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Cited by 211Anxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesNeural and Behavioral Psychology StudiesVisual Attention and Saliency Detection

Anxiety and Threat-Related Attention: Cognitive-Motivational Framework and Treatment

Open access
Mogg, Karin, Bradley, Brendan P.·2018·Trends in Cognitive Sciences
DOI 10.1016/j.tics.2018.01.001
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Abstract

Research in experimental psychopathology and cognitive theories of anxiety highlight threat-related attention biases (ABs) [ 4 9 0 _ T D $ D I F F ] and underpin the development of a computer-delivered treatment for anxiety disorders: attention-bias modification (ABM) training.Variable effects of ABM training on anxiety and ABs generate conflicting research recommendations, novel ABM training procedures, and theoretical controversy.This article summarises an updated cognitive-motivational framework, integrating proposals from cognitive models of anxiety and attention, as well as evidence of ABs.Interactions between motivational salience-driven and goal-directed influences on multiple cognitive processes (e.g., stimulus evaluation, inhibition, switching, orienting) underlie anxiety and the variable manifestations of ABs (orienting towards and away from threat; threat-distractor interference).This theoretical analysis also considers ABM training as cognitive skill training, describes a conceptual framework for evaluating/developing novel ABM training procedures, and complements network-based research on reciprocal anxiety-cognition relationships. Search for Cognitive Mechanisms in Anxiety and New TreatmentsAnxiety disorders are common mental-health problems that are burdensome for sufferers and health services [1].Treatments include medication and cognitive behavioural therapy (CBT); however, many anxiety sufferers fail to respond, or relapse [1,2].Consequently, there is need for additional treatment options which are effective, low-cost, and easily delivered.One potential computer-delivered treatment is [ 4 9 3 _ T D $ D I F F ] attention-bias modification (ABM) training.ABM training arose from research in experimental psychopathology (see Glossary), and draws on theory and methods in experimental cognitive psychology to examine [ 4 9 4 _ T D $ D I F F ] and modify attention processes in anxiety.The original version, ABM threat-avoidance training, is based on assumptions that anxious individuals have an enduring automatic tendency to attend preferentially to threat information [3], and reduction of this attention bias (AB) should reduce anxiety [4,5].However, there is dispute about the clinical effectiveness of ABM training and the cognitive processes underlying anxiety and threat-related ABs.The purpose of this article is several-fold: to provide a brief overview of these issues, which builds on and extends our previous reviews [6,7]; to describe an updated cognitive-motivational model of anxiety and threat-related attention; to view ABM training as cognitive skill training; to apply the distinction between processes and procedures [8] to this updated perspective; to describe a conceptual framework for evaluating and developing novel ABM training procedures; and to encourage networkbased research evaluating reciprocal anxiety-cognition relationships. TrendsResearch in experimental psychopathology [ 4 9 2 _ T D $ D I F F ] has led to the development of ABM training as a potential computer-delivered treatment for anxiety disorders.Conventional ABM threat-avoidance training encourages anxious individuals to orient attention away from threat, but has variable effects on anxiety and threat-related ABs.Differing explanations for mixed outcomes of ABM training, and theoretical controversy about the causes of anxiety and ABs, encourage the development of alternative novel ABM training methods.Development of effective attentionbased treatments for anxiety would be advanced by better theoretical understanding of the cognitive processes underlying anxiety and ABs, and by using more refined and comprehensive assessments of threatrelated attention and associated cognitive and neural functioning.

AI snapshot

Written from the paper’s full text.

TL;DR

This review updates a cognitive-motivational framework in which anxiety and threat-related attention biases (ABs) arise from interacting salience-driven and goal-directed influences on multiple cognitive processes, rather than from a single automatic threat-orienting bias. It argues that conventional attention-bias modification (ABM) threat-avoidance training has inconsistent effects and that ABM should be reconceived as cognitive skill training targeting multiple processes.

