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Threat Sensitivity

Some individuals may be more vulnerable to acute or chronic stress due to past experiences (trauma, early adversity), current environment (poverty, stigmatization), and/or personality/dispositions. Individual moderators of stress may illuminate who is more or less likely to experience physical or mental health problems. There are a variety of measures that attempt to capture individual vulnerability. Here we review a class of measures that fall under the larger category of “Threat Sensitivity Measures.” All of these measures offer a non-self-report approach to measuring threat sensitivity, which reduces concerns related to social desirability and dispositional positive/negative responding. Below we review seven of the most commonly used threat sensitivity measures.

Dot Probe Task​

The Dot Probe Task for assessment of attentional bias for threat displays two stimuli (e.g., words/images) on a screen with one at the top and the other at the bottom (or one on the left and one on the right). Following a brief presentation of the stimuli (e.g., 500ms), both stimuli disappear and a probe appears in the place of one of the stimuli. The participant must either identify the probe or indicate where it appeared as quickly as possible. Outcomes are based on response times to probes replacing threatening versus neutral stimuli (MacLeod, Mathews, & Tata, 1986; Mather & Carstensen, 2005; Wald et al., 2011). 

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Reliability: Both the test-retest reliability and internal consistency are “very low” for dot probe difference scores (i.e., bias scores). However, the test-retest reliability of individual emotional and neutral response times may be higher.

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State or trait:  Attentional bias for threat using dot probe associated with trait anxiety in a meta-analysis. Older adults with high trait anxiety scores show a “vigilant-avoidant” reaction to sad faces (i.e., initially orient towards sad faces and then away from threat) and an “avoidant-vigilant” reaction to negative words (i.e., initially orient away from negative words but then towards them) (Lee & Knight, 2009). 

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Associations with chronic stress and depression: In a meta-analysis of 29 studies, there was a moderate and significant difference in attentional bias between groups, with depressed subjects showing significantly greater bias towards negative stimuli than healthy individuals (Peckham et al., 2010).

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Stroop Task

The Modified Stroop Task for assessment of cognitive interference by threat includes different types of words (either neutral or threatening) in varying colors. The participant is asked to report the color of the text while ignoring the semantic content of the word. One variation includes emotional and neutral pictures tinted a certain color. Longer response times to report the color of threat words indicate greater cognitive interference by threatening information (MacLeod, 1991; Michael et al., 2002).

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Reliability: Test-retest reliability and internal consistency appear low for difference scores between neutral and threatening conditions, but higher for scores for either neutral or threatening conditions considered separately (Cisler et al., 2009; Kindt, Bierman, & Brosschot, 1996; Schmukle, 2005; Siegrist, 1997; Strauss et al., 2005).

State or trait. Researchers found a significant relationship between state anxiety and emotional Stroop reaction times (Dresler et al., 2009). The combination of low trait anxiety and high social desirability was associated with less interference in naming threat compared to neutral words, whereas the combination of high trait anxiety and low social desirability was associated with increased interference due to threat words (Mogg et al., 2000).

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Associations with chronic stress and depression: In a meta-analysis of 29 studies, there was a marginally significant difference in Stroop scores between depressed and non-depression groups (Peckham et al., 2010). Lim and Kim reported depressed patients showed slower response times to negative words on the Stroop compared to healthy controls (Lim & Kim, 2005). A study by Broomfield et al reported a similar finding in elderly depressed patients (Broomfield et al., 2007). Conversely, Hill and Knowles reported that depressed subjects did not show selective attention to threat and instead displayed slower responses to all verbal stimuli, including threatening, negative and positive nouns (Hill & Knowles, 1991). Kerr et al reported similar findings, with MDD patients demonstrating slower response times on neutral, positive and negative conditions compared to healthy subjects (Kerr, Scott, & Phillips, 2005).

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Posner Cueing Task/Posner Paradigm

Participants are asked to focus on a fixation point between two rectangles. A cue is presented in one of the rectangles (e.g. a threatening stimulus), which is followed by an asterisk appearing in one of the two rectangles. The participants press a key to indicate which rectangle the asterisk is in. The paradigm consists of “valid cues” (i.e. the cue brings attention to the rectangle the asterisk then appears in), “invalid cues” (i.e. the cue brings attention to the opposite rectangle that the asterisk then appears in), and “uncued” trials (no cue is presented). If a participant can detect the probe faster on validity cued trails with a threatening cue, it suggests “facilitated attention to threatening cues” as the threatening stimulus brings attention to the probe faster than a neutral cue. If a participant is slower in detecting the probe during invalid cues with a threatening cue, it suggests “difficulty in disengaging” from the threatening cue (Cisler et al., 2009).

