Confusing procedures with process when appraising the impact of cognitive bias modification on emotional vulnerability†

If meta-analysis is to provide valuable answers, then it is critical to ensure clarity about the questions being asked. Here, we distinguish two important questions concerning cognitive bias modification research that are not differentiated in the meta-analysis recently published by Cristea et al (2015) in this journal: (1) do the varying procedures that investigators have employed with the intention of modifying cognitive bias, on average, significantly impact emotional vulnerability?; and (2) does the process of successfully modifying cognitive bias, on average, significantly impact emotional vulnerability? We reanalyse the data from Cristea et al to address this latter question. Our new analyses demonstrate that successfully modifying cognitive bias does significantly alter emotional vulnerability. We revisit Cristea et al's conclusions in light of these findings.

Uncontrolled eating in adolescents: The role of impulsivity and automatic approach bias for food

Obesity is a global problem reaching epidemic proportions and can be explained by unhealthy eating and sedentary lifestyles. Understanding the psychological processes underlying unhealthy eating behaviour is crucial for the development of effective obesity prevention programmes. Dual-process models implicate the interplay between impaired cognitive control and enhanced automatic responsivity to rewarding food cues as key risk factors. The current study assessed the influence of four different components of trait impulsivity (reflecting impaired cognitive control) and automatic approach bias for food (reflecting automatic responsivity to food) on uncontrolled eating in a large sample (N = 504) of young adolescents. Of the four impulsivity factors, negative urgency was found to be the strongest predictor of uncontrolled eating. Interestingly, we found that lack of premeditation was a key risk factor for uncontrolled eating, but only when approach bias for food was high, supporting a dual-process model. Lack of perseverance showed a similar interactive pattern to a lesser degree and sensation-seeking did not predict uncontrolled eating. Together, our results show that distinct components of trait impulsivity are differentially associated with uncontrolled eating behaviour in adolescents, and that automatic processing of food cues may be an important factor in modulating this relationship.

Performance on a 1-week delayed recall task is associated with medial temporal lobe structures in neurologically normal older adults

OBJECTIVE

Traditional episodic memory tests employ a delayed recall length ranging from 10 to 30 min. The neurobiological process of memory consolidation extends well beyond these time intervals, however, raising the possibility that these tests might not be fully sensitive to the subtle neurocognitive changes found in early disease or age-related decline. We aimed to determine the sensitivity of a 1-week delayed recall paradigm to medial temporal lobe (MTL) structure among neurologically normal older adults.

METHODS

One hundred and forty functionally intact, older adults (mean age = 75.8) completed a story recall test in which participants learned to 90% criterion. Recall was tested after 30-min and 1-week. Participants also completed a standardized list learning task with a 20-min delay (n = 129) and a structural brain MRI. The MTL, including the parahippocampal gyrus, hippocampus, and entorhinal, was our primary region of interest.

RESULTS

Controlling for age, education, gender and total intracranial volume, the standard 20- and 30-min recalls showed no significant relationship with MTL. In contrast, 1-week recall was uniquely associated with MTL structure (partial r = .24, p = .006), specifically entorhinal (partial r = .27; p = .001) and hippocampal (partial r = .21, p = .02) volumes.

CONCLUSION

Memory paradigms that utilize 1-week delays are more sensitive than standard paradigms to MTL volumes in neurologically normal older adults. Longer delay periods may improve detection of memory consolidation abilities associated with age-related, and potentially pathological, neurobehavioral change.

Investigation of reference levels and radiation dose associated with abdominal EVAR (endovascular aneurysm repair) procedures across several European Centres

OBJECTIVES

Endovascular aneurysm repair (EVAR) is considered the treatment of choice for abdominal aortic aneurysms with suitable anatomy. In order to improve radiation safety, European Directive (2013/59) requires member states to implement diagnostic reference levels (DRLs) in radio-diagnostic and interventional procedures. This study aimed to determine local DRLs for EVAR across five European centres and identify an interim European DRL, which currently remains unestablished.

METHODS

Retrospective data was collected for 180 standard EVARs performed between January 2014 and July 2015 from five specialist centres in Ireland (n=2) and Italy (n=3). Data capture included: air kerma-area product (P_KA), total air kerma at the reference point (K_a,r), fluoroscopic time (FT), number of acquisitions, frame rate of acquisition, type of acquisition, patient height, weight, and gender.

RESULTS

The mean values for each site A, B, C, D, and E were: P_KAs of 4343 ± 994 μGym², 18,200 ± 2141 μGym², 11,423 ± 1390 μGym², 7796 ± 704 μGym², 31,897 ± 5798 μGym²; FTs of 816 ± 92 s, 950 ± 150 s, 708 ± 70 s, 972 ± 61 s, 827 ± 118 s; and number of acquisitions of 6.72 ± 0.56, 10.38 ± 1.54, 4.74 ± 0.19, 5.64 ± 0.36, 7.28 ± 0.65, respectively. The overall pooled 75th percentile P_KA was 15,849 μGym².