Key findings

  • Conventional ABM threat-avoidance training has been evaluated in over 30 studies and often is no more effective than control attention training; reviews and meta-analyses conclude it has inconsistent effects on anxiety and AB and is “unsuitable as a treatment for anxiety.”
  • Anxiety-related ABs are not unitary: manifestations include initial orienting toward threat, attention maintenance on threat, orienting away from threat, and threat-distractor interference, and these are commonly uncorrelated. Meta-analytic findings cited report small-to-medium effect sizes for threat-related ABs in anxious individuals on visual probe and emotional Stroop tasks (d = 0.37–0.49).
  • The updated framework proposes that anxiety and variable ABs emerge from imbalance between threat-hypersensitive automatic salience evaluation and goal-directed cognitive control, involving evaluation, inhibition, switching, and orienting functions.
  • ABM is reframed as cognitive skill training; the paper predicts greater efficacy from combined procedures targeting multiple processes, such as explicit goal-setting, feedback, goal rehearsal, goal-switching, varied training, and extensive practice, while noting that evidence for alternative ABM methods is preliminary.

Methods

  • Design: theoretical review and conceptual synthesis, updating a prior cognitive-motivational framework of anxiety and threat-related attention.
  • Data/sample: no primary empirical sample; the paper draws on experimental psychopathology, cognitive models of anxiety and attention, ABM training studies, and meta-analytic findings.
  • Main analysis: narrative integration of evidence into a framework distinguishing salience-driven versus goal-directed processes, with tables comparing target processes, training procedures, and features of conventional and alternative ABM methods.

Limitations

  • Stated: only conventional ABM threat-avoidance training has been extensively evaluated in high-anxiety individuals, with disappointing results; evidence for therapeutic efficacy of alternative ABM methods is limited and preliminary.
  • Stated: conclusions about ABM and AB are complicated by methodological issues including differing outcome measures, confounding variables, low-quality studies, publication bias, and limited reliability of AB indices derived from manual response times.
  • Evident: as a narrative theoretical review, it does not report a systematic search strategy, meta-analysis, or new empirical data, and many cited studies are summarized only briefly.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1016/j.tics.2018.01.001

Cites

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Statistics

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Claims the paper makes

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  • Premisecitation

    Anxiety and ABs depend on multiple processes, including automatic salience-driven and goal-directed cognitive control processes.

    “This may be explained by cognitive models of anxiety which propose that anxiety and ABs depend on multiple processes, including automatic salience-driven (also known as bottom-up, stimulus-driven) and goal-directed cognitive control (also known as top-down, executive control) processes [6,[23][24][25][26][27][28][29][30][31][32].”
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    ABM threat-avoidance training is often no more effective in reducing anxiety than control attention training.

    “ABM threatavoidance training is often no more effective in reducing anxiety than [ 4 9 5 _ T D $ D I F F ] control attention training”
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  • Premisecitation

    Multiple cognitive functions support automatic salience evaluation and detection, including automatic salience evaluation, inhibition or interruption of ongoing activity, alerting, salience-driven switching, and reflexive orienting.

    “These include automatic salience evaluation, [ 4 9 8 _ T D $ D I F F ] inhibition/interruption of ongoing activity[ 4 9 9 _ T D $ D I F F ] , alerting, salience-driven switching, and reflexive orienting [40,43,47,48].”
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  • Interpretationreasoning

    Anxiety and threat-related ABs emerge from interactive salience-driven and goal-directed influences on multiple processes.

    “Accordingly, anxiety and threat-related ABs emerge from interactive salience-driven and goal-directed influences on multiple processes (Figure 2, Key Figure).”
    Quote in the paperSubstantial claim
  • Interpretationreasoning

    Imbalance between salience-driven and goal-directed systems underlies emotion dysregulation, excessive anxiety, and threat-related ABs.

    “Imbalance between these systems underlies emotion dysregulation, excessive anxiety, and threat-related ABs.”
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  • Classified as probably not a substantial claim. 10
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    Premisecitation

    Many anxiety sufferers fail to respond to medication and cognitive behavioural therapy, or relapse.

    “Treatments include medication and cognitive behavioural therapy (CBT); however, many anxiety sufferers fail to respond, or relapse [1,2].”
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    Interpretationnone given

    Other ABM training methods may be more effective, but outcome data are preliminary.