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Reliability: Attention bias scores from the Posner task have low reliability (Enock, Hofmann, & McNally, 2014).

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State or trait: Differences in attentional engagement and disengagement between high and low trait anxious individuals (Sagliano et al., 2014). High compared to low trait anxious individuals showed slower reaction times on trials with invalid threat cues than invalid neutral cues, indicating difficulty in disengagement from threat cues. However, threat cues led to the slowing of reaction times in high but not low anxious individuals. When adjusting for this threat cue-related slowing, high anxious individuals showed greater engagement with threat cues, but no evidence of bias in disengagement processes (Mogg et al., 2008).

 

Associations with chronic stress and depression: Unknown

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Fear Potentiated Startle

Startle responses to an acoustic stimulus are examined in varying threat conditions. Threat can be manipulated using dark/light, threat of shock and threat of airpuff etc. Outcomes can include changes in electromyography (EMG; eye blink, heart rate, skin conductance etc.). One startle paradigm consists of a visual threat cue (a monitor displaying the condition) as well as devices to deliver audio and shock and three threat conditions: low threat (participants perform the procedure without a finger shock device and are told they would not be shocked); ambiguous threat (participants wear a finger electrode during the procedure but are indicated by the monitor that they would not be shocked); and high shock (participants wear the finger shock device and the monitor indicated that shocks are possible). During the high threat condition, all shocks are delivered after the auditory cues (Pole et al., 2007).

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Reliability: Multiple studies have claimed that the fear-potentiated startle response is a reliable measure that produces a reliable startle response in non-humans. However, reliability is less clear in humans (Campeau, Liang, & Davis 1990; Davis, 1993; Falls, Miserendino, & Davis, 1992).

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State or trait: The measure has been correlated more with state anxiety (as measured by the STAI). Grillon, C., et al. found that high-fear subjected (based on state anxiety score) had larger startle amplitudes at time of shock expectation compared to low-fear. Further, the high fear subjects showed no difference in startle amplitude during the transition between No-Threat and Treat conditions. Trait anxiety was not associated with fear-potentiated startle (Grillon et al., 1993; Morgan et al., 1995).

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Associations with chronic stress and depression: In a study of individuals with MDD, a lifetime history of suicide attempt was associated with an increased fear-potentiated startle to predictable shock. Further, the retrospective subjective anxiety ratings were higher for subjects with a suicide attempt history during the unpredictable condition than for subjects without a history (Ballard et al., 2014). Another study investigated whether children and grandchildren of individuals with MDD would exhibit increased startle reactivity. Results of the fear-potentiated startle task revealed a significantly greater overall magnitude of startle for the high-risk group compared to the low-risk group (Grillon et al., 2005). Finally, another study showed that childhood trauma was associated with greater skin conductance responses to startle across all threat conditions (Pole et al., 2007).

 

Dichotic Listening Task

This task is used to study selective attention. In this task, the participant is presented with two different stimuli simultaneously, each on one side of the headphones. The participant is directed to repeat aloud the words they heard in one ear while a different message is presented in the other year. As a result of focusing to repeat the words, participants do not notice the message in the other year, suggesting a selective consciousness to specific information. Attention bias in this task can be measured through 4 ways: 1) Asking the participants questions about the two different auditory stimuli, 2) Questions about the patterns of the words they were told to attend to, 3) both parts 1) and 2), or 4) Detect target words in the list of words (Arciuli & Slowiaczek, 2006; Drachman et al., 1980; Moray, 1959).

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Reliability: Unknown

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State or trait: Anxious subjects complaining of generalized anxiety were slower in performing a simultaneous reaction time task when unattended words were threatening in content, although neither anxious nor non-anxious subjects could report on or recognize the words to which they had been exposed (Mathews, Andrew, & MacLeod, 1986).

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Associations with chronic stress and depression: Researchers found that patients with anxious depression have a greater propensity to activate right than left-hemisphere regions during auditory tasks. Those with a non-anxious depression have the opposite hemispheric asymmetry. There was no group difference in the sensitivity to emotional words (Bruder et al., 1999). In another study, researchers did not find a significant difference in cognitive functioning between depressed patients and the control group. Both groups showed a right ear advantage during the not-forced and forced-right conditions and a left ear advantage during the forced left condition (Hugdahl et al., 2003).

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Facial Recognition Task

In relation to threat sensitivity, this task is also known as the Fearful Face Detection Task. This task asks participants to focus on a central point on a screen to orient themselves to the task, which is then followed by a blank screen. Next, a pair of faces appear on the screen consecutively. The first of the two faces, the target, is either fearful, happy, or neutral. The second face is neutral. Participants are asked to press a button to denote when they perceive fear, and press another button when they do not perceive fear. Threat sensitivity is measured by response time to each pair of faces, contrasting a pairing of neutral-neutral faces and fearful-neutral faces (Doty et al., 2013; Pessoa et al., 2006).

