Korean Clinical Psychology Association

Current Issue

Korean Journal of Clinical Psychology - Vol. 39 , No. 4

[ Original Article ]
Korean Journal of Clinical Psychology - Vol. 39 , No. 3 , pp.242-256
ISSN: 2733-4538 (Online)
publication date 30 Aug 2020
Received 04 Mar 2020 Revised 01 Jul 2020 Accepted 06 Jul 2020
DOI: https://doi.org/10.15842/kjcp.2020.39.3.004

주의 편향 수정 훈련이 사회불안 증상에 미치는 영향: 작업기억 용량을 중심으로
장한비 ; 이종선
강원대학교 심리학과

Do Effects of Attention Bias Modification Training Depend on Working Memory Capacity for Social Anxiety Symptoms?
Hanbi Jang ; Jong-Sun Lee
Department of Psychology, Kangwon National University, Chuncheon, Korea
Correspondence to : Jong-Sun Lee, Department of Psychology, Kangwon National University, 1 Kangwondaehak-gil, Chuncheon, Korea; jongsunlee@kangwon.ac.kr

© 2020 Korean Clinical Psychology Association
Funding Information ▼


본 연구는 사회불안 증상 경향성을 보이는 대학생들을 대상으로 주의 편향 수정 훈련을 실시하고, 훈련으로 인한 주의 편향 점수 및 사회불안 증상 개선의 정도가 개인의 작업 기억 용량 수준에 따라서 다르게 나타나는지 비교하였다. 사회불안 증상을 측정하는 척도인 SADS에서 64점 이상의 점수를 보고한 경우 사회불안 경향이 있는 것으로 간주하였다. 참가자들은 작업 기억 용량에 따라 높은 작업 기억(HWM) 집단(n=34), 중간 작업 기억(IWM) 집단(n=30) 그리고 낮은 작업 기억(LWM) 집단(n=35)으로 구분되었으며, 총 99명의 데이터를 분석에 사용하였으며, 주의 편향 수정 훈련의 효과는 주의 편향 점수(ABS) 및 사회불안 증상 척도(SADS, SIAS, SPS, B-FNE)에서의 변화 정도로 확인하였다. 주의 편향 수정 훈련은 1회기로 실시하였으며, 훈련 전과 후에 ABS 및 사회불안 증상들을 측정하였다. 연구 결과, 주의 편향 수정 훈련 전에 비해서 훈련 후 ABS, SADS, SIAS, SPS 그리고 B-FNE이 유의하게 감소하였다. 이는 주의 편향 수정 훈련이 사회불안 증상을 감소시키는 데 효과가 있었다는 것을 의미한다. 또한 훈련 후에 작업 기억 용량이 높을수록 SADS, SIAS, SPS, 그리고 B-FNE에서 더 많은 감소를 보였다. 이는 주의 편향 수정 훈련의 효과가 작업 기억 용량에 따라서 달라질 수 있다는 것을 시사한다. 마지막으로 본 연구의 의의 및 제한점에 대해 논의하였다.


This study examined Attention Bias Modification (ABM) training for college students’ with social anxiety tendencies and compared the degree of improvement of social anxiety symptoms and attention bias scores depending on the level of working memory capacity. Social avoidance and distress scale (SADS) was used to measure social anxiety symptoms, and scores above 64 in were considered as having social anxiety tendencies. Participants were divided into high, intermediate, and low working memory groups, depending on their working memory capacity. A total of 99 data points were used for analysis. The effects of ABM training were identified as changes in the attention bias scores (ABS) and the social anxiety symptom scales (SADS, SIAS, SPS, B-FNE). The ABM training was conducted in a single session, and the ABS and social anxiety symptoms were measured before and after the training. The results showed that ABS, SADS, SIAS, SPS, and B-FNE significantly decreased after training. This means that ABM training was effective in reducing social anxiety symptoms. In addition, after training, the higher the working memory capacity, the greater the decrease in SADS, SIAS, SPS, and B-FNE. This suggests that the effects of ABM training may vary depending on working memory capacity. Finally, the therapeutic implications and limitations of this study are discussed.

