Individual differences in affective flexibility predict future anxiety and worry

Deficits in cognitive flexibility have been associated with anxiety and worry, however few studies have assessed cognitive flexibility in the context of emotional stimuli (i.e. affective flexibility). The present study (n = 79) investigated whether individual differences in affective flexibility predict levels of trait anxiety and worry over a period of seven weeks. Affective flexibility was measured using a task-switching paradigm. Results showed that less efficient shifting of attention towards affective aspects of positive stimuli predicted higher anxiety over time. Additionally, more efficient shifting of attention away from affective towards non-affective aspects of negative stimuli predicted higher anxiety and worry over time. This latter finding may be understood by considering theoretical models and empirical evidence associating avoidance of negative information with increased anxiety. The effects were small and require replication in larger, representative samples, but they are an initial indication that anxiety may not be associated with general impairments in cognitive flexibility. Instead, our study emphasises the importance of breaking down cognitive flexibility into different components to investigate more nuanced relationships.

Anxiety and Depressive Symptom Trajectories in Adolescence and the Co-Occurring Development of Cognitive Biases: Evidence from the CogBIAS Longitudinal Study

The development of negative cognitive biases, together with symptoms of anxiety and depression, has yet to be investigated longitudinally. Using a three-wave design, the present study examined developmental trajectories of anxiety and depressive symptoms and the co-occurrence of cognitive biases, in a large normative sample of adolescents (N = 504). Data was drawn from the CogBIAS Longitudinal Study (CogBIAS-L-S), which assessed a wide range of psychological variables, including cognitive biases and self-reported anxiety and depressive symptoms, when adolescents were approximately 13, 14.5, and 16 years of age. The results showed that overall levels of anxiety were low and stable, while levels of depression were low but increased slightly at each wave. Growth mixture modeling identified four distinct developmental classes with regard to anxiety and depressive symptoms. Multiple group analysis further showed that class membership was related to the development of cognitive biases. The majority of the sample (75%) was characterised by ‘Low symptoms’ of anxiety and depression and showed low interpretation and memory biases for negative stimuli at each wave. A second class (11%) displayed ‘Decreasing anxiety symptoms’ and showed decreasing interpretation bias, but increasing memory bias. A third class (8%) displayed ‘Comorbid increasing symptoms’ and showed increasing interpretation and memory biases. While the fourth class (6%) displayed ‘Comorbid decreasing symptoms’ and showed decreasing interpretation and memory biases. This longitudinal study sheds light on healthy and psychopathological emotional development in adolescence and highlights cognitive mechanisms that may be useful targets for prevention and early interventions.

Mental health in UK Biobank - development, implementation and results from an online questionnaire completed by 157 366 participants: a reanalysis

BACKGROUND

UK Biobank is a well-characterised cohort of over 500 000 participants including genetics, environmental data and imaging. An online mental health questionnaire was designed for UK Biobank participants to expand its potential.

AIMS

Describe the development, implementation and results of this questionnaire.

METHOD

An expert working group designed the questionnaire, using established measures where possible, and consulting a patient group. Operational criteria were agreed for defining likely disorder and risk states, including lifetime depression, mania/hypomania, generalised anxiety disorder, unusual experiences and self-harm, and current post-traumatic stress and hazardous/harmful alcohol use.

RESULTS

A total of 157 366 completed online questionnaires were available by August 2017. Participants were aged 45-82 (53% were ≥65 years) and 57% women. Comparison of self-reported diagnosed mental disorder with a contemporary study shows a similar prevalence, despite respondents being of higher average socioeconomic status. Lifetime depression was a common finding, with 24% (37 434) of participants meeting criteria and current hazardous/harmful alcohol use criteria were met by 21% (32 602), whereas other criteria were met by less than 8% of the participants. There was extensive comorbidity among the syndromes. Mental disorders were associated with a high neuroticism score, adverse life events and long-term illness; addiction and bipolar affective disorder in particular were associated with measures of deprivation.