CONCLUSION

Local reference levels were identified. The pooled data has been used to establish an interim European DRL for EVAR procedures.

KEY POINTS

• Abdominal endovascular aneurysm repair (EVAR) requires the use of ionising radiation. • EVAR is a minimally invasive procedure for the treatment of abdominal aortic aneurysms. • Diagnostic reference levels (DRLs) are used to monitor patient radiation exposure. • Radiation dose data was collected from five European centres for EVAR procedures. • Local DRLs have been determined and an interim European DRL is proposed.

Differential sensitivity to the environment: contribution of cognitive biases and genes to psychological wellbeing

Negative cognitive biases and genetic variation have been associated with risk of psychopathology in largely independent lines of research. Here, we discuss ways in which these dynamic fields of research might be fruitfully combined. We propose that gene by environment (G × E) interactions may be mediated by selective cognitive biases and that certain forms of genetic 'reactivity' or 'sensitivity' may represent heightened sensitivity to the learning environment in a 'for better and for worse' manner. To progress knowledge in this field, we recommend including assessments of cognitive processing biases; examining G × E interactions in 'both' negative and positive environments; experimentally manipulating the environment when possible; and moving beyond single-gene effects to assess polygenic sensitivity scores. We formulate a new methodological framework encapsulating cognitive and genetic factors in the development of both psychopathology and optimal wellbeing that holds long-term promise for the development of new personalized therapies.

Capturing Dynamics of Biased Attention: Are New Attention Variability Measures the Way Forward?

Background

New indices, calculated on data from the widely used Dot Probe Task, were recently proposed to capture variability in biased attention allocation. We observed that it remains unclear which data pattern is meant to be indicative of dynamic bias and thus to be captured by these indices. Moreover, we hypothesized that the new indices are sensitive to SD differences at the response time (RT) level in the absence of bias.

Method

Randomly generated datasets were analyzed to assess properties of the Attention Bias Variability (ABV) and Trial Level Bias Score (TL-BS) indices. Sensitivity to creating differences in 1) RT standard deviation, 2) mean RT, and 3) bias magnitude were assessed. In addition, two possible definitions of dynamic attention bias were explored by creating differences in 4) frequency of bias switching, and 5) bias magnitude in the presence of constant switching.

Results

ABV and TL-BS indices were found highly sensitive to increasing SD at the response time level, insensitive to increasing bias, linearly sensitive to increasing bias magnitude in the presence of bias switches, and non-linearly sensitive to increasing the frequency of bias switches. The ABV index was also found responsive to increasing mean response times in the absence of bias.

Conclusion

Recently proposed DPT derived variability indices cannot uncouple measurement error from bias variability. Significant group differences may be observed even if there is no bias present in any individual dataset. This renders the new indices in their current form unfit for empirical purposes. Our discussion focuses on fostering debate and ideas for new research to validate the potentially very important notion of biased attention being dynamic.

The Hemlock Society Membership: Comparisons between 1983 and 1995 Surveys and the General Population

While most Right to Die studies have examined the ethical and moral implications of assisted suicide, few have investigated the active membership of Right to Die organizations. Two studies, one in 1983 and one in 1995, have surveyed The Hemlock Society USA membership in an effort to identify those who are actively involved in the Right to Die social movement. This study compares the social demographic descriptors of members of the Hemlock Society at these two different points in time: from the 1983 survey to the California portion of the 1995 survey and between all three Hemlock samples and the General Social Survey. The most significant findings of this study demonstrate that the population of the Hemlock Society is increasing in religiosity and continues to be defined as a well-educated and healthy membership. The Hemlock Society membership over-represents the female population, those over 55 years of age, divorcees and widows/widowers, atheists, and those who are well-educated compared to the general population. Additionally, Hemlock Society members appear to be healthy adults who are still living on their own as opposed to depending on their families for assistance. In other words, the Hemlock Society members constitute a unique and dynamic group of individuals.