Keywords: social anxiety, attention bias modification, working memory capacity, spatial cueing task, self-ordered pointing task (SOPT)
키워드: 사회불안, 주의 편향 수정, 작업기억 용량, 공간단서과제, 자기 순서 지시 과제(SOPT)


This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIT) (No. 2018R1C1B5043272).

This study was adapted from the first author’s Master’s Thesis.

Author contributions statement

Han-bi Jang, a graduate student at Kangwon National University, who is now an intern counselor at Kangwon National University’s Student Life Counseling Center, designed the study, collected, and analyzed the data, and led manuscript preparation. Jong-sun Lee, an assistant professor at Kangwon National University, served as the principal investigator of the research grant and supervised all the research process. All authors provided critical feedback, participated in the revision of the manuscript, and approved the final submission.

1. Amir, N, Elias, J, Klumpp, H, & Przeworski, A. (2003). Attentional bias to threat in social phobia: Facilitated processing of threat or difficulty disengaging attention from threat? Behaviour Research and Therapy, 41, 1325-1335.
2. Amir, N., Beard, C., Taylor, C. T., Klumpp, H., Elias, J., Burns, M., & Chen, X. (2009). Attention training in individuals with generalized social phobia: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 77, 961-973.
3. Amir, N., & Bomyea, J. (2011). Working memory capacity in generalized social phobia. Journal of Abnormal Psychology, 120, 504-509.
4. Amir, N., Bomyea, J., & Beard, C. (2010). The effect of single-session interpretation modification on attention bias in socially anxious individuals. Journal of Anxiety Disorders, 24, 178-182.
5. Amir, N., Weber, G., Beard, C., Bomyea, J., & Taylor, C. T. (2008). The effect of a single-session attention modification program on response to a public-speaking challenge in socially anxious individuals. Journal of Abnormal Psychology, 117, 860-868.
6. Baddeley, A. D. (1998). Recent developments in working memory. Current Opinion in Neurobiology, 8, 234-238.
7. Baddeley, A. D., & Hitch, G. (1974). Working memory. In Psychology of Learning and Motivation (Vol. 8, pp. 47-89). Academic press.
8. Bantin, T., Stevens, S., Gerlach, A. L., & Hermann, C. (2016). What does the facial dot-probe task tell us about attentional processes in social anxiety? A systematic review. Journal of Behavior Therapy and Experimental Psychiatry, 50, 40-51.
9. Bar-Haim, Y., Lamy, D., Pergamin, L., Bakermans-Kranenburg, M. J., & Van Ijzendoorn, M. H. (2007). Threat-related attentional bias in anxious and nonanxious individuals: a meta-analytic study. Psychological Bulletin, 133, 1-24.
10. Bar‐Haim, Y. (2010). Research review: attention bias modification (ABM): a novel treatment for anxiety disorders. Journal of Child Psychology and Psychiatry, 51, 859-870.
11. Bar‐Haim, Y., Morag, I., & Glickman, S. (2011). Training anxious children to disengage attention from threat: a randomized controlled trial. Journal of Child Psychology and Psychiatry, 52, 861-869.
12. Belger, A., Puce, A., Krystal, J. H., Gore, J. C., Goldman‐Rakic, P., & McCarthy, G. (1998). Dissociation of mnemonic and perceptual processes during spatial and nonspatial working memory using fMRI. Human Brain Mapping, 6, 14-32.
13. Bishop, S. J. (2009). Trait anxiety and impoverished prefrontal control of attention. Nature Neuroscience, 12, 92-98.
14. Boettcher, J., Leek, L., Matson, L., Holmes, E. A., Browning, M., MacLeod, C., ... Carlbring, P. (2013). Internet-based attention bias modification for social anxiety: a randomised controlled comparison of training towards negative and training towards positive cues. PloS one, 8, e71760: 1-14.