CONCLUSIONS

The UK Biobank questionnaire represents a very large mental health survey in itself, and the results presented here show high face validity, although caution is needed because of selection bias. Built into UK Biobank, these data intersect with other health data to offer unparalleled potential for crosscutting biomedical research involving mental health.

A meta-analysis of bias at baseline in RCTs of attention bias modification: No evidence for dot-probe bias towards threat in clinical anxiety and PTSD

Considerable effort and funding have been spent on developing Attention Bias Modification (ABM) as a treatment for anxiety disorders, theorized to exert therapeutic effects through reduction of a tendency to orient attention toward threat. However, meta-analytical evidence that clinical anxiety is characterized by threat-related attention bias is thin. The largest meta-analysis to date included dot-probe data for n = 337 clinically anxious individuals. Baseline measures of biased attention obtained in ABM RCTs form an additional body of data that has not previously been meta-analyzed. This article presents a meta-analysis of threat-related dot-probe bias measured at baseline for 1,005 clinically anxious individuals enrolled in 13 ABM RCTs. Random-effects meta-analysis indicated no evidence that the mean bias index (BI) differed from zero (k = 13, n = 1005, mean BI = 1.8 ms, SE = 1.26 ms, p = .144, 95% confidence interval [-0.6, 4.3]. Additional Bayes factor analyses also supported the point-zero hypothesis (BF10 = .23), whereas interval-based analysis indicated that mean bias in clinical anxiety is unlikely to extend beyond the 0 to 5 ms interval. Findings are discussed with respect to strengths (relatively large samples, possible bypassing of publication bias), limitations (lack of control comparison, repurposing data, specificity to dot-probe data), and theoretical and practical context. We suggest that it should no longer be assumed that clinically anxious individuals are characterized by selective attention toward threat. Clinically anxious individuals enrolled in RCTs for Attention Bias Modification are not characterized by threat-related attention bias at baseline. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The CogBIAS longitudinal study of adolescence: cohort profile and stability and change in measures across three waves

Background

Adolescence is a time of considerable social, cognitive, and physiological development. It reflects a period of heightened risk for the onset of mental health problems, as well as heightened opportunity for flourishing and resilience. The CogBIAS Longitudinal Study (CogBIAS-L-S) aims to investigate psychological development during adolescence.

Methods

We present the cohort profile of the sample (N = 504) across three waves of data collection, when participants were approximately 13, 14.5, and 16 years of age. Further, we present descriptive statistics for all of the psychological variables assessed including (a) the self-report mood measures, (b) the other self-report measures, and (c) the behavioural measures. Differential and normative stability were investigated for each variable, in order to assess (i) measurement reliability (internal consistency), (ii) the stability of individual differences (intra-class correlations), and (iii) whether any adolescent-typical developmental changes occurred (multilevel growth curve models).

Results

Measurement reliability was good for the self-report measures (> .70), but lower for the behavioural measures (between .00 and .78). Differential stability was substantial, as individual differences were largely maintained across waves. Although, stability was lower for the behavioural measures. Some adolescent-typical normative changes were observed, reflected by (i) worsening mood, (ii) increasing impulsivity, and (iii) improvements in executive functions.

Conclusions

The stability of individual differences was substantial across most variables, supporting classical test theory. Some normative changes were observed that reflected adolescent-typical development. Although, normative changes were relatively small compared to the stability of individual differences. The development of stable psychological characteristics during this period highlights a potential intervention window in early adolescence.

