Journal of Abnormal Psychology Copyright 2005 by the American Psychological Association

2005, Vol. 114, No. 2, 314 –318 0021-843X/05/$12.00 DOI: 10.1037/0021-843X.114.2.314

Attentional Biases to Internal and External Sources of Potential Threat in

Social Anxiety
Suzanne L. Pineles and Susan Mineka
Northwestern University

D. M. Clark and A. Wells (1995) proposed that a shift of attention inward toward interoceptive
information is a central feature of social phobia. However, few studies have examined attentional biases
toward internal physiological cues in social phobia. The current experiment assessed whether socially
anxious individuals exhibit an attentional bias (a) toward cues for an internal source of potential threat
(heart-rate information), (b) toward cues for an external source of potential threat (threatening faces) or
(c) both. Ninety-one participants who were selected to form extreme groups based on a social anxiety
screening measure performed a dot-probe task to assess location of attention. Results showed that socially
anxious participants exhibited an attentional bias toward cues of internal, but not external, sources of
potential threat.

Keywords: attentional bias, threat, social anxiety, social phobia

Clark and Wells (1995) proposed that a shift of attention inward
toward interoceptive information is a central feature of social
phobia. They hypothesized that socially anxious individuals shift
their attention inward and use their interoceptive information and
feared behavioral symptoms to construct impressions of them-
selves that they believe reflect how others see them. Further, such
individuals’ preoccupation with their somatic responses and neg-
ative social-evaluative thoughts interferes with their ability to
process external social cues. To date, however, research supporting
this theory is very sparse because most of it has either not distin-
guished between internal and external sources of threat (e.g., threat
words can represent either internal or external threat, but no such
comparisons have been made) or has focused exclusively on
external sources of threat (e.g., threatening faces). The results of
studies assessing attentional bias for threatening (vs. neutral) faces
in social phobia are very mixed (e.g., Mogg, Philippot, & Bradley,
2004, for vigilance results; R. Rapee & A. Öhman, personal
communication, October 2003, for null results; Chen, Ehlers,
Clark, & Mansell, 2002, for avoidance results). It is unclear why
Suzanne L. Pineles and Susan Mineka, Department of Psychology,
Northwestern University.
This research was partially supported by a Dissertation Year Fellowship
and a Dissertation Year Grant by the University Research Grants Commit-
tee at Northwestern University granted to Suzanne L. Pineles. This article
is based on research conducted by Suzanne L. Pineles in partial fulfillment
of the requirements for her doctoral dissertation.
We thank Rick Zinbarg, Marcia Grabowecky, Galen Bodenhausen, and
Iftah Yovel for their comments and contributions to this research. We are
also grateful to Thomas Powers, Amanda Moates, Kim Baglien, Anita
Kalhan, and Julie Landa for their help in collecting data for this experi-
ment.
Correspondence concerning this article should be addressed to Suzanne
L. Pineles who is now at the National Center for PTSD, Women’s Health
Sciences Division (116B-3), Veteran’s Affairs Boston Healthcare System,
150 South Huntington Avenue, Boston, MA 02130. E-mail: Suzanne
.Pineles@med.va.gov
314
some studies have found an attentional bias toward threat faces in
persons with high social anxiety, whereas others have not.
There has been very little research on the role of internal
somatic cues in social anxiety. Most such evidence derives indi-
rectly from the literature on self-focused attention showing that
socially anxious individuals report more self-focused attention
than do nonanxious individuals (e.g., Mellings & Alden, 2000).
However, recently, Mansell, Clark, and Ehlers (2003) used a new
experimental paradigm to compare high versus low speech-
anxious individuals on their relative attention to a tactile cue for
internal physiological changes versus to an external visual cue.
They compared the balance of attention to an external visual probe
on some trials (superimposed on pictures of happy, angry, or
neutral faces or household objects) versus to a tactile probe to the
fingers on other picture presentation trials (ostensibly signaling
changes in heart rate and sweating). As compared with low speech-
anxious participants, high speech-anxious participants asked to
