Electrocortical effects of directing attention during visual exposure in dentophobia

Fear of pain is a main motivator for avoidance or delay of dental treatment in patients afflicted with dentophobia. Studies employing passive viewing paradigms found motivated attention to the phobic object to be associated with enhanced amplitudes of the late positive potential (LPP). The aim of the current study was to investigate, if explicit attention-guiding instructions are able to modify the LPP. Twenty-three patients suffering from dentophobia and 23 controls were presented with pictures showing disorder-relevant or neutral contents, which were combined with different instructions: to distract the attention away from the picture, to classify the content, or to decide whether the scene elicited fear of pain. Relative to controls, dentophobics displayed enhanced late positivity (300-1000 ms after picture onset) in the fear of pain condition at frontal and central recording sites, whereas there was no group difference during classification and distraction. Within patients, fear of pain elicited greater positivity than classification and distraction. The findings are discussed within the framework of attentional direction. Future studies could investigate whether psychotherapy differentially affects neural correlates of attention regulation.