Psychological Science Needs a Standard Practice of Reporting the Reliability of Cognitive-Behavioral Measurements

Psychological science relies on behavioral measures to assess cognitive processing; however, the field has not yet developed a tradition of routinely examining the reliability of these behavioral measures. Reliable measures are essential to draw robust inferences from statistical analyses, and subpar reliability has severe implications for measures’ validity and interpretation. Without examining and reporting the reliability of measurements used in an analysis, it is nearly impossible to ascertain whether results are robust or have arisen largely from measurement error. In this article, we propose that researchers adopt a standard practice of estimating and reporting the reliability of behavioral assessments of cognitive processing. We illustrate the need for this practice using an example from experimental psychopathology, the dot-probe task, although we argue that reporting reliability is relevant across fields (e.g., social cognition and cognitive psychology). We explore several implications of low measurement reliability and the detrimental impact that failure to assess measurement reliability has on interpretability and comparison of results and therefore research quality. We argue that researchers in the field of cognition need to report measurement reliability as routine practice so that more reliable assessment tools can be developed. To provide some guidance on estimating and reporting reliability, we describe the use of bootstrapped split-half estimation and intraclass correlation coefficients to estimate internal consistency and test-retest reliability, respectively. For future researchers to build upon current results, it is imperative that all researchers provide psychometric information sufficient for estimating the accuracy of inferences and informing further development of cognitive-behavioral assessments.

Attentional control, rumination and recurrence of depression

BACKGROUND

Depressive recurrence is highly prevalent and adds significantly to the burden of depressive disorder. Whilst some clinical predictors of recurrence have been clearly demonstrated (e.g. residual symptoms, previous episodes), the cognitive and psychological processes that may contribute to recurrence risk are less well established. In this study we examine whether cognitive flexibility deficits and rumination are related to recurrence in a remitted clinical sample.

METHOD

We compared remitted patients with 2 or more previous depressive episodes (N = 69) to a matched group of healthy controls (N = 43). Cognitive flexibility was measured using the Internal Shift Task (IST) and a version of the Exogenous Cueing Task (ECT); rumination was assessed with the Ruminative Responses Scale.

RESULTS

IST and ECT performance did not differ between remitted patients and controls. Remitted patients had higher levels of rumination than controls. Within the remitted patient group, faster disengagement from angry and happy faces on the ECT was predictive of shorter time to recurrence (hazard ratio for 1 standard deviation, (HR_SD) = 0.563 [CI, 0.381-0.832], p = 0.004, (HR_SD) = 0.561 [CI, 0.389-0.808], p = 0.002, respectively). Rumination predicted recurrence (HR_SD = 1.526 [CI, 1.152-2.202]; p = 0.003) but was not related to emotional disengagement.

LIMITATIONS

We had low power to detect small effects for the analysis within remitted patients.

CONCLUSIONS

Whilst cognitive flexibility in remitted patients was not impaired relative to controls, rapid disengagement from emotional stimuli and rumination were independently associated with time to recurrence. Cognitive flexibility may be an important indicator of recurrence risk, and a target for interventions to reduce recurrence.

Does rumination mediate the relationship between attentional control and symptoms of depression?

BACKGROUND AND OBJECTIVES

It has been suggested that impaired attentional control (AC) promotes the use of maladaptive emotional regulation strategies, such as rumination, with subsequent increase in risk of depression.

METHOD

This study examined this hypothesis in a healthy community sample. Questionnaire measures of depression, anxiety, rumination and self-reported AC (shifting and focusing) were used, as well as an attention performance task (Attention Network Task; ANT).

RESULTS

While self-report and performance measures of AC were not significantly related, both depression and rumination were associated with reduced self-reported AC. Depression was specifically associated with poorer attentional shifting. Depression and brooding were also associated with better performance on the conflict component of the ANT. Importantly, the relationships of ANT conflict and self-reported AC to depression were mediated by brooding.

LIMITATIONS

The current study used a community sample, and it is unclear if results would generalise to a clinical population. All measures were taken concurrently and so it is not possible to confidently ascertain causality or direction of effects.

CONCLUSIONS

These results are consistent with the suggestion that impaired AC, particularly a narrow and inflexible attentional focus, may increase risk of depression by promoting ruminative thinking. The results highlight the importance of considering both self-report and performance measures of AC, as well as different components of attentional performance.

