Cogn Ther Res (2014) 38:189–199
DOI 10.1007/s10608-013-9581-9
ORIGINAL ARTICLE
Rumination Moderates the Effects of Cognitive Bias Modification
of Attention
Kimberly A. Arditte • Jutta Joormann
Published online: 29 September 2013
Ó Springer Science+Business Media New York 2013
Abstract Whereas research on cognitive bias modifica-
tion of attention has produced promising results, it remains
unclear how and for whom such techniques may be most
effectively implemented. This study examined how trait
rumination moderated the effects of two attention training
tasks on biased attention, assessed via eye tracking, and
subsequent stress reactivity. Using a modified dot-probe
task, participants were trained to develop a negative
attention bias, a positive attention bias, or no attention bias.
Though neither the train-negative nor the train-positive
conditions produced significant main effects on attention
biases or emotional reactivity, rumination was found to
moderate training efficacy, such that train-positive partic-
ipants reporting high levels of rumination demonstrated
greater early-stage positive attention biases at post-training,
as compared to controls. Further, train-negative and train-
positive participants who reported low levels of rumination
demonstrated greater positive affect following an acute
stressor as compared to controls. Theoretical and clinical
implications of results are discussed.
Keywords Cognitive bias modification
Attention
bias modification
Eye tracking
Attention bias

Emotional reactivity
Introduction
The preference, or bias, to attend to emotion-congruent
environmental stimuli is posited to play an important role
K. A. Arditte (&)
J. Joormann
Department of Psychology, University of Miami, 5665 Ponce de
Leon Boulevard, Coral Gables, FL 33146, USA
e-mail: karditte@psy.miami.edu
in the etiology and maintenance of emotional disorders
(e.g., Beck and Clark 1997; Beck et al. 1979). Specifically,
it has been proposed that cognitive biases are related to
impaired ability to regulate affect, thereby affecting stress
responding and recovery. These difficulties in affect reg-
ulation result in the sustained negative affect and difficul-
ties experiencing positive affect that characterize mood
disorders (e.g., Joormann 2010). Research has supported
theory on attention and emotion, finding that an attentional
preference for negative stimuli (negative attention bias
[NAB]) is related to heightened emotional reactivity (El-
lenbogen et al. 2002), as well as clinical symptoms of
depression and anxiety (for a meta-analytic review, see
Armstrong and Olatunji 2012). Conversely, an attentional
preference for positive stimuli (positive attention bias
[PAB]) appears to be associated with greater positive
affect, lesser negative affect, and reduced levels of physi-
ological arousal in response to stress (Segerstrom 2001;
Strauss and Allen 2006).
Despite all that is known about attention biases, much of
the extant research has been limited by its correlational
nature. As a result, it remains unclear whether biased atten-
tion represents a causal mechanism that leads to altered
emotional responding or merely a state-dependent symptom
of such responding. To address the causal impact of biased
attention on emotion, research has begun to experimentally
manipulate biases. Cognitive bias modification of attention
(CBM-A) has the potential to increase our understanding of
the interaction of cognition and emotion and is also thought
to be an important next step in translating basic research into
clinically-relevant interventions. Initial findings have pro-
duced promising, albeit modest, effects. CBM-A tasks have
been shown to effectively alter participants’ ensuing emo-
tional responsivity and reduce clinical symptoms, particu-
larly symptoms of anxiety (for reviews, see Beard et al. 2012;
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Hallion and Ruscio 2011). Few studies, however, have
assessed the impact of CBM-A on symptoms of depression,
and those that have, have produced equivocal results (e.g.,
Wells and Beevers 2010, but Baert et al. 2010). Thus,
important questions about the utility of CBM-A remain
unanswered.
For one, the literature lacks a complete understanding of
how CBM-A paradigms affect change. Altered attention is
often presumed to be the mechanism of change underlying
CBM-A, but other factors (e.g., increased self-regulation
and effortful control; Rueda et al. 2005) may also be at
play. Whereas the impact of CBM-A on attention for
emotional stimuli is undoubtedly a central focus of the
literature, training studies have not always included a
systematic, pre-post assessment of attention. Further, when
they have, assessments have typically been limited in
important ways.
For example, most studies have assessed change in
attention biases using the dot-probe task (e.g., Amir et al.
2008; Baert et al. 2010; MacLeod et al. 2002; Wells and
Beevers 2010). Yet, this task is limited in that it can only
provide a cross-sectional snapshot of attention allocation at
the time the probe appears and can miss key information on
how attention to emotional stimuli changes over time
(Caseras et al. 2007). In contrast to the dot-probe, eye
tracking can provide a more ecologically valid under-
standing of biased attention because it allows for the con-
tinuous evaluation of both early- and late-stage focal
attention. A number of previous CBM-A studies have also
been limited by their use of the same stimuli within both
the assessment and training phases (Baert et al. 2010) or by
their use of some component of the training phase as an
assessment (MacLeod et al. 2002; Wells and Beevers
2010). Yet, to fully understand the implications of CBM-A,
it will be important to examine whether training effects
generalize to other content-similar stimuli (MacLeod and
Mathews 2012).
