, Josh M., Koster, Ernst H.W.·2010·Clinical Psychology Review

Abstract

A wealth of research demonstrates attentional biases toward threat in the anxiety disorders. Several models have been advanced to explain these biases in anxiety, yet the mechanisms comprising and mediating the biases remain unclear. In the present article, we review evidence regarding the mechanisms of attentional biases through careful examination of the components of attentional bias, the mechanisms underlying these components, and the stage of information processing during which the biases occur. Facilitated attention, difficulty in disengagement, and attentional avoidance comprise the components of attentional bias. A threat detection mechanism likely underlies facilitated attention, a process that may be neurally centered around the amygdala. Attentional control ability likely underlies difficulty in disengagement, emotion regulation goals likely underlie attentional avoidance, and both of these processes may be neurally centered around prefrontal cortex functioning. The threat detection mechanism may be a mostly automatic process, attentional avoidance may be a mostly strategic process, and difficulty in disengagement may be a mixture of automatic and strategic processing. Recommendations for future research are discussed.

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Crossref · 10.1016/j.cpr.2009.11.003

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  • Willingness may enhance extinction learning by addressing some of the attentional biases that are observed in anxiety disorders and linked to their maintenance.

    “Third, willingness may enhance extinction learning by addressing some of the attentional biases that are observed in anxiety disorders and linked to their maintenance (Cisler & Koster, 2010).”

    From How willing are you? Willingness as a predictor of change during treatment of adults with obsessive–compulsive disorder (2017) · cites this paper as Cisler & Koster, 2010

    The review’s “Anxiety Diagnosis” section (page unavailable) reports attentional biases across anxiety disorders and links them to chronic anxiety. But its “Future Directions” section says their relationship to success during exposure remains unclear; it does not establish that willingness improves extinction learning by addressing those biases. (LLM, conf=0.86)

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  • There is strong evidence in the field of anxiety disorders that people with anxiety preferentially attend to feared stimuli, and this attentional bias plays an important role in the aetiology and maintenance of anxiety disorders.

    “There is strong evidence in the field of anxiety disorders that people with anxiety preferentially attend to feared stimuli,22 23 and this attentional bias plays an important role in the aetiology and maintenance of anxiety disorders.24”

    From Effectiveness of a projection-based augmented reality exposure system in treating cockroach phobia: Study protocol of a randomised controlled trial (2023) · cites this paper as [24]

    Citation 24 is attached to the claim about the aetiology and maintenance of anxiety disorders. The Anxiety Diagnosis section says threat-related attentional bias co-occurs with chronic anxiety, and Future Directions reports that attention training can affect anxiety symptoms. Those passages support a possible role in anxiety, but the review does not establish that the bias plays an important causal role in both the onset and maintenance of anxiety disorders. (LLM, conf=0.83)

    Experimental — accuracy not yet measured
  • Hypervigilance is tightly coupled with attentional threat bias, referring to the fact that negative valence content captures human attention more than other content.

    “It is tightly coupled with attentional threat bias, referring to the fact that negative valence content captures human attention more than other content [121,122].”

    From Impact of Media-Induced Uncertainty on Mental Health: Narrative-Based Perspective. (2025) · cites this paper as [121]

    The Summary reports that attention is biased toward threatening information among anxious individuals, and the Components of Attentional Bias section describes how threat can draw or capture attention (pages unavailable in our copy). The claim extends this to negative-valence content generally capturing human attention more than other content; the review's evidence is more specifically about threat and anxiety, and it also describes attentional avoidance of threat. (LLM, conf=0.87)

    Experimental — accuracy not yet measured
  • Neural and behavioural biases in processing emotional information, in particular increased processing of threat-related and negatively valenced stimuli, are core functional markers of anxiety and depression.

    “Neural and behavioural biases in the processing of emotional information, in particular increased processing of threat-related and negatively valenced stimuli, are core functional markers of anxiety and depression (Beck 2008; Cisler and Koster 2010).”
  • At longer stimulus durations, attentional vigilance may involve a difficulty to disengage from salient emotional stimuli.

    “Attentional vigilance to brief, masked presentations of threatening cues has primarily been interpreted as an involuntary deployment of attention (Browning et al. 2010), whereas at longer stimulus durations, it may further involve a difficulty to disengage from salient emotional stimuli (Koster et al. 2004; Cisler and Koster 2010).”

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Authors
Cisler, J. M., & Koster, E. H. W.
Affiliations
  • Medical University of South Carolina (US)
  • Ghent University (BE)
Corresponding author
Cisler, Josh M.
Venue
Clinical Psychology Review
Publisher
Elsevier BV
Published
2010-03
Volume
30
Issue
2
Pages
203-216
ISSN
0272-7358 (ISSN-L)
OpenAlex
W2029774343
Cited by
1,753
References
183
Citations by year
2026: 87 · 2025: 122 · 2024: 96 · 2023: 111 · 2022: 119 · 2021: 123 · 2020: 173 · 2019: 148 · 2018: 133 · 2017: 106 · 2016: 120 · 2015: 97 · 2014: 79 · 2013: 98 · 2012: 77
FWCI
6.74
Type
journal article
Language
en
Open access
Locations
  • Clinical Psychology Review (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
  • Ghent University Academic Bibliography (Ghent University) (submittedVersion)
Funders
National Institute of Mental Health (T32MH018869)
Topics
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
  • Life Sciences › Neuroscience › Cognitive Neuroscience › Neural and Behavioral Psychology Studies
  • Physical Sciences › Computer Science › Computer Vision and Pattern Recognition › Visual Attention and Saliency Detection
Keywords
anxiety disorders, attentional disengagement, attentional avoidance, threat detection, amygdala, prefrontal cortex, attentional control, emotion regulation
MeSH terms
Anxiety Disorders, Attention, Emotions, Humans, Models, Psychological, Neuropsychological Tests, Orientation

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