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19 (2005) 105–116
Hypervigilance–avoidance pattern in
spider phobia
Tobias Pflugshaupta,1, Urs P. Mosimanna,
Roman von Wartburga, Wolfgang Schmittb,2,
Thomas Nyffelera, René M. Müria,*
a
Perception and Eye Movement Laboratory, Departments of Neurology and Clinical Research,
University of Berne, Inselspital, Freiburgstrasse 10, 3010 Berne, Switzerland
b
Department of Psychiatry, University of Berne, Inselspital,
Freiburgstrasse 10, 3010 Berne, Switzerland
Received 4 August 2003; received in revised form 24 November 2003; accepted 3 December 2003
Abstract
*
Corresponding author. Tel.: þ41-31-632-3081; fax: þ41-31-632-9679.
E-mail address: rene.mueri@insel.ch (R.M. Müri).
1
Tel.: þ41-31-632-3368; fax: þ41-31-632-9679.
2
Tel.: þ41-31-632-8811; fax: þ41-31-632-8950.
0887-6185/$ – see front matter # 2003 Elsevier Inc. All rights reserved.
doi:10.1016/j.janxdis.2003.12.002
106 T. Pflugshaupt et al. / Anxiety Disorders 19 (2005) 105–116
1. Introduction
Cuthbert, 1990), although they appear somewhat mutually exclusive at first glance.
One might ask how phobics manage to avoid something that permanently attracts
their attention. Cognitive-motivational theories (e.g., Mathews, 1990; Mogg,
Mathews, & Weinman, 1987) postulate that hypervigilance and avoidance co-
occur in phobics’ behavior in a temporally ordered manner. That is, phobics initially
direct their attention towards threat, but may then try to avoid detailed processing of
such stimuli in an attempt to reduce their anxious mood state (Mogg et al., 1987).
This hypervigilance–avoidance hypothesis was investigated in non-clinical
anxiety (Mogg et al., 1997) and in subjects with general anxiety disorder (Bradley
et al., 1999). Both studies were based on modified versions of the dot probe task.
During a typical dot probe task, pairs of stimuli (e.g., a threat word and a neutral
word) are presented on a screen, followed by a small dot probe that appears in the
location of one of the stimuli. Participants are required to respond manually to the
probe as quickly as possible. The idea behind this task is that response latencies
will be accelerated when probes occur in an attended, rather than unattended part
of the display (Posner, Snyder, & Davidson, 1980). In the two studies mentioned
above, the duration of stimulus exposure was manipulated and the focus of
analysis was on two predictions. First, due to initial hypervigilance, anxious
individuals should respond faster to probes replacing briefly presented threat
stimuli than healthy subjects. Second, as a consequence of subsequent avoidance,
it was expected that anxious individuals respond more slowly to these probes than
controls when longer stimulus durations were applied. Both studies found ample
evidence for hypervigilance in anxious individuals. However, the same subjects
did not show avoidance after longer stimulus durations.
This absence of evidence for avoidance can be interpreted in several ways.
Mogg et al. (1997) and Bradley et al. (1999) provided two explanations. First, it
was assumed that the hypervigilance–avoidance hypothesis might be incorrect.
Results indicated that both initial shifting and subsequent maintenance of
attention were consistently biased towards threat information in anxious indivi-
duals. Thus, a simple hypervigilance hypothesis would explain the results
sufficiently. Second, the stimuli may not have been anxiety-provoking enough
to prompt avoidance strategies. In our opinion, there are two further explanations.
First, the applied duration of stimulus exposure (i.e., up to 1500 ms) was possibly
not long enough to allow for elaborative processing that prompts avoidance
behavior. Second, the dot probe task may not be the method of choice to
investigate hypervigilance–avoidance patterns. Researchers cannot observe
hypervigilance and avoidance behavior per se in this task, since both tendencies
have to be inferred from manual reaction times. In order to investigate them in a
more direct manner, we used eye movement measurements to analyze phobic
behavior. Eye movement tracking allows the registration of temporal as well as
spatial aspects of fixations and saccades, which in turn are closely related to
attentional mechanisms (e.g., Kowler, Anderson, Dosher, & Blaser, 1995). Thus,
eye movement analysis is particularly suitable for investigating attentional biases
such as hypervigilance or avoidance.