give a speech responded more quickly when the tactile probe
signaling internal physiological changes was presented than when
the external probe was presented. This suggests that high speech-
anxious participants exhibited a relative attentional bias for inter-
nal cues relative to external cues. However, the only significant
effect was in relative bias score; high speech-anxious participants
did not respond faster than low speech-anxious participants to
probes for potential internal (or external) threat. Furthermore, and
unexpectedly, this bias was not specific to angry faces because the
high speech-anxious group exhibited a similar bias toward tactile
probes delivered with happy faces. Obviously, further research is
needed to better understand the role of attention to physiological
cues in social anxiety.
The current study was designed to assess whether an attentional
bias for cues of either external or internal sources of potential
threat could be demonstrated in high social anxiety. A dot-probe
paradigm with stimuli that represented both external and internal
sources of potential social threat was used. External sources of
threat were manipulated via exposure to threatening, happy, and
 BRIEF REPORTS
neutral faces. Internal sources of threat were manipulated using
exposure to visual depictions of what was ostensibly the partici-
pant’s own heart rate and segments of a perceptually similar sound
wave. Attention was assessed through comparing reaction times
(RTs) for pairings of different combinations of the three types of
faces (for external sources of potential threat) and for pairings of
the heart-rate information with sound-wave segments (for internal
sources of potential threat). The two between-groups variables
were the social anxiety group (high social anxiety vs. low social
anxiety) and speech condition (speech vs. no speech).
On the basis of Clark and Wells’s (1995) model, we hypothe-
sized that high social anxiety (but not low social anxiety) partic-
ipants would exhibit an attentional bias toward heart rate (relative
to the sound wave) information. Second, because of mixed results
in the literature, we tentatively hypothesized that participants in the
high social anxiety group would be more likely than those in the
low social anxiety group to exhibit a bias toward threat faces
relative to both happy and neutral faces. Finally, because increas-
ing state anxiety is sometimes necessary to detect attentional
biases in studies with analog participants (e.g., Mansell et al.,
2003; Williams, Watts, Macleod, & Mathews, 1997), we believed
that these attentional effects would be potentiated for high social
anxiety participants in the speech condition, relative to the no-
speech condition.
Method
Participants
From an initial pool of 480 students who completed the Social Phobia
Scale (SPS; Mattick & Clarke, 1998), 133 students who scored in the top
(SPS ⱖ 26) or bottom (SPS ⱕ 6) 15th percentile on the SPS were chosen
to participate in the study. All participants were randomly assigned to
condition (speech vs. no speech) and were told that they were going to see
images of their own heart rate throughout the experiment. Nine participants
who did not believe the request to give a speech (if applicable) or heart-rate
information to be real and 33 participants whose SPS scores were no longer
in the same range at the time of the study were excluded from the analyses,
leaving a total of 91 participants in the final sample. The number of
participants in each group were as follows: for the high social anxiety/
speech condition, n ⫽ 24; for the high social anxiety/no-speech condition,
n ⫽ 25; for the low social anxiety/speech condition, n ⫽ 19; and for the
low social anxiety/no-speech condition, n ⫽ 23. The SPS scores at the time
of the experiment in our high social anxiety group (M ⫽ 35.32, SD ⫽ 7.87)
are quite close to those reported by the diagnosed socially phobic individ-
uals (M ⫽ 40.00, SD ⫽ 16.00) from the SPS validation study (Mattick &
Clarke, 1998). The mean score in the low social anxiety group was 3.81
(SD ⫽ 2.38).
Materials
Stimuli. Two types of stimulus pairs were used in this study: (a) pairs
of faces and (b) pairs of visual depictions of heart rates versus sound
waves. The three possible face stimulus pairs consisted of two photographs
of the same person exhibiting different facial expressions: (a) threat versus
neutral (48 pairs), (b) happy versus neutral (48 pairs), and (c) threat versus
happy (48 pairs). The faces were selected from two sets that have been used
