Generalized Anxiety Disorder, worry and attention to threat: A systematic review

Generalized Anxiety Disorder, worry and attention to threat: A systematic review
June 17, 2017 by
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Generalized Anxiety Disorder, worry and attention to threat: A systematic review

One of the main symptoms of Generalised Anxiety Disorder (GAD) is high levels of worry- the tendency to ruminate on things that are considered frightening and dwell on repetitive negative thoughts about the future. Those with high levels of worry and GAD symptoms often display an attentional bias towards threats- their attention is naturally drawn to things around them which are deemed threatening.

Attention to threats in our environment can be considered either “bottom up” or “top down”. The bottom up process involves automatic changes in attention driven by changes in events around us, while the “top down” system is a more consciously controlled and deliberate attempt to focus attention in order to regulate emotions.

Being able to quickly detect threats and having your attention automatically drawn to them poses some survival advantage and all people show this enhanced threat perception to some extent, but the effect is more pronounced in those suffering from anxiety disorders. This attentional bias towards threats serves to maintain high levels of anxiety since the more you are looking for threats around you, the more you are likely to see.

Those who show high levels of worry often experience poorer control over their attention and an inability to disengage their thoughts from worrying thoughts and stimuli. This may be caused by a bottom-up impairment of their automatic threat perception or it could be a top-down or motivated process, reflecting worrier’s belief that worry helps them in some way.

Since worry and attentional bias are both key symptoms of GAD, this study aims to provide a review of all current research into levels of worry and attentional bias. The study also aims to evaluate evidence as to whether attentional bias in patients with GAD is primarily driven by top-down or bottom-up processes.

From an initial search pool of over 4,000 articles, 29 high quality studies were identified which examined attentional bias and worry. The studies consistently found that participants with GAD or high levels of worry showed a stronger attentional bias towards threatening stimuli than the general population. This effect was found across all experimental paradigms- experiments monitoring eye movement, reaction speed and other measures all found the same results.

Patients with GAD were compared to patients with other mental disorders such as panic disorder, speech phobia and depression, but results were inconclusive, with 7 of the studies showing that GAD resulted in higher levels of attentional bias than other disorders, and 6 studies showing no difference.

By measuring reaction times the majority of studies found that attentional bias to threats was present as both a subliminal and conscious process, suggesting that both bottom-up and top-down process can be involved in this bias. The effect of informational bias was stronger for word-based threats than pictures or faces, which may be due to the verbal nature of worry thoughts.

This review consistently demonstrated the tendency of high-worriers to be predisposed to noticing threats around them. Given that this bias in attention serves to maintain anxiety symptoms by making people overly sensitive to dangers around them, this research has important implications for the treatment of GAD and other anxiety disorders.

For more information on GAD visit our anxiety page or contact us.

Source :


Authors: Huw Goodwin, Jenny Yiend, Colette Hirsch
Journal: Clinical Psychology Review
Source Title:Generalized Anxiety Disorder, worry and attention to threat: A systematic review
Publish Date: Mar, 17