15. Bögels, S. M., & Mansell, W. (2004). Attention processes in the maintenance and treatment of social phobia: hypervigilance, avoidance and self-focused attention. Clinical Psychology Review, 24, 827-856.
16. Breiter, H. C., Etcoff, N. L., Whalen, P. J., Kennedy, W. A., Rauch, S. L., Buckner, R. L., ... Rosen, B. R. (1996). Response and habituation of the human amygdala during visual processing of facial expression. Neuron, 17, 875-887.
17. Browning, M., Holmes, E. A., Murphy, S. E., Goodwin, G. M., & Harmer, C. J. (2010). Lateral prefrontal cortex mediates the cognitive modification of attentional bias. Biological Psychiatry, 67, 919-925.
18. Choi, B. H. (2007). Cognitive-behavioral group therapy for social phobia. Seoul: Sigmapress.
19. Chon, K. K., Choi, S. C., & Yang, B. C. (2001). Integrated adaptation of CES-D in Korea. Korean Journal of Health Psychology, 6, 59-76.
20. Cisler, J. M., & Koster, E. H. (2010). Mechanisms of attentional biases towards threat in anxiety disorders: An integrative review. Clinical Psychology Review, 30, 203-216.
21. Clark, D. M., & Wells, A. (1995). A cognitive model of social phobia. In Liebowitz, M., & Heimberg, R. G. (Eds.), Social phobia: Diagnosis, assessment, and treatment (pp. 69-93). New York: Guilford Press.
22. Clarke, P. J., Browning, M., Hammond, G., Notebaert, L., & MacLeod, C. (2014). The causal role of the dorsolateral prefrontal cortex in the modification of attentional bias: evidence from transcranial direct current stimulation. Biological Psychiatry, 76, 946-952.
23. Cohen, J. D., Forman, S. D., Braver, T. S., Casey, B., Servan‐Schreiber, D., & Noll, D. C. (1994). Activation of the prefrontal cortex in a nonspatial working memory task with functional MRI. Human Brain Mapping, 1, 293-304.
24. de Hullu, E., Sportel, B. E., Nauta, M. H., & de Jong, P. J. (2017). Cognitive bias modification and CBT as early interventions for adolescent social and test anxiety: Two-year follow-up of a randomized controlled trial. Journal of Behavior Therapy and Experimental Psychiatry, 55, 81-89.
25. Derryberry, D., & Reed, M. A. (2002). Anxiety-related attentional biases and their regulation by attentional control. Journal of Abnormal Psychology, 111, 225-236.
26. Engle, R. W. (2002). Working memory capacity as executive attention. Current Directions in Psychological Science, 11, 19-23.
27. Enock, P. M., Hofmann, S. G., & McNally, R. J. (2014). Attention bias modification training via smartphone to reduce social anxiety: A randomized, controlled multi-session experiment. Cognitive Therapy and Research, 38, 200-216.
28. Eysenck, M. W., Derakshan, N., Santos, R., & Calvo, M. G. (2007). Anxiety and cognitive performance: Attentional control theory. Emotion, 7, 336-353.
29. Fox, E., Russo, R., Bowles, R., & Dutton, K. (2001). Do threatening stimuli draw or hold visual attention in subclinical anxiety? Journal of Experimental Psychology: General, 130, 681-700.
30. Fuster, J. n. M. (1997). Network memory. Trends in Neurosciences, 20, 451-459.
31. Grenard, J. L., Ames, S. L., Wiers, R. W., Thush, C., Sussman, S., & Stacy, A. W. (2008). Working memory capacity moderates the predictive effects of drug-related associations on substance use. Psychology of Addictive Behaviors, 22, 426-432.
32. Hayes, S., Hirsch, C., & Mathews, A. (2008). Restriction of working memory capacity during worry. Journal of Abnormal Psychology, 117, 712-717.
