Attention Bias Modification and Anorexia Nervosa

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There is no end to the list of factors that may influence eating disorder development, and cognitive factors are a large part of this list. An interesting study is digging into a cognitive process (Attention Bias) related to what stimuli, such as food, catch our attention, and how this may impact our brain and behavioral responses.

The study involves the discussion of concepts that are not commonly understood but absolutely worth learning more about.

Attention Bias

The foundation of this study considers how a cognitive response known as Attention Bias impacts what grabs our attention and how we then respond to it. Attention Bias looks at how salient stimuli, such as food, may capture our attention as compared to more neutral stimuli.

Essentially, our brains have a certain “bias” to be more cognizant of certain stimuli, particularly, stimuli that are crucial to our survival. Now, if mental and medical health advancements have taught us anything, it is that the mind and body are never “one size fits all.” No two people function the same.

If some people’s brains function differently and food-related stimuli do not capture their attention as strongly, can this contribute to disordered eating behaviors? There is evidence that this is the case, particularly with Anorexia Nervosa (AN).

One study determined that individuals diagnosed with anorexia had similar initial attention responses to food stimuli, but they did not maintain attention on these food cues [1]. Instead, individuals with AN showed attentional avoidance, in which they purposely avoided placing attention on these cues. This attentional avoidance increased as they were presented with high caloric food stimuli versus low caloric food stimuli [1].

Even more interestingly, “attentional avoidance of high caloric food cues is mainly seen in adults with AN (longer illness duration) compared to adolescents (shorter illness duration), suggesting that this behavior becomes more ingrained as the illness progresses and may be an important element in maintaining the fear of food or restrictive eating behavior [1].”

Attention Bias Modification Training

Take any cognitive phenomenon, and there is generally at least one therapeutic intervention intended to modify it. Thus, we have Attention Bias Modification Training (ABMT), which is used to train attention toward disorder-incompatible stimuli (in this case, food).

The way this intervention works is a bit confusing. Participants are presented with a disorder-relevant stimulus at the same time as a neutral stimulus on either side of a computer screen.

Almost immediately, one of the two images is replaced with a “probe,” and participants are asked to identify the location of the probe as quickly as possible.

Asian Lady thinking about Attention Bias“Attention Bias is assumed when individuals respond faster when the probe replaces disorder-relevant stimuli. In the training version of the paradigm, the probe almost always (e.g., 95% of the time) replaces either the disorder-relevant or neutral stimulus, depending on the design [1].”

The goal here is that the probe would be set to appear over the location of the disorder-relevant stimuli, for example, food or high caloric food. This manipulates the individual’s attention toward the disorder-relevant stimuli, therefore, combatting and reducing attentional avoidance [1].

Essentially, it is a trickier version of exposure therapy. As the individuals engage in the task of looking at and locating the probe, they are actively looking at cues they would normally avoid.


Through this study, researchers determined that ABMT “has the potential of providing a novel treatment approach for AN [1].” The study also determined that ABMT could “contribute to our understanding of cognitive patterns that underlie some of the maladaptive behaviors in anorexia” such as food restriction or food fears.

Learning more about the cognitive processes involved in food avoidance or attention bias can help as add-on treatments for eating disorders as well as provide a stronger understanding of why some individuals struggle differently with these disorders.


[1] Mercado, D. et al., (2020). Food related attention bias modification training for anorexia nervosa and its potential underpinning mechanisms. Journal of Eating Disorders, 8:1.

About the Author:

Image of Margot Rittenhouse.Margot Rittenhouse, MS, PLPC, NCC is a therapist who is passionate about providing mental health support to all in need and has worked with clients with substance abuse issues, eating disorders, domestic violence victims, and offenders, and severely mentally ill youth.

As a freelance writer for Eating Disorder Hope and Addiction Hope and a mentor with MentorConnect, Margot is a passionate eating disorder advocate, committed to de-stigmatizing these illnesses while showing support for those struggling through mentoring, writing, and volunteering. Margot has a Master’s of Science in Clinical Mental Health Counseling from Johns Hopkins University.

The opinions and views of our guest contributors are shared to provide a broad perspective on eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer a discussion of various issues by different concerned individuals.

We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.

Published May 27, 2020, on
Reviewed & Approved on May 27, 2020, by Jacquelyn Ekern MS, LPC

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