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Pepping N, Weinborn M, Pestell CF, Preece DA, Malkani M, Moore S, Gross JJ, Becerra R. Improving emotion regulation ability after brain injury: A systematic review of targeted interventions. Neuropsychol Rehabil 2024:1-41. [PMID: 39230344 DOI: 10.1080/09602011.2024.2398029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 08/25/2024] [Indexed: 09/05/2024]
Abstract
Emotion dysregulation is a common sequela after a brain injury, and it can have serious negative consequences for individuals, families, and the community. A systematic review of the literature was conducted to identify and evaluate interventions designed to improve emotion regulation ability in adults with acquired brain injury. Studies were identified on ProQuest, PsycInfo, ScienceDirect, Scopus, and Web of Science; last searched on 3 August 2023. A review protocol was prospectively registered on PROSPERO (CRD42020218175). Risk of bias was assessed using the Cochrane Risk-of-Bias tool (version 2). Sixteen studies were included in the review comprising one case series, five pilot studies, four pre-post studies, and six RCTs. There was a total of 652 participants across studies. Fourteen of the sixteen studies reported statistically significant improvements in at least one emotional functioning variable. Ten studies reported medium-large effect sizes. Limitations included inconsistency in the measurement, reporting of intervention outcomes and processes. Future directions are discussed.
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Affiliation(s)
- Natalie Pepping
- School of Psychological Science, The University of Western Australia, Perth, Australia
| | - Michael Weinborn
- School of Psychological Science, The University of Western Australia, Perth, Australia
| | - Carmela F Pestell
- School of Psychological Science, The University of Western Australia, Perth, Australia
| | - David A Preece
- School of Psychological Science, The University of Western Australia, Perth, Australia
- School of Population Health, Curtin University, Perth, Australia
- Psychological Sciences Research Institute, UCLouvain, Ottignies-Louvain-la-Neuve, Belgium
| | - Maya Malkani
- School of Psychological Science, The University of Western Australia, Perth, Australia
| | - Sammy Moore
- School of Psychological Science, The University of Western Australia, Perth, Australia
| | - James J Gross
- Department of Psychology, Stanford University, Stanford, CA, USA
| | - Rodrigo Becerra
- School of Psychological Science, The University of Western Australia, Perth, Australia
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2
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Rubin M. Testing a brief attention training protocol to prevent emotional distress from a fear induction procedure. J Behav Ther Exp Psychiatry 2024; 84:101956. [PMID: 38447472 DOI: 10.1016/j.jbtep.2024.101956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 01/25/2024] [Accepted: 02/25/2024] [Indexed: 03/08/2024]
Abstract
BACKGROUND AND OBJECTIVES Attentional hypervigilance to threat in posttraumatic stress disorder (PTSD) is an important topic to investigate. Efforts to leverage attention training to prevent PTSD have been promising but underlying mechanisms have not been fully elucidated. The current study tested whether Attention Bias Modification (ABM) prior to an emotion induction of fear could reduce self-reported fear and arousal compared to two control conditions. METHODS Participants (N = 86) were recruited from Amazon Mechanical Turk and randomized to receive either (1) ABM where they were directed towards fear related words on every trial; (2) Attention Control Training (ACT) where they were directed towards fear related words on 50% of trials; or (3) Neutral training where all words were neutral. Participants then completed a fear emotion induction (a 2-min video), reporting fear, arousal, and mood before and after the emotion induction. RESULTS Participants in the ABM condition had lower fear compared to the Neutral condition b = 11.43, 95% CI (1.20, 21.65), d = 0.48. Participants in the ABM condition did not have lower fear compared to the ACT condition b = 9.75, 95% CI (-0.64, 19.96), d = 0.41. Importantly, attentional avoidance at baseline moderated the effect of condition for both fear and arousal; higher avoidance at baseline for the ABM condition was associated with lower fear and arousal after the emotion induction compared to the Neutral condition. LIMITATIONS The sample size was relatively small and limited in diversity. CONCLUSIONS These findings are the first experimental evidence showing that the benefit of ABM prior to a fearful experience may be in its reduction of the target emotion. Additionally, ABM may work best for those that demonstrate the most avoidance at baseline in their attention towards fearful stimuli.
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3
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Vrijsen JN, Grafton B, Koster EHW, Lau J, Wittekind CE, Bar-Haim Y, Becker ES, Brotman MA, Joormann J, Lazarov A, MacLeod C, Manning V, Pettit JW, Rinck M, Salemink E, Woud ML, Hallion LS, Wiers RW. Towards implementation of cognitive bias modification in mental health care: State of the science, best practices, and ways forward. Behav Res Ther 2024; 179:104557. [PMID: 38797055 DOI: 10.1016/j.brat.2024.104557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 04/17/2024] [Accepted: 05/06/2024] [Indexed: 05/29/2024]
Abstract
Cognitive bias modification (CBM) has evolved from an experimental method testing cognitive mechanisms of psychopathology to a promising tool for accessible digital mental health care. While we are still discovering the conditions under which clinically relevant effects occur, the dire need for accessible, effective, and low-cost mental health tools underscores the need for implementation where such tools are available. Providing our expert opinion as Association for Cognitive Bias Modification members, we first discuss the readiness of different CBM approaches for clinical implementation, then discuss key considerations with regard to implementation. Evidence is robust for approach bias modification as an adjunctive intervention for alcohol use disorders and interpretation bias modification as a stand-alone intervention for anxiety disorders. Theoretical predictions regarding the mechanisms by which bias and symptom change occur await further testing. We propose that CBM interventions with demonstrated efficacy should be provided to the targeted populations. To facilitate this, we set a research agenda based on implementation frameworks, which includes feasibility and acceptability testing, co-creation with end-users, and collaboration with industry partners.