in previous studies of facial emotion (e.g., Mogg et al., 2004; Lundquist,
Flykt, & Öhman, 1998).
For measuring attention to cues of internal sources of potential threat, we
randomly presented 48 trials, with each trial pairing pictures ostensibly
representing static segments of the participant’s heart rate with different
315
segments of a sound wave (from a horse neighing and galloping). There
were 32 slightly different, static, photo-like EKG images (half were re-
peated for each participant), and the sound wave was divided into 48
segments. The images were designed to be perceptually similar in both
shape and saturation of gray color of the wave.1 Participants have been
reported to believe (and have shown increased anxiety to false feedback
for) heart-rate information in both attentional studies of panic disorder and
studies inducing anxiety with false heart-rate feedback (e.g., Ehlers, Mar-
graf, Roth, Taylor, & Birbaumer, 1988; Kroeze & van den Hout, 2000).
Modified dot-probe task. This task was programmed using the
PsyScope program (Version 1.1; Cohen, MacWhinney, Flatt, & Provost,
1993). Participants used a chin rest and were seated with their eyes 114 cm
from the monitor and level with the center of the screen. Before each of the
192 trials, participants focused on a black central fixation cross for 500 ms.
The pairs of stimuli (face vs. face; heart rate vs. sound wave) were
presented vertically on the screen for 500 ms with the centers of the images
separated by a distance of 11 cm, creating a visual angle of 5.5° between
the centers of the pictures. Immediately following the offset, the probe (a
small x) was presented in the former location of one of the stimuli, and
participants indicated the location of the probe by pressing one of two
response buttons on a button box. RTs measured the time interval between
the onset of the probe and the response. The position of the pairs of stimuli
and of the probe were counterbalanced so that they appeared in either
location with equal frequency. There were two blocks of trials (10 practice
and 96 experimental trials each) separated by a 30-s break; the intertrial
interval between a response and a new trial was 500 ms. Within each block,
there were 24 of each of the four types of stimulus pairs. Each participant
saw the 192 trial pairs in a different random order.
Procedure
Participants in the speech condition were given 2 min to plan a 5-min
speech, describing their experiences in college to be given at the end of the
session, videotaped, and rated by experts. Participants in the no-speech
condition were simply asked to wait a few minutes until the experimenter
was ready to begin. When the experimenter returned, participants were told
that they were going to complete a computer task in which they would see
three types of images: faces, pictures of their heart rate, and segments of a
visual depiction of a sound wave. In explaining the heart-rate images, the
experimenter told participants that their heart rates would be measured and
asked participants to put their index finger into a finger plethysmograph
that was connected to a heart-rate monitor in the adjoining room, which
was connected to the computer used in the task. The experimenter briefly
left the room to allegedly check to make sure the heart-rate monitor was
recording. Participants were then shown what was ostensibly their heart
rate at the current moment on the computer screen and were told that they
would see snapshots depicting their current heart rates throughout the
experiment. To explain the sound-wave images, the experimenter ensured
that participants heard a sound clip (of a horse neighing and galloping) and
told them that they would be seeing segments of this sound in visual format
throughout the experiment; participants were then shown the first sound-
wave image. Participants were asked to identify differences between the
sound-wave image and the heart-rate image to ensure that they understood
and were paying attention to the perceptual features of the stimuli. Partic-
ipants were then told that their task was to identify the location (top or
bottom) of an “x” on the computer screen and that a pair of the images
previously described would precede the presentation of the “x.” Partici-
1
In two pilot experiments, unselected participants attended to the sound-
wave and heart-rate information equally both when participants were given
information as to what the pictures represented (n ⫽ 11) and when only
shown the physical stimuli (without information as to what the stimuli
represented; n ⫽ 8).
316 BRIEF REPORTS