Rumination and postnatal depression: A systematic review and a cognitive model

Postnatal depression (PND) confers risk for a range of negative child developmental outcomes, at least in part through its impact on parenting behaviour. Whilst the behavioural effects of depression on parenting are well established, the cognitive mechanisms that may mediate this effect are less well understood. The current paper proposes that rumination may be a key cognitive mechanism through which parenting is affected in PND, and provides a systematic review of the existing literature on rumination in the context of perinatal depression. The review identifies ten relevant papers. Eight are questionnaire-based studies examining the role of rumination in predicting future depression and/or mother-infant relationship outcomes, such as bonding. Two are experimental studies examining the effects of induced rumination on parenting behaviours. The results of the review are discussed, and remaining questions highlighted. We then present a new theoretical model, developed specifically for the perinatal context, and informed by existing models of rumination and worry. Our cognitive model emphasises the relationship between rumination, cognitive biases and cognitive control, and the impact of these variables on infant cue processing and subsequent parenting responses. The model provides a potential framework for future work in this area, and to guide the development of treatment interventions.

Multicentre audit of the treatment of uncomplicated urinary tract infection in South Thames

A regional audit report on the management of uncomplicated urinary tract infections (UTIs) in genitourinary (GU) medicine clinics in the UK in South Thames (South London, Kent, Surrey and Sussex). The majority of centres use trimethoprim as first-line treatment for uncomplicated UTIs. The incidence of trimethoprim resistance was 22.6%. The group has therefore recommended that cephalexin should be the first choice antibiotic for suspected UTIs within GU medicine.

Investigating the efficacy of attention bias modification in reducing high spider fear: The role of individual differences in initial bias

BACKGROUND AND OBJECTIVES

Attention Bias Modification (ABM) targets attention bias (AB) towards threat and is a potential therapeutic intervention for anxiety. The current study investigated whether initial AB (towards or away from spider images) influenced the effectiveness of ABM in spider fear.

METHODS

AB was assessed with an attentional probe task consisting of spider and neutral images presented simultaneously followed by a probe in spider congruent or spider incongruent locations. Response time (RT) differences between spider and neutral trials > 25 ms was considered 'Bias Toward' threat. RT difference < - 25 ms was considered 'Bias Away' from threat, and a difference between -25 ms and +25 ms was considered 'No Bias'. Participants were categorized into Initial Bias groups using pre-ABM AB scores calculated at the end of the study. 66 participants' (Bias Toward n = 27, Bias Away n = 18, No Bias n = 21) were randomly assigned to ABM-active training designed to reduce or eliminate a bias toward threat and 61 (Bias Toward n = 17, Bias Away n = 18, No Bias n = 26) to ABM-control.

RESULTS

ABM-active had the largest impact on those demonstrating an initial Bias Towards spider images in terms of changing AB and reducing Spider Fear Vulnerability, with the Bias Away group experiencing least benefit from ABM. However, all Initial Bias groups benefited equally from active ABM in a Stress Task.

LIMITATIONS

Participants were high spider fearful but not formally diagnosed with a specific phobia. Therefore, results should be confirmed within a clinical population.

CONCLUSIONS

Individual differences in Initial Bias may be an important determinant of ABM efficacy.

Sensory-processing sensitivity moderates the association between childhood experiences and adult life satisfaction

There are few studies testing the differential susceptibility hypothesis (DSH: hypothesizing that some individuals are more responsive to both positive and negative experiences) with adult personality traits. The current study examined the DSH by investigating the moderating effect of sensory-processing sensitivity (SPS) on childhood experiences and life satisfaction. A total of 185 adults completed measures of SPS, positive/negative childhood experiences and life satisfaction. SPS did moderate the association between childhood experiences and life satisfaction. Simple slopes analysis compared those reporting high and low SPS (+/− 1 SD) and revealed that the difference was observed only for those who reported negative childhood experiences; with the high SPS group reporting lower life satisfaction. There was no difference observed in those reporting positive childhood experiences, which supported a diathesis-stress model rather than the DSH.

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SPS moderated the association between childhood experiences and life satisfaction.

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The SPS-by-experiences interaction was significant (β = .14, p = .033).

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High SPS (+ 1 SDmean) were affected by experiences (β = .77, t(181) = 5.82, p < .001).

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Low SPS (− 1 SDmean) were less affected (β = .36, t(181) = 2.41, p = .017).

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This supported a diathesis-stress model.

Mechanisms of Selective Attention in Generalized Anxiety Disorder

A well-established literature has identified different selective attentional orienting mechanisms underlying anxiety-related attentional bias, such as engagement and disengagement of attention. These mechanisms are thought to contribute to the onset and maintenance of anxiety disorders. However, conclusions to date have relied heavily on experimental work from subclinical samples. We therefore investigated individuals with diagnosed generalized anxiety disorder (GAD), healthy volunteers, and individuals with high trait anxiety (but not meeting GAD diagnostic criteria). Across two experiments we found faster disengagement from negative (angry and fearful) faces in GAD groups, an effect opposite to that expected on the basis of the subclinical literature. Together these data challenge current assumptions that we can generalize, to those with GAD, the pattern of selective attentional orienting to threat found in subclinical groups. We suggest a decisive two-stage experiment identifying stimuli of primary salience in GAD, then using these to reexamine orienting mechanisms across groups.