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Affiliation(s)
- Janna N Vrijsen
- Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands; Depression Expertise Center, Pro Persona Mental Health Care, Nijmegen, the Netherlands.
| | - Ben Grafton
- Centre for the Advancement of Research on Emotion, School of Psychological Science, University of Western Australia, Australia
| | - Ernst H W Koster
- Department of Experimental-Clinical and Health Psychology, Ghent University, Belgium
| | - Jennifer Lau
- Youth Resilience Unit, Queen Mary University of London, UK
| | - Charlotte E Wittekind
- Department of Psychology, Clinical Psychology and Psychotherapy, LMU Munich, Germany
| | - Yair Bar-Haim
- School of Psychological Sciences, Tel-Aviv University, Tel Aviv-Yafo, Israel; School of Neuroscience, Tel-Aviv University, Tel Aviv-Yafo, Israel
| | - Eni S Becker
- Behavioural Science Institute, Radboud University, Nijmegen, the Netherlands
| | - Melissa A Brotman
- Emotion and Development Branch, National Institute of Mental Health Intramural Research Program, National Institutes of Health, Bethesda, MD, USA
| | - Jutta Joormann
- Department of Psychology, Yale University, New Haven, Conneticut, USA
| | - Amit Lazarov
- School of Neuroscience, Tel-Aviv University, Tel Aviv-Yafo, Israel
| | - Colin MacLeod
- Centre for the Advancement of Research on Emotion, School of Psychological Science, University of Western Australia, Australia
| | - Victoria Manning
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia; Turning Point, Eastern Health, Melbourne, Victoria, Australia
| | - Jeremy W Pettit
- Department of Psychology and Center for Children and Families, Florida International University, Miami, FL, USA
| | - Mike Rinck
- Emotion and Development Branch, National Institute of Mental Health Intramural Research Program, National Institutes of Health, Bethesda, MD, USA
| | - Elske Salemink
- Department of Clinical Psychology, Faculty of Social and Behavioural Sciences, Utrecht University, the Netherlands
| | - Marcella L Woud
- Clinical Psychology and Experimental Psychopathology, Georg-Elias-Mueller-Institute of Psychology, University of Göttingen, Göttingen, Germany; Mental Health Research and Treatment Center, Ruhr-University Bochum, Bochum, Germany
| | | | - Reinout W Wiers
- Addiction Development and Psychopathology (ADAPT) Lab, Department of Psychology, and Centre for Urban Mental Health, University of Amsterdam, Amsterdam, the Netherlands
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Fernandes-Magalhaes R, Carpio A, Ferrera D, Peláez I, De Lahoz ME, Van Ryckeghem D, Van Damme S, Mercado F. Neural mechanisms underlying attentional bias modification in fibromyalgia patients: a double-blind ERP study. Eur Arch Psychiatry Clin Neurosci 2024; 274:1197-1213. [PMID: 37980687 DOI: 10.1007/s00406-023-01709-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 10/15/2023] [Indexed: 11/21/2023]
Abstract
There is a growing interest in the potential benefits of attentional bias modification (ABM) training in chronic pain patients. However, studies examining the effectiveness of ABM programs in fibromyalgia patients have demonstrated inconclusive effects on both behavioral indices and clinical symptoms. Additionally, underlying neural dynamics of ABM effects could yield new insights but remain yet unexplored. Current study, therefore, aims to investigate the effects of ABM training on known neural electrophysiological indicators of attentional bias to pain (P2, N2a). Thirty-two fibromyalgia patients were enrolled and randomly assigned to an ABM training (N = 16) or control (N = 16) condition (2 weeks duration). Within the ABM training condition participants performed five sessions consisting of a modified version of the dot-probe task in which patients were trained to avoid facial pain expressions, whereas in the control group participants performed five sessions consisting of a standard version of the dot-probe task. Potential ABM training effects were evaluated by comparing a single pre- and post-treatment session, in which event-related potentials (ERPs) were recorded in response to both facial expressions and target stimuli. Furthermore, patients filled out a series of self-report questionnaires assessing anxiety, depression, pain-related worrying, fear of pain, fatigue and pain status. After training, results indicated an overall reduction of the amplitude of the P2 component followed by an enhancement of N2a amplitude for the ABM condition compared to control condition. In addition, scores on anxiety and depression decreased in patients assigned to the training condition. However, we found no effects derived from the training on pain-related and fatigue status. Present study offers new insights related to the possible neural mechanisms underlying the effect of ABM training in fibromyalgia. Clinical trial (TRN: NCT05905159) retrospectively registered (30/05/2023).
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Affiliation(s)
- Roberto Fernandes-Magalhaes
- Department of Psychology, Faculty of Health Sciences, Universidad Rey Juan Carlos, Av. Atenas s/n, 28922, Alcorcón, Madrid, Spain
| | - Alberto Carpio
- Department of Psychology, Faculty of Health Sciences, Universidad Rey Juan Carlos, Av. Atenas s/n, 28922, Alcorcón, Madrid, Spain
| | - David Ferrera
- Department of Psychology, Faculty of Health Sciences, Universidad Rey Juan Carlos, Av. Atenas s/n, 28922, Alcorcón, Madrid, Spain
| | - Irene Peláez
- Department of Psychology, Faculty of Health Sciences, Universidad Rey Juan Carlos, Av. Atenas s/n, 28922, Alcorcón, Madrid, Spain
| | - María Eugenia De Lahoz
- Department of Psychology, Faculty of Health Sciences, Universidad Rey Juan Carlos, Av. Atenas s/n, 28922, Alcorcón, Madrid, Spain
| | - Dimitri Van Ryckeghem
- Department of Clinical Psychological Science, Maastricht University, Maastricht, Netherlands
- Department of Behavioural and Cognitive Sciences, University of Luxembourg, Esch-sur-Alzette, Luxembourg
- Department of Experimental-Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Stefaan Van Damme
- Department of Experimental-Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Francisco Mercado
- Department of Psychology, Faculty of Health Sciences, Universidad Rey Juan Carlos, Av. Atenas s/n, 28922, Alcorcón, Madrid, Spain.