108 T. Pflugshaupt et al. / Anxiety Disorders 19 (2005) 105–116
The main objective of the present study was to empirically validate the
hypervigilance–avoidance hypothesis (Mogg et al., 1987) in phobics during a
visual task that required participants to search for fear-relevant stimuli. Due to a
relatively high prevalence rate (Szymanski & O’Donohue, 1995), we decided to
concentrate on spider phobia. Data analysis was focussed on variables that
represent hypervigilance or avoidance. As a consequence and based on the
hypervigilance–avoidance hypothesis, three main predictions were investigated:
(a) phobics detect spiders faster than controls; (b) relative to controls, phobics’
fixations are spatially closer to spiders during the initial search phase; and (c)
phobics subsequently fixate further from spiders than controls.
2. Methods
2.1. Participants
Twenty-six spider phobics (22 females, 4 males; age in years: mean ¼ 28:04,
S:D: ¼ 8:92; 20 right-handers, 6 left-handers) and 26 control subjects (22 females,
4 males; age in years: mean ¼ 28:73, S:D: ¼ 4:41; 23 right-handers, 3 left-handers)
volunteered for the study. Participants were assigned to groups according to self-
evaluation. Standardized phobia questionnaires (see the following) allowed the
validation of this self-evaluative assignment. Exclusion criteria were depressive
mood states (Beck Depression Inventory/BDI; Hautzinger, Bailer, Wollall, &
Keller, 1994), color blindness (Ishihara’s color plates; Ishihara, 1999), visual
disturbances (e.g., ocular motor paralysis, strabism), and limited visual acuity
(i.e., normal or corrected to normal). The local ethical committee approved the
study. All participants gave written informed consent prior to the examination.
The extent to which participants suffered from spider phobia was assessed with
two questionnaires, the Watts and Sharrock’s Spider Fear Questionnaire (WSQ)
(Watts & Sharrock, 1984) and the Fear of Spiders Questionnaire (FSQ) (Szy-
manski & O’Donohue, 1995). The WSQ consists of 33 items requiring a ‘‘yes/no’’
response. For example, participants are asked whether they are always on the
lookout for spiders. With an internal consistency of .78 (Johnsen & Hugdahl,
1990) and a test–retest reliability of .94 (Muris & Merckelbach, 1996), the WSQ
has demonstrated adequate psychometric properties. The FSQ is an 18-item
questionnaire and each item is rated on a seven-point likert-type scale (i.e.,
3 ¼ strongly disagree, þ3 ¼ strongly agree). For instance, participants have to
rate the following statement: If I came across a spider now, I would leave the
room. With regard to psychometric properties, the FSQ has demonstrated an
internal consistency of .92 (Szymanski & O’Donohue, 1995) and a test–retest
reliability of .91 (Muris & Merckelbach, 1996).
T. Pflugshaupt et al. / Anxiety Disorders 19 (2005) 105–116 109
2.3. Apparatus
During the search task, participants were confronted with 16 everyday scenes
onto each of which 1, 2, or 3 identical black spiders were placed as targets. Blocks
of four scenes were formed to allow for recalibration in-between. Scenes covered
the entire screen (i.e., 29 228) and spider targets were 1:81 1:278 in size.
Each scene included two horizontal black bars, one at the top and the other at the
bottom, in order to maintain the original aspect ratio of the pictures. Six scenes
with one target, four scenes with two targets, and six scenes with three targets
were applied, resulting in a total number of 32 targets. In order to distribute targets
in a balanced manner, scenes were symmetrically subdivided into 16 rectangles,
each of which was used twice as target location. Prior to each scene, a central
fixation point was shown. Every scene was presented for 5 s, immediately
followed by a forced-choice task, during which participants had to decide and
click whether they had seen 0, 1, 2, or 3 spiders. An example is given in Fig. 1.