Moreover, with the understanding that on the whole
CBM-A has produced only modest effects on subsequent
emotional responding (e.g., Beard et al. 2012; Hallion and
Ruscio 2011), it will be essential to begin to identify who
stands to benefit from attention training. Aside from
comparing clinical and non-clinical populations, CBM-A
research must explore potential moderators of training
effects, such as trait-level differences in the use of specific
emotion regulation strategies within both clinical and non-
clinical populations. Taking an individual differences
approach to the study of attention biases may provide
insight into the mechanisms by which CBM-A elicits
change in emotional responding and may aid us in targeting
individuals who stand to benefit from completion of CBM-
A procedures. Examining the use of specific emotion reg-
ulation strategies is a natural starting point for research on
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Cogn Ther Res (2014) 38:189–199
CBM-A moderation, as attentional deployment is, itself,
conceptualized as an emotion regulation strategy that is
commonly used to up- or down-regulate one’s emotional
response and which has been found to relate to the use of
other emotion regulation strategies (Gross and Thompson
2007; Wadlinger and Isaacowitz 2011). Thus, reliance on
specific emotion regulation strategies that are associated
with attentional deployment may be expected to impact
training efficacy.
It has been theorized that rumination, an emotion reg-
ulation strategy that involves perseverative, introspective
focus on negative thoughts and feelings, is associated with
attentional deployment, such that individuals who rely on
this strategy demonstrate difficulty disengaging with both
negative thoughts and negative environmental stimuli
(Johnson 2009). Research suggests that rumination is
associated with attentional inflexibility, driven by difficulty
inhibiting response to negative emotional material and
impairment in set-shifting ability (De Lissnyder et al.
2010). Further, research has linked rumination with biased
attention, finding that it is uniquely associated with
increased attention for sad stimuli in both children and
adults (Joormann et al. 2006; Romens and Pollack 2012).
In an initial attempt to link CBM-A with the habitual use of
rumination, Baert et al. 2010 assessed change in self-
reported rumination as a function of training. Whereas the
authors found a general decline in rumination scores from
pre- to post-training, there was no difference as a function
of training condition. Rather than examining the impact of
a brief attention training on habitual use of this strategy,
however, it may be more helpful to explore the moderating
effect of this trait-level characteristic on the effects of
CBM-A.
The current investigation utilized an attention training
paradigm to alter attention towards positive or negative
stimuli (referred to as the PAB and NAB conditions,
respectively). These conditions were compared to a no-
training control (CTL) condition in order to assess the
causal impact of attention biases on natural gaze patterns
and subsequent stress reactivity. The study also sought to
understand how individual differences in habitual use of
rumination would moderate the effects of the training on
attention biases and emotional responding. It was hypoth-
esized that the completion of the attention training would
alter attentional patterns assessed via eye tracking before
and after training. Specifically, it was predicted that,
compared to controls, participants in the NAB condition
would demonstrate increased attention for negative stimuli
at post-training, whereas participants in the PAB condition
would demonstrate increased attention to positive stimuli at
post-training. It was also hypothesized that completion of
the attention training would alter patterns of emotional
reactivity in response to a laboratory stressor. Here it was
Cogn Ther Res (2014) 38:189–199
predicted that, as compared to the CTL condition, partici-
pants completing the NAB training would demonstrate
greater emotional reactivity (i.e., more subjective negative
affect/less subjective positive affect), whereas participants
completing the PAB training would demonstrate less
emotional reactivity (i.e., less subjective negative affect/
more subjective positive affect). Finally, it was predicted
that habitual use of rumination would moderate training,
though given the exploratory nature of this hypothesis, no
specific predictions were made about the direction of such
moderation effects.
Method
Participants
A sample of N = 104 undergraduate students was recruited
for the current study. Eligible participants were required to
be at least 18 years of age or have parental consent and to
be currently enrolled as a student at the University of
Miami.
Self-Report Measures
Rumination
The Ruminative Responses Scale (RRS; Treynor et al.
2003) is a 22-item questionnaire that assesses the habitual
use of rumination in response to dysphoric mood. In par-
ticular, the measure examines responses that are focused on
the self, on symptoms, or on possible consequences and
causes of moods using a 4-point scale (Almost never to
Almost always). The RRS has two subscales, brooding
(e.g., ‘‘I think ‘what am I doing to deserve this’’) and
reflection (e.g., ‘‘Analyze recent events to try to understand
why you are depressed’’). Subscales are then summed to
create a total score that ranges from 22 to 88, with higher
scores indicating greater habitual reliance on rumination.
Internal consistency (a = .76 across subscales) and test–
retest reliability (r = .61 across subscales) have been pre-
viously determined within a community sample (Treynor
et al. 2003).
Subjective Mood Ratings
Participants’ self-reported affect was monitored throughout
the study using the Positive Affect Negative Affect Scales
(PANAS; Watson et al. 1988). The PANAS consists of
two, 10-item mood scales: positive (e.g., ‘‘enthusiastic’’)
and negative (e.g., ‘‘upset’’) affect. Participants are asked
to rate each emotion on a scale of 1 (Not at all) to 5
(Extremely) based on how much they are experiencing that
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emotion ‘‘right now, in this moment.’’ The psychometric
properties of these scales have been assessed in a sample of
undergraduate students. Results indicate that the measure is
internally consistent (a’s ranging from .86 to .90), has
strong convergent and divergent validity, and is reliable
across time (Watson et al. 1988).