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Reliability: Unknown

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State or trait: Higher trait anxiety scores correlate with detection sensitivity for fearful faces. Subjects who were faster to correctly identify faces as fearful also had higher levels of state anxiety (Doty et al., 2013).

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Associations with chronic stress and depression: Unknown

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Author(s) and Reviewer(s): Prepared by Aoife O'Donovan, PhD. Reviewed by Stress Measurement Network leadership. If you have any comments on these measures, email aoife.odonovan@ucsf.edu.

Version date: February 2018.

 

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References:

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Arciuli, J., & Slowiaczek, L. M. (2006). What does Dichotic Listening reveal about the Processing of Stress Typically? http://www.assta.org/sst/2006/sst2006-9.pdf

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Ballard, E.D., Ionescu, D.F., Vande Voort, J.L., Slonena, E.E., Franco-Chaves, J.A., Zarate, C.A., Grillon, C. (2014). Increased Fear-Potentiated Startle in Major Depressive Disorder Patients with Lifetime History of Suicide Attempt. Journal of Affective Disorders, 162. 34-38

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Broomfield NM, Davies R, MacMahon K, et al. Further evidence of attentional bias for negative information in late life depression. Int J Geriatr Psych 2007;22:175–180.

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Bruder, G.E., Wexler, B.E., Stewart, J.W., Price, L.H., Quitkin, F.M. (1999). Perceptual asymmetry differences between major depression with or without a comorbid anxiety disorder: A dichotic listening study. Journal of Abnormal Psychology, 108(2). 233-239

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Campeau, S., Liang, K.C., Davis, M. (1990). Long-term retention of fear-potentiated startle following a short training session. Animal Learning & Behavior, 18, 462-468

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Cisler, J.M., Bacon, A.K., Williams, N.L. (2009). Phenomenological Characteristics of Attentional Biases Towards Threat: A Critical Review. Cogn Ther Res, 33(2). 221-234

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Davis, M. (1993). Pharmacological analysis of fear-potentiated startle. Brazilian Journal of Medical and Biological Research, 26, 235-60

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Doty, T.J., Japee, S. Ingvar, M., Ungerleider, L.G. (2013). Fearful Face Detection Sensitivity in Healthy Adults Correlates with Anxiety-Related Traits. Emotion, 13, 183-188

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Drachman, D. A., Noffsinger, D. Sahakian, B. J., Kurdziel, S., & Fleming, P. (1980). Aging, memory, and the cholinergic system: A study of dichotic listening. Neurobiology of Aging, 1, 39-43, ISSN 0197-4580, http://dx.doi.org/10.1016/0197-4580(80)90022-6.

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Dresler, T., Meriau, K., Heekeren, H.R., van der Meer, E. (2009). Emotional Stroop task: effect of word arousal and subject anxiety on emotional interference. Psychology Research, 73(3). 364-71

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Enock, P.M., Hofmann, S.G., McNally, R.J. (2014). Attention Bias Modification Training Via Smartphone to Reduce Social Anxiety: A Randomized, Controlled Multi-Session Experiment. Cogn Ther Res, 38. 200-216

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Falls, W.A., Miserendino, M.J., Davis, M. (1992). Extinction of Fear-potentiated Startle: Blockade by Infusion of an NMDA Antagonist into the Amygdala. The Journal of Neuroscience, 12, 854-863

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Grillon, C., Ameli, R., Foot, M., Davis, M. (1993). Fear-potentiated startle: relationship to the level of state/trait anxiety is healthy subjects. Biological Psychiatry, 33(8-9). 566-74

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Grillon, C., Warner, V., Hille, J., Merikangas, K. R., Bruder, G. E., Tenke, C. E., ... & Weissman, M. M. (2005). Families at high and low risk for depression: a three-generation startle study. Biological psychiatry, 57(9), 953-960.

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Hill AB, Knowles TH. Depression and the “emotional” Stroop effect. Pers Indiv Differ 1991;12:481–485.

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Hugdahl, K., Rund, B.R., Lund, A., Asbjornsen, A., Egeland, J., Landro, N.I., Roness, A., Stordal, K.I., Sundet, K. (2003). Attentional and executie dysfunctions in schizophrenia and depression: evidence from dichotic listening performance. Biological Psychiatry, 53(7), 609-616

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Kerr N, Scott J, Phillips ML. Patterns of attentional deficits and emotional bias in bipolar and major depressive disorder. Br J Clin Psychol 2005;44:343–356.

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Kindt M, Bierman D, Brosschot JF. Stroop versus Stroop: comparison of a card format and a singletrial format of the standard color-word Stroop task and emotional Stroop task. Personality and Individual Differences 1996;21:653–661.