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Rooney T, Sharpe L, Todd J, Michalski SC, Van Ryckeghem D, Crombez G, Colagiuri B. Beyond the modified dot-probe task: A meta-analysis of the efficacy of alternate attention bias modification tasks across domains. Clin Psychol Rev 2024; 110:102436. [PMID: 38696911 DOI: 10.1016/j.cpr.2024.102436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 02/25/2024] [Accepted: 04/25/2024] [Indexed: 05/04/2024]
Abstract
Attention biases towards disease-relevant cues have been implicated in numerous disorders and health conditions, such as anxiety, cancer, drug-use disorders, and chronic pain. Attention bias modification (ABM) has shown that changing attention biases can change related emotional processes. ABM most commonly uses a modified dot-probe task, which has received increasing criticism regarding its reliability and inconsistent findings. The purpose of the present review was thus to systematically review and meta-analyse alternative tasks used in ABM research. We sought to examine whether alternative tasks significantly changed attention biases and emotional outcomes, and critically examined whether relevant sample, task and intervention characteristics moderated each of these effect sizes. Seventy-four (completer n = 15,294) study level comparisons were included in the meta-analysis. Overall, alternative ABM designs had a medium effect on changing biases (g = 0.488), and a small, but significant effect on improving clinical outcomes (g = 0.117). We found this effect to be significantly larger for studies which successfully changed biases compared to those that did not. Across all tasks, it appeared that targeting engagement biases results in the largest change to attention biases. Importantly, we found tasks incorporating gaze-contingency - encouraging engagement with non-biased stimuli - show the most promise for improving emotional outcomes.
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Affiliation(s)
- Tessa Rooney
- School of Psychology, Faculty of Science, The University of Sydney, Australia.
| | - Louise Sharpe
- School of Psychology, Faculty of Science, The University of Sydney, Australia
| | - Jemma Todd
- School of Psychology, Faculty of Science, The University of Sydney, Australia
| | - Stefan Carlo Michalski
- Department of Developmental Disability Neuropsychiatry, Faculty of Medicine and Health, The University of New South Wales, Australia
| | - Dimitri Van Ryckeghem
- Department of Experimental-Clinical and Health Psychology, Ghent University, Belgium; Department of Clinical Psychological Science, Maastricht University, Maastricht, Netherlands; Department of Behavioural and Cognitive Sciences, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Geert Crombez
- Department of Experimental-Clinical and Health Psychology, Ghent University, Belgium
| | - Ben Colagiuri
- School of Psychology, Faculty of Science, The University of Sydney, Australia
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Kong Q, Han B. Pharmacotherapy and cognitive bias modification for the treatment of anxiety disorders. Expert Rev Neurother 2024; 24:517-525. [PMID: 38557434 DOI: 10.1080/14737175.2024.2334847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 03/21/2024] [Indexed: 04/04/2024]
Abstract
INTRODUCTION Anxiety disorders are characterized by widespread and persistent anxiety or recurrent panic attacks. As a result of their high prevalence, chronicity, and comorbidity, patients' quality of life and functioning are severely compromised. However, several patients do not receive treatment. AREAS COVERED This review discusses the effectiveness, safety, and limitations of major medications and cognitive bias modification (CBM) for treating anxiety disorders. The possibility of combined treatment is also discussed in the literature. Furthermore, drawing on Chinese cultural perspectives, the authors suggest that anxiety can be recognized, measured, and coped with at three levels of skill (), vision (), and Tao (). EXPERT OPINION The combination of pharmacotherapy and CBM is possibly more effective in treating anxiety disorders than either treatment alone. However, clinicians and patients should participate in the joint decision-making process and consider comprehensive factors. Moderate anxiety has adaptive significance. In the coming years, by combining the downward analytical system of western culture with the upward integrative system of Chinese culture, a comprehensive understanding of anxiety and anxiety disorders should be established, rather than focusing only on their treatment.
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Affiliation(s)
- Qingyan Kong
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Buxin Han
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
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7
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Zhang F, Huang C, Yan W, Ouyang H, Liu W. Attentional bias modification and attention control training in PTSD: a systematic review and meta-analysis. Ther Adv Psychopharmacol 2024; 14:20451253241243260. [PMID: 38633357 PMCID: PMC11022678 DOI: 10.1177/20451253241243260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 03/14/2024] [Indexed: 04/19/2024] Open
Abstract
Background Cognitive models of post-traumatic stress disorder (PTSD) highlighted the effect of maladaptive cognitive processing in the development and maintenance of PTSD. PTSD is related to attentional bias (AB) toward threatening stimuli and greater attentional bias variability (ABV). Attentional bias modification (ABM) and attention control training (ACT) have demonstrated the effect of improving PTSD, but the results of randomized controlled trials (RCTs) are controversial. Objectives The current study aimed to evaluate the extent of evidence supporting the efficacy of ABM in the treatment of PTSD. Design Systematic review and meta-analysis. Methods We searched PUBMED, PsycINFO, EMBASE, ClinicalTrials.gov, and the Cochrane Central Register of Controlled Trials for articles published between 1980 and 2022. RCTs of ABM for adult participants with PTSD symptoms were identified. The primary outcome was changes in PTSD severity, and the second outcome was changes in AB and ABV. Trial quality was assessed using the Cochrane Risk of Bias Tool. Publication bias was assessed using the Doi plot and Luis Furuya-Kanamori (LFK) index. Results Eight RCTs comparing the effect of ABM to ACT were included in the review, and six studies were meta-analyzed. Meta-analysis favored ACT in improving PTSD symptoms and ABV, and the effect size was large. ABM and ACT demonstrated similar effects in improving AB. Conclusion ACT should not only be seen as a control training condition but also has therapeutic values. However, since the current meta-analysis only included a limited number of studies, further research was still needed to examine the clinical value of ACT in PTSD treatment.