Attention Training Task
Task
Participants were randomly assigned to one of three
attention training conditions: NAB, PAB, or CTL. Across
conditions, training tasks consisted of 10 practice trials and
160 experiment trials. Participants began each trial by
fixating their gaze on a black cross presented in the middle
of the screen (500 ms). Then, two faces appeared simul-
taneously on either side of the screen (500 ms). Finally, a
probe (the letter E or the letter F) appeared on either the left
or right side of the screen, in the spatial location of one of
the two faces. Participants were instructed to identify the
probe as quickly as possible. Probe detection accuracy and
response latencies were recorded.
Participants assigned to the NAB condition were pre-
sented with 128 (80 %) negative-neutral trials and 32
(20 %) neutral–neutral trials. Similarly, participants
assigned to the PAB condition were presented with 128
(80 %) positive-neutral trials and 32 (20 %) neutral–neu-
tral trials. Image location (i.e., valenced image located on
the left or right side of the screen) and probe type (E or F)
were counterbalanced across trials. In both the NAB and
the PAB conditions, the probe appeared behind the val-
enced image in each of the 128 valenced-neutral trials.
Thus, as participants completed the training it was expec-
ted that they would learn to shift their attention towards the
valenced image. Previous research has found similar par-
adigms to effectively induce negative and positive attention
biases (e.g., Amir et al. 2008).
In the CTL condition, participants were presented with
64 (40 %) negative-neutral, 64 (40 %) positive-neutral, and
32 (20 %) neutral–neutral images. As with the NAB and
PAB conditions, image location and probe type were
counterbalanced. Additionally, within the CTL condition,
probe location was counterbalanced, such that the probe
could appear behind either the valenced or the neutral
image. It was expected that participants in the CTL con-
dition would not learn to shift attention towards valenced
stimuli and, thus, would not develop an attention bias.
Stimuli
Images used during the attention training were selected
from the NimStim Face Stimulus Set (MacArthur
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Foundation Research Network on Early Experience and
Brain Development).1 Participants were presented with 10
expression pairs (i.e., neutral–neutral expressions from the
same model) during the practice phase of the task and 16
expression pairs (i.e., sad-neutral, happy-neutral, or neu-
tral–neutral expressions from the same model) during the
training phase of the task. Face stimuli were selected to
control for the gender and race of the model. In addition,
the original stimuli were edited so that only the facial
features of each model were visible to the participant.
Assessment of Attention Biases
Task
A passive viewing paradigm was used pre- and post-
attention training to assess change in attention to positive
and negative stimuli. During this task, participants viewed
a series of 60 trials, each of which included two images
selected from the International Affective Picture System
(IAPS; NIMH Center for the Study of Emotion and
Attention 1999). Trials were presented in six blocks of ten,
categorized by valence. Block order and image location
were randomized to control for order effects. Each trial
began with the presentation of a black fixation cross in the
middle of the screen (500 ms), followed by a number from
one to five (500 ms). To ensure that participants began
each trial with eye gaze directed at the center of the screen,
participants were required to say this number aloud. Trials
ended with the presentation of a picture pair. The images
remained on the screen for 6,000 ms, during which, par-
ticipants were instructed to look at whatever they liked.
Stimuli
Attention for positive and negative stimuli was assessed
using 20 positive-neutral and 20 negative-neutral (negative
images were dysphoric in nature) picture pairs, respec-
tively. In addition, 20 neutral–neutral picture pairs were
included in the task. In keeping with the study’s attention
training tasks, neutral trials were included as filler trials
and were intended to mask the purpose of the passive
viewing task. IAPS image pairs were selected for use in
this task based on normed valence and arousal ratings
(Lang et al. 2005) and previous research (e.g., Caseras
et al. 2007; See Footnote 1). The three categories of images
differed significantly in their valence ratings, F(2,
116) = 1,013.97, p \ .001, g2 = .95, with negative ima-
ges (M = 2.44, SD = .43) rated as less pleasurable than
1 trial. Finally, total visit duration (TVD) was assessed by
For information on specific stimuli used in the attention training
task and/or in the assessment of attention biases, please contact the
first author, Kimberly A. Arditte, at karditte@psy.miami.edu.
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neutral images (M = 4.99, SD = .34), t (97) = 28.28,
p \ .001, d = 5.74, and neutral images rated as less
pleasurable than positive images (M = 7.45, SD = .31),
t (97) = 29.37, p \ .001, d = 5.96. The categories also
differed significantly in their arousal ratings, F(2, 116) =
103.02, p \ .001, g2 = .64. Negative (M = 4.94, SD =
.45) and positive (M = 4.87, SD = .69) images were sig-
nificantly more arousing than the neutral images (M =
3.17, SD = .64), t (97) = 11.58, p \ .001, d = 2.35, and
t (97) = 10.44, p \ .001, d = 2.12 for negative-neutral
and positive-neutral comparisons, respectively, but not
significantly different from each other, t (38) = .34,
p = .74, d = .11.
Eye Tracking
During the passive viewing paradigm, bilateral eye
movements were unobtrusively tracked using a Tobii X120
Eye Tracker and Tobii Studio Analysis Software (Tobii
Technology, Danderyd, Sweden). Eye tracking data were
recorded at a rate of 60 times per second (60 Hz) during the
6,000 ms per trial when the IAPS images were presented.
