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Graduate Student Journal of Psychology
Fall 2024 - Vol. 23

Copyright 2024 by the Department of Counseling and Clinical Psychology
Teachers College, Columbia University

Exploring the Relationship Between Attentional Bias 
Towards Threat and Symptoms of Adult Separation 

Nikki Kaiser & Michael G. Wheaton
Department of Psychology, Barnard College of Columbia University, New York, NY, United States

Purpose: Research has identified attentional bias towards threatening stimuli as a contributing factor to anxiety dis-
orders, and treatment targeting this bias has been shown to reduce symptoms of anxiety (Azriel & Bar-Haim, 2020). 
Studies have found attentional bias to threats among children with separation anxiety disorder (SAD) when tested 
with dot-probe tasks, with a stronger bias seen when threats are disorder-congruent (Pergamin-Hight et al., 2015). 
No study has yet investigated this relationship among adults, despite growing recognition that separation anxiety is 
frequent in this population. Therefore, we investigated the relationship between SAD symptoms and attentional 
bias toward threatening stimuli (general and separation-specific) on a dot-probe task in a sample of adults, with the 
goal of informing targeted treatment for adult separation anxiety disorder (ASAD). Methods: Undergraduate par-
ticipants (n = 57) completed a measure of ASAD symptom severity (ASA-27) and two versions of the dot-probe task, 
one with separation-specific threatening words and one with generally threatening words. Attentional bias was tested 
using detection latency. Results: Spearman’s rho correlations between ASA-27 and separation-specific threat trials 
(rs = -.07; p = .62) and general threat trials (rs = .07; p = .60) were not significant. However, ASAD symptoms were 
correlated with reduced accuracy on trials following ASAD-specific threat words (rs = -.38, p = .004), but not general 
threat words (rs = -.16, p = .22). Conclusions: We did not find that ASAD symptoms related to attentional bias. 
However, individuals with more ASAD symptoms were less accurate on trials that involved ASAD-threat words, 
suggesting an emotional interference effect of disorder-specific threats on task performance. 
 Keywords: separation anxiety, attentional bias, interference effects

 Separation anxiety disorder (SAD) is characterized 
by persistent and excessive distress or worry related to 
separation from home or significant attachment figures 
(American Psychiatric Association [APA], 2022). An 
attachment figure is often a parent when the disorder 
is present in a child, but when seen in adults, the figure 
may be a parent, partner, child, or spouse. Whether 
seen in a child or adult, symptoms can include fears 
about harm befalling the attachment figure, night-
mares about separation, somatic complaints when 
separated, and a reluctance to leave the attachment 
figure even for short periods of time. In prior editions 
of the Diagnostic and Statistical Manual of Mental 
Disorders (DSM), SAD was categorized under “Disor-
ders First Diagnosed in Infancy, Childhood, or Ado-
lescence” and included a required diagnostic criterion 
of onset prior to the age of 18 years old (APA, 1994). 
The 5th edition of the DSM (APA, 2013) removed 
this criterion and amended features of the disorder, re-
flecting the growing recognition that SAD frequently 
occurs among adults, which has been referred to in the 
literature as adult separation anxiety disorder (ASAD). 
 Empirical support for the notion of ASAD con-
tinues to grow, with data establishing high prevalence 
rates, high comorbidity with anxiety and mood disor-
ders, and most notably, evidence of poor prognoses for 
those diagnosed (Manicavasagar & Silove, 2020; Shear 
et al., 2006). ASAD can be debilitating in a variety of 

functional areas, many of which can lead to long-term 
impairment (APA, 2022). For example, individuals 
may be unable to leave their homes out of fear of leaving 
their attachment figure during the day, or they may be 
unable to form or maintain healthy relationships due to 
the pervasive need to be with their attachment figure. 
 Given that SAD was formally seen as primarily a 
childhood disorder, the bulk of studies and treatment 
explorations surrounding SAD centers on children 
and adolescents (Bogels et al., 2013). Although SAD is 
characterized by the same symptoms in both children 
and adults, the attachment figure and the impairment 
in daily functioning differ between the two popu-
lations (APA, 2022). For example, a child with SAD 
might wish to stay home with their parent and there-
fore have poor school attendance. An adult with SAD 
may be unable to leave their spouse and therefore re-
peatedly miss work, leading to loss of employment. To 
date, very little research exists on ASAD, creating a gap 
in not only the understanding of the disorder’s mech-
anisms, but also in the possibility of creating tailored 
treatments (Baldwin et al., 2016; Bogels et al., 2013).
 A rich area of literature has investigated attention-
al bias towards threat as a prominent maintenance for 
many anxiety disorders, with a premise that modifying 
biases in attention may be foundational to anxiety dis-
order treatment (Barry et al., 2015). Attentional bias is 
the phenomenon of a person’s attention being more 