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Affiliation(s)
- Fan Zhang
- Lab for Post-traumatic Stress Disorder, Faculty of Psychology, Naval Medical University, Shanghai, China
- The Emotion and Cognition Lab, Faculty of Psychology, Naval Medical University, Shanghai, China
| | - Chenwei Huang
- Faculty of Psychology, Naval Medical University, Shanghai, China
| | - Wenjie Yan
- Lab for Post-traumatic Stress Disorder, Faculty of Psychology, Naval Medical University, Shanghai, China
- The Emotion and Cognition Lab, Faculty of Psychology, Naval Medical University, Shanghai, China
| | - Hui Ouyang
- Lab for Post-traumatic Stress Disorder, Faculty of Psychology, Naval Medical University, #800 Xiangyin Road, Shanghai 200433, China
- The Emotion and Cognition Lab, Faculty of Psychology, Naval Medical University, Shanghai, China
- Lab for Post-traumatic Stress Disorder, Faculty of Psychology, Naval Medical University, Shanghai, China
- The Emotion and Cognition Lab, Faculty of Psychology, Naval Medical University, Shanghai, China
| | - Weizhi Liu
- Lab for Post-traumatic Stress Disorder, Faculty of Psychology, Naval Medical University, #800 Xiangyin Road, Shanghai 200433, China
- The Emotion and Cognition Lab, Faculty of Psychology, Naval Medical University, Shanghai, China
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8
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Zainal NH, Jacobson NC. Reliability (or lack thereof) of smartphone ecological momentary assessment of visual dot probe attention bias toward threat indices. J Behav Ther Exp Psychiatry 2024; 82:101918. [PMID: 37907019 DOI: 10.1016/j.jbtep.2023.101918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 07/05/2023] [Accepted: 10/09/2023] [Indexed: 11/02/2023]
Abstract
BACKGROUND AND OBJECTIVES Cognitive bias theories posit that generalized anxiety disorder (GAD) and social anxiety disorder (SAD) are entwined with attention bias toward threats, commonly indexed by faster response time (RT) on threat-congruent (vs. threat-incongruent) trials on the visual dot probe. Moreover, although smartphone ecological momentary assessment (EMA) of the visual dot probe has been developed, their psychometric properties are understudied. This study thus aimed to assess the reliability of 8 smartphone-delivered visual dot probe attention bias and related indices in persons with and without GAD and SAD. METHODS Community-dwelling adults (n = 819; GAD: 64%; SAD: 49%; Mixed GAD and SAD: 37%; Non-GAD/SAD Controls: 24%) completed a five-trial smartphone-delivered visual dot probe for a median of 60 trials (12 sessions x 5 trials/session) and an average of 100 trials (20 sessions x 5 trials/session). RESULTS As hypothesized, Global Attention Bias Index, Disengagement Effect, and Facilitation Bias had low-reliability estimates. However, retest-reliability and internal reliability were good for Trial-Level Bias Scores (TLBS) (Bias Toward Treat: intra-class correlation coefficients (ICCs) = 0.626-0.644; split-half r = 0.640-0.670; Attention Bias Variability: ICCs = 0.507-0.567; split-half r = 0.520-0.580) and (In)congruent RTs. Poor retest-reliability and internal reliability estimates were consistently observed for all traditional attention bias and related indices but not TLBS. LIMITATIONS Our visual dot probe EMA should have administered ≥320 trials to match best-practice guidelines based on similar laboratory studies. CONCLUSIONS Future research should strive to examine attention bias paradigms beyond the dot-probe task that evidenced meaningful test-retest reliability properties in laboratory and real-world naturalistic settings.
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Affiliation(s)
- Nur Hani Zainal
- Harvard Medical School, Department of Health Care Policy, USA; National University of Singapore, Department of Psychology, Singapore.
| | - Nicholas C Jacobson
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, USA
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Haller SP, Linke JO, Grassie HL, Jones EL, Pagliaccio D, Harrewijn A, White LK, Naim R, Abend R, Mallidi A, Berman E, Lewis KM, Kircanski K, Fox NA, Silverman WK, Kalin NH, Bar-Haim Y, Brotman MA. Normalization of Fronto-Parietal Activation by Cognitive-Behavioral Therapy in Unmedicated Pediatric Patients With Anxiety Disorders. Am J Psychiatry 2024; 181:201-212. [PMID: 38263879 DOI: 10.1176/appi.ajp.20220449] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
OBJECTIVE Anxiety disorders are prevalent among youths and are often highly impairing. Cognitive-behavioral therapy (CBT) is an effective first-line treatment. The authors investigated the brain mechanisms associated with symptom change following CBT. METHODS Unmedicated youths diagnosed with an anxiety disorder underwent 12 weeks of CBT as part of two randomized clinical trials testing the efficacy of adjunctive computerized cognitive training. Across both trials, participants completed a threat-processing task during functional MRI before and after treatment. Age-matched healthy comparison youths completed two scans over the same time span. The mean age of the samples was 13.20 years (SD=2.68); 41% were male (youths with anxiety disorders, N=69; healthy comparison youths, N=62). An additional sample including youths at temperamental risk for anxiety (N=87; mean age, 10.51 years [SD=0.43]; 41% male) was utilized to test the stability of anxiety-related neural differences in the absence of treatment. Whole-brain regional activation changes (thresholded at p<0.001) were examined using task-based blood-oxygen-level-dependent response. RESULTS Before treatment, patients with an anxiety disorder exhibited altered activation in fronto-parietal attention networks and limbic regions relative to healthy comparison children across all task conditions. Fronto-parietal hyperactivation normalized over the course of treatment, whereas limbic responses remained elevated after treatment. In the at-risk sample, overlapping clusters emerged between regions showing stable associations with anxiety over time and regions showing treatment-related changes. CONCLUSIONS Activation in fronto-parietal networks may normalize after CBT in unmedicated pediatric anxiety patients. Limbic regions may be less amenable to acute CBT effects. Findings from the at-risk sample suggest that treatment-related changes may not be attributed solely to the passage of time.