Data on four indices of attention were collected for each
of the prescribed areas-of-interest (i.e., each of the two
images within a given trial). Early-stage attention biases
were assessed by initial orientation (IO), or the decision to
initially attend to one image over another. IO was calcu-
lated by examining the time to first fixation, with fixation
defined as the maintenance of gaze on a single location, for
both the valenced and neutral images presented in a given
trial. As with previous research (e.g., Caseras et al. 2007;
Armstrong et al. 2010), bias scores were calculated by
summing the number of trials in which the participant first
oriented to the valenced image and dividing this by the
total number of valid trials. Bias scores were calculated
separately for negative-neutral and positive-neutral trials
with a score of .50 (i.e., 50 %) indicating no bias, a score of
[.50 indicating bias towards emotional images, and a score
\.50 indicating bias away from emotional images.
Each of the remaining three indices was calculated as an
indicator of attentional maintenance. Fixation count (FC)
was assessed by examining the number of times a partici-
pant fixated on each of the images in a given trial. In
contrast, visit count (VC) was assessed by examining the
number of visits to each image in a given trial. A visit was
defined as the time spent looking at an image without
disengaging from it, such that one visit could contain an
indefinite number of fixations. VC is, thus, conceptualized
as the number of times a participant engaged, disengaged
and then re-engaged with an image over the course of a
examining the length of time a participant spent examining
each image over the course of a trial. Bias scores for each
Cogn Ther Res (2014) 38:189–199
of these indices were calculated by finding the mean for
valenced images and subtracting from this the mean for
neutral images (e.g., Armstrong et al. 2010). As with IO,
separate scores were calculated for negative-neutral and
positive-neutral trials. With the indices of attentional
maintenance, a score of zero represented no bias, a positive
value indicated bias towards emotional images, and a
negative value indicated bias away from emotional images.
Assessment of Emotional Reactivity
To examine the effects of the attention training on emo-
tional reactivity, participants underwent a speech prepara-
tion task designed to elicit stress and anxiety (Sanchez
et al. 2012). Participants were instructed that they would
have to prepare and deliver a 5-min speech on the topic
‘‘Why am I a good friend?’’ To increase the stressfulness of
the task participants were informed that their speech would
be video recorded and judged based on factors such as
clarity, cohesiveness, and persuasiveness. In addition, they
were told that their speech could be used for training
purposes at the university, with the top 10 % and the bot-
tom 10 % of speeches based on the evaluators rating being
used as examples of strong and weak public speaking
skills, respectively. After receiving these instructions,
participants were given 5 min to prepare their speech and
were allowed a pen and paper to make notes.
Procedure
The study protocol was reviewed and approved by the
University of Miami’s Institutional Review Board. Prior to
providing consent, participants were told that the purpose
of the study was to investigate how people respond to
positive and negative information. Participants were not
provided with explicit information about study aims or
hypotheses, and they were not informed that they would
complete an attention training task. After providing con-
sent, participants completed the RRS and a questionnaire
assessing relevant demographic information. Upon com-
pletion of these measures, participants watched a brief (5-
min) nature video. They were, then, asked to provide a
mood rating, which was used as a measure of baseline
positive and negative affect. Next, participants underwent
the pre-training assessment of attention, before being
assigned to complete one of the three attention training
tasks. At the conclusion of the attention training, partici-
pants provided a second mood rating. Participants, then,
underwent the second assessment of attention. The proce-
dure for this portion of the protocol was identical to that of
the pre-training assessment.
Finally, the experimenter provided the instructions for
the stressor task. Instructions were followed by a 5-min
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speech preparation period, after which a third and final
mood rating was collected. Once the participants had
provided this mood rating, the experimenter explained to
participants that ‘‘only about half of the people enrolled in
the study’’ would actually have to give the speech. Whether
or not a participant had to give a speech was ‘‘determined’’
by the flip of a coin. The experimenter then flipped a
quarter (which, unbeknownst to participants was double-
sided) and ‘‘determined’’ that the participant would not
have to give the speech. Participants were debriefed on the
use of this minor deception, as well as the study’s aims and
hypotheses prior to the conclusion of study sessions.
Results
Following randomization, n = 35 participants were
assigned to the NAB condition, n = 34 were assigned to
the PAB condition, and n = 35 were assigned to the CTL
condition. Data on age were missing from four participants
and complete data from the RRS were missing from eight
participants. Throughout analyses, we have opted to use all
available and valid data. On average, participants were
19.68 (SD = 2.27) years. The sample was 53 % female
and 47 % male. Further, 56 % of the sample identified as
White/Caucasian, 15 % as Hispanic/Latino, 12 % as Black/
African American, 8 % as Asian, and 9 % as ‘‘other.’’
Given the breakdown of participants’ reported race/eth-
nicity this variable was dichotomized as White/Caucasian
versus non-White/Caucasian for subsequent analyses.
Demographic characteristics within each training condi-
tion are presented in Table 1. Results revealed that random
assignment of participants to attention training condition was
effective at minimizing between-group differences on
demographic variables of interest. Study conditions did not
differ as a function of age, F(2, 97) = .18, p = .84,
g2 = .003, gender, v2 (2, N = 104) = 3.30, p = .19, or
race/ethnicity v2 (2, N = 104) = 1.75, p = .42. The aver-
age score on the RRS was 39.23 (SD = 11.70). Variability in
RRS scores appeared to be evenly distributed across training
tasks and no significant differences among conditions were
found, F(2, 93) = .90, p = .41, g2 = .02.
