Case Control Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Psychiatr. Mar 19, 2021; 11(3): 73-86
Published online Mar 19, 2021. doi: 10.5498/wjp.v11.i3.73
Using eye movements in the dot-probe paradigm to investigate attention bias in illness anxiety disorder
Yan-Bo Zhang, Peng-Chong Wang, Yun Ma, Xiang-Yun Yang, Fan-Qiang Meng, Simon A Broadley, Jing Sun, Zhan-Jiang Li
Yan-Bo Zhang, Peng-Chong Wang, Yun Ma, Xiang-Yun Yang, Fan-Qiang Meng, Jing Sun, Zhan-Jiang Li, The Department of Clinical Psychology and National Clinical Research Center for Mental Disorders and Beijing Key Laboratory of Mental Disorders, Beijing An’Ding Hospital, Capital Medical University, and Center of Schizophrenia, Beijing Institute for Brain Disorders, Beijing 100089, China
Yan-Bo Zhang, Peng-Chong Wang, Yun Ma, Xiang-Yun Yang, Fan-Qiang Meng, Jing Sun, Zhan-Jiang Li, Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing 100089, China
Yan-Bo Zhang, Psychology Department, Beijing Tongren Hospital, Capital Medical University, Beijing 100089, China
Simon A Broadley, Jing Sun, Menzies Health Institute Queensland and School of Medicine, Griffith University, Gold Coast 4222, Queensland, Australia
Author contributions: Zhang YB and Wang PC contributed equally to the study, both collected data, conducted statistical analysis, and drafted the manuscript and are parallel first authors; Ma Y, Yang XY, and Meng FQ collected the data; Broadley SA edited and commented on the manuscript’s intellectual content; Sun J and Li ZJ both contributed to the study equally; Sun J conducted statistical analysis, critically reviewed, edited, and revised the manuscript; Li ZJ designed and supervised the study.
Supported by the Capital Health Development Research Project, No. 2016-1-2121.
Institutional review board statement: The study was approved by the Ethics Committee of Beijing An’Ding Hospital, Capital Medical University.
Informed consent statement: All patients gave informed consent.
Conflict-of-interest statement: All authors declare that they have no conflict of interests.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at ksiaaleila@yahoo.fr.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jing Sun, PhD, Associate Professor, Menzies Health Institute Queensland and School of Medicine, Griffith University, Parkland Drive, Gold Coast 4222, Queensland, Australia. j.sun@griffith.edu.au
Received: December 1, 2020
Peer-review started: December 1, 2020
First decision: December 12, 2020
Revised: December 23, 2020
Accepted: January 28, 2021
Article in press: January 28, 2021
Published online: March 19, 2021
Abstract
BACKGROUND

Illness anxiety disorder (IAD) is a common, distressing, and debilitating condition with the key feature being a persistent conviction of the possibility of having one or more serious or progressive physical disorders. Because eye movements are guided by visual-spatial attention, eye-tracking technology is a comparatively direct, continuous measure of attention direction and speed when stimuli are oriented. Researchers have tried to identify selective visual attention biases by tracking eye movements within dot-probe paradigms because dot-probe paradigm can distinguish these attentional biases more clearly.

AIM

To examine the association between IAD and biased processing of illness-related information.

METHODS

A case-control study design was used to record eye movements of individuals with IAD and healthy controls while participants viewed a set of pictures from four categories (illness-related, socially threatening, positive, and neutral images). Biases in initial orienting were assessed from the location of the initial shift in gaze, and biases in the maintenance of attention were assessed from the duration of gaze that was initially fixated on the picture per image category.

RESULTS

The eye movement of the participants in the IAD group was characterized by an avoidance bias in initial orienting to illness-related pictures. There was no evidence of individuals with IAD spending significantly more time viewing illness-related images compared with other images. Patients with IAD had an attention bias at the early stage and overall attentional avoidance. In addition, this study found that patients with significant anxiety symptoms showed attention bias in the late stages of attention processing.

CONCLUSION

Illness-related information processing biases appear to be a robust feature of IAD and may have an important role in explaining the etiology and maintenance of the disorder.

Keywords: Attention bias, Selective attention, Eye tracking, Dot-probe, Illness anxiety disorder, Disengagement

Core Tip: This is the first study which has examined patients with illness anxiety disorder (IAD) having an attention bias that is mainly manifested as attentional avoidance at the early stage and overall attentional maintenance when presented with illness-related stimuli. They also have demonstrated vigilance of attention at the early attention stage and overall attentional maintenance when presented with disease and positive/neutral stimuli. In addition, this study found that patients with suspected disorders with significant anxiety symptoms show attention bias in the late stage of attention processing and struggle to dismiss the stimulus, showing delayed detachment. This study suggests that patients with IAD have attention bias and this may have provided a new way of identification of IAD symptoms using an eye-tracking evaluation method.