    “Other ABM training methods (considered later) may be more effective, but outcome data are preliminary.”
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    Premisecitation

    ABM threat-avoidance training is less effective when delivered at home than in laboratory or clinic settings, possibly because greater distractions at home impair learning.

    “ABM threatavoidance training is less effective when delivered at home than in laboratory/clinic settings, possibly because greater distractions at home impair learning [8,13].”
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    Interpretationcitation

    Poor outcomes of conventional ABM may be explained if AB in orienting towards threat does not play a strong causal role in anxiety.

    “Another explanation for poor outcomes concerns the target process: if AB in orienting towards threat does not play a strong causal role in anxiety, this may explain the inconsistent effects of ABM threat-avoidance training [6,11,12,18].”
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    Premisecitation

    Salience evaluation automatically evaluates the motivational importance of stimuli and modulates other processes to prioritise salient stimuli.

    “Salience evaluation is a core process that not only automatically evaluates the motivational importance of stimuli (threat value) but also modulates other processes to prioritise salient stimuli”
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    Premisecitation

    ABM threat-avoidance training is repetitious and boring, which may reduce treatment compliance.

    “ABM threat-avoidance training is also repetitious and boring, which may reduce treatment compliance [20,21].”
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    Premisecitation

    Anxiety disorders are common mental-health problems that are burdensome for sufferers and health services.

    “Anxiety disorders are common mental-health problems that are burdensome for sufferers and health services [1].”
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    Premisecitation

    Empirical research indicates several manifestations of anxiety-related ABs, which are commonly uncorrelated.

    “Empirical research indicates several manifestations of anxiety-related ABs, which are commonly uncorrelated [6,18,25,53].”
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    Interpretationreasoning

    Over-reactivity of automatic threat salience evaluation, salience-driven switching, and orienting functions may each contribute to anxiety symptoms and ABs.

    “Over-reactivity of automatic threat salience evaluation, salience-driven switching, and orienting functions may each contribute to anxiety symptoms and ABs.”
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    Premisecitation

    Empirical evidence increasingly indicates that anxious individuals do not consistently exhibit AB towards threat, and sometimes show no AB or threat avoidance.

    “Empirical evidence increasingly indicates that anxious individuals do not consistently exhibit AB towards threat, and sometimes show no AB or threat avoidance [6,12,18,25,31,[36][37][38][39].”
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    Interpretationreasoning

    In high-anxiety individuals, the automatic salience-evaluation mechanism is over-reactive to threat cues and influences other processes to facilitate rapid identification and responding to threat.

    “In high-anxiety individuals, the automatic salience-evaluation mechanism is proposed to be over-reactive to threat cues and, when activated, influences other processes (e.g., inhibition, switching, orienting, alerting, perceptual analyses) to facilitate rapid identification and responding to threat.”
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    Premisecitation

    ABs in attention-orienting include initial orienting towards threat, maintaining attention on threat, and orienting away from threat.

    “ABs in attentionorienting are observed on spatial attention tasks (e.g., visual probe and eye-tracking tasks), and include initial orienting towards threat, maintaining attention on threat (also known as delayed disengagement), and orienting away from threat [6,25,29,53,54].”
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    Premisecitation

    Goal-directed inhibitory control is a core function underlying attention control and cognitive control, and is important in emotion regulation by downregulating reactivity of automatic salience evaluation to threat cues.

    “Goal-directed inhibitory control is a core function underlying [ 5 0 1 _ T D $ D I F F ] attention control, and cognitive control processes generally [45], which operate in a coordinated manner to support goals [41,51].Goal-directed inhibitory control is also important in emotion regulation by downregulating the reactivity of the automatic salience evaluation mechanism to threat cues [46].”
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    Interpretationreasoning

    Other cognitive processes may underpin both anxiety and ABs to threat.

    “Other cognitive processes may underpin both anxiety and ABs to threat.”
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    Interpretationreasoning

    ABM training may be viewed as cognitive skill training, whereby anxious individuals learn adaptive attention responses to minor threat cues to apply in daily life.