33. Heeren, A., De Raedt, R., Koster, E. H., & Philippot, P. (2013). The (neuro) cognitive mechanisms behind attention bias modification in anxiety: Proposals based on theoretical accounts of attentional bias. Frontiers in Human Neuroscience, 7, 1-6.
34. Heeren, A., Lievens, L., & Philippot, P. (2011). How does attention training work in social phobia: Disengagement from threat or re-engagement to non-threat? Journal of Anxiety Disorders, 25, 1108-1115.
35. Heeren, A., Mogoaşe, C., McNally, R. J., Schmitz, A., & Philippot, P. (2015). Does attention bias modification improve attentional control? A double-blind randomized experiment with individuals with social anxiety disorder. Journal of Anxiety Disorders, 29, 35-42.
36. Heerey, E. A., & Kring, A. M. (2007). Interpersonal consequences of social anxiety. Journal of Abnormal Psychology, 116, 125-134.
37. Jones, E. B., & Sharpe, L. (2017). Cognitive bias modification: a review of meta-analyses. Journal of Affective Disorders, 223, 175-183.
38. Kane, M. J., Bleckley, M. K., Conway, A. R., & Engle, R. W. (2001). A controlled-attention view of working-memory capacity. Journal of Experimental Psychology: General, 130, 169-183.
39. Kim, H. J., & Oh, S. S. (2012). Attentional biases for emotional stimuli according to trait anxiety and deFNEsiveness. Korean Journal of Psychology: General, 31, 127-145.
40. Kim, H. S. (2001). Memory bias in subtypes of social phobia (Unpublished master’s thesis). Seoul National University, Seoul, Korea.
41. Kim, S. J., Yoon, H. Y., & Kwon, J. H. (2013). Validation of the short form of the korean social interaction anxiety scale(K-SIAS) and the korean social phobia scale(K-SPS). Cognitive Behavior Therapy in Korea, 13, 511-535.
42. Klumpp, H., & Amir, N. (2010). Preliminary study of attention training to threat and neutral faces on anxious reactivity to a social stressor in social anxiety. Cognitive Therapy and Research, 34, 263-271.
43. Koster, E. H., Crombez, G., Verschuere, B., & De Houwer, J. (2004). Selective attention to threat in the dot probe paradigm: Differentiating vigilance and difficulty to disengage. Behaviour Research and Therapy, 42, 1183-1192.
44. Lee, H. J. (2007). The relationship between middle school students' inhibition behavior and neuroticism, attention control and anxiety (Unpublished master’s thesis). Ewha Womans University, Seoul, Korea.
45. Lee, J. Y., & Choi, C. H. (1997). A study of the reliability and the validity of the korean versions of social phobia scales(K-SAD, K-FNE). Korean Journal of Clinical Psychology, 16, 251-264.
46. Lee, T. H., Lee, K., Lee, K. Y., Choi, J. S., & Kim, H. T. (2006). The Korea University facial expression collection: KUFEC [Photographic slides]. Seoul, Korea: Laboratory of Behavioral Neuroscience, Department of Psychology, Korea University.
47. Leigh, E., & Hirsch, C. R. (2011). Worry in imagery and verbal form: Effect on residual working memory capacity. Behaviour research and therapy, 49, 99-105.
48. LeMoult, J., Colich, N., Joormann, J., Singh, M. K., Eggleston, C., & Gotlib, I. H. (2018). Interpretation bias training in depressed adolescents: Near-and far-transfer effects. Journal of Abnormal Child Psychology, 46, 159-167.
49. Li, S., Tan, J., Qian, M., & Liu, X. (2008). Continual training of attentional bias in social anxiety. Behaviour Research and Therapy, 46, 905-912.
50. MacLeod, C., Rutherford, E., Campbell, L., Ebsworthy, G., & Holker, L. (2002). Selective attention and emotional vulnerability: assessing the causal basis of their association through the experimental manipulation of attentional bias. Journal of Abnormal Psychology, 111, 107-123.
