Sport-related concussion is associated with elevated anxiety, but not attentional bias to threat

ABSTRACT

Primary Objective: Symptoms following concussion commonly include deficits in attentional processing and elevated anxiety. Prioritized allocation of attentional resources to threat-related information is referred to as attentional bias to threat, which is a cardinal symptom – and in some cases a causal factor in the development – of anxiety. Here, we aimed to assess two possibilities regarding the relationship between attentional bias and anxiety in the post-concussive phase of sport-related concussion: (1) attentional bias mediates the relationship between concussion and anxiety or (2) attentional bias and concussion are uniquely associated with anxiety.

Research Design: A cross-sectional between-groups design was used to assess differences in anxiety and attentional bias to threat between collegiate athletes with a recent sport-related concussion and a matched control group.

Methods and Procedures: Forty-two collegiate athletes, 21 with a sport-related concussion and 21 matched controls, completed the dot-probe task of attentional bias and an anxiety questionnaire.

Main Outcomes and Results: Anxiety, but not attentional bias, is elevated in concussion. Additionally, concussion and attentional bias to threat appear to be uniquely associated with anxiety symptoms.

Conclusions: Unique treatment/rehabilitation strategies should be considered for individuals with elevated anxiety following concussion.

KEYWORDS:

• mTBI
• attentional bias
• anxiety
• threat bias
• collegiate athletes
• concussion

Conflicts of Interest

The authors declare no conflict of interest.

Disclosure of Funding Received

JMC & MTM received internal funding from Northern Michigan University for this project.

Notes

1. Note that days since concussion did not correlate with anxiety (r= 0.02, p= 0.93), attention bias (r= −0.03, p= 0.91), or other DASS measures (ps > 0.36) and therefore, was not further considered in analyses.

2. Note that after controlling for group (i.e., concussion vs. control), number of concussions did not correlate with anxiety (r= 0.03, p= 0.87), attention bias (r= 0.20, p= 0.22), or other DASS measures (ps ≥ 0.84) and therefore, not included in analyses.

3. The behavioral data were collected while near-infrared spectroscopy (NIRS) measures were acquired. The 7 s intertrial interval was used to allow the hemodynamic response to stabilize. NIRS measured contained excessive artifact and were therefore not usable for data analysis.

4. Note that four participants only completed half of the DASS questionnaire (i.e., the first 21 items). Similar to the scoring of DASS 21, scores for these four individuals were doubled (i.e., converted to the 42 item scale).