34

KAISER & WHEATON

focused toward or away from a threatening stimulus 
in comparison to a neutral stimulus (Azriel & Bar-
Haim, 2020). When an individual has an attentional 
bias towards a threat, they may excessively focus on 
potentially threatening stimuli, leading to heightened 
anxiety and distress. Having a bias to direct attention 
toward threats may result in difficulties with concen-
tration, decision-making, and problem-solving. For 
example, an individual with ASAD may need to im-
mediately check their phone after the arrival of every 
new notification, worried it may be about their loved 
one. This bias towards potential threats can distract 
from important duties or responsibilities and may 
impair daily functioning. Furthermore, by repeat-
edly attending to threatening cues, individuals may 
amplify and sustain their anxiety responses, causing 
heightened sensitivity towards potential threats and 
further reinforcing a cycle (Azriel & Bar-Haim, 2020).
 The presence of attentional bias is often tested 
with a visual dot-probe task (Price et al., 2013). In 
this task, participants are presented with an emotion-
ally neutral stimulus and an emotionally threatening 
stimulus, such as a neutral face and an angry face, on 
a computer monitor for a set display length of milli-
seconds (Bantin et al., 2016). A target probe, such as 
a dot or arrow, then appears behind either the neutral 
or threatening stimulus, and the participant is asked to 
identify the probe's shape or location by a key press 
or mouse click. Detection latency, the time from the 
target’s arrival to the participant’s detection of the tar-
get, as indicated by a key press or mouse click, is re-
corded for each trial. A shorter detection latency on 
trials in which the target is behind the threatening 
stimulus would indicate an attentional bias toward 
threatening stimuli. Specifically, decreased response 
latency to detect the probe when it is located behind a 
threatening word or image implies the person’s atten-
tion was drawn to the area of the threatening stimulus 
compared to the neutral stimulus (Bantin et al., 2016). 
 Another task utilized to study the effect of threat 
cues on attention and information process is the emo-
tional Stroop task, a modified version of the classic 
Stroop task, in which participants are asked to name the 
color of a shown word (Bar-Haim et al., 2007). In the 
original Stroop task, the presented word is either con-
gruent with a color (such as the word “green” shown in 
the color green) or incongruent with a color (such as the 
word “green” shown in the color red). The emotional 

Stroop task displays words relating to threatening and 
neutral stimuli instead of the names of colors (i.e., 
death and harm instead of blue and green). A slower 
response to identifying the color of threatening words 
as compared to neutral words indicates biased process-
ing of the threat. It is inferred that the participant is 
unable to focus exclusively on processing the color of 
the word as their attention is distracted by the pres-
ence of a threatening stimulus (Bar-Haim et al., 2007). 
 A meta-analysis conducted by Bair-Haim et al. 
(2007) examined 172 studies that tested attention-
al bias, most of which used either the dot-probe task 
or the emotional Stroop task. Overall, a significant 
attentional bias towards threat was found in anxious 
individuals and was absent in non-anxious individuals. 
Furthermore, no difference in threat bias was found 
when comparing results from studies that used the dot-
probe task measure to studies that used the emotional 
Stroop task measure. Within analyses of the dot-probe 
task, attentional bias toward threat was found in trials 
that used pairs of faces as well as pairs of words, with no 
significant difference between the two stimuli. These 
results were shown to be true for both adult and child 
participants, with no significant difference between 
the two populations. Attentional bias was found in all 
anxiety disorders analyzed: panic disorder, post-trau-
matic stress disorder, social phobia (social anxiety dis-
order), and specific phobia (Bar-Haim et al., 2007).
 SAD was not specifically analyzed as a discrete diag-
nostic category in Bar-Haim et al.’s (2007) meta-analy-
sis, as research on the relationship between attentional 
bias and SAD was extremely limited. Only a handful 
of studies that examined attentional bias have included 
participants with SAD, all of which were conducted 
with children given the previous categorization of this 
disorder (Roy et al., 2008; Salum et al., 2013; Waters et 
al., 2014). However, given ASAD and SAD in children 
overlap in symptomatology, it is important to review 
the existing literature on SAD and attentional pro-
cesses to better inform study design when researching 
this phenomenon in adults. To present an overview of 
the current literature regarding SAD and attentional 
bias, the results of these studies are summarized below.
 In perhaps the largest SAD and attentional bias 
study, Roy et al. (2008) assessed attentional bias in 
101 clinically anxious children, 59 of whom met 
the criteria for SAD. The study used a visual dot-
probe task that showed pairs of angry/neutral and 



