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How Anxiety Distorts Your Perception of the World

A tendency to focus on threat may be warping how you see reality.

As your thoughts run uncontrollably, your heartbeat starts to race and your breathing becomes heavy. Uneasiness is followed by fear, and then without warning, panic begins to set in. Suddenly you feel overwhelmed and overstimulated. If you periodically experience these symptoms, know that you’re in good company. Actors like Jennifer Lawrence and Emma Stone, musicians such as The Beach Boys’ Brian Wilson and Taylor Swift, artists and writers like Vincent Van Gogh and Emily Dickinson, all struggled with crippling bouts of anxiety.

We all know that anxiety affects our emotional state and makes interacting with the world difficult, but what may be less obvious is how it changes what we focus our attention on throughout the day. By biasing attention, anxiety alters what we are conscious of, and in turn, the way we experience reality. This can have profound consequences. Anxiety’s effects on attention may shape worldviews and belief systems in specific and predictable ways. It can even affect our politics without us knowing.

To protect against the reality-distorting effects of anxiety, we must first understand how attention works and the ways in which it can be influenced.

To use the metaphor inspired by the brilliantly forward-thinking 19th Century American psychologist, William James, our visual attention system works a lot like a spotlight that scans the world around us. This ‘attentional spotlight’ represents the finite region of space that is occupied by our focus of attention at any given moment. What falls inside the spotlight is consciously processed while that which is outside is not. By moving our eyes around a visual scene, we can shine our spotlight on any area of the environment we want to inspect in detail. In fact, in-depth processing of an object, a string of text, or a location can’t be carried out unless it is first brought inside the spotlight of attention.

We can appreciate what this means by considering what our attention is doing when we read a book on a crowded train. Our eyes move across the page from left to right, line-by-line, dragging our attentional spotlight from word to word. While the word we are focusing our attention on is sharp and clear to our perception, words on the page that lie outside our attentional spotlight appear blurry and are largely indecipherable.

We have a localized spotlight of attention because taking in all the visual information from the environment at once would overwhelm the brain, which is a system with limited resources, much like a computer. The spotlight allows your mind to focus only on what's important while ignoring the irrelevant. This makes reality comprehensible.

While most of the time we intentionally choose what to focus our spotlight of attention on, it’s not always under voluntary control, and it doesn’t treat everything in the environment equally. Certain things, like a bright flash of light or a sudden large movement in an unexpected area, automatically capture the focus of the spotlight, yanking attention to the location where they appear.

Having your attention immediately snatched from you might seem like an inconvenience, but this process happens for a very good reason. These involuntary attention shifts instantly alert us of something in the environment that may be crucial to survival. To pre-modern humans, an automatic attention shift could have signaled a meaty dinner running by, or if one was less lucky, a threat lurking in the periphery, like a predator or a dangerous enemy.

Thanks to evolution, our visual attention system automatically responds to a wide variety of forms of threat. Snakes, spiders, angry and fearful faces, threatening postures, and objects shaped like weapons, all have the power to capture our attentional spotlight. We can say that visual attention is “biased” toward threat in the interest of self-preservation.

While this function helps us survive, anxiety causes this quick and simple threat detection system to become hypersensitive, changing the behavior of the attentional spotlight in a way that does harm. Specifically, some control over the spotlight is lost as it becomes too easily grabbed by anything that could potentially be perceived as threatening, whether or not it actually is. And when one is only focused on the threat, negative information consumes one’s consciousness. To understand exactly how anxiety can change one’s entire perception of the world just by biasing attention, consider what it is like for a highly anxious person to ride the train in a crowded metropolitan area.

Imagine standing on a busy subway platform, peering into the crowd of people waiting alongside you. Your attentional spotlight is automatically dragged towards the negative facial expressions while the positive ones are ignored. As a result, everyone seems to be a little upset, and suddenly, things just seem gloomier overall. On the train ride home, after all the stops have passed but yours, a large man wearing a hoodie sitting near you abruptly reaches into his jacket pocket, which captures your attention as if he was reaching for a weapon. Luckily it was just a cell phone, but it causes you to think about how you could have not been so lucky. The whole experience strengthens your perception of the subway as a dangerous place full of questionable characters and agitated people.