pants then completed the dot-probe task with the experimenter present in
the room. After the task, they completed a series of self-report measures
including the SPS (Mattick & Clarke, 1998) and the State–Trait Anxiety
Inventory—State version (STAI–S; Spielberger, Gorusch, & Lushene,
1970). Finally, as part of the debriefing, participants were told that they
would not have to give a speech and were asked whether they had believed
that the request for a speech (only for relevant participants) and the
heart-rate information were real.
Results
State Anxiety
Although firm conclusions cannot be drawn due to the lack of
pre- and postmanipulation measures, we wanted to assess whether
the speech manipulation affected state anxiety levels. As expected,
a 2 (Anxiety Group) ⫻ 2 (Speech Condition) analysis of variance
(ANOVA) on the STAI–S revealed a main effect of anxiety group:
for the high social anxiety group (M ⫽ 54.12, SD ⫽ 9.94); for the
low social anxiety group (M ⫽ 32.56, SD ⫽ 6.93), F(1, 87) ⫽
142.45, effect size (ES) ⫽ .62, p ⬍ .05. However, neither the main
effect of condition nor the interaction of Anxiety Group ⫻ Speech
Condition was significant, Fs ⬍ 3.35, ES ⬍ .04, ns. Thus, the
speech manipulation either did not affect state anxiety levels for
socially anxious participants or the STAI–S may not have been
sensitive enough to detect potential group differences in anxiety
aroused by the speech manipulation. Alternatively, to assess the
possibility that we had inadequate power to detect a 2 ⫻ 2
interaction— given our sample size, a medium effect size, and an
␣ ⫽ .05—we found the power was .65. Thus, we may have had
insufficient power to detect a medium-sized effect of speech.
Attentional Task
The mean percentages of data lost due to errors and outliers
were 0.7% and 1.4%, respectively. The RT data were subjected to
a 2 ⫻ 2 ⫻ 4 ⫻ 2 ⫻ 2 ANOVA with two between-groups variables
of anxiety group and speech condition and three within-participant
variables of stimulus type (heart rate vs. sound wave, threat vs.
neutral faces, happy vs. neutral faces, and threat vs. happy faces),
stimulus location (up vs. down), and probe location (up vs. down).
The main effect of stimulus type, F(3, 85) ⫽ 4.74, ES ⫽ .14, p ⬍
.05, was significant, with participants responding more quickly on
the heart-rate trials than on all face trials ( ps ⬍ .05; see Table 1).
This main effect was modified by a two-way interaction of Stim-
ulus Type ⫻ Stimulus Location, F(3, 85) ⫽ 3.09, ES ⫽ .10, p ⬍
.05; a three-way interaction of Stimulus Type ⫻ Stimulus Loca-
tion ⫻ Probe Location, F(3, 85) ⫽ 7.97, ES ⫽ .22, p ⬍ .05; and
a four-way interaction of Stimulus Type ⫻ Stimulus Location ⫻
Probe Location ⫻ Anxiety Group, F(3, 85) ⫽ 3.38, ES ⫽ .11, p ⬍
.05. However, neither the main effect of speech condition nor the
interaction of Anxiety Group ⫻ Speech Condition was significant
(Fs ⬍ 1, ES ⬍ .01). To test our a priori hypotheses about perfor-
mance within stimulus sets, we conducted separate ANOVAs for
attention to heart rate versus sound waves and for attention to
different combinations of faces.
Attention to heart rate. A 2 (anxiety group) ⫻ 2 (speech
condition) ⫻ 2 (stimulus location) ⫻ 2 (probe location) mixed-
design ANOVA revealed a main effect of stimulus location, F(1,
87) ⫽ 7.98, ES ⫽ .09, p ⬍ .01; a two-way interaction of Stimulus
Location ⫻ Probe Location, F(1, 87) ⫽ 18.84, ES ⫽ .18, p ⬍ .001;
and the predicted three-way interaction of Anxiety Group ⫻ Stim-
ulus Location ⫻ Probe Location, F(1, 87) ⫽ 8.98, ES ⫽ .09, p ⬍
.01. Again, neither the main effect of speech condition nor the
Anxiety Group ⫻ Speech Condition was significant (Fs ⬍1, ES ⬍
.02). To break down these interactions, we computed a bias score
for each participant that compares RTs when the probe is in the
location of the heart rate versus RTs when the probe is in the
location of the sound wave (cf. MacLeod & Mathews, 1988).
Positive values reflect an attentional bias toward heart rate, and