Attention training performance was examined by con-
ducting one-way ANOVAs to examine between-group
differences on mean accuracy and reaction time as a
function of training condition. Overall, participants
were highly accurate in their response to task probes
(M = 97 %, SD = 3 %) and no difference in accuracy was
found as a function of training condition, F(2, 101) = 2.38,
p = .10, g2 = .04. Training conditions also did not differ
in their mean reaction times (RT) to trial probes, F(2,
101) = 1.00, p = .37, g2 = .02. Across conditions, par-
ticipants were relatively quick to respond (M = 773.20 ms,
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Table 1 Means (standard deviations) and percentages (where speci-
fied) for demographic variables of interest and habitual use of rumi-
nation, as measured by the Ruminative Responses Scale (RRS),
across the negative attention bias (NAB), positive attention bias
(PAB), and control conditions
NAB PAB Control
Table 2 Means (standard deviations) for pre-training and post-
training eye tracking indices, including initial orientation (IO), fixa-
tion count (FC), visit count (VC), and total visit duration (TVD) for
negative (Neg) and positive (Pos) stimuli, across the negative atten-
tion bias (NAB), positive attention bias (PAB), and control conditions
NAB PAB Control

Age 19.50 (2.66) 19.71 (2.08) 19.83 (2.09) Pre-training

Gender (% female) 62.80 41.17 54.28 IO-Neg .52 (.07) .53 (.06) .51 (.05)
Race/ethnicity (% 34.28 47.05 48.57 IO-Pos .61 (.09) .61 (.09) .59 (.07)
White/Caucasian) FC-Neg 1.93 (1.49) 1.06 (1.56) 1.58 (1.56)
RRS 37.22 (12.49) 39.38 (10.93) 41.16 (11.63) FC-Pos 1.77 (1.57) 1.87 (1.29) 1.82 (1.47)
VC-Neg .08 (.18) .00 (.20) .13 (.22)
VC-Pos .17 (.27) .15 (.16) .15 (.22)
SD = 90.79 ms) and no individual participant had a mean TVD-Neg .68 (.53) .45 (.61) .69 (.79)
RT above 1,250 ms. To examine if conditions did, indeed, TVD-Pos .63 (.57) .62 (.53) .77 (.73)
train attention for positive and negative stimuli, we com- Post-training
pared RTs in the first and second halves of the training IO-Neg .52 (.10) .52 (.15) .53 (.06)
within each of the three training conditions. Results indi- IO-Pos .57 (.10) .55 (.15) .58 (.09)
cated no difference in RTs when collapsing across all FC-Neg 1.66 (1.85) 1.03 (1.29) .86 (2.14)
training trials, F(2, 101) = 1.06, p = .35, g2 = .02, or FC-Pos 1.84 (1.39) 2.17 (1.95) 1.78 (1.26)
when assessing condition-congruent trials, F(2, 101) =
VC-Neg .05 (.23) .05 (.20) .00 (.26)
.96, p = .38, g2 = .02.
VC-Pos .14 (.14) .14 (.22) .15 (.18)
Following completion of data collection, but prior to
TVD-Neg .54 (.74) .37 (.62) .16 (.95)
analysis, eye tracking data were examined for outliers.
TVD-Pos .65 (.58) .65 (.67) .79 (.87)
Participants’ data were included in analyses if valid data
were collected for at least 70 % of the stimulus presenta-
tion duration collapsed across trials. Of the 104 partici-
pants, valid data were collected from n = 72 participants at Next, habitual use of rumination was explored as a
both the pre-training and post-training assessments (n = 26 moderator of training effects using multiple regression
NAB participants, n = 24 PAB participants, and n = 22 analyses. To do this, the condition variable was dummy
CTL participants). For an additional four cases (one NAB coded, such that the control condition served as the referent
and three PAB participants), the IO index could not be group. Participants’ RRS scores were, then, centered to
calculated due to insufficient data. For the subset of par- examine the main effect of condition at mean levels of
ticipants included in eye tracking analyses, the average rumination. Finally, regressions of eye tracking indices on
percentage of data collected was 89.64 (SD = 6.09) during rumination were specified separately for each condition
the pre-training assessment and 86.38 (SD = 7.01) during (i.e., the model included interaction terms for rumination
the post-training assessment. by condition). Condition dummy codes, the centered RRS
Eye tracking data were first examined using a series of term, and Condition 9 RRS interaction terms were
mixed-factor ANOVAs that included Time (pre- and post- simultaneously entered into a series of regression models
training) as a within-subjects variable and Condition examining post-training attention biases. In all cases, the
(NAB, PAB, or CTL) as a between-subjects variable (see bias score for the relevant pre-training index of attention
Table 2 for descriptive statistics). Results revealed no was also included as a predictor to control for baseline
significant Time 9 Condition interactions for the four biases across participants. The approach of controlling for
indices of attention for negative stimuli: IO, F(2, 65) = baseline biases by entering pre-training scores as a covar-
.26, p = .77, partial g2 = .01; FC, F(2, 67) = .96, iate in our regression model was selected over the use of a
p = .39, partial g2 = .03; VC, F(2, 67) = 2.32, p = .11, pre-post difference scores, because differences scores may
partial g2 = .07; TVD, F(2, 67) = 2.30, p = .11, partial be systematically related to random error and are often
g2 = .06. Likewise, no significant Time 9 Condition correlated with baseline scores (Cronbach and Furby 1970;
interactions emerged from analyses examining attention for Cohen et al. 2003). Regressions were used to separately
positive stimuli: IO, F(2, 65) = .74, p = .48, partial examine attention for positive and negative stimuli for each
g2 = .02; FC, F(2, 67) = .19, p = .83 partial g2 = .01; of the four eye tracking indices (IO, FC, VC, and TVD).
