The Effect of Mindfulness-Based Cognitive Therapy on ERP Markers of Attentional Bias in Anxiety

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PROJECT SUMMARY/ABSTRACT In the past year, an estimated 19.1% of adults aged 18 or older in the United States had an anxiety disorder, and an estimated 31.1% of U.S. adults experience any anxiety disorder sometime in their lives. As of 2010, anxiety disorders were the fifth leading cause of years lived with disability. Anxiety disorders are associated with attentional bias to threat, which refers to differential attentional allocation towards threatening stimuli relative to neutral stimuli. Anxious individuals direct their attention toward threat during early, automatic stages of processing, whereas during later, more strategic stages of processing, they tend to direct their attention away from threat. Attentional bias may prolong anxiety states by placing inordinate priority on potential threats in the environment, thus intensifying anxious mood states. In a dot-probe (DP) paradigm, individuals with social anxiety disorder display enhanced P1 amplitudes to angry–neutral versus happy–neutral face pairs, suggesting early hypervigilance to angry faces, and decreased P1 amplitudes to probes replacing emotional (angry and happy) versus neutral faces, suggesting reduced visual processing of emotionally salient locations at later stages of information processing—potentially a manifestation of attentional avoidance. Meditation practice has been proposed to improve the control of attention by improving efficiency of engagement and disengagement processes, thereby reducing bias of attention. In preliminary work using a DP task with fibromyalgia patients, a mindfulness intervention reduced avoidance of pain-related threat at early levels of processing and facilitated disengagement from threat at later stages of processing. Building on these encouraging findings, the current application wishes to investigate whether Mindfulness-based Cognitive Therapy (MBCT) can modify P1 threat- related attentional bias markers in a DP task in patients with clinical levels of anxiety, and whether MBCT- induced modification of P1 markers account for treatment gains. The proposed research is designed (1) to determine whether an 8-week MBCT modifies P1 threat-related attentional bias markers in anxious patients, and (2) to investigate the relationship between P1 threat-related attentional bias markers, acute treatment response and durability. Forty-two individuals with moderate to high levels of trait anxiety will be recruited from an ongoing trial of open-label MBCT at the Osher Center for Integrative Medicine (OCIM) using the State-Trait Anxiety Inventory (STAI). Before and after intervention, P1 marker amplitudes to cues and probes in the DP task will be monitored. Anxiety symptom levels will be evaluated using the Depression Anxiety Stress Scale (DASS) as the primary outcome along with secondary evaluation by the STAI and the Clinical Global Impression (CGI) Scale. Treatment durability will also be assessed with the DASS, STAI, and CGI six months after MBCT intervention. The proposed research will provide insight into a potential physiological mechanism through which MBCT may target early and later stages of attentional bias and reduce clinical symptoms of anxiety. The effect of depression and stress on MBCT-induced marker modification will also be explored.