Table 1
Mean Response Latencies (and Standard Deviations) to Probes (in ms)

Location Low SA High SA

No No
Stimulus pair Stimulus Probe Speech speech Speech speech

Threat/neutral faces Tu/Nd Up 432 (58) 433 (115) 430 (78) 412 (76)
Tu/Nd Down 440 (77) 433 (98) 441 (66) 416 (62)
Nu/Td Up 430 (68) 437 (110) 435 (88) 415 (77)
Nu/Td Down 448 (76) 428 (89) 435 (64) 418 (61)
Happy/neutral faces Fu/Nd Up 433 (69) 434 (102) 438 (79) 410 (73)
Fu/Nd Down 437 (66) 438 (96) 435 (67) 412 (62)
Nu/Fd Up 432 (64) 437 (109) 429 (81) 412 (79)
Nu/Fd Down 436 (81) 436 (110) 441 (55) 415 (55)
Threat/happy faces Tu/Fd Up 434 (70) 438 (109) 438 (80) 415 (73)
Tu/Fd Down 437 (77) 436 (114) 445 (69) 416 (67)
Fu/Td Up 432 (70) 433 (98) 445 (65) 422 (66)
Fu/Td Down 441 (74) 446 (105) 431 (78) 421 (72)
Heart rate/sound wave Hu/Sd Up 430 (68) 431 (103) 426 (80) 399 (69)
Hu/Sd Down 431 (60) 444 (118) 443 (79) 418 (61)
Su/Hd Up 418 (62) 428 (105) 441 (96) 415 (76)
Su/Hd Down 419 (71) 429 (103) 435 (77) 399 (58)