The experimental procedure was held constant across groups. After partici-
pants had given informed consent, the two spider phobia questionnaires were
administered, followed by the search task that was introduced with verbal
instructions and two practice trials. Eye movements were recorded while parti-
cipants sat in a dimly lit room. The average duration of the entire examination was
approximately 45 min.
The main focus of data analysis was on the three predictions inferred from the
hypervigilance–avoidance hypothesis. The duration from stimulus onset to the
first fixation-on-a-spider allowed investigating whether phobics detect spiders
110 T. Pflugshaupt et al. / Anxiety Disorders 19 (2005) 105–116
Fig. 1. An example stimulus of the visual search task. Everyday scene with two targets (top),
superimposed white arrows indicate target locations, left target magnified for enhanced visibility;
forced-choice task (bottom).
search performance could be examined. On the other hand, two basic oculomotor
parameters (i.e., fixation duration, saccade amplitude) were used to analyze
general aspects of oculomotor behavior.
Since relevant eye movement parameters did not deviate from normal dis-
tribution (Kolmogorov–Smirnov tests), parametric tests (i.e., t-tests, ANOVAs)
were performed for group comparisons. For the same reason, means and standard
deviations will be presented as central tendency and dispersion measures. A P-
value of less than .05 was considered statistically significant and all tests were
two-tailed.
3. Results
Table 1 illustrates that both WSQ and FSQ clearly distinguished spider phobics
from controls. Therefore, the self-evaluative assignment of participants to groups
(i.e., phobics vs. controls) was validated by means of standardized, clinically
relevant questionnaires. Controls’ relatively low a-scores indicate that their
performance was rather randomly distributed in both questionnaires, whereas
phobics showed a more consistent response pattern. Overall, our results are
comparable with those Watts and Sharrock (1984) and Szymanski and O’Dono-
hue (1995) obtained in their studies.
Table 2 shows that the two groups did not differ significantly from each other
with regard to the number of omissions in the forced-choice task. Thus, whatever
Table 1
Spider phobia questionnaires
t P
WSQ
Mean 17.83 3.27 15.245 <.001***
S.D. 4.53 1.78
a .74 .28
FSQ
Mean 16.08 47.46 18.663 <.001***
S.D. 16.46 5.55
a .87 .66
Means, standard deviations and Cronbach’s a of the WSQ (Watts & Sharrock, 1984) and the FSQ
(Szymanski & O’Donohue, 1995).
***
Significant at the .001 level.
112 T. Pflugshaupt et al. / Anxiety Disorders 19 (2005) 105–116
Table 2
Search performance and basic oculomotor parameters
the following group differences in eye movement behavior may be, they did not
result in differential search performance. However, basic oculomotor behavior
was group-specific. Phobics made slightly shorter fixations and significantly
longer saccades than controls.
With regard to the first of our main predictions (i.e., phobics detect spiders
faster than controls), we compared the duration from stimulus onset to the first
fixation-on-a-spider between groups. Table 3 shows that this duration was
significantly shorter in phobics compared with controls. Thus, the first fixa-
tion-on-a-spider occurred earlier in phobics, indicating the expected hypervigi-
lance.