    “ABM training may be viewed as cognitive skill training, whereby anxious individuals learn adaptive attention responses to minor threat cues (which are not objective dangers) to be applied in daily life.”
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    • Rests on an assumption: Threat cues used in ABM training are minor and not objective dangers.

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    Interpretationcitation

    Anxiety-related ABs likely reflect the current motivational or goal state of the individual, influenced by individual differences and situational variables.

    “In sum, anxiety-related ABs likely reflect the current motivational/goal state of the individual (e.g., to detect, monitor, and/or avoid threat), that is in turn influenced by individual differences (e.g., anxiety/fear/trauma, attention control) and situational variables (e.g., threat duration/severity) ([6] for evidence).”
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    Interpretationreasoning

    Anxiety and variable AB manifestations emerge from interacting cognitive-motivational influences, including threat-hypersensitive automatic salience evaluation, salience-driven switching and orienting, and inadequate or maladaptive goal-directed cognitive control.

    “Accordingly, anxiety and variable AB manifestations emerge from interacting cognitive-motivational influences on information processing, including threat-hypersensitive automatic salience evaluation, salience-driven switching and orienting, and inadequate/maladaptive goal-directed cognitive control.”
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    Interpretationcitation

    ABs in attention-orienting may reflect both salience-driven and goal-directed processes, including reflexive orienting and strategic maintenance, suppression, or avoidance of threat.

    “ABs in attention-orienting (e.g., on a visual probe task) may also reflect both salience-driven and goal-directed processes.”
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    Interpretationcitation

    High anxiety may intensify threat salience evaluation and impair goal-directed inhibitory attention control, both enhancing threat salience-driven ABs.

    “High anxiety may not only intensify threat salience evaluation (resulting in overestimation of stimulus threat value), but also impair goaldirected inhibitory attention control [26,52], both enhancing threat salience-driven ABs.”
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    Interpretationreasoning

    Reciprocal interrelationships between anxiety, ABs, and their underlying processes may maintain anxiety and be usefully modified by attention training procedures.

    “Reciprocal interrelationships between anxiety, ABs, and their underlying processes may maintain anxiety and be usefully modified by attention training procedures.”
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    Premisecitation

    Research in cognitive skill training highlights contributions of explicit and implicit learning and identifies multiple training procedures that facilitate acquisition, retention, and transfer of cognitive skills.

    “Research in cognitive skill training highlights the contributions of both explicit and implicit learning (i.e., learning with and without awareness/intention) [61,62], and identifies multiple training procedures which facilitate acquisition, retention, and transfer of cognitive skills.”
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    Interpretationcitation

    Threat-avoidant orienting may reduce immediate distress, but be maladaptive in the long term by impairing reason-based appraisal of feared stimuli, thereby impeding habituation and fear reduction.

    “Threat-avoidant orienting may reduce immediate distress, but be maladaptive in the long term by impairing reason-based appraisal of feared stimuli, thereby impeding habituation and fear reduction.”
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    Interpretationcitation

    Attention maintenance on threat and poor threat-distractor inhibition may exacerbate anxiety-related thoughts and worries.

    “Attention maintenance on threat and poor threat-distractor inhibition may exacerbate anxiety-related thoughts and worries.”
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    Interpretationreasoning

    ABM training efficacy would be enhanced by combining several procedural features, including selective attention to nonthreat targets, explicit goal-setting, maximising threat exposure, evaluation or appraisal of threat cues as task-irrelevant, goal-directed orienting, goal rehearsal, goal-switching, extensive practice, feedback, content relevance, and variation.

    “The framework, together with cognitive skill training research, therefore predicts that ABM training efficacy would be enhanced by combining several procedural features”
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    Premisecitation

    Only conventional ABM threat-avoidance training has been extensively evaluated in high-anxiety individuals, with disappointing results.

    “Regarding clinical efficacy, only conventional ABM threat-avoidance training has been extensively evaluated in high-anxiety individuals, with disappointing results, as noted earlier.”
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    Premisecitation

    Multi-session emotional face visual search training has mixed effects on nonclinical adolescent anxiety, with poor compliance possibly due to insufficient goal engagement.