35

ATTENTIONAL BIAS AND SYMPTOMS OF ADULT SAD  

 happy/neutral faces and compared detection latency 
between a clinically anxious group and a non-anx-
ious control group. Results indicated that clinically 
anxious children more quickly detected the probe 
located behind an angry face, suggesting an atten-
tional bias toward threatening stimuli. Furthermore, 
no significant differences were found in attention-
al bias toward threat between anxiety disorders. 
 Another study analyzed the dot-probe task per-
formance of 363 children in three disorder groups: 
fear-related, distress-related, and behavioral (Salum et 
al., 2013). The fear-related sample was comprised of 86 
children, 30 of whom met the criteria for SAD. Of the 
three disorder groups, only the ‘fear’ group showed at-
tentional bias directed away from the threat rather than 
toward the threat. This finding was explained through 
the theoretical lens of the fear versus distress structural 
model of emotional disorders. Anxiety disorders cate-
gorized by distress are more likely to result in hypervig-
ilance toward threat, such as general anxiety disorder 
and post-traumatic stress disorder, whereas anxiety 
disorders categorized by fear (such as SAD and social 
phobia) would result in an avoidance of fearful stimuli 
and therefore a bias away from threat. In line with this 
model, this study found that high internalizing symp-
toms in the ‘distress’ group resulted in a greater bias to-
wards threatening stimuli, whereas in the ‘fear’ group, 
high internalizing symptoms resulted in a greater bias 
away from threatening stimuli. A study conducted 
by Waters et al. (2014) found similar results among 
a sample of anxious children, some of whom had a 
primary diagnosis of SAD. Although these studies in-
cluded children with SAD, results were presented in 
aggregate in which these participants were combined 
with those suffering from other anxiety disorders. 
 Importantly, the extant studies have not yet ac-
counted for specific threat-related content for SAD. 
The dot-probe task and the emotional Stroop task 
can be conducted with general threatening stimuli or 
disorder-specific threatening stimuli (Pergamin-Hight 
et al., 2015). Specific threatening stimuli refer to pic-
tures or words that are congruent to the disorder be-
ing analyzed, such as social-related words for social 
anxiety disorder. General threatening stimuli refer 
to pictures or words that are disorder-incongruent 
and related to an anxiety disorder different from that 
of the person being tested. To illustrate, for a person 
with SAD, generally threatening words might be dis-

ease and danger, and specific threatening words, or 
disorder-congruent words, might include “alone” 
and “abandoned”, which have specific content rel-
evant to the notion of separation from loved ones.
 A recent meta-analysis examining attentional 
bias in youth and adults with measures including 
disorder-congruent threats versus disorder-incongru-
ent threats found that clinically anxious participants 
displayed a larger bias toward disorder-congruent 
threats (Pergamin-Hight et al., 2015). The analy-
sis included studies that used the emotional Stroop 
task as well as studies that used the dot-probe task, 
and effect sizes were combined to reach an overall 
effect of threat bias. When the combined effect sizes 
of the two tasks were compared, the difference be-
tween the two tasks was not statistically significant. 
This meta-analysis only included one study that ex-
amined attentional bias in participants with SAD 
(exclusively in children): a single study that found 
no evidence of attentional bias in general-threat 
trials or specific-threat trials (Kindt et al., 2003).
 The primary takeaway from the literature avail-
able is ultimately that it has been scarce and incon-
clusive (Roy et al., 2008; Salum et al., 2013; Waters 
et al., 2014). Though meta-analyses have shown 
evidence for attentional bias toward threat in chil-
dren and adults with various anxiety disorders, the 
limited number of studies involving participants 
with SAD has left the field with less than substan-
tial answers regarding attentional processes in those 
with SAD. This is an important topic for study, as 
prior research has investigated attentional training as 
a treatment for other forms of anxiety, and therefore 
extending research on attention in ASAD might be 
used to develop new interventions for this condition. 
 Moreover, the studies discussed above were con-
ducted with children; no studies have yet examined the 
role of attentional bias in adults with SAD. Though 
results have been mixed, the bulk of previous research 
has shown that children with SAD show an attentional 
bias in regard to threat, and adults with other anxiety 
disorders show an attentional bias toward threat, with 
a greater bias towards disorder-specific threat (Bar-
Haim et al., 2007; Pergamin-Hight et al., 2015). Atten-
tional bias has been shown to be a pivotal mechanism 
in maintaining anxiety disorders, and treatment target-
ing this bias has proven successful in reducing anxiety 
(Azriel & Bar-Haim, 2020; Hakamata et al., 2010). It is 



