Eye tracking evidence of threat-related attentional bias in anxiety- and fear-related disorders: A systematic review and meta-analysis

Cognitive theories of anxiety- and fear-related pathology suggest that individuals with these forms of pathology (versus those without) exhibit greater threat-related attentional bias (AB). However, there are a multitude of mixed and null findings in this area of research. Unlike other commonly used measures of AB, eye-tracking indices of AB exhibit acceptable reliability, and thus, may help clarify the relationship between AB and anxiety- and fear-related symptoms. The purpose of this study was to conduct a meta-analysis, to determine whether there is evidence of a relationship between anxiety and fear-related symptoms and expressions of threat-related AB (i.e., reflexive orienting and maintenance) measured via free-viewing eye- tracking tasks. A total of 40 articles were retained for this meta-analysis. Significant relations were observed between anxiety and fear-related symptoms and both reflexive orienting toward threat (r = 0.13, 95% CI: 0.03, 0.22) and maintenance of attention on threat (r = 0.15, 95% CI: 0.05, 0.25). Results from the present study suggests that it may be important to develop attention bias modification interventions that target AB at both early (bottom-up) and later (top-down) stages of information processing to reduce anxiety- and fear-related pathology.