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Affiliation(s)
- Simone P Haller
- Emotion and Development Branch, NIMH, Bethesda, Md. (Haller, Grassie, Jones, Mallidi, Berman, Lewis, Kircanski, Brotman); Department of Psychology, University of Freiburg, Freiburg, Germany (Linke); Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York (Pagliaccio); Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, the Netherlands (Harrewijn); Department of Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia (White); Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel (Abend); Department of Human Development and Quantitative Methodology, University of Maryland, College Park (Fox); Yale Child Study Center, Yale School of Medicine, New Haven, Conn. (Silverman); Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison (Kalin); School of Psychological Sciences (Bar-Heim, Naim) and Sagol School of Neuroscience (Bar-Haim), Tel Aviv University, Tel Aviv, Israel
| | - Julia O Linke
- Emotion and Development Branch, NIMH, Bethesda, Md. (Haller, Grassie, Jones, Mallidi, Berman, Lewis, Kircanski, Brotman); Department of Psychology, University of Freiburg, Freiburg, Germany (Linke); Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York (Pagliaccio); Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, the Netherlands (Harrewijn); Department of Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia (White); Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel (Abend); Department of Human Development and Quantitative Methodology, University of Maryland, College Park (Fox); Yale Child Study Center, Yale School of Medicine, New Haven, Conn. (Silverman); Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison (Kalin); School of Psychological Sciences (Bar-Heim, Naim) and Sagol School of Neuroscience (Bar-Haim), Tel Aviv University, Tel Aviv, Israel
| | - Hannah L Grassie
- Emotion and Development Branch, NIMH, Bethesda, Md. (Haller, Grassie, Jones, Mallidi, Berman, Lewis, Kircanski, Brotman); Department of Psychology, University of Freiburg, Freiburg, Germany (Linke); Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York (Pagliaccio); Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, the Netherlands (Harrewijn); Department of Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia (White); Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel (Abend); Department of Human Development and Quantitative Methodology, University of Maryland, College Park (Fox); Yale Child Study Center, Yale School of Medicine, New Haven, Conn. (Silverman); Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison (Kalin); School of Psychological Sciences (Bar-Heim, Naim) and Sagol School of Neuroscience (Bar-Haim), Tel Aviv University, Tel Aviv, Israel
| | - Emily L Jones
- Emotion and Development Branch, NIMH, Bethesda, Md. (Haller, Grassie, Jones, Mallidi, Berman, Lewis, Kircanski, Brotman); Department of Psychology, University of Freiburg, Freiburg, Germany (Linke); Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York (Pagliaccio); Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, the Netherlands (Harrewijn); Department of Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia (White); Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel (Abend); Department of Human Development and Quantitative Methodology, University of Maryland, College Park (Fox); Yale Child Study Center, Yale School of Medicine, New Haven, Conn. (Silverman); Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison (Kalin); School of Psychological Sciences (Bar-Heim, Naim) and Sagol School of Neuroscience (Bar-Haim), Tel Aviv University, Tel Aviv, Israel
| | - David Pagliaccio
- Emotion and Development Branch, NIMH, Bethesda, Md. (Haller, Grassie, Jones, Mallidi, Berman, Lewis, Kircanski, Brotman); Department of Psychology, University of Freiburg, Freiburg, Germany (Linke); Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York (Pagliaccio); Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, the Netherlands (Harrewijn); Department of Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia (White); Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel (Abend); Department of Human Development and Quantitative Methodology, University of Maryland, College Park (Fox); Yale Child Study Center, Yale School of Medicine, New Haven, Conn. (Silverman); Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison (Kalin); School of Psychological Sciences (Bar-Heim, Naim) and Sagol School of Neuroscience (Bar-Haim), Tel Aviv University, Tel Aviv, Israel
| | - Anita Harrewijn
- Emotion and Development Branch, NIMH, Bethesda, Md. (Haller, Grassie, Jones, Mallidi, Berman, Lewis, Kircanski, Brotman); Department of Psychology, University of Freiburg, Freiburg, Germany (Linke); Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York (Pagliaccio); Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, the Netherlands (Harrewijn); Department of Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia (White); Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel (Abend); Department of Human Development and Quantitative Methodology, University of Maryland, College Park (Fox); Yale Child Study Center, Yale School of Medicine, New Haven, Conn. (Silverman); Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison (Kalin); School of Psychological Sciences (Bar-Heim, Naim) and Sagol School of Neuroscience (Bar-Haim), Tel Aviv University, Tel Aviv, Israel
| | - Lauren K White
- Emotion and Development Branch, NIMH, Bethesda, Md. (Haller, Grassie, Jones, Mallidi, Berman, Lewis, Kircanski, Brotman); Department of Psychology, University of Freiburg, Freiburg, Germany (Linke); Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York (Pagliaccio); Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, the Netherlands (Harrewijn); Department of Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia (White); Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel (Abend); Department of Human Development and Quantitative Methodology, University of Maryland, College Park (Fox); Yale Child Study Center, Yale School of Medicine, New Haven, Conn. (Silverman); Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison (Kalin); School of Psychological Sciences (Bar-Heim, Naim) and Sagol School of Neuroscience (Bar-Haim), Tel Aviv University, Tel Aviv, Israel
| | - Reut Naim
- Emotion and Development Branch, NIMH, Bethesda, Md. (Haller, Grassie, Jones, Mallidi, Berman, Lewis, Kircanski, Brotman); Department of Psychology, University of Freiburg, Freiburg, Germany (Linke); Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York (Pagliaccio); Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, the Netherlands (Harrewijn); Department of Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia (White); Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel (Abend); Department of Human Development and Quantitative Methodology, University of Maryland, College Park (Fox); Yale Child Study Center, Yale School of Medicine, New Haven, Conn. (Silverman); Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison (Kalin); School of Psychological Sciences (Bar-Heim, Naim) and Sagol School of Neuroscience (Bar-Haim), Tel Aviv University, Tel Aviv, Israel
| | - Rany Abend
