Effects of Attentional Focus Towards Internal and External Threats on Post-Event Processing in Social Anxiety

Abstract

Attentional allocation towards threat has been theorized to play a maintaining role in social anxiety disorder (SAD). However, it is unclear if both attentional focus towards internal threats (i.e., interoceptive signals of anxiety) and external threats (i.e., negative social-evaluative cues) are pathogenic. Further, evidence for the causal pathways by which attentional focus on threat maintains SAD is limited. The present study tested the effects of experimentally induced attentional allocation towards internal and external threats on state anxiety and post-event processing (PEP) in a highly socially anxious sample. During an impromptu speech task, participants (N = 123) were randomized to allocating their attention to their own thoughts, actions, or body sensations (internal condition; n = 41), to an audience member’s reactions and evaluations (external condition; n = 42), or to a neutral figurine (control condition; n = 40). State anxiety and PEP were assessed immediately following the speech and 24 hours later. Although no differences between the control group and the external and internal threat groups were observed, results indicated that the internal threat group reported significantly higher acute state anxiety after the manipulation and higher PEP 24 hours later compared to the external threat group. State anxiety after the manipulation also mediated heightened PEP 24 hours later among the internal threat group compared to the external threat group. Findings support the theorized maladaptive role of self-focused attention in the maintenance of SAD and suggest that attentional focus towards internal threats may be more harmful than focus towards external threats.