Attentional Control and Suppressing Negative Thought Intrusions in Pathological Worry

Adaptive behavior relies on the ability to effectively and efficiently ignore irrelevant information, an important component of attentional control. The current research found that fundamental difficulties in ignoring irrelevant material are related to dispositional differences in trait propensity to worry, suggesting a core deficit in attentional control in high worriers. The degree of deficit in attentional control correlated with the degree of difficulty in suppressing negative thought intrusions in a worry assessment task. A cognitive training procedure utilizing a flanker task was used in an attempt to improve attentional control. Although the cognitive training was largely ineffective, improvements in attentional control were associated with improvements in the ability to suppress worry-related thought intrusions. Across two studies, the findings indicate that the inability to control worry-related negative thought intrusions is associated with a general deficiency in attentional control.

The sooner the better: Genetic testing following ovarian cancer diagnosis

OBJECTIVE

As treatment based genetic testing becomes a reality, it is important to assess the attitudes and preferences of women newly diagnosed with ovarian cancer regarding genetic testing. The objective of this study was to determine when women with a diagnosis of high grade serous ovarian cancer would prefer to undergo genetic testing and factors that influence this preference.

METHODS

Women over 18years of age with a known diagnosis of high grade serous ovarian cancer diagnosed between October 2010-2013 were identified via the Princess Margaret Cancer Center Registry. Participants completed a questionnaire, which obtained preferences and attitudes towards genetic testing, cancer history, and demographic information.

RESULTS

120 of the 355 women identified (33.8%) completed the questionnaires. The median age at time of ovarian cancer diagnosis was 57years (range 35-84). The majority of participants in this study were offered (94.6%) and pursued (84.8%) genetic testing. In this cohort, testing was most frequently offered at diagnosis (41.8%) or during treatment (19.1%). In this study, women with high grade serous ovarian cancer felt that genetic testing should be offered before or at the time of diagnosis (67.8%). Having a family history of breast or ovarian cancer was significantly (p=0.012) associated with preferring genetic testing at an earlier time point in the disease course.

CONCLUSIONS

Our results demonstrate that women with high grade serous ovarian cancer acknowledge the personal and clinical utility of genetic testing and support test implementation at the time of cancer diagnosis.

Aggregated data from two double-blind base station provocation studies comparing individuals with idiopathic environmental intolerance with attribution to electromagnetic fields and controls

Data from two previous studies were aggregated to provide a statistically powerful test of whether exposure to electromagnetic fields (EMFs) produced by telecommunication base stations negatively affects well-being in individuals who report idiopathic environmental illness with attribution to electromagnetic fields (IEI-EMF) and control participants. A total of 102 IEI-EMF and 237 controls participated in open provocation trials and 88 IEI-EMF and 231 controls went on to complete double-blind trials in which they were exposed to EMFs from a base station emitting either a Global System for Mobile Communication and Universal Mobile Telecommunications System or a Terrestrial Trunked Radio Telecommunications System signal. Both experiments included a comparison sham condition. Visual analog and symptom scales measured subjective well-being. Results showed that IEI-EMF participants reported lower levels of well-being during real compared to sham exposure during open provocation, but not during double-blind trials. Additionally, participants reported lower levels of well-being during high compared to low load trials and this did not interact with radiofrequency-EMF exposure. These findings are consistent with a growing body of literature indicating there is no causal relationship between short-term exposure to EMFs and subjective well-being in members of the public whether or not they report perceived sensitivity to EMFs.

Vandetanib successfully controls medullary thyroid cancer-related Cushing syndrome in an adolescent patient

CONTEXT

Ectopic Cushing syndrome due to ACTH secretion from metastatic medullary thyroid cancer (MTC) is associated with significant morbidity and mortality.

OBJECTIVE

The aim of the study was to describe the first case of Cushing syndrome associated with MTC in a pediatric patient and the successful reversal of Cushing syndrome with tyrosine kinase inhibitor (vandetanib) therapy.

PATIENT AND METHODS

A 17-year-old Brazilian adolescent presented with metastatic MTC and associated ACTH-dependent ectopic Cushing syndrome in the context of multiple endocrine neoplasia type 2B. When the patient was treated with the tyrosine kinase inhibitor vandetanib, rapid decrease in serum cortisol and improvement of clinical symptoms were observed.

CONCLUSION

We describe the first pediatric case of clinical and biochemical improvement of paraneoplastic MTC-related Cushing syndrome after treatment with vandetanib. Vandetanib and possibly other tyrosine kinase inhibitors may be a novel beneficial option in patients with neuroendocrine tumor-related ectopic Cushing syndrome.