36

KAISER & WHEATON

reasonable to assume that ASAD, which overlaps consider-
ably with SAD in children and is often comorbid with other 
anxiety disorders, might also be maintained by an attention-
al bias mechanism. Therefore, understanding attentional 
bias in ASAD is crucial to informing targeted treatment. 
 The present study aimed to address this important 
gap in the literature. We sought to determine if adults with 
greater levels of ASAD symptoms would also display great-
er attentional bias to threatening stimuli (general and dis-
order-specific) when tested with versions of the dot-probe 
task. We elected to use the dot-probe task to test this aim 
because, unlike the Stroop task, it is possible to measure if 
attentional bias is directed towards or away from threaten-
ing stimuli by calculating how long it takes for participants 
to detect the probe behind threatening words compared 
to neutral words (with a slower response indicating bias 
directed away from threat and a faster response indicating 
bias towards threat). Furthermore, we included trials with 
facial stimuli and trials with word stimuli to replicate the 
methods of past SAD and attentional bias studies (Roy et 
al., 2008; Salum et al., 2013; Waters et al., 2014), and to test 
both general threats and disorder-specific threats via word 
pairs. Based on previous research findings, it was hypothe-
sized that higher ASAD symptom severity would correlate 
with greater attentional bias to threat, with a stronger 
bias toward threat in trials with disorder-relevant stimuli. 

Methods
Participants
 This study received approval from the Institutional Re-
view Board (IRB) of Barnard College. All ethics guidelines 
were adhered to while conducting this study. Participants 
were given a written consent form to sign prior to begin-
ning participation. Fifty-seven participants were recruited 
through Barnard College’s Sona system. Each participant 
received laboratory credit for their Introduction to Psy-
chology course after completing the study. The sample was 
89% female and had a mean age of 18.92 years (SD = 0.98, 
range 18-21). The racial-ethnic composition was as follows: 
55.9% non-Hispanic White, 5.1% African American, 6.8% 
Hispanic, 27.1% Asian/Pacific Islander, and 5.1% “other.”
Measures
 Adult Separation Anxiety Questionnaire (ASA-27): 
This 27-item questionnaire is used to determine ASAD 
symptom severity. Each item states a symptom or feature of 
ASAD and participants choose a response on a 4-point scale 
from 0, “this has never happened to me,” to 3, “this hap-
pens very often” (Manicavasagar et al., 2003). Scores on the 

