Fight, Not Flight! Avoidant Goals Strengthen Attentional Biases During Increased Anxiety in Healthy Adults

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

I would like to express my utmost appreciation and respect to the editor and the authors for giving me the opportunity to review the manuscript entitled "Fight, Not Flight! Avoidant Goals Strengthen Attentional Biases During Increased Anxiety in Healthy Adults." The work thoroughly examines the influence of avoidant behavioral goals and their impact on attentional control under heightened anxiety conditions, using solid scientific methods and a well-structured experimental design. The supporting literature is up-to-date, and the results offer valuable insights into the relationship between anxiety and perceptual-motor performance.

Below, I propose a detailed review aimed at further enhancing the scientific contribution of the manuscript.

Proposed changes:

• Title (lines 1-2): The title is well formulated but could be refined by including the study participants, specifying "Healthy Adults."

• Abstract (lines 11-25): The abstract is well-structured. However, it would be beneficial to add a concluding sentence that references the potential practical implications of the findings for anxiety management in everyday contexts.

• Introduction (lines 29-68): The introduction provides good context, but in line 39, it would be useful to clarify the concept of "attentional bias toward threat," specifying the psychological mechanisms involved. Lines 66-67: I suggest including a specific example of the "few studies" mentioned to strengthen this statement.

• Materials and Methods (lines 112-220): The details here are very clear, but I propose some clarifications: in line 115, better specify how normal vision was ensured in the participants. Line 167: further clarify the electric shock protocol, particularly the method used to exclude any physiological risks for participants. Lines 196-199: I suggest rephrasing slightly to make the randomization of experimental conditions clearer.

• Results (lines 271-320): The results are accurately described. However, I would recommend reorganizing some information to make the comparison between the two groups more immediate. Add a more detailed explanation regarding the significance of Hypothesis I (lines 295-296), clarifying the implications of the non-significant difference.

• Discussion (lines 321-391): Overall, a strong discussion. However, in lines 336-338, it would be useful to further elaborate on why healthy individuals displayed disengagement difficulty in the avoidance mode. Lines 368-370: better specify the connection between "disengagement difficulty" and "threat-related interpretation," as it is not immediately apparent. Finally, in line 389, it may be valuable to hypothesize potential clinical implications for patients with anxiety disorders.

• Limitations (lines 393-405): This section on limitations is well-written, but an additional limitation related to the sample population should be mentioned, as it only includes university students. Furthermore, it would be useful to indicate potential limitations related to the use of standardized visual stimuli, such as facial expressions, and the possible lack of ecological validity in real-world settings.

Data analysis and results: The statistical analysis seems correctly performed, with appropriate tests used for the analyzed variables. However, the sample size is relatively small (N=32 after exclusions), and this should be more emphasized in the limitations, as it may restrict the generalizability of the findings. Moreover, the conclusions drawn from the data analysis are consistent with the hypotheses, but greater emphasis on the practical applications of the results would be beneficial.

Conclusions (lines 413-417): The conclusion is well-done, but I would suggest making it more explicit regarding potential therapeutic or clinical applications. I would add a sentence that highlights the need for further research to test the effectiveness of "challenge mindset" strategies in improving performance under high anxiety conditions.

Proposed eliminations: There are no sections to be eliminated, but some overly descriptive sections, such as the one on the technical details of the materials (lines 131-164), could be shortened without compromising clarity.

Study limitations: While some limitations have been mentioned, I would add that the results cannot be generalized to clinical populations or other age groups. Additionally, the ToS protocol may not reflect more complex forms of anxiety in everyday life.

I kindly request the authors to consider citing the following article in their manuscript:

Diotaiuti, P., Valente, G., Mancone, S., Grambone, A., & Chirico, A. (2021). Metric goodness and measurement invariance of the Italian brief version of Interpersonal Reactivity Index: A study with young adults. Frontiers in Psychology, 12, Article 773363. https://doi.org/10.3389/fpsyg.2021.773363

This citation would be particularly relevant in the discussion or introduction sections, especially when discussing the psychometric evaluation of scales used in anxiety-related research or the validation of psychological instruments across different populations. For example, when discussing the reliability and consistency of the methods used in measuring attentional bias or other related constructs, this article could serve as a strong reference supporting the psychometric rigor of similar tools. This reference would strengthen the methodological framework of the current study, providing additional support for the validity of the tools employed in anxiety research.

I suggest including this reference either when discussing the psychological measures or when citing related literature on measurement validation and reliability in the context of anxiety or attentional bias studies.

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

The topic of the study is very interesting and open to further purposes of study. The experiment identified two associations between increased anxiety and attentional control in response to emotional stimuli in healthy individuals: delayed responses to targets near angry and neutral faces during heightened anxiety, supporting disengagement difficulty and threat-related interpretation hypotheses. The study contrasts with innate approach-avoidance mechanisms and highlights that heightened anxiety can alter perceptions of neutral stimuli. Results suggest that avoidance strategies may hinder coping with anxiety, emphasizing the importance of a challenge mindset for improving attentional control under pressure. Overall, the methodology combining avoidant action modes and task-irrelevant stimuli offers insights into attentional biases related to anxiety. The study is clear, easy to understand. The study is accepted in the present form.

Comments on the Quality of English Language

The topic of the study is very interesting and open to further purposes of study. The experiment identified two associations between increased anxiety and attentional control in response to emotional stimuli in healthy individuals: delayed responses to targets near angry and neutral faces during heightened anxiety, supporting disengagement difficulty and threat-related interpretation hypotheses. The study contrasts with innate approach-avoidance mechanisms and highlights that heightened anxiety can alter perceptions of neutral stimuli. Results suggest that avoidance strategies may hinder coping with anxiety, emphasizing the importance of a challenge mindset for improving attentional control under pressure. Overall, the methodology combining avoidant action modes and task-irrelevant stimuli offers insights into attentional biases related to anxiety. The study is clear, easy to understand.

Author Response

Thank you very much for taking the time to review our manuscript. We are pleased to inform you that the revised version (1st revision) has been submitted after undergoing a professional English language editing service.

Reviewer 3 Report

Comments and Suggestions for Authors

Thank you for inviting me to review this basic science (social-cognitive psychology) inquiry into coping with threat -- thought to have some applicability to treating anxiety disorders.  It is a nicely described and analyzed experimental paradigm; the figures are a particular strength of the manuscript.

I recommend a follow-up power analysis after removal of outliers, and if needed an expanded discussion of this in the limitations section.  The sample is very small, based on already extremely ambitious (high) power estimates for what are relatively modest effects.  

Please say more about the clinical implications of your findings for people with diagnosed anxiety disorders based on an expanded literature review pertinent to clinical populations.  

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Round 2

Reviewer 1 Report

Comments and Suggestions for Authors

Dear Editor and Authors,

After a careful review of the manuscript and the modifications the authors have implemented following our suggestions, we are pleased to inform you that the article has now reached a level of quality and completeness that meets the requirements for publication.

The proposed revisions have been effectively incorporated, enhancing the clarity, coherence, and depth of the content. The structure of the article is now solid and well-organized, with arguments thoroughly developed and supported by appropriate evidence. Additionally, the authors have diligently addressed the points raised during the review process, demonstrating particular attention to scientific accuracy and clarity of presentation.

Given the results achieved and the high quality of the content, we believe the article is now ready for publication. We are confident that this work will make a significant contribution to the literature in the field and will be of great interest to the scientific community.

Best regards

Reviewer 3 Report

Comments and Suggestions for Authors

Thank you for your careful response to reviewers' suggestions.  I have no further concerns.