Perspectives from affective science on understanding the nature of emotion

Emotions are at the heart of how we understand the human mind and of our relationships within the social world. Yet, there is still no scientific consensus on the fundamental nature of emotion. A central quest within the discipline of affective science is to develop an in-depth understanding of emotions, moods, and feelings and how they are embodied within the brain (affective neuroscience). This article provides a brief overview of the scientific study of emotion with a particular emphasis on psychological and neuroscientific perspectives. Following a selective snapshot of past and present research in this field, some current challenges and controversies in affective science are highlighted.

The influence of positive and negative affect on emotional attention

BACKGROUND AND OBJECTIVES

Mechanisms of engagement and disengagement of attention to emotional information are thought to contribute to the onset and maintenance of anxiety and depression, a conclusion based largely on findings in analogue subclinical samples. However, we argue that traditionally defined analogue samples can be misleading. Firstly, research has challenged the adequacy of conventional measures of subclinical traits by illustrating that supposedly distinct scales are highly inter-correlated and do not therefore measure independent constructs. Secondly, recent research in clinical groups has revealed results opposite to those expected from the analogue literature, suggesting speeded, rather than impaired, disengagement from threat.

METHODS

We present analogue findings, from a sample of 70 healthy participants, allowing a purer distinction between the phenomenology of anxiety versus depression using the orthogonal traits of positive and negative affect to classify individuals.

RESULTS

Using emotional peripheral cueing we found that, at short cue durations, dysphoric individuals' (those with low positive and high negative affect) attention to facial expressions was slowed by emotional compared to neutral invalid cues.

LIMITATIONS

Limitations included a small sample size and limited generalisability due to sampling from a student population.

CONCLUSIONS

The data suggest that, in line with the previous subclinical literature, dysphoric individuals are slow to disengage attention from emotional information at early stages of processing and are consistent with the possibility that patterns of orienting of attention might be qualitatively different in subclinical versus clinical populations.

A comparison of biofluid cytokine markers across platform technologies: Correspondence or divergence?

BACKGROUND

Quantification of biofluid cytokines is a rapidly growing area of translational research. However, comparability across the expanding number of available assay platforms for detection of the same proteins remains to be determined. We aimed to directly compare a panel of commonly measured cytokines in plasma of typically aging adults across two high sensitivity quantification platforms, Meso Scale Discovery high performance electrochemiluminiscence (HPE) and single-molecule immunosorbent assays (Simoa) by Quanterix.

METHODS

57 community-dwelling older adults completed a blood draw, neuropsychological assessment, and brain MRI as part of a healthy brain aging study. Plasma samples from the same draw dates were analyzed for IL-10, IP-10, IL-6, TNFα, and IL-1β on HPE and Simoa, separately. Reliable detectability (coefficient of variance (CV) < 20% and outliers 3 interquartiles above the median removed), intra-assay precision, absolute concentrations, reproducibility across platforms, and concurrent associations with external variables of interest (e.g., demographics, peripheral markers of vascular health, and brain health) were examined.

RESULTS

The proportion of cytokines reliably measured on HPE (87.7-93.0%) and Simoa (75.4-93.0%) did not differ (ps > 0.32), with the exception of IL-1β which was only reliably measured using Simoa (68.4%). On average, CVs were acceptable at <8% across both platforms. Absolute measured concentrations were higher using Simoa for IL-10, IL-6, and TNFα (ps < 0.05). HPE and Simoa shared only small-to-moderate proportions of variance with one another on the same cytokine proteins (range: r = 0.26 for IL-10 to r = 0.64 for IL-6), though platform agreement did not dependent on cytokine concentrations. Cytokine ratios within each platform demonstrated similar relative patterns of up- and down-regulation across HPE and Simoa, though still significantly differed (ps < 0.001). Supporting concurrent validity, all 95% confidence intervals of the correlations between cytokines and external variables overlapped between the two platforms. Moreover, most associations were in expected directions and consistently so across platforms (e.g., IL-6 and TNFα), though with several notable exceptions for IP-10 and IL-10.