VC, F(2, 67) = .16, p = .86, partial g2 = .01; TVD, F(2, A significant interaction emerged from regression
67) = .001, p = .99, partial g2 \ .001. analyses, which demonstrated that rumination impacted the

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effects of the PAB, versus CTL, condition on participants’
IO for positive stimuli (b = .41, t [55] = 2.19, p = .03;
see Fig. 1). Methods for probing this interaction were
based on those laid out by Preacher et al. (2004) and
involved examining the simple slopes, as well as the simple
intercepts, of the model. Simple slopes were examined by
separately regressing post-training IO on RRS scores for
the PAB and CTL conditions. For participants within the
PAB condition, rumination predicted greater post-training
bias scores (b = .59, t [55] = 2.01, p = .049). In contrast,
the relation between rumination and post-training biases
was not significant for participants assigned to the control
condition (b = -.32, t [55] = 1.04, p = .30). The simple
intercepts of the model were examined, by regressing post-
training IO on the condition variable at different levels of
the moderator (e.g., ±1 SD from the mean; Preacher et al.
2004). Here, the b value represents the vertical difference
between the two regression lines. It is interpreted as the
estimated mean difference at each of the three levels of the
moderator and is tested for statistical significance using a
t test (see Eckenrode et al. 2000). Testing the simple
intercepts, it was found that participants reporting high
levels of habitual rumination and who were assigned to the
PAB condition demonstrated more pronounced biases at
post-training, compared to their counterparts in the control
condition (b = .52, t [55] = 2.03, p = .047). Yet, partic-
ipants reporting low levels of rumination, did not differ in
post-training biases as a function of assignment to the PAB
or control condition (b = .38, t [55] = 1.46, p = .15). To
further support regression analyses, the relations between
pre- and post-training IO for positive stimuli and RRS
scores were examined using zero-order correlations. The
relation between pre-training IO for positive stimuli and
RRS scores were non-significant for the CTL (r = .35,
p = .30) and PAB (r = .24, p = .30) conditions. At post-
0.8
PAB
0.75 Control
0.7
Bias Score
* positive attention bias (PAB), and control conditions
0.65
0.6
0.55
0.5
-1 SD +1 SD
RRS Score
Fig. 1 Ruminative Responses Scale (RRS) score 9 Condition (posi-
tive attention bias [PAB] versus Control) interaction effects on early-
stage attention biases (i.e., initial orientation) for positive stimuli at
post-training; solid line indicates p \ .05; * = p \ .05; all other
comparisons, p [ .10
195
training, the relation remained non-significant in the CTL
condition (r = -.24, p = .30), but was significant within
the PAB condition (r = .45, p = .04). As rumination
increased, so too did PAB participants’ early-stage positive
attention biases.
None of the other regression analyses yielded evidence
for rumination as a moderator of training effects on eye
tracking indices (all p’s [ .10). No other interaction effects
emerged from analyses. Contrary to hypotheses, rumina-
tion did not interact with the NAB training to alter early-
(IO: b = -.32, t [55] = 1.29, p = .20) or late-stage (FC:
b = .12, t [57] = .46, p = 65; VC: b = .08, t [57] = .32,
p = .75; TVD: b = .22, t [57] = 1.59, p = .12) attention
for negative stimuli. Rumination also did not moderate the
effects of the PAB training on late-stage attention for
positive stimuli, as assessed by FC (b = .02, t [57] = .11,
p = .94), VC (b = .28, t [57] = 1.48, p = .15), or TVD
(b = .01, t [57] = .08, p = .94).
As with analyses examining attention, data on emotional
reactivity were first examined with a series of mixed-factor
ANOVAs. Again, Time (mood ratings following baseline,
training, and stressor task periods) was included as a
within-subjects factor and Condition as a between subjects
factor, with rumination excluded from analyses (see
Table 3 for descriptive statistics). As expected, a main
effect of time was found for negative affect, F(2,
196) = 51.95, p \ .001, partial g2 = .35; across condi-
tions, participants’ negative affect increased from baseline
(M = 11.34, SD = 2.28) to training (M = 12.37, SD =
3.03), t (101) = 3.40, p = .001, d = 1.37, and from
training to stressor (M = 15.58, SD = 5.09), t (101) =
6.59, p \ .001, d = 1.54. Regardless of training condition,
the stressor task effectively elicited negative affect. A main
effect of time was also found for positive affect, F(2,
200) = 30.89, p \ .001, partial g2 = .40. Across condi-
tions, positive affect decreased from baseline (M =
19.29, SD = 6.76) to training (M = 15.27, SD = 5.61),
Table 3 Means (standard deviations) for subjective negative and
positive affect at baseline, as well as immediately after the attention
training and stressor tasks, across the negative attention bias (NAB),
NAB PAB Control
Baseline
Negative affect 12.09 (3.21) 11.03 (1.74) 10.97 (1.45)
Positive affect 20.41 (6.43) 18.53 (6.82) 19.11 (7.08)
Post-training
Negative affect 11.85 (2.56) 12.82 (3.65) 12.51 (2.82)
Positive affect 15.50 (5.44) 15.06 (4.68) 15.23 (6.73)
Post-stressor
Negative affect 15.70 (4.96) 15.33 (4.57) 15.69 (5.82)
Positive affect 20.74 (8.03) 20.09 (8.98) 22.97 (8.50)
123
196
t (103) = 6.89, p \ .001, d = 3.50, but increased again
following the stressor (M = 21.28, SD = 8.52),
t (102) = 6.85, p \ .001, d = 2.09. Despite these main
effects, neither negative affect, F(4, 196) =
2 *
1.18, p = .32, partial g = .02, nor positive affect, F(4,
200) = 1.11, p = .35, partial g2 = .02, differed as a func-
tion of condition across time.