ASA-27 were treated as a continuous variable, with a 
higher score indicating greater symptoms of ASAD.
 Dot-Probe Task: A plus sign was fixed in the 
center of a display to focus participants’ attention. 
Emotionally neutral stimuli and emotionally threat-
ening stimuli were then displayed on the screen in 
pairs. After 500ms, an arrow appeared behind either 
the neutral or threatening stimulus, and the partici-
pant was instructed to indicate which direction the 
arrow was pointing by clicking the corresponding 
mouse button (i.e., right-click for a right-pointing 
arrow). Detection latency was then recorded, with 
a shorter detection latency on threatening trials 
indicating an attentional bias toward threatening 
stimuli (MacLeod et al., 1986). The following three 
versions of the dot-probe task were administered:
 1) Facial Stimuli: A pair of faces were displayed 
on the screen for 500ms. Pairs either depicted two 
happy faces, or an angry face and a happy face. 30 
pairs were displayed in total; 15 pairs contained only 
happy faces and 15 pairs contained an angry face. The 
faces shown were black-and-white pictures of White 
men and women; the stimuli were not altered based 
on the gender or racial appearance of the participants. 
 2) General Threat Word Stimuli: A pair of 
words were displayed on the screen for 500ms (see 
Fig. 1). On threatening trials, one word was neu-
tral (i.e., signature), and one word was a randomly 
selected generally threatening word (i.e., strangled). 
30 pairs were displayed in total; 15 pairs contained 
only neutral words and 15 pairs contained a gen-
erally threatening word (see Table 1 for examples). 
	 3)	 Specific	 Threat	 Word	 Stimuli: A pair of 
words were displayed on the screen for 500ms (see 
Fig. 1). On threatening trials, one word was neu-
tral (i.e., hotel), and one word was a randomly se-
lected specifically threatening word (i.e., alone). 
30 pairs were displayed in total; 15 pairs contained 
only neutral words and 15 pairs contained a specif-
ically threatening word (see Table 1 for examples). 
Procedure
 The design of this study was cross-sectional. 
After signing a written consent form, each par-
ticipant was seated at a desk in a quiet laborato-
ry testing room and asked to complete an online 
survey which included a demographics section 
inquiring about gender, age, race, and ethnicity, 
and the ASA-27 questionnaire. Upon finishing 



37

ATTENTIONAL BIAS AND SYMPTOMS OF ADULT SAD  

the surveys, participants completed three dot-probe 
tasks: one consisting of facial pairs, one consist-
ing of general threat words and neutral words, and 
one consisting of specific threat words and neutral 
words. For each trial, words and faces were displayed 
in a randomized order to reduce bias. After complet-
ing all study measures, participants were debriefed. 
Statistical Analysis
 Each participant’s total score on the ASA-27 
(ASATotal) was calculated, as well as any attentional 
bias toward threatening faces, specifically threaten-
ing words (i.e., ASAD-congruent words), or gener-
ally threatening words. To calculate attentional bias 
for each type of threat (FacialThreatBias, Specific-
ThreatBias, GeneralThreatBias), reaction time on 
trials during which the target followed an angry face, 
specifically threatening word, or generally threatening 
word (threat trials) was subtracted from reaction time 
on trials during which the target followed a neutral 
word (neutral trials). Due to the presence of outlier 
responses on the ASA-27, Spearman’s rho was used to 
test for associations between ASATotal and threat bias 
on all tasks. Within-subject accuracy between Specific 
Word task threat trials and Specific Word task neutral 
trials, and between General Word task threat trials 
and General Word task neutral trials, was calculated 
by subtracting accuracy on threat trials from accuracy 
on neutral trials and was then correlated with partici-
pants’ total score on the ASA-27 using Spearman’s rho.

Results
 The sample mean on the ASA-27 (M = 12.93, SD 
= 7.82) was similar to that reported in other undergrad-
uate samples, while the observed range (minimum = 1, 
maximum = 33) indicated a sufficient range of ASAD 
symptom severity to consider this variable as a con-
tinuous marker of ASAD symptoms. No significant 
correlations were found between ASATotal and Gen-
eralThreatBias (rs = .07; p = .60), between ASATotal 
and SpecificThreatBias (rs = -.07; p = .62), or between 
ASATotal and FacialThreatBias (rs = .12, p = .37). 
 Average accuracy at detecting the arrow direc-
tion on all trials within the Specific Word task and 
the General Word task was high (see Table 2 for in-
dividual task accuracy percentages). To determine 
whether participants might be less accurate on trials 
that contained threatening stimuli (as compared to 
neutral-only trials) which would represent a marker 

of emotional interference effects, we calculated in-
tra-individual difference scores in accuracy for these 
trial types by subtracting accuracy on threat trials 
from accuracy on neutral trials. The within-subject 
difference in accuracy, as calculated, was then cor-
related with participants’ total score on the ASA-27. 
Spearman’s rho showed a weak to moderate negative 
correlation between differences in accuracy on Specific 
Word task trials and total score on the ASA-27 (rs = 
-.38, p = .004), which was statistically significant. In 
contrast, there was no relationship between ASAD 
symptoms and the difference in accuracy comparing 
trials involving general threat words to neutral words 
as there was no significant correlation found between 
the difference in accuracy on General Word task tri-
als and total score on the ASA-27 (rs = -.16, p = .22). 

