Volume 24, Issue 5 (December & January 2021)                   J Arak Uni Med Sci 2021, 24(5): 674-687 | Back to browse issues page

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Nasiri S, Noori M, Aslezaker M. Effectiveness of Attention Control Training on Attentional Bias Towards Death, Death Anxiety, and Sensitivity to Mortality Salience. J Arak Uni Med Sci 2021; 24 (5) :674-687
URL: http://jams.arakmu.ac.ir/article-1-6859-en.html
1- Department of Clinical Psychology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
2- Department of Clinical Psychology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran. , m.noori@sbmu.ac.ir
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Death awareness is introduced in terror management theory as the root of all human anxieties [1]. Encountering reminders of one’s mortality which bring about death awareness and cause mortality salience, can cause significant distress, anxiety, and depression [6]. Recent research has demonstrated a significant association between emotion regulation and anxiety [12]. Selective attention towards negative information, known as attentional bias, has a causal effect on emotion dysregulation. 
Research has shown that it has an important role in various psychopathologies, including anxiety disorders [16171819]. Attention control training has been studied as a new intervention method for several mental problems and seems specifically effective for anxiety disorders [16, 20]. This study aimed to examine the effectiveness of attention control training on attentional bias towards death, death anxiety, and sensitivity to mortality salience.
Materials and Methods
The present clinical trial was designed with pretest, posttest, and follow-up and consisted of two intervention groups and one control group. 50 students aged 18-30 were randomly sampled from Shahid Beheshti University of Medical Sciences, Shahid Beheshti University, Tehran University, and the Amirkabir University of Technology in the academic year of 2018-19. They were randomly assigned to the 1st and 2nd experimental and control groups. Death anxiety was assessed using the Multidimensional Fear of Death Scale (MFODS), and sensitivity to mortality salience was evaluated using the Propensity to Morally Disengage Scale (PMDS) after writing two sentences about one’s death. Lastly, the Modified Stroop Task measured attentional biases towards death and towards negative stimuli. After the pretest measurements, attention control training with death-related stimuli for 1st experimental group and negative stimuli for 2nd experimental group was conducted in four sessions across two weeks. Posttest measurements were performed after the last session of the intervention for the experimental groups and after 2 weeks from the pretest for the control group. 
These measurements were repeated after three months to assess the longevity of the intervention effects. The study’s data were analyzed using two-way repeated-measures ANOVA and paired comparisons in the SPSS software.
The results of two-way repeated-measures ANOVA (Table 1) showed that the effects of group, time, and their interaction on the three variables of attentional bias towards death, death anxiety, and sensitivity to mortality salience have been significant (P<0.05).

In other words, there have been significant differences between 1st and 2nd experimental and control groups in the scores of Modified Stroop Task, MFODS, and PMDS at different stages of measurements. None of the effects of the group, time and group×time interaction were significant on attentional bias towards negative stimuli unrelated to death (P>0.05). The results of paired comparisons between the means of the three groups at three stages of measurements (Table 2) showed that significant change has only happened in 1st experimental group.

This change has been observed as a reduction in this group’s posttest scores of Modified Stroop Task, MFODS, and PMDS compared with the pretest (P<0.05). This significant change was also evident in follow-up measurements. There were no differences in the 2nd experimental and control groups’ attentional bias towards death, death anxiety, and sensitivity to mortality salience, and in all three groups’ attentional bias towards negative stimuli unrelated to death at different stages of measurements (P>0.05).
The findings of this study confirmed the hypothesis that attention control training could significantly reduce attentional bias towards death-related stimuli. Given that this significant reduction at posttest and follow-up didn’t occur in the 2nd experimental and control groups, it could be inferred that the designed intervention has effectively reduced attentional bias towards death. In line with the reduction of attentional bias towards death, participants’ death anxiety and sensitivity to mortality salience were significantly decreased after attention control training. Consistent with existing evidence in the research background, these findings demonstrate that targeting attentional bias, an influential factor in the etiology of anxiety disorders helps ameliorate these disorders [16]. 
Considering that attentional bias is an autonomous cognitive mechanism that can cause emotional vulnerability and malfunction at the unconscious level [26], it is not surprising that successful reduction of attentional bias towards death after attention control training has also affected the participants’ death anxiety and decreased their sensitivity to mortality salience.
There were certain limitations in the conduction of this study, namely the use of numerous and long assessment measures, lack of comparison between different methods of intervention, and short-term follow-up of three months. Therefore, it is recommended for future research that shorter assessment measures, long-term follow-up, and comparison of this intervention with other methods of intervention be implemented.
Overall, it could be concluded that attention control training can significantly reduce attentional bias towards death-related stimuli, which helps with emotion regulation when confronting death and mortality and consequently leads to decreased death anxiety and sensitivity to mortality salience.

Ethical Considerations
Compliance with ethical guidelines

This study was approved by the Ethics Committee of Shahid Beheshti University of Medical Sciences (Code: IR.SBMU.MSP.REC.1398.539).

The paper was extracted from the MSc. thesis of the first author, Department of Clinical Psychology, School of Medicine, Shahid Beheshti University of Medical Sciences

Authors' contributions
All authors equally contributed to preparing this article.

Conflicts of interest
The authors declared no conflict of interest.

The authors would like to express their sincere gratitude to all the participants who spent their time and energy to make this study possible.


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Type of Study: Original Atricle | Subject: psychology
Received: 2021/03/22 | Accepted: 2021/08/22

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