Note. Standard deviations are in parentheses. In the stimuli location column, T ⫽ threat faces; N ⫽ neutral
faces; F ⫽ happy faces; H ⫽ heart-rate information; S ⫽ sound-wave information; u ⫽ up; d ⫽ down; SA ⫽
social anxiety.
 BRIEF REPORTS
Figure 1. Bias scores for the four pairs of stimuli by group. Positive values represent bias toward the first
stimulus of the pair, and negative values represent bias toward the second stimulus. SA ⫽ social anxiety.
negative values reflect an attentional bias away from heart rate.
The two groups were compared on the heart-rate bias score. High
social anxiety participants (M ⫽ 17.47, SD ⫽ 21.26) showed
greater attentional bias scores toward heart rate than did low social
anxiety participants (M ⫽ 4.23, SD ⫽ 23.87), t(89) ⫽ 2.80, p ⬍
.01. In addition, separate t tests compared each group’s bias score
with zero (0 ⫽ no bias) and found that the high social anxiety
group’s bias score differed from zero, t(48) ⫽ 5.75, p ⬍ .01,
whereas the low social anxiety group’s bias score did not signif-
icantly differ from zero, t(41) ⫽ 1.14, ns (see Figure 1).
Attention to faces. A 2 (anxiety group) ⫻ 2 (speech condi-
tion) ⫻ 3 (type of face pair) ⫻ 2 (stimulus location) ⫻ 2 (probe
location) mixed-design ANOVA revealed no significant main ef-
fects or interactions (all ps ⬎ .10).2
Discussion
The present study investigated whether socially anxious indi-
viduals preferentially attended to signals representing internal
physiological cues as might be expected according to Clark and
Wells’s (1995) cognitive model of social phobia. The results
indicated that high (but not low) socially anxious individuals
clearly showed preferential attention to information about their
heart rate (relative to a sound wave), thus supporting Clark and
Wells’s hypothesis that socially phobic individuals turn their at-
tention inward to monitor internal physiological cues. This shift of
attention to cues for possible internal sources of threat is thought
to be central to the “vicious cycle” of anxiety in social situations.
317
If socially anxious individuals shift their attention to monitor these
internal cues, they may also assume that others can both see these
signs of anxiety and judge them harshly, further reinforcing their
perceived dangerousness of the social situation.
Some other evidence also suggests that socially anxious indi-
viduals exhibit an internal shift of attention. Indirect support for
2
Despite the fact that the mixed-design ANOVA did not yield signifi-
cant main effects or interactions, we conducted a few specific planned
comparisons to determine whether there was a trend for an attentional bias
to threat faces given that some prior studies have found this effect. We
conducted two planned comparisons using only participants who were in
the speech condition because we believed that the speech manipulation
might have had a slight impact on speech or social anxiety that the
STAI–State was not sensitive enough to detect. Bias scores were computed
for the two types of face pairs that included threat faces using the same
formula that was used to form the bias score for the heart-rate information.
Thus, one bias score was for attention toward threat versus neutral faces
and one was for attention toward threat versus happy faces. T tests
comparing the high and low social anxiety groups in the speech condition
revealed no group differences on the threat/happy bias scores, t(41) ⫽ .05,
ns, but there was a trend for a group effect on the threat/neutral bias scores,
t(41) ⫽ 1.86, p ⫽ .07. The high social anxiety group (M ⫽ 5.82, SD ⫽
18.2) attended slightly more to the threat faces when paired with the neutral
faces as compared with the low social anxiety group, which, if anything,
showed a bias away from threat faces (M ⫽ ⫺4.42, SD ⫽ 17.62). However,
these results should be interpreted cautiously because any effects of the
speech manipulation on anxiety were not apparent using the STAI–S.
318 BRIEF REPORTS
this bias has been found in studies assessing reported self- focused
attention (e.g., Mellings & Alden, 2000). Somewhat more direct
evidence is derived from Mansell et al.’s (2003) study in which
socially anxious individuals asked to give a speech responded
more quickly to a tactile probe ostensibly signaling internal phys-
iological changes relative to an external visual probe. The current
study adds to this body of literature by using a different paradigm
that looked at socially anxious participants’ attentional bias to a
cue ostensibly representing heart-rate changes versus a visually
similar sound-wave cue. Thus, socially anxious individuals have
now been shown not only to report an internal shift of attention but
also to exhibit an attentional bias toward cues ostensibly signaling
internal physiological changes.
Not unlike some other studies using faces as stimuli with dot-
probe paradigms that assessed attentional biases in high socially
anxious individuals (e.g., Bradley et al., 1997; R. Rapee and A.
Öhman, personal communication, October 2003), we failed to find
significant group differences in location of attention to threat
versus neutral faces (although there was a trend for this effect in
the speech condition; see Footnote 2). The exact parameters gov-
erning the occurrence of attentional bias toward (or away from)
threatening faces obviously awaits further research.
There are several limitations of this study. One is that the speech
manipulation was not successful in inducing anxiety, at least as
measured by the STAI, possibly because it was not sensitive
enough to detect any speech or social anxiety that participants may
have experienced. Alternatively, the high social anxiety group may
not have been very afraid of giving speeches given that they were
selected on a general measure of social (rather than speech) anx-
iety (see Mansell et al., 2003). Finally, all the high social anxiety
participants might have been socially stressed because an experi-
menter was in the room at the time of the experiment to ensure that
the participants focused on the task. A second limitation of this
study is that it was conducted with an analog sample, and so the
results await replication with a clinical sample. However, the
average levels of social anxiety in the high social anxiety group
(M ⫽ 35.32, SD ⫽ 7.87) were fairly close to those reported by
Mattick and Clarke’s (1998) diagnosed socially phobic individuals
(M ⫽ 40.00, SD ⫽ 16.00). Further, because the groups were
selected on a social anxiety measure, we do not know whether the
bias toward heart-rate information is specific to social anxiety.
The final limitations of the study involve the stimuli involved. It
was not feasible to measure an attentional bias toward actual
interoceptive information, and so internal cues were represented by
pictures of what participants believed to be their own heart rate.
However, two studies have now found evidence for an attentional
bias for interoceptive information signaled through either visual or
tactile modalities. Moreover, this seems to make this a particularly
conservative test of Clark and Wells’s (1995) model because the
attentional bias detected in socially anxious individuals was to
information about internal events and not to internal signals per se.
Overall, findings of preferential attention toward cues for inter-
nal sources of threat lend support to Clark and Wells’s (1995)
contention that socially anxious individuals may shift attention
inward to monitor their physiological cues. Addressing the role of
internal sources of threat in research on social anxiety parallels an
earlier development that occurred 20 –25 years ago with agorapho-
bia and panic disorder when focus on the fear of external situations
in agoraphobia began to change toward an additional focus on the
importance of fear of internal bodily sensations in panic disorder.
Although very few studies using tightly controlled information-
processing methodology have yet assessed attentional biases to-
ward cues of internal threat in social anxiety, we hope this study
provides a useful start for future work in this area.
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Received January 21, 2004
Revision received July 16, 2004
Accepted July 19, 2004 䡲