CONCLUSIONS

HPE and Simoa showed comparable detectability and intra-assay precision measuring a panel of commonly examined cytokine proteins, with the exception of IL-1β which was not reliably detected on HPE. However, Simoa demonstrated overall higher concentrations and the two platforms did not show agreement when directly compared against one another. Relative cytokine ratios and associations demonstrated similar patterns across platforms. Absolute cytokine concentrations may not be directly comparable across platforms, may be analyte dependent, and interpretation may be best limited to discussion of relative associations.

Erratum: Mental health in UK Biobank: development, implementation and results from an online questionnaire completed by 157 366 participants - CORRIGENDUM

[This corrects the article DOI: 10.1192/bjo.2018.12.].

Symptom Presentation in Idiopathic Environmental Intolerance With Attribution to Electromagnetic Fields: Evidence for a Nocebo Effect Based on Data Re-Analyzed From Two Previous Provocation Studies

Individuals with idiopathic environmental illness with attribution to electromagnetic fields (IEI-EMF) claim they experience adverse symptoms when exposed to electromagnetic fields (EMFs) from mobile telecommunication devices. However, research has consistently reported no relationship between exposure to EMFs and symptoms in IEI-EMF individuals. The current study investigated whether presence of symptoms in IEI-EMF individuals were associated with a nocebo effect. Data from two previous double-blind provocation studies were re-analyzed based on participants' judgments as to whether or not they believed a telecommunication base station was "on" or "off". Experiment 1 examined data in which participants were exposed to EMFs from Global System for Mobile Communication, Universal Mobile Telecommunications System, and sham base station signals. In Experiment 2, participants were exposed to EMFs from Terrestrial Trunked Radio Telecommunications System and sham base station signals. Our measures of subjective well-being indicated IEI-EMF participants consistently reported significantly lower levels of well-being, when they believed the base station was "on" compared to "off". Interestingly, control participants also reported experiencing more symptoms and greater symptom severity when they too believed the base station was "on" compared to "off". Thus, a nocebo effect provides a reasonable explanation for the presence of symptoms in IEI-EMF and control participants.

Skeletal muscle and plasma concentrations of cefazolin during complex paediatric spinal surgery

BACKGROUND

Surgical site infections (SSIs) can have devastating consequences for children who undergo spinal instrumentation. Prospective evaluations of prophylactic cefazolin in this population are limited. The purpose of this study was to describe the pharmacokinetics and skeletal muscle disposition of prophylactic cefazolin in a paediatric population undergoing complex spinal surgery.

METHODS

This prospective pharmacokinetic study included 17 children with adolescent idiopathic scoliosis undergoing posterior spinal fusion, with a median age of 13.8 [interquartile range (IQR) 13.4-15.4] yr and a median weight of 60.6 (IQR 50.8-66.0) kg. A dosing strategy consistent with published guidelines was used. Serial plasma and skeletal muscle microdialysis samples were obtained during the operative procedure and unbound cefazolin concentrations measured. Non-compartmental pharmacokinetic analyses were performed. The amount of time that the concentration of unbound cefazolin exceeded the minimal inhibitory concentration for bacterial growth for selected SSI pathogens was calculated.

RESULTS

Skeletal muscle concentrations peaked at a median of 37.6 (IQR 26.8-40.0) µg ml(-1) within 30-60 min after the first cefazolin 30 mg kg(-1) dose. For patients who received a second 30 mg kg(-1) dose, the peak concentrations reached a median of 40.5 (IQR 30.8-45.7) µg ml(-1) within 30-60 min. The target cefazolin concentrations for SSI prophylaxis for meticillin-sensitive Staphylococcus aureus (MSSA) and Gram-negative pathogens were exceeded in skeletal muscle 98.9 and 58.3% of the intraoperative time, respectively.