Discussion
 This study sought to determine if adults with 
greater levels of ASAD symptoms would also display 
greater attentional bias to threatening stimuli (gener-
al and separation-specific). The hypothesis that those 
who score higher on a measure of ASAD would have 
a greater attentional bias toward specifically threat-
ening words was not supported, as the correlations 
between reaction time on dot-probe tasks and total 
scores on the ASA-27 were not significant. However, 
the significant correlation between difference in ac-
curacy on Specific Word task trials and total score on 
the ASA-27 indicates that participants with higher 
levels of ASAD symptoms had a greater reduction in 
accuracy on separation-specific threat trials than on 
neutral trials. This reduction in accuracy would sug-
gest that seeing the words related to separation caused 
impaired accuracy in identifying the target, possibly an 
emotional interference effect specific to words related 
to separation that did not extend to general threat.  
 One possible explanation for these results is the 
vigilance-avoidance theory of attentional bias (In-Al-
bon et al., 2010). The vigilance-avoidance theory of at-
tention theorizes that anxious individuals may initially 
be vigilant towards threat in their surroundings, but 
upon detecting threat, subsequently avoid the threat 
and divert attention away from it. In-Albon et al. 
(2010) found that in the first 1000ms of a task, both 
anxious and non-anxious participants gazed at threat-
ening images and neutral images for a similar length of 
time, but after 1000ms, anxious participants gazed at 



38

KAISER & WHEATON

threatening images longer than at the neutral images. 
After 3000ms, anxious participants gazed at threat-
ening images for a shorter duration than they did the 
neutral images, indicating that within the duration of 
1000ms to 3000ms anxious individuals may be vigi-
lant toward threat before subsequently disengaging 
from the threat and avoiding it. The display duration 
of the dot-probe task word pairs used in this study was 
500ms, which may have been too short a duration to 
assess attentional bias away from threat. If the display 
duration was longer than 1000ms, it is possible that vig-
ilance toward threatening words would have been seen. 
 Though the original hypothesis of this paper was 
not supported by the results, there was a significant 
correlation between a reduction in accuracy on the 
dot-probe tasks and ASAD symptom levels. Partic-
ipants who scored higher on the ASA-27 performed 
less accurately on trials that included an ASAD-specif-
ic threat rather than a general threat. Based on these re-
sults, we hypothesize that ASAD-specific threats may 
have led to an emotional trigger that resulted in poorer 
task performance. However, it is important to note that 
these findings are correlational, and additional research 
is needed to further understand the nature of this re-
lationship and any potential causal factors involved. 
 Limitations of this study included a small sample 
size, a limited participant age range of 18-21, and using 
convenience sampling to recruit participants, which 
may have resulted in bias. This was a non-clinical 
sample, and therefore all results are based on ASAD 
symptom levels rather than a clinical diagnosis. Fur-
thermore, we recognize a major limitation in the fact 
that we did not screen participants for any comorbid 
disorders, and it is possible that subjects had co-occur-
ring anxiety disorders. Another limitation was includ-
ing only one length of our dot-probe task trials, which 
as discussed above, may have impacted our findings. In 
addition, our facial stimuli were limited and did not 
include images from all racial-ethnic groups. Future 
studies should seek to investigate the role of attention-
al bias in a large population of adults with varying ages 
and a primary diagnosis of ASAD, as a greater sample 
size and clinical sample are both necessary to replicate 
and extend these findings. This study was also limit-
ed by its correlational design; future studies should 
investigate this topic with experimental approaches.
 Additionally, testing the use of dot-probe tasks 
with varying display duration could provide addition-