    “Multi-session emotional face visual search training has mixed effects on nonclinical adolescent anxiety, with problems of poor compliance possibly owing to insufficient goal engagement [71,73,74].”
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    Interpretationcitation

    CBT and exposure are thought to be effective by increasing inhibitory control over aversive salience-driven processing, and ABM training may augment their effects by further supporting these processes.

    “Both CBT and exposure are thought to be effective by increasing inhibitory control over aversive salience-driven processing [77,78], and ABM training may therefore augment their effects by further supporting these processes.”
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    Interpretationnone given

    ABM training potentially offers a low-cost and easily delivered treatment option, either standalone or alongside other therapies.

    “ABM training potentially offers a low-cost and easily delivered treatment option, either standalone or alongside other therapies.”
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    Interpretationreasoning

    ABM training methods targeting multiple processes warrant further evaluation in larger-scale clinical trials.

    “Thus, ABM training methods, using combined procedures to target these processes (Table 1), which reduce anxiety in preliminary home-based treatment studies, warrant further evaluation in larger-scale clinical trials.”
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    Premisecitation

    Enhanced positive search training delivered at home to children with mixed anxiety disorders produced therapeutic benefit related to verbalisation of attention goals, maintained for 6 months.

    “Enhanced positive search training was delivered at home to children with mixed anxiety disorders; therapeutic benefit was related to verbalisation of attention goals (assessed during training) and was maintained for 6 months post-training [75,76].”
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    Interpretationreasoning

    Several ABM training methods explicitly inform participants of training goals, which should facilitate goal-directed cognitive control.

    “Several ABM training methods explicitly inform participants of the training goals, and this should also facilitate goal-directed cognitive control (adaptive ABM, A-FACT, enhanced positive search training).”
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    Premisecitation

    Clinical studies report anxiety reduction following adaptive ABM, gaze-contingent music-reward therapy combined with CBT, emotional face visual search training, and enhanced positive search training.

    “Clinical studies which evaluate multi-session ABM training in individuals with anxiety disorders report anxiety reduction following adaptive ABM (uncontrolled pilot study), gaze-contingent music-reward therapy (combined with CBT), emotional face visual search training, and enhanced positive search training [21,69,72,75,76].”
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    Interpretationreasoning

    It is unclear whether effects of ABM training transfer to other AB measures or related cognitive functions.

    “In addition, ABM threat-avoidance training studies often use similar tasks to both modify AB and assess AB change (e.g., probe-based spatial attention tasks are used in both ABM threatavoidance training and AB assessment), and it is therefore unclear whether effects of training transfer to other AB measures or related cognitive functions [7,82].”
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    Premisenone given

    There is continuing debate about the processes underlying anxiety, threat-related ABs, and ABM training; the effectiveness of differing ABM training methods; and their active constituent procedures.

    “In sum, there is continuing debate about the processes underlying anxiety, threat-related ABs, and ABM training; the effectiveness of differing ABM training methods (e.g., variants of visual probe, spatial cueing, visual search, card game-based tasks); and their active constituent procedures (Tables 1,2).”
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    Premisecitation

    The executive control network supports goal-directed activity and spans frontal/parietal regions.

    “Such research links anxiety with dysfunctional interactions among multiple brain regions, including the salience network (supporting automatic threat evaluation/detection, and spanning amygdala/insula/frontal regions) and executive control network (supporting goal-directed activity, and spanning frontal/parietal regions) [110-115].”
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    Premisecitation

    AB assessment methods include visual probe, spatial cueing, modified Stroop, flanker, and visual search tasks.

    “AB assessment methods include visual probe, spatial cueing, modified Stroop, flanker, and visual search tasks [6,7,12,19,35,53-55,86,98-100].”
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    Premisecitation

    The salience network supports automatic threat evaluation/detection and spans amygdala/insula/frontal regions.

