Cognitive Therapy and Research

, Volume 42, Issue 6, pp 856–866 | Cite as

Does Exposure Therapy Lead to Changes in Attention Bias and Approach-Avoidance Bias in Patients with Social Anxiety Disorder?

  • Isabel L. KampmannEmail author
  • Paul M. G. Emmelkamp
  • Nexhmedin Morina
Original Article


Cognitive biases have been suggested to play a crucial role in the etiology and maintenance of social anxiety disorder (SAD). The aim of the present study was to investigate the effects of exposure therapy on attention- and approach-avoidance bias in SAD. In a randomized controlled trial, we compared changes from pre- to posttreatment in both biases in patients receiving stand-alone exposure therapy to a waiting-list control condition comprising 60 participants (Mage = 36.9 years) with SAD with heterogeneous social fears. Before and after treatment, attention bias was assessed using the dot probe task and approach-avoidance bias using the approach avoidance task. Results revealed that pre- to posttreatment changes in attention bias and approach-avoidance bias in exposure therapy did not significantly differ from changes in the waiting-list condition. Limitations and potential implications of the current results are discussed.


Exposure therapy Social anxiety disorder Cognitive biases Attention bias Approach avoidance bias 



This work was supported by the Netherlands Organisation for Scientific Research (NWO; 655.010.207). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. We thank the Intelligent System Department of the Delft University of Technology for their technical support.

Compliance with Ethical Standards

Conflict of Interest

Isabel L. Kampmann, Paul M.G. Emmelkamp, and Nexhmedin Morina declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Animal Rights

This article does not contain any studies with animals performed by any of the authors.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

10608_2018_9934_MOESM1_ESM.docx (14 kb)
Supplementary material 1 (DOCX 13 KB)
10608_2018_9934_MOESM2_ESM.docx (30 kb)
Supplementary material 2 (DOCX 30 KB)


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Authors and Affiliations

  1. 1.Department of Clinical PsychologyUniversity of AmsterdamAmsterdamThe Netherlands
  2. 2.Department of Clinical PsychologyWestfälische Wilhelms-University MünsterMünsterGermany
  3. 3.HSK Groep WoerdenWoerdenThe Netherlands

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