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Lee, L.O., Knight, B.G. (2009). Attentional Bias for Threat in Older Adults: Moderation of the Positivity Bias by Trait Anxiety and Stimulus Modality. Psychology and Aging, 24(3). 741-747

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Lim SL, Kim JH. Cognitive processing of emotional information in depression, panic, and somatoform disorder. J Abnorm Psychol 2005;114:50–61.

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MacLeod, C, Mathews, A., & Tata, P. (1986). Attentional Bias in emotional disorders. Journal of Abnormal Psychology, 95, 15-20. http://dx.doi.org/10.1037/0021-843X.95.1.15

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MacLeod, C. (1991) Half a century of research on the Stroop effect: An integrative review. Psychological Bulletin, 1091, 163-203. http://dx.doi.org/10.1037/0033-2909.109.2.163

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Mather, M. & Carstensen, L. (2005). Aging and motivated cognition: the positivity effect in attention and memory, Trends in Cognitive Sciences, 9, 496-502. doi.org/10.1016/j.tics.2005.08.005.

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Mathews, Andrew, and MacLeod. 1986. "Discrimination of threat cues without awareness in anxiety states." Journal of Abnormal Psychology 95, 131-138.

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Matsumoto, E. (2010). Bias in Attending to Emotional Facial Expressions: Anxiety and Visual Search Efficiency. Applied Cognitive Psychology, 24. 414-424

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Michael P., Milham, K., Erickson, M., Banich, AF., Kramer, AW, Wszalek, T., & Cohen, N.J. (2002). Attentional Control in the Aging Brain: Insights from an fMRI Study of the Stroop Task, Brain and Cognition, 49, 277-296, http://dx.doi.org/10.1006/brcg.2001.1501.

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Mogg, K., Bradly, B., Dixon, C., Fisher, S., Twelftree, H., McWilliams, A. (2000). Trait anxiety, defensiveness and selective processing of threat: an investigation using two measures of attentional bias

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Mogg, K., Holmes, A., Garner, M., Bradley, B.P. (2008). Effects of threat cues on attentional shifting, disengagement and response slowing in anxious individuals. Behav Res Ther, 46(5). 656-667.

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Moray, N. (1959). Attention in dichotic listening: Affective cues and the influence of instructions. Quarterly journal of experimental psychology 11, 56-60.

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Morgan, C., Grillon, C., Southwick, S., Davis, M., Charney, D. (1995). Fear-Potentiated Startle in Posttraumatic Stress Disorder

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Peckham, A. D., McHugh, R. K. and Otto, M. W. (2010), A meta-analysis of the magnitude of biased attention in depression. Depress. Anxiety, 27: 1135–1142. doi: 10.1002/da.20755

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Pessoa, L., Japee, S., Sturman, D., Ungerleider, L.G. (2006). Target Visibility and Visual Awareness Modulate Amygdala Responses to Fearful Faces. Cerebral Cortex, 16(3). 366-375

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Pole, N, Neylan, T. C., Otte, C., Metzler, t. J., Best, s. R., Henn-Haase, C., & Marmar, C. R. (2007). Associations between childhood trauma and emotion-modulated psychophysiological responses to startling sounds: A study of police cadets. Journal of Abnormal Psychology 116, 352.

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Sagliano, L., Trojano, L., Amoriello, K., Migliozzi, M., D’Olimpio, F. (2014). Attentional biases toward threat: the concomitant presence of difficulty of disengagement and attentional avoidance in low trait anxious individuals. Frontiers in Psychology, 5(685).

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Strauss, G.P., Allen, D.N., Jorgensen, M.L., Cramer, S.L., (2005). Test-Retest Reliability of Standard and Emotional Stroop Tasks: An Investigation of Color-Word and Picture-Word Versions. Assessment, 12(3). 330-337

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Schmukle SC. Unreliability of the dot probe task. European Journal of Personality 2005;19:595–605.

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Siegrist M. Test-retest reliability of different versions of the Stroop test. The Journal of Psychology 1997;131:299–306.

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Van Wert, M., Nova, N., Horowitz, T., Wolfe, J. (2008). What does performance on one visual search task tell you about performance on another? Journal of Vision, 8(312)

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Wald,G. Lubin, Y. Holoshitz, D. Muller,E. Fruchter,D.S. Pine, D.S. Charney, Y. Bar-Haim (2011). Battlefield-like stress following simulated combat and suppression of attention bias to threat, Psychological Medicine, 41, 699-707,DOI 10.1017/S0033291710002308

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Stroop.jpg
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facial recognition.jpg
dot probe task
stroop task
posner cueing
fear potentiated startle
dichotic listening task
facial recognition
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