Multiple regression models to examine the interactive
effects of rumination and training condition on positive and
negative affect were constructed in a manner consistent
with attention analyses. Dummy coded condition variables,
the centered RRS term, and Condition 9 RRS interaction
terms were simultaneously entered into a model, which
also controlled for baseline affect, to predict subjective
affect following the stressor. Separate analyses were con-
ducted for positive and negative affect. Rumination did not
appear to moderate the attention training effects on nega-
tive affect (p’s [ .10). However, after controlling for
baseline levels of affect, nearly significant effects emerged
for interaction terms comparing participants assigned to the
NAB versus control condition (b = -.27, t [86] = 1.97,
p = .05) and PAB versus control condition (b = -25,
t [86] = 1.93, p = .06), predicting positive affect follow-
ing the stressor (see Fig. 2).
Once again, interactions were probed by examining both
simple slopes and simple intercepts. Compared to partici-
pants in the control condition, individuals assigned to the
NAB (b = .30, t [86] = 2.18, p = .03) or PAB (b = .30,
t [86] = 2.16, p = .03) conditions and who reported low
levels of rumination demonstrated greater positive affect
following the stressor. However, among participants
endorsing high levels of habitual rumination, conditions
did not differ in self-reported positive affect (p’s [ .10).
Moreover, while none of the simple slopes were found to
be statistically significant (p’s [ .10), the direction of these
effects was, perhaps, notable. Among participants assigned
to the CTL condition, rumination was positively related to
positive affect following the stressor. In contrast, partici-
pants assigned to both the NAB and PAB conditions
demonstrated inverse relations between rumination and
subsequent positive affect (See Footnote 2).2 To further
2
Though a systematic examination of the moderating effects of
depression and social anxiety symptoms were beyond the scope of
this paper, analyses were conducted to ensure that the reported
moderation effects were not driven by either of these related
constructs. To do this, zero-order correlations were used to examine
the relation between self-reported depression (Beck Depression
Inventory, Second Edition; Beck et al. 1996) and social anxiety
(Social Interaction Anxiety Scale; Mattick and Clarke 1998) symp-
toms and all outcome variables. Depression was significantly
associated with post-training FC for positive stimuli (r = .24,
p = .046), but no other pre- or post-training eye tracking indices
(all p’s [ .10). Social anxiety was not related to any of the eye
tracking variables at pre- or post-training (all p’s [ .10). In addition,
123
Cogn Ther Res (2014) 38:189–199
25
NAB
PAB
* Control
Positive Affect
20
15
-1 SD +1 SD
RRS Score
Fig. 2 Ruminative Responses Scale (RRS) score 9 Condition (neg-
ative attention bias [NAB] vesus control; positive attention bias
[PAB] versus control) interaction effects on subjective positive affect
following completion of the stressor task; * = p \ .05; all other
comparisons, p [ .10
support regression analyses, the relations between baseline
and stressor positive affect and RRS scores were examined
using zero-order correlations. Though no significant cor-
relations emerged from these analyses, the relation between
positive affect following the stressor and RRS scores was
marginally significant (r = -.30, p = .09).
Discussion
The current study examined the effects of two CBM-A
tasks on attention biases and subsequent emotional reac-
tivity. It was predicted that, compared to controls, partici-
pants who were trained to attend to negative stimuli would
demonstrate more pronounced NABs and greater sub-
sequent stress reactivity. Conversely, participants trained to
attend to positive stimuli were expected to demonstrate
greater PABs and attenuated subsequent stress reactivity as
compared to controls. Moreover, it was expected that
habitual use of rumination would moderate training effects.
Excluding rumination from analyses, neither the NAB
nor the PAB condition produced significant effects on
Footnote 2 continued
depression was significantly associated with negative affect at base-
line (r = .31, p = .002), whereas social anxiety was related to neg-
ative affect following the stressor (r = .55, p \ .001). No other
relations between depression or social anxiety and affect at baseline
or stressor were found (all p’s [ .10). Where significant relations
were found, depression and/or social anxiety were controlled for in
moderation analyses. This did not impact any of our original results.
Rumination still did not moderate the NAB condition’s effect on
subsequent negative affect (b = .03, t [84] = .19, p = .85 and
b = .05, t [44] = .27, p = .78 when controlling for depression and
social anxiety, respectively), nor did it impact the PAB condition’s
effect on FC for positive stimuli at post-training (b = .11,
t [56] = .54, p = .59).
Cogn Ther Res (2014) 38:189–199
indices of attention biases or subjective affect in response
to the stressor. Though contrary to our hypotheses, such
null findings are consistent with some past research, par-
ticularly that which has employed CBM-A with dysphoric
stimuli (e.g., Baert et al. 2010). Still, as predicted, habitual
use of rumination was found to moderate training condition
effects. Specifically, across all participants who underwent
the PAB versus the CTL training, rumination was related to
greater IO biases for positive stimuli at post-training.