51. Mathews, A., & MacLeod, C. (2002). Induced processing biases have causal effects on anxiety. Cognition & Emotion, 16, 331-354.
52. Mattick, R. P., & Clarke, J. C. (1998). Development and validation of measures of social phobia scrutiny fear and social interaction anxiety. Behaviour Research and Therapy, 36, 455-470.
53. McNally, R. J., Enock, P. M., Tsai, C., & Tousian, M. (2013). Attention bias modification for reducing speech anxiety. Behaviour Research and Therapy, 51, 882-888.
54. Mogg, K., Bradley, B. P., De Bono, J., & Painter, M. (1997). Time course of attentional bias for threat information in non-clinical anxiety. Behaviour Research and Therapy, 35, 297-303.
55. Mogg, K., Philippot, P., & Bradley, B. P. (2004). Selective attention to angry faces in clinical social phobia. Journal of Abnormal Psychology, 113, 160-165.
56. Murphy, S. E., Yiend, J., Lester, K. J., Cowen, P. J., & Harmer, C. J. (2009). Short-term serotonergic but not noradrenergic antidepressant administration reduces attentional vigilance to threat in healthy volunteers. International Journal of Neuropsychopharmacology, 12, 169-179.
57. Ollendick, T. H., White, S. W., & White, B. A. (Eds.). (2018). The Oxford handbook of clinical child and adolescent psychology. Oxford Library of Psychology (pp. 742). Retrieved from: https://www.oxfordhandbooks.com/view/10.1093/oxfordhb/9780190634841.001.0001/oxfordhb-9780190634841.
58. Petrides, M., & Milner, B. (1982). Deficits on subject-ordered tasks after frontal-and temporal-lobe lesions in man. Neuropsychologia, 20, 249-262.
59. Posner, M. I. (1980). Orienting of attention. Quarterly Journal of Experimental Psychology, 32, 3-25.
60. Posner, M. I., & Petersen, S. E. (1990). The attention system of the human brain. Annual Review of Neuroscience, 13, 25-42.
61. Radloff, L. S. (1977). The CES-D scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1, 385-401.
62. Rapee, R. M., & Heimberg, R. G. (1997). A cognitive-behavioral model of anxiety in social phobia. Behaviour Research and Therapy, 35, 741-756.
63. Rapee, R. M., MacLeod, C., Carpenter, L., Gaston, J. E., Frei, J., Peters, L., & Baillie, A. J. (2013). Integrating cognitive bias modification into a standard cognitive behavioural treatment package for social phobia: A randomized controlled trial. Behaviour Research and Therapy, 51, 207-215.
64. Ross, T. P., Hanouskova, E., Giarla, K., Calhoun, E., & Tucker, M. (2007). The reliability and validity of the self-ordered pointing task. Archives of Clinical Neuropsychology, 22, 449-458.
65. Schmidt, N. B., Richey, J. A., Buckner, J. D., & Timpano, K. R. (2009). Attention training for generalized social anxiety disorder. Journal of Abnormal Psychology, 118, 5-14.
66. Staugaard, S. R. (2009). Reliability of two versions of the dot-probe task using photographic faces. Psychology Science Quarterly, 51, 339-350.
67. Sweeney, J., Mintun, M., Kwee, S., Wiseman, M., Brown, D., Rosenberg, D., & Carl, J. (1996). Positron emission tomography study of voluntary saccadic eye movements and spatial working memory. Journal of Neurophysiology, 75, 454-468.
68. Taylor CT., & Amir, N. (2010). Attention and emotion regulation. In Kring, A., & Sloan, D. (Eds.), Emotion Regulation and Psychopathology: A Transdiagnostic Approach to Etiology and Treatment (pp. 380-404). New York: Guilford Press.
69. Watson, D., & Friend, R. (1969). Measurement of social-evaluative anxiety. Journal of Consulting and Clinical Psychology, 33, 448-457.