- Emotion and Development Branch, NIMH, Bethesda, Md. (Haller, Grassie, Jones, Mallidi, Berman, Lewis, Kircanski, Brotman); Department of Psychology, University of Freiburg, Freiburg, Germany (Linke); Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York (Pagliaccio); Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, the Netherlands (Harrewijn); Department of Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia (White); Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel (Abend); Department of Human Development and Quantitative Methodology, University of Maryland, College Park (Fox); Yale Child Study Center, Yale School of Medicine, New Haven, Conn. (Silverman); Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison (Kalin); School of Psychological Sciences (Bar-Heim, Naim) and Sagol School of Neuroscience (Bar-Haim), Tel Aviv University, Tel Aviv, Israel
| | - Ajitha Mallidi
- Emotion and Development Branch, NIMH, Bethesda, Md. (Haller, Grassie, Jones, Mallidi, Berman, Lewis, Kircanski, Brotman); Department of Psychology, University of Freiburg, Freiburg, Germany (Linke); Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York (Pagliaccio); Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, the Netherlands (Harrewijn); Department of Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia (White); Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel (Abend); Department of Human Development and Quantitative Methodology, University of Maryland, College Park (Fox); Yale Child Study Center, Yale School of Medicine, New Haven, Conn. (Silverman); Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison (Kalin); School of Psychological Sciences (Bar-Heim, Naim) and Sagol School of Neuroscience (Bar-Haim), Tel Aviv University, Tel Aviv, Israel
| | - Erin Berman
- Emotion and Development Branch, NIMH, Bethesda, Md. (Haller, Grassie, Jones, Mallidi, Berman, Lewis, Kircanski, Brotman); Department of Psychology, University of Freiburg, Freiburg, Germany (Linke); Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York (Pagliaccio); Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, the Netherlands (Harrewijn); Department of Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia (White); Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel (Abend); Department of Human Development and Quantitative Methodology, University of Maryland, College Park (Fox); Yale Child Study Center, Yale School of Medicine, New Haven, Conn. (Silverman); Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison (Kalin); School of Psychological Sciences (Bar-Heim, Naim) and Sagol School of Neuroscience (Bar-Haim), Tel Aviv University, Tel Aviv, Israel
| | - Krystal M Lewis
- Emotion and Development Branch, NIMH, Bethesda, Md. (Haller, Grassie, Jones, Mallidi, Berman, Lewis, Kircanski, Brotman); Department of Psychology, University of Freiburg, Freiburg, Germany (Linke); Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York (Pagliaccio); Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, the Netherlands (Harrewijn); Department of Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia (White); Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel (Abend); Department of Human Development and Quantitative Methodology, University of Maryland, College Park (Fox); Yale Child Study Center, Yale School of Medicine, New Haven, Conn. (Silverman); Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison (Kalin); School of Psychological Sciences (Bar-Heim, Naim) and Sagol School of Neuroscience (Bar-Haim), Tel Aviv University, Tel Aviv, Israel
| | - Katharina Kircanski
- Emotion and Development Branch, NIMH, Bethesda, Md. (Haller, Grassie, Jones, Mallidi, Berman, Lewis, Kircanski, Brotman); Department of Psychology, University of Freiburg, Freiburg, Germany (Linke); Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York (Pagliaccio); Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, the Netherlands (Harrewijn); Department of Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia (White); Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel (Abend); Department of Human Development and Quantitative Methodology, University of Maryland, College Park (Fox); Yale Child Study Center, Yale School of Medicine, New Haven, Conn. (Silverman); Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison (Kalin); School of Psychological Sciences (Bar-Heim, Naim) and Sagol School of Neuroscience (Bar-Haim), Tel Aviv University, Tel Aviv, Israel
| | - Nathan A Fox
- Emotion and Development Branch, NIMH, Bethesda, Md. (Haller, Grassie, Jones, Mallidi, Berman, Lewis, Kircanski, Brotman); Department of Psychology, University of Freiburg, Freiburg, Germany (Linke); Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York (Pagliaccio); Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, the Netherlands (Harrewijn); Department of Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia (White); Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel (Abend); Department of Human Development and Quantitative Methodology, University of Maryland, College Park (Fox); Yale Child Study Center, Yale School of Medicine, New Haven, Conn. (Silverman); Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison (Kalin); School of Psychological Sciences (Bar-Heim, Naim) and Sagol School of Neuroscience (Bar-Haim), Tel Aviv University, Tel Aviv, Israel
| | - Wendy K Silverman
- Emotion and Development Branch, NIMH, Bethesda, Md. (Haller, Grassie, Jones, Mallidi, Berman, Lewis, Kircanski, Brotman); Department of Psychology, University of Freiburg, Freiburg, Germany (Linke); Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York (Pagliaccio); Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, the Netherlands (Harrewijn); Department of Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia (White); Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel (Abend); Department of Human Development and Quantitative Methodology, University of Maryland, College Park (Fox); Yale Child Study Center, Yale School of Medicine, New Haven, Conn. (Silverman); Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison (Kalin); School of Psychological Sciences (Bar-Heim, Naim) and Sagol School of Neuroscience (Bar-Haim), Tel Aviv University, Tel Aviv, Israel
| | - Ned H Kalin
- Emotion and Development Branch, NIMH, Bethesda, Md. (Haller, Grassie, Jones, Mallidi, Berman, Lewis, Kircanski, Brotman); Department of Psychology, University of Freiburg, Freiburg, Germany (Linke); Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York (Pagliaccio); Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, the Netherlands (Harrewijn); Department of Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia (White); Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel (Abend); Department of Human Development and Quantitative Methodology, University of Maryland, College Park (Fox); Yale Child Study Center, Yale School of Medicine, New Haven, Conn. (Silverman); Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison (Kalin); School of Psychological Sciences (Bar-Heim, Naim) and Sagol School of Neuroscience (Bar-Haim), Tel Aviv University, Tel Aviv, Israel
| | - Yair Bar-Haim