Further, among participants who reported high levels of
habitual rumination, those assigned to the PAB condition
were more likely to demonstrate IO biases for positive
images at post-training than were high ruminators assigned
to the CTL condtion. Overall, individuals high in trait-level
rumination who were assigned to the PAB condition
appeared to receive the most benefit from training proce-
dures. Rumination was not found to moderate effects on
late-stage attention biases, nor did it moderate effects of the
NAB training on post-training attention.
Evidence for moderation effects was also found when
looking at participants’ subjective positive affect immedi-
ately following the speech preparation task. When partic-
ipants endorsed high levels of rumination, affect did not
differ as a function of study condition. Yet, among par-
ticipants reporting low levels of rumination, those who
were assigned to either of the training conditions reported
significantly more positive affect following the stressor
than participants assigned to the control condition.
Taken together, results indicate that CBM-A may not
work the same for all individuals. Indeed, the extent to which
training tasks can effectively alter attention and emotional
responding appears to be dependent on the ways in which a
given individual typically responds to their emotions.
Interestingly, training effects were not confined to individ-
uals reporting either high or low levels of rumination. Rather,
increased use of rumination predicted greater biasing
towards positive stimuli, but decreased use of rumination
predicted more adaptive stress responding. Though it
remains unclear why this pattern of findings emerged, one
possible explanation is that persons that ruminate continue to
process previously presented emotional stimuli at the
expense of regulating their current affective state (Yoon and
Joormann 2012). Whereas this explanation fits well for the
PAB training, it does not explain the greater degree of
positive affect experienced by participants in the NAB, as
compared to the CTL, condition. Though this greater degree
of positive affect among NAB participants was unexpected,
some previous research has found that training attention
towards threat is associated with attenuated anxiety, as
compared to a control condition (Klumpp and Amir 2010). It
is suggested that the mechanism of change in such cases is
not altered attention biases, but rather increased attentional
control following training. This may explain the presense of
197
an emotional reactivity effect, even in the absence of an
attention bias effect, that participants with low levels of
rumination assigned to the NAB condition demonstrated.
However, it is recommended that these results be replicated
before drawing firm conclusions about the impact of the
NAB training on subsequent emotional responding.
Despite evidence to support our moderation hypotheses,
it is acknowledged that the CBM-A procedures used in the
study did not produce effects that were robust enough to
elicit change in attention or emotional responding across all
participants. There may be a couple of explanations for this
lack of findings. First, it may be that biased attention
functions differently in healthy versus clinical populations.
For example, it is suggested that patterns of engagement
and disengagement with emotional stimuli are differen-
tially implicated in dysfunction across clinical and non-
clinical populations (Ellenbogen et al. 2010). In addition, it
may be more difficult to train biases within healthy indi-
viduals, perhaps because valenced environmental stimuli
(particularly negative/dysphoric stimuli) are less salient.
This hypothesis may, in part, explain why participants RTs
did not change over the course of training trials. If this is
the case, inducing attention biases in non-clinical popula-
tions may require multiple training sessions.
That the current study utilized a CBM-A paradigm
comprised of a single, 160-trial, training session should be
considered a potential limitation of the study design. The
amount of training that is needed to produce effects on
emotional reactivity remains unknown. While other
research has effectively altered attention using single-ses-
sion paradigms of identical length (Amir et al. 2008),
others have relied on a greater number of trials (MacLeod
et al. 2002) or multiple training sessions (Wells and Bee-
vers 2010) to produce effects. Moreover, when a single
session of training has produced effects, it has not typically
included a pre-post assessment of attention. Thus, it
remains unclear how long single-session training effects
may be expected to last. While the addition of the pre-post
assessment of attention should be noted as a methodolog-
ical strength of the study, conducting the assessments at
separate time points before and after multiple sessions of
training could increase the magnitude of observed training
effects. In addition, though stimuli used during the assess-
ment of attention differed from that used during the training
procedures, future studies may wish to employ different
stimuli at the pre- and post-training assessments to ensure
that familiarity with emotional content does not affect
results. Lastly, while the CTL condition was designed to
serve as a comparison for both the NAB and PAB condi-
tions, an unintended consequence of the design was that the
CTL differed from both conditions in the amount of expo-
sure it provided to either positive or negative stimuli. Thus,
the possibility that effects were due to differences in
123
198
exposure to valenced stimuli, rather than to altered attention
biases cannot be ruled out. However, given that conditions
did not differ in reported levels of positive or negative affect
following training, this hypothesis seems unlikely.
Of final note, regression analyses may have lacked
sufficient power to detect change. While the overall sample
was relatively large, there was a prominent loss of data in
the collection of continuous focal attention via eye track-
ing. Because of this, eye tracking analyses were conducted
on a subsample that was significantly smaller than the
sample as a whole. Given this, drawing conclusions about
null eye tracking effects is cautioned against. That rumi-
nation was found to moderate early-stage attention biases
for positive stimuli, however, speaks to the strength of this
relation.
Despite its limitations, the current study adds to the
extant literature by providing empirical support for rumi-
nation as a moderator of CBM-A effects. This finding has
obvious clinical implications, particularly for major
depression, which is often associated with high levels of
this construct. Future research should look to extend these
findings to CBM-A research with clinical samples. Doing
so may allow us to better understand the link between
rumination and attentional deployment for dysphoric
environmental stimuli, as well as to identify a potential
barrier in the implementation of CBM-A to reduce symp-
toms in depressed populations.
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