The second and third prediction could be examined by calculating the distance
to the nearest spider for each fixation and by analyzing the group-specific time
course of these distances. In order to examine time courses in detail, we decided to
analyze them on a fixation-to-fixation basis, focussing on the first 10 fixations. This
somewhat arbitrary upper limit is justified by the observation that all subjects made
at least 10 fixations during each search task. On average, the 10th fixation occurred
after 2946 ms (phobics: mean ¼ 2902 ms, S:D: ¼ 406 ms; controls:
mean ¼ 2991 ms, S:D: ¼ 491 ms). A two-way ANOVA with time (i.e., first to
10th fixation, repeated measures) as a within-subject factor and group (i.e., phobics
vs. controls) as a between-subject factor revealed a significant main effect of time
(Fð9; 450Þ ¼ 7:454, P < :001) and a significant interaction ‘time group’
(Fð9; 450Þ ¼ 3:029, P < :001). Fig. 2 illustrates that both of our predictions could
Table 3
Duration from stimulus onset to the first fixation-on-a-spider
8.5
7.5
degrees
6.5
5.5
phobics
controls
5
1 2 3 4 5 6 7 8 9 10
temporal order of fixations
Fig. 3. An example of group-specific fixation behavior; based on averaged coordinates of the first 10
fixations; phobics (red) versus controls (blue); filled circles mark the first fixation; the superimposed
white arrow points at the target location.
114 T. Pflugshaupt et al. / Anxiety Disorders 19 (2005) 105–116
4. Conclusion
from manual reaction times. A second explanation is related to the time frame that
was under investigation. While previous studies applied time frames of up to
1500 ms, our results showed that avoidance became evident after 1700 ms of
stimulus exposure at the earliest. Controlled avoidance strategies might thus need
that much time to fully develop and replace initial hypervigilance.
Beside the three predictions that directly refer to the hypervigilance–avoidance
hypothesis, a further focus of analysis was on search performance. In this regard,
the two groups did not differ significantly from each other, as indicated by the
number of omissions in the forced-choice task. Hence, the hypervigilance–
avoidance pattern observed in phobics’ fixation behavior had no effect on search
performance. This may, however, depend on the time frame of 5 s in our
experiment. Given the findings that, relative to controls, phobics fixated earlier
on a spider and closer to spiders up to the fifth fixation, it seems plausible that a
time frame of 2 s could have allowed phobics to surpass controls with regard to
search performance. Since the main focus of the present study was on the
hypervigilance–avoidance hypothesis rather than on search performance, we
decided to apply a relatively long time frame in order to include fast detection
as well as subsequent avoidance.
A third focus of analysis was on fixation duration and saccade amplitude.
These two basic oculomotor parameters were used to evaluate general group
differences in visual search behavior. Results showed that phobics made slightly
shorter fixations and significantly longer saccades than controls during the search
task. This can be interpreted in terms of an accelerated and more far-ranging
search behavior in phobics, possibly due to the arousing nature of the stimuli and/
or the task per se. Although search performance was not group-specific, these
results nevertheless indicate that the stimuli of our experiment were not exces-
sively frightening for phobics. Otherwise we might probably have observed a
near-to-refusal avoidance with enhanced fixation durations, smaller saccadic
amplitudes, and a poorer search performance in phobics.
In sum, the main objective of the present study was to empirically validate the
hypervigilance–avoidance hypothesis (Mogg et al., 1987) in spider phobics
during a visual task that required participants to search for spiders. Our results
clearly confirmed this hypothesis. In contrast to previous findings that exclusively
demonstrated initial hypervigilance (Bradley et al., 1999; Mogg et al., 1997), the
present study revealed evidence for subsequent avoidance as well, possibly due to
a more appropriate methodology (i.e., eye movement analysis instead of dot probe
tasks, extended time frame). We thus consider our findings as the first empirical
validation of the hypervigilance–avoidance hypothesis as a whole. According to
Mogg et al. (1997), this behavioral pattern may be a key factor in maintaining
phobia. As a consequence of initial hypervigilance, phobics are more likely to
detect potentially threatening events and thus perceive the world as a dangerous
place, while subsequent cognitive avoidance prevents objective evaluation and
habituation to such events. In this respect, the present study contributed to the
empirical validation of a clinically relevant concept in phobia research.
116 T. Pflugshaupt et al. / Anxiety Disorders 19 (2005) 105–116
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