- Emotion and Development Branch, NIMH, Bethesda, Md. (Haller, Grassie, Jones, Mallidi, Berman, Lewis, Kircanski, Brotman); Department of Psychology, University of Freiburg, Freiburg, Germany (Linke); Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York (Pagliaccio); Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, the Netherlands (Harrewijn); Department of Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia (White); Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel (Abend); Department of Human Development and Quantitative Methodology, University of Maryland, College Park (Fox); Yale Child Study Center, Yale School of Medicine, New Haven, Conn. (Silverman); Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison (Kalin); School of Psychological Sciences (Bar-Heim, Naim) and Sagol School of Neuroscience (Bar-Haim), Tel Aviv University, Tel Aviv, Israel
| | - Melissa A Brotman
- Emotion and Development Branch, NIMH, Bethesda, Md. (Haller, Grassie, Jones, Mallidi, Berman, Lewis, Kircanski, Brotman); Department of Psychology, University of Freiburg, Freiburg, Germany (Linke); Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York (Pagliaccio); Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, the Netherlands (Harrewijn); Department of Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia (White); Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel (Abend); Department of Human Development and Quantitative Methodology, University of Maryland, College Park (Fox); Yale Child Study Center, Yale School of Medicine, New Haven, Conn. (Silverman); Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison (Kalin); School of Psychological Sciences (Bar-Heim, Naim) and Sagol School of Neuroscience (Bar-Haim), Tel Aviv University, Tel Aviv, Israel
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10
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Gradi N, Chopin A, Bavelier D, Shechner T, Pichon S. Evaluating the effect of action-like video game play and of casual video game play on anxiety in adolescents with elevated anxiety: protocol for a multi-center, parallel group, assessor-blind, randomized controlled trial. BMC Psychiatry 2024; 24:56. [PMID: 38243201 PMCID: PMC10799487 DOI: 10.1186/s12888-024-05515-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 01/10/2024] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND Adolescence is a critical period for the onset and maintenance of anxiety disorders, which raises the importance of intervening early; one possibility of doing so is via digital interventions. Within that research field, at least two important research paths have been explored in the past years. On the one hand, the anxiolytic effect of casual video games has been tested as such gaming activity may distract away from anxious thoughts through the induction of flow and redirection of attention toward the game and thus away of anxious thoughts. On the other hand, the bidirectional link between weak attentional control and higher anxiety has led to the design of interventions aiming at improving attentional control such as working memory training studies. Taking stock that another genre of gaming, action video games, improves attentional control, game-based interventions that combines cognitive training and action-like game features would seem relevant. This three-arm randomized controlled trial aims to evaluate the feasibility and the efficacy of two video game interventions to document how each may potentially alleviate adolescent anxiety-related symptoms when deployed fully on-line. METHODS The study aims to recruit 150 individuals, 12 to 14 years of age, with high levels of anxiety as reported by the parents' online form of the Screen for Child Anxiety Related Disorders questionnaire. This trial contrasts a child-friendly, "action-like" video game designed to improve attentional control abilities in a progressive and stepwise manner (Eco-Rescue), a casual puzzle video game selected to act as a positive distraction tool (Bejeweled) and finally a control group with no assigned training intervention to control for possible test-retest effects (No-training). Participants will be assigned randomly to one of the three study arms. They will be assessed for main (anxiety) and secondary outcomes (attentional control, affective working memory) at three time points, before training (T1), one week after the 6-week training (T2) and four months after completing the training (T3). DISCUSSION The results will provide evidence for the feasibility and the efficacy of two online video game interventions at improving mental health and emotional well-being in adolescents with high levels of anxiety. This project will contribute unique knowledge to the field, as few studies have examined the effects of video game play in the context of digital mental health interventions for adolescents. TRIAL REGISTRATION The trial is registered on ClinicalTrials.gov (NCT05923944, June 20, 2023).
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Affiliation(s)
- Naïma Gradi
- Department of Psychology, University of Geneva, Geneva, Switzerland.
| | - Adrien Chopin
- Smith Kettlewell Eye Research Institute, San Francisco, CA, USA
| | - Daphné Bavelier
- Department of Psychology, University of Geneva, Geneva, Switzerland.
| | - Tomer Shechner
- Department of Psychology, University of Haifa, Haifa, Israel
| | - Swann Pichon
- Geneva School of Health Sciences, Geneva, Switzerland
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11
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Ozturk S, Zhang X, Glasgow S, Karnani RR, Imbriano G, Luhmann C, Jin J, Mohanty A. Knowledge of Threat Biases Perceptual Decision Making in Anxiety: Evidence From Signal Detection Theory and Drift Diffusion Modeling. BIOLOGICAL PSYCHIATRY GLOBAL OPEN SCIENCE 2024; 4:145-154. [PMID: 38298800 PMCID: PMC10829620 DOI: 10.1016/j.bpsgos.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 07/06/2023] [Accepted: 07/10/2023] [Indexed: 02/02/2024] Open
Abstract
Background Threat biases are considered key factors in the development and maintenance of anxiety. However, these biases are poorly operationalized and remain unquantified. Furthermore, it is unclear whether and how prior knowledge of threat and its uncertainty induce these biases and how they manifest in anxiety. Method Participants (n = 55) used prestimulus cues to decide whether the subsequently presented stimuli were threatening or neutral. The cues either provided no information about the probability (high uncertainty) or indicated high probability (low uncertainty) of encountering threatening or neutral targets. We used signal detection theory and hierarchical drift diffusion modeling to quantify bias. Results High-uncertainty threat cues improved discrimination of subsequent threatening and neutral stimuli more than neutral cues. However, anxiety was associated with worse discrimination of threatening versus neutral stimuli following high-uncertainty threat cues. Using hierarchical drift diffusion modeling, we found that threat cues biased decision making not only by shifting the starting point of evidence accumulation toward the threat decision but also by increasing the efficiency with which sensory evidence was accumulated for both threat-related and neutral decisions. However, higher anxiety was associated with a greater shift of starting point toward the threat decision but not with the efficiency of evidence accumulation. Conclusions Using computational modeling, these results highlight the biases by which knowledge regarding uncertain threat improves perceptual decision making but impairs it in case of anxiety.