    “Such research links anxiety with dysfunctional interactions among multiple brain regions, including the salience network (supporting automatic threat evaluation/detection, and spanning amygdala/insula/frontal regions) and executive control network (supporting goal-directed activity, and spanning frontal/parietal regions) [110-115].”
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  • The paper relies on this without support.

    Threat cues used in ABM training are minor and not objective dangers.

    “minor threat cues (which are not objective dangers)”
1 of 1

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?

  • Individuals with good attentional control ability can regulate top-down attention allocation and avoid bottom-up stimulus drive systems that are overly enhanced and more easily attracted to negative stimuli.

    “Individuals with good attentional control ability can regulate top-down attention allocation and avoid bottom-up stimulus drive systems that are overly enhanced and more easily attracted to negative stimuli.”

    From Media multitasking, depression, and anxiety of college students: Serial mediating effects of attention control and negative information attentional bias (2022) · cites this paper as [55]

    The Cognitive-Motivational Framework section says anxious individuals may sometimes suppress attention bias to threat by focusing on task-relevant information, particularly if they have good inhibitory attention control. It also says inhibitory control can downregulate automatic threat-salience responses. The claim extends this conditional account of anxious individuals and threat cues to individuals generally and negative stimuli broadly. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

  • The lower the attentional control, the more susceptible the individual is to the stimulus drive system, and the more attention is captured by negative stimuli, leading to anxiety and depression.

    “However, the lower the attentional control, the more susceptible the individual is to the stimulus drive system, and the more attention is captured by negative stimuli, leading to anxiety and depression (54–56).”

    From Media multitasking, depression, and anxiety of college students: Serial mediating effects of attention control and negative information attentional bias (2022) · cites this paper as [55]

    The Cognitive-Motivational Framework section says inhibitory attention control can oppose threat-salience-driven influences, supporting the attentional-control and anxiety portions of the claim. It does not establish that this sequence leads to depression; the Glossary mentions attention bias toward negative information in depression but does not link it to reduced attentional control. The framework also describes the relationship between attention bias and anxiety as probably reciprocal, rather than a one-way causal chain. Page numbers are not available in our copy. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • Individual differences in the sensitivity to cues may confer risk for anxiety disorders.

    “In the human literature, substantial research has supported that individual differences in the sensitivity to cues may also confer risk for anxiety disorders (Bar-Haim, Lamy, Pergamin, Bakermans-Kranenburg, & van IJzendoorn, 2007; Heeren, Peschard, & Philippot, 2011; Mogg & Bradley, 2018; Shackman et al., 2016; Van Bockstaele et al., 2014).”

    From Cued for Risk: Evidence for an Incentive Sensitization Framework to Explain the Interplay between Stress and Anxiety, Substance Abuse, and Reward Uncertainty in Disordered Gambling Behavior (2019) · cites this paper as Mogg & Bradley, 2018

Cites

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Related

Authors
Mogg, K., & Bradley, B. P.
Affiliations
University of Cambridge (GB)
Corresponding author
Mogg, Karin
ORCID
Venue
Trends in Cognitive Sciences
Publisher
Elsevier BV
Published
2018-03
Volume
22
Issue
3
Pages
225-240
ISSN
1364-6613 (ISSN-L)
DOI
10.1016/j.tics.2018.01.001
OpenAlex
W2786684171
Semantic Scholar
e85c12ba9fc39a5205fb939fd6341fd5e9bc3367
Cited by
210
References
123
Citations by year
2026: 18 · 2025: 34 · 2024: 35 · 2023: 30 · 2022: 21 · 2021: 25 · 2020: 24 · 2019: 17 · 2018: 6
FWCI
2.87
Type
journal article
Language
en
Open access
Licence
Locations
  • Trends in Cognitive Sciences (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • ePrints Soton (University of Southampton) (submittedVersion)
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, threat-related attention, attentional bias, attentional bias modification, motivational salience, goal-directed behavior, inhibition, cognitive shifting, stimulus evaluation, anxiety disorders
MeSH terms
Attentional Bias, Anxiety, Cognition, Fear, Humans, Motivation, Cognitive Behavioral Therapy

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 2026-10-09.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-09.

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