al understanding of how attentional bias operates in 
ASAD and provide insight into what specific factors 
may impede cognitive processes. For example, dot-
probe tasks with a duration greater than 3000ms on 
trials may show an attentional bias towards specific 
threats but not general threats. Results of the current 
study suggest that there may be a negative effect of 
disorder-specific threats on task performance, which 
should be further researched due to its possible appli-
cations, such as informing treatment. For instance, in 
work settings, individuals with ASAD may struggle 
to perform well on tasks when exposed to stimuli re-
lated to their separation anxiety, such as reminders of 
separation from attachment figures. This can affect 
job performance and overall success. Through cogni-
tive restructuring and attentional training exercises, 
individuals can learn to redirect their attention away 
from threat cues and develop more adaptive coping 
strategies (Hakamata et al., 2010). This highlights the 
importance of considering disorder-specific threats 
and attentional biases in the assessment and treatment 
planning for ASAD, enhancing the effectiveness of 
interventions and improving overall outcomes for in-
dividuals experiencing separation anxiety. Researchers 
might test the effects of ASAD-specific threat words in 
a clinical sample on various tasks, including the Stroop 
task which has been previously used to assess emotional 
interference effects. Future work could also investigate 
if disorder-specific triggers affect task performance in 
those with other anxiety disorders in the same manner.
Conclusion
 This study examined attentional bias in a sam-
ple of adults, some of whom experienced symptoms 
of ASAD, using the dot-probe task. The aim was to 
elucidate the relationship between these two vari-
ables and inform the creation of targeted treatment. 
Although the initial hypothesis that higher ASAD 
symptom severity would correlate with greater atten-
tional bias toward threatening stimuli was not sup-
ported, there was a significant correlation between 
ASAD symptom levels and reduced accuracy in trials 
involving ASAD-specific threat words. These results 
suggest that there may be emotional interference oc-
curring in ASAD-specific threat trials which affects 
task performance. However, this study’s findings were 
correlational, and additional research is needed to 
better understand the relationship and mechanisms. 



39

ATTENTIONAL BIAS AND SYMPTOMS OF ADULT SAD  

References
American Psychiatric Association. (1994). Diagnostic 

and statistical manual of mental disorders (4th 
ed.). American Psychiatric Publishing.

American Psychiatric Association. (2013). Diagnostic 
and statistical manual of mental disorders (5th 
ed.). American Psychiatric Publishing.

American Psychiatric Association. (2022). Diagnostic 
and statistical manual of mental disorders (5th 
ed., Text Revision). American Psychiatric Pub-
lishing.

Azriel, O., & Bar-Haim, Y. (2020). Attention bias. In 
J. S. Abramowitz & S. M. Blakey (Eds.), Clinical 
handbook of fear and anxiety: Maintenance pro-
cesses and treatment mechanisms (pp. 203–218). 
American Psychological Association. https://doi.
org/10.1037/0000150-012

Baldwin, D. S., Gordon, R., Abelli, M., & Pini, S. 
(2016). The separation of adult separation  
 anxiety disorder. CNS Spectrums, 21, 289-294. 
https://doi.org/10.1017/S1092852916000080

Bantin, T., Stevens, S., Gerlach, A. L., & Hermann, 
C. (2016). What does the facial dot-probe task tell 
us about attentional processes in social anxiety? 
A systematic review. Journal of Behavior Therapy 
and Experimental Psychiatry, 50, 40-51. https://
doi.org/10.1016/j.jbtep.2015.04.009

Bar-Haim, Y., Lamy, D., Pergamin, L., Baker-
mans-Kranenburg, M. J., & Van Ijzendoorn, M. 
H. (2007). Threat-related attentional bias in anx-
ious and non-anxious individuals: a meta-analytic 
study. Psychological Bulletin, 133(1), 1-24. https://
doi.org/10.1037/0033-2909.133.1.1

Barry, T. J., Vervliet, B., & Hermans, D. (2015). An 
integrative review of attention biases and their 
contribution to treatment for anxiety disor-
ders. Frontiers in Psychology, 6, 968. https://doi.
org/10.3389/fpsyg.2015.00968 

Bogels, S., Knappe, S., & Clark, L. (2013). Adult 
separation anxiety disorder in DSM-5. Clinical-
Psychology Review, 33(5). 663-674. https://doi.
org/10.1016/j.cpr.2013.03.006

Hakamata, Y., Lissek, S., Bar-Haim, Y., Britton, J. C., 
Fox, N. A., Leibenluft, E., Ernst, M., & Pine, D. 
S. (2010). Attention bias modification treatment: 
a meta-analysis toward the establishment of nov-
el treatment for anxiety. Biological psychiatry, 
68(11), 982–990. https://doi.org/10.1016/j.bio-

psych.2010.07.021
In-Albon, T., Kossowsky, J., & Schneider, S. (2010). 

