Effects of Internal, External, and Neutral Attentional Allocation on Post-Event Processing in Social Anxiety

Abstract

Abstract Purpose Excessive attentional allocation towards threats has been theorized to play a maintaining role in social anxiety disorder (SAD). However, it is unclear if both heightened 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 biased attention maintains SAD is limited. The present study tested the effects of experimentally induced internally and externally oriented attention towards threats relative to a neutral control on state anxiety and post-event processing (PEP) in a highly socially anxious sample. Methods 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 object (control condition; n = 40). State anxiety and PEP were assessed immediately following the speech and 24 h later. Results Although no differences between the control condition and the external and internal conditions were observed, participants in the internal condition reported significantly higher state anxiety immediately after the speech and higher PEP 24 h later compared to the external condition. State anxiety immediately after the speech mediated heightened PEP 24 h later among the internal condition compared to the external condition. Conclusions Findings support the theorized maladaptive role of self-focused attention in the maintenance of SAD and suggest that attending internally may be more harmful than attending externally, despite the presence of socio-evaluative threats in the environment.