Now imagine that this attentional behavior is going on all the time. As the threat bias filters out the positive and lets in only the negative, worry and fear flow through the cognitive system. The result is an overly threat-conscious appraisal of the environment. Essentially, to the anxious, the world literally looks like a much scarier, unhappier place.

This drastic change in perception can shape our broader worldviews, affecting one’s politics and ideologies.

A 2009 study, for instance, showed that anxiety has the power to bias attention in ways that create a perception of people from the Middle East as threatening, which undoubtedly influences political views concerning immigration. In the experiment, researchers had anxious and non-anxious Western participants do a computer task that involved responding to visual stimuli on a screen with keyboard buttons. First, a word was briefly presented, then a display of two faces — one Arab and one White — followed by a target dot that could appear behind either face. The results revealed that those with anxiety were faster to respond to targets occurring behind the Arab face when the word flashed just before was terrorism-related, such as “bomb”. This means that when anxious people were primed to think about terrorism, their visual attention was biased toward Middle Eastern faces, which indicates vigilance for threat.

This finding makes it easy to see why anxious people might gravitate toward politicians who offer protection through things like extreme immigration bans and national security crackdowns. Sure enough, in 2012 a team at the University of Nebraska, Lincoln found that people who pay more attention to aversive images tend to lean to the right politically. In the experiment, researchers showed liberal and conservative participants collages of both positive and negative images on a computer screen while they tracked their attention by recording eye movements.

The results showed that those who tended to look at negative and threatening pictures more quickly and for longer — like those depicting car accidents, dead bodies, and open wounds — were more likely to identify as a conservative. According to the authors of the study, it makes sense that those who are more attuned and attentive to threat would be attracted to right-of-center policy positions, which are often aimed at protecting society from outside threats, through strengthened military and national security, harsher punishment for criminals, and opposition to immigration.

At its worst, anxiety can be a debilitating condition, but new research is showing that we can reverse these biases directly using various types of attention training. Furthermore, this training is now offered through easy-to-use software and even smartphone apps.

The most popular type of training is known as Attention Bias Modification Training (ABMT), also known more generally as Cognitive Bias Modification (CBM). Although the type of specific task used varies, the general idea is roughly the same. In a typical training session, every few seconds a display featuring both positive and negative images appears on the screen — usually happy and angry faces — which is repeated hundreds of times. Since anxiety is associated with a tendency to focus on negative stimuli, the goal of the task is to locate or respond to the positive images with a button response or a tap on the screen. By doing this over and over, and ideally, over the course of days or weeks, the brain is trained to habitually focus attention away from the threat and negative information towards positive information.

Dozens of studies have confirmed the effectiveness of the regimen, and one specific study published in Clinical Psychological Science — a journal of the Association of Psychological Science — found that playing a ‘gamified’ ABMT mobile app significantly reduced threat-bias, subjective anxiety, and observed stress reactivity, all in just a single 25-45 minute session. By delivering the therapy through an engaging mobile game, anxiety sufferers who can’t afford clinical therapy now can get some relief, and on-the-go.

However, ABMT is not without its skeptics. Recent studies have called its effectiveness into question by demonstrating that single sessions of ABMT often work no better than other cognitive-based anxiety treatments like Cognitive Behavioral Therapy, and in some cases, placebo treatments.

While acknowledging the validity of these criticisms, researcher, professor, and licensed psychologist Per Carlbring of Stockholm University says that we should not abandon attention training altogether, pointing out that a meta-analysis found that attention bias modification was shown to be highly effective for patients under 37, especially when it occurs in a clinic or lab rather than remotely.

Carlbring noticed that ABMT was only ineffective in decreasing anxiety when it failed to reverse threat-related attentional biases. Therefore, it is likely the effectiveness of training could be heavily improved with more dynamic tasks that use highly realistic stimuli. In an effort to greatly increase the robustness of attention training, Carlbring has received a grant for developing and testing a virtual reality form of attention training that is more immersive and natural. "I think that moving the training into a more lifelike environment could be a breakthrough," Carlbring says. "I would not be surprised if attention training is common practice in 2020."

Through exercises that work to dissolve anxiety-driven attentional biases for threat, and by becoming self-aware of the way that anxiety influences our attentional spotlight, we can help prevent it from distorting reality, instilling fear, and altering belief systems.

This article was originally published by at BBC Future on September 29th, 2016.

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