Vigilance and avoidance of threat in the eye move-
ments of children with separation anxiety disor-
der. Journal of Abnormal Psychology, 38(2), 225-
235. https://doi.org/10.1007/s10802-009-9359-4

Kindt, M., Bögels, S., & Morren, M. (2003). Process-
ing bias in children with separation anxiety disor-
der, social phobia and generalised anxiety disor-
der. Behaviour Change, 20(3), 143-150. https://
doi.org/10.1375/bech.20.3.143.24832

MacLeod, C., Mathews, A., & Tata, P. (1986). At-
tentional bias in emotional disorders. Journal 
of Abnormal Psychology, 95(1), 15. https://doi.
org/10.1037/0021-843X.95.1.15

Manicavasagar, V., Silove, D., Wagner, R., & Drob-
ny, J. A. (2003). A self‐report questionnaire for 
measuring separation anxiety in adulthood. Com-
prehensive Psychiatry, 44, 146–153. https://doi.
org/10.1053/comp.2003.50024 

Manicavasagar, V., & Silove, D. (2020). Separation 
anxiety disorder in adults: Clinical features, diag-
nostic dilemmas and treatment guidelines. Elsevier 
Academic Press.

Pergamin-Hight, L., Naim, R., Bakermans-Kranen-
burg, M. K., van IJzendoorn, M. H., & Bar-Haim, 
Y. (2015). Content specificity of attention bias to 
threat in anxiety disorders: a meta-analysis. Clin-
ical Psychology Review, 35, 10-18. https://doi.
org/10.1016/j.cpr.2014.10.005

Price, R. B., Siegle, G. J., Silk, J. S., Ladouceur, C., Mc-
Farland, A., Dahl, R. E., & Ryan, N. D. (2013). 
Sustained neural alterations in anxious youth 
performing an attentional bias task: A pupilome-
try study. Depression and Anxiety, 30(1), 22-30. 
https://doi.org/10.1002/da.21966

Roy, A. K., Vasa, R. A., Bruck, M., Mogg, K., Bradley, 
B. P., Sweeney, M., ... & CAMS Team. (2008). At-
tention bias toward threat in pediatric anxiety dis-
orders. J. Am. Acad. Child & Adolescent Psychia-
try, 47(10), 1189-1196. https://doi.org/10.1097/
CHI.0b013e3181825ace

Salum, G. A., Mogg, K., Bradley, B. P., Gadelha, A., 
Pan, P., Tamanaha, A. C., ... & Pine, D. S. (2013). 
Threat bias in attention orienting: evidence of 
specificity in a large community-based study. Psy-
chological Medicine, 43(4), 733-745. https://doi.
org/10.1017/S0033291712001651



40

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Shear, K., Jin, R., Ruscio, A. M., Walters, E. E., & 
Kessler, R. C. (2006). Prevalence and correlates 
of estimated DSM-IV child and adult separation 
anxiety disorder in the national comorbidity 
survey replication. American Journal of Psychi-
atry, 163, 1074-1083. https://doi.org/10.1176/
ajp.2006.163.6.1074

Waters, A. M., Bradley, B. P., and Mogg, K. (2014). Bi-
ased attention to threat in pediatric anxiety disor-
ders (generalized anxiety disorder, social phobia, 
specific phobia) separation anxiety disorder) as a 
function of ‘distress’ versus ‘fear’ diagnostic cate-
gorization. Psychological Medicine, 44, 607-616. 
https://doi.org/10.1017/S0033291713000779



41

ATTENTIONAL BIAS AND SYMPTOMS OF ADULT SAD  

Figure 1

Examples of the Dot-Probe Tasks’ Displays

Note. This figure provides examples of how word pairs were displayed in the General Threat Word dot-
probe task and the Specific Threat Word dot-probe task, as well as the arrow probe used in all trials. 



42

KAISER & WHEATON

Table 1

Examples of Word Pairs Used in the Dot-Probe Tasks

Note. This table displays the mean percentage of accurate responses in indicating the direction of the 
arrow probe on four trial types.

Table 2

Mean Percentage of Accurate Responses