CONCLUSIONS

For children with adolescent idiopathic scoliosis undergoing posterior spinal fusion, the cefazolin dosing strategy used in this study resulted in skeletal muscle concentrations that were likely not to be effective for intraoperative SSI prophylaxis against Gram-negative pathogens.

Erratum: Mental health in UK Biobank: development, implementation and results from an online questionnaire completed by 157 366 participants - CORRIGENDUM

[This corrects the article DOI: 10.1192/bjo.2018.12.].

Mental health in UK Biobank: development, implementation and results from an online questionnaire completed by 157 366 participants

BACKGROUND

UK Biobank is a well-characterised cohort of over 500 000 participants that offers unique opportunities to investigate multiple diseases and risk factors.

AIMS

An online mental health questionnaire completed by UK Biobank participants was expected to expand the potential for research into mental disorders.

METHOD

An expert working group designed the questionnaire, using established measures where possible, and consulting with a patient group regarding acceptability. Case definitions were defined using operational criteria for lifetime depression, mania, anxiety disorder, psychotic-like experiences and self-harm, as well as current post-traumatic stress and alcohol use disorders.

RESULTS

157 366 completed online questionnaires were available by August 2017. Comparison of self-reported diagnosed mental disorder with a contemporary study shows a similar prevalence, despite respondents being of higher average socioeconomic status than the general population across a range of indicators. Thirty-five per cent (55 750) of participants had at least one defined syndrome, of which lifetime depression was the most common at 24% (37 434). There was extensive comorbidity among the syndromes. Mental disorders were associated with high neuroticism score, adverse life events and long-term illness; addiction and bipolar affective disorder in particular were associated with measures of deprivation.

CONCLUSIONS

The questionnaire represents a very large mental health survey in itself, and the results presented here show high face validity, although caution is needed owing to selection bias. Built into UK Biobank, these data intersect with other health data to offer unparalleled potential for crosscutting biomedical research involving mental health.

DECLARATION OF INTEREST

G.B. received grants from the National Institute for Health Research during the study; and support from Illumina Ltd. and the European Commission outside the submitted work. B.C. received grants from the Scottish Executive Chief Scientist Office and from The Dr Mortimer and Theresa Sackler Foundation during the study. C.S. received grants from the Medical Research Council and Wellcome Trust during the study, and is the Chief Scientist for UK Biobank. M.H. received grants from the Innovative Medicines Initiative via the RADAR-CNS programme and personal fees as an expert witness outside the submitted work.

The CogBIAS longitudinal study protocol: cognitive and genetic factors influencing psychological functioning in adolescence

BACKGROUND

Optimal psychological development is dependent upon a complex interplay between individual and situational factors. Investigating the development of these factors in adolescence will help to improve understanding of emotional vulnerability and resilience. The CogBIAS longitudinal study (CogBIAS-L-S) aims to combine cognitive and genetic approaches to investigate risk and protective factors associated with the development of mood and impulsivity-related outcomes in an adolescent sample.

METHODS

CogBIAS-L-S is a three-wave longitudinal study of typically developing adolescents conducted over 4 years, with data collection at age 12, 14 and 16. At each wave participants will undergo multiple assessments including a range of selective cognitive processing tasks (e.g. attention bias, interpretation bias, memory bias) and psychological self-report measures (e.g. anxiety, depression, resilience). Saliva samples will also be collected at the baseline assessment for genetic analyses. Multilevel statistical analyses will be performed to investigate the developmental trajectory of cognitive biases on psychological functioning, as well as the influence of genetic moderation on these relationships.

DISCUSSION

CogBIAS-L-S represents the first longitudinal study to assess multiple cognitive biases across adolescent development and the largest study of its kind to collect genetic data. It therefore provides a unique opportunity to understand how genes and the environment influence the development and maintenance of cognitive biases and provide insight into risk and protective factors that may be key targets for intervention.