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Małgorzata Starzomska
Recent years have seen an increasing interest in the cognitive approach to eating disorders, which postulates that patients selectively attend to information associated with eating, body shape, and body weight. The unreliability of self-report measures in eating disorders due to strong denial of illness gave rise to experimental studies inspired by research into anxiety disorders involving attentional bias, with the prevalent method being a modified color-naming Stroop task. Unfortunately, that tool was shown to exhibit many limitations, especially in terms of attentional bias measurement. Thus, researchers started to seek alternative methods of evaluating attention in persons with eating disorders. Along with the Stroop test and the Posner paradigm, one of the most frequently used methods is the dot probe task. This paper presents the dot probe protocol as well as the rationale underpinning its use, including its advantages and drawbacks.
Furthermore, a modification of the task is proposed to enable the assessment of all components of attentional bias in patients with eating disorders. The paper also discusses practical implications of the modification for the treatment of these patients. For several years now there has been an increasingly widespread use of so-called attentional training employing, amongst others, the dot probe task, which may be modified for the purpose of reducing or eliminating of attentional biases in patients with eating disorders. Unfortunately, due to the absence of studies providing a reliable account of all types of attentional bias in eating disorders, this field of research lags considerably behind anxiety research and does not enable therapeutic applications.
For many years now researchers have endeavored to determine the etiology of eating disorders and discover how they are maintained.
Recently, an increasing focus has been directed to the cognitive approach, including selective attention. There is robust evidence that eating disordered individuals display an attentional bias for eating disorder-salient stimuli.
Scholars have at their disposal a wide array of measures which have been successfully deployed in studies on fear. The attentional bias test most frequently used on patients with eating disorders is the Stroop test, which is unfortunately fraught with some shortcomings and it is debatable whether it actually measures attentional bias or distraction. One of the most promising measures of attentional bias, which is increasingly often used in eating disorder research, is the dot probe task. Again, the popularly used version of this tool has a number of shortcomings; for instance, the obtained results do not permit a distinction between the various components of attention (i.e., vigilance to relevant stimuli vs. difficulty disengaging attention from those stimuli). The modification introduced by Koster and colleagues (2004) is particularly promising as it solves the problem by means of baseline trials (with both stimuli being neutral). On the one hand, meta-analyses concerning the dot probe task in patients with eating disorders and analogue conditions indicate that this task needs to be methodologically perfected (it sometimes leads to inconclusive results). On the other hand, the rapidly increasing numbers of studies in this area make it possible to attain a more comprehensive view of attentional bias in this group of patients. In recent years, it has been suggested that the dot probe task could be used as a tool for training attentional bias in eating disordered patients (e.g., Renwick 2013a,b). Some researchers (e.g., Kemps et al., 2016) have already successfully undertaken such efforts (albeit only on subclinical groups).
Indeed, this type of attention training has been found to result in very good outcomes. It should be emphasized that the use of such an intervention in eating disorders, whether as a stand-alone treatment or as an adjunct to the standard therapy, offers promising prospects to the patients as long as the training is designed to include all components of attentional bias.
