Investigation of attentional bias in obsessive-compulsive disorder

  • Rachel Johnston

Student thesis: Doctoral ThesisDoctor of Philosophy


Obsessive-compulsive disorder (OCD) is a prevalent mental health difficulty that has a substantive negative impact on quality of life. The leading psychological treatment, Exposure and Response Prevention (ERP), is highly effective but has high rates of treatment refusal and dropout resulting in a need for innovative, acceptable and effective interventions for OCD to be created. A potential avenue for therapeutic intervention is the reduction of an attentional bias for anxiogenic stimuli. Salkovskis’ (1999) model of OCD suggests that an attentional bias for symptom specific to OCD symptoms plays a role in the creation and maintenance of symptoms. However, the previous literature exploring attentional bias in OCD has produced inconsistent findings and as a result the attentional processes involved in OCD are unclear. An intervention that targets attention bias and has significant therapeutic potential is Attentional Bias Modification Training (ABMT). ABMT has demonstrated efficacy in treating symptoms of psychopathology, but little research has been carried out on the application of ABMT to OCD. The aims of this PhD project was to explore an attentional bias in OCD in order to: 1. discern if ABMT paradigms are acceptable, efficacious interventions for OCD; 2. improve the stimuli and paradigms used in the measurement of attentional bias; and 3. further explore the mechanisms of attentional bias using this improved measurement understanding.

Chapter 4 aimed to explore the perceived acceptability of ABMT by 66 individuals with a self-reported diagnosis of OCD and compared this with acceptability of ERP in order to ascertain if ABMT would be a preferable treatment option. The results indicated that ERP was rated higher than ABMT in terms of level of anxiety-provocation and how challenging it would be as a treatment modality. Despite this, ERP was also rated higher by participants for its effectiveness and ability to reduce OCD symptoms.

Chapter 5 aimed to compare the effects of ABMT with those of ERP on attentional bias, OCD symptoms and performance in a behavioural approach task (BAT) towards contamination related objects. A total of 77 participants without a diagnosis of OCD but with clinical levels of OCD symptoms took part. In contrast to what was hypothesised, the results of Chapter 5 found that ABMT had a negative influence on attentional bias. Inspection of BAT performance revealed that both ERP groups displayed significantly greater reduction of avoidance in the BAT task in comparison to the ABMT group. No differences were detected between acceptability of the ERP group and ABMT.

Chapter 6 sought to create and validate visual stimuli related to OCD symptoms of symmetry, checking and contamination as there are few visual resources available for OCD research which is problematic when investigating attentional biases and designing appropriate interventions. It also included a neutral category that could be employed as control images. The images were validated by three groups: individuals with OCD (N=25), clinical psychologists (N=5) and a control group (N=40). A high test-retest reliability and Cronbach’s alpha was found for the stimuli set.

The previous research exploring attentional bias in OCD has been filled with inconsistent and conflicting findings. Chapter 7 aimed to investigate the conditions in which an attentional bias in OCD can be observed by comparing different types of stimuli and methods of measuring attention. Participants were individuals with moderate obsessive-compulsive symptoms with contamination concerns (N=21) and control participants (N=21). The results found that the traditional approach for measuring attentional bias, reaction time, did not reveal any significant findings. However, the eye tracking data found that all participants displayed attentional biases for aversive words, aversive images and contamination images. No attentional bias was detected for neutral stimuli or contamination related words. The results suggest that reaction time is not sensitive enough to detect an attentional bias. They also support the argument that verbal stimuli may not be enough to provoke anxiety in individuals with contamination concerns as neither reaction time nor eye tracking data found evidence of an attentional bias. Finally, Chapter 8 provides a discussion of the clinical implications of the empirical findings of the current thesis.
Date of AwardJul 2020
Original languageEnglish
Awarding Institution
  • Queen's University Belfast
SponsorsNorthern Ireland Department for the Economy
SupervisorEugene O'Hare (Supervisor) & Donncha Hanna (Supervisor)


  • obsessive-compulsive disorder
  • OCD
  • eye tracking
  • attentional bias

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