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Affiliation(s)
- Sekine Ozturk
- Department of Psychology, Stony Brook University, Stony Brook, New York
| | - Xian Zhang
- Department of Psychology, Stony Brook University, Stony Brook, New York
| | - Shannon Glasgow
- Department of Psychology, Stony Brook University, Stony Brook, New York
| | - Ramesh R. Karnani
- Department of Psychology, The University of Hong Kong, Hong Kong SAR, China
| | - Gabriella Imbriano
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | - Christian Luhmann
- Department of Psychology, Stony Brook University, Stony Brook, New York
| | - Jingwen Jin
- Department of Psychology, The University of Hong Kong, Hong Kong SAR, China
- State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong SAR, China
| | - Aprajita Mohanty
- Department of Psychology, Stony Brook University, Stony Brook, New York
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12
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Shamai-Leshem D, Abend R, Arad G, Azriel O, Chong L, de Jong P, Dykan CDG, Hajcak G, Klawohn J, Meyer A, Neophytou K, Neria Y, Panayiotou G, Schneier F, Soleymani A, Yair N, Pine DS, Bar-Haim Y, Lazarov A. The free-viewing matrix task: A reliable measure of attention allocation in psychopathology. J Anxiety Disord 2023; 100:102789. [PMID: 37949029 DOI: 10.1016/j.janxdis.2023.102789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 09/25/2023] [Accepted: 10/12/2023] [Indexed: 11/12/2023]
Abstract
Aberrant attention allocation has been implicated in the etiology and maintenance of a range of psychopathologies. However, three decades of research, relying primarily on manual response-time tasks, have been challenged on the grounds of poor reliability of its attention bias indices. Here, in a large, multisite, international study we provide reliability information for a new eye-tracking-based measure of attention allocation and its relation to psychopathology and age. Data from 1567 participants, across a wide range of psychiatric diagnoses and ages, were aggregated from nine sites around the world. Of these, 213 participants also provided retest data. Acceptable overall internal consistency and test-retest reliability were observed among adult participants (Cronbach's alpha = 0.86 and r(213) = 0.89, respectively), as well as across all examined psychopathologies. Youth demonstrated lower internal consistency scores (Cronbach's alpha = 0.65). Finally, the percent dwell time index derived from the task statistically differentiated between healthy participants and participants diagnosed with social anxiety disorder, major depression, and post-traumatic stress disorder. These results potentially address a long-standing reliability crisis in this research field. Aberrant attention allocation patterns in a variety of psychiatric disorders may be targeted with the hope of affecting symptoms. The attention allocation index derived from the matrix task offers reliable means to measure such cognitive target engagement in clinical contexts.
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Affiliation(s)
- Dana Shamai-Leshem
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel; School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel.
| | - Rany Abend
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, USA
| | - Gal Arad
- School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Omer Azriel
- School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Lyndsey Chong
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - Peter de Jong
- Department of Clinical Psychology & Experimental Psychopathology, University of Groningen, Groningen, the Netherlands
| | | | - Greg Hajcak
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - Julia Klawohn
- Department of Psychology, Florida State University, Tallahassee, FL, USA; Department of Medicine, MSB Medical School Berlin, Berlin, Germany
| | - Alexandria Meyer
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | | | - Yuval Neria
- Department of Psychiatry, Columbia University Irving Medical Center and New York State Psychiatric Institute, New York, NY, USA
| | | | - Franklin Schneier
- Department of Psychiatry, Columbia University Irving Medical Center and New York State Psychiatric Institute, New York, NY, USA
| | - Ali Soleymani
- Department of Clinical Psychology & Experimental Psychopathology, University of Groningen, Groningen, the Netherlands; Centre of Education and Learning, Technical University of Delft, Delft, the Netherlands
| | - Noga Yair
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Daniel S Pine
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, USA
| | - Yair Bar-Haim
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel; School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Amit Lazarov
- School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel
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13
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Baek S, Ha S, Lee JH. Application of attentional bias modification to reduce attentional bias and emotional reactivity to stress in mildly depressed individuals. Front Psychol 2023; 14:1273512. [PMID: 37965674 PMCID: PMC10641893 DOI: 10.3389/fpsyg.2023.1273512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 09/25/2023] [Indexed: 11/16/2023] Open
Abstract
This study aims to verify the effectiveness of attentional bias modification (ABM) in reducing attentional bias related to depression, particularly in the later stages of attention as a pattern of difficulty in disengagement from depression-relevant stimuli, and to assess its effects on emotional reactivity to stress. A total of 78 participants were separated into four groups based on their levels of depression (minimal and mild) and the types of ABM. The positive ABM (pABM) trained participants to disengage their attention from depression-relevant stimuli and directed their attention toward more positive stimuli, whereas the neutral ABM (nABM) was designed to have no effect. The participants underwent a free-viewing task by eye tracker both before and after ABM to observe changes in attentional bias. Subsequently, they reported their emotional response after a stress-inducing task. The group of mildly depressed participants receiving pABM showed significantly less attention to depression-relevant negative affective stimuli and reported significantly decreased negative emotional reactivity to stress compared to the other groups. pABM had an effect on decreasing difficulty in disengaging from depression-relevant negative affective words (DW). However, it did not increase the dwell time on positive affective words (PW) in the current study. This might be due to the short duration of the application of ABM. The current study conducted ABM twice in 1 day, and this might not be enough to increase the dwell time on PA. This study verified that the ABM effectively decreased the attentional bias of depression and its relevant symptom, emotional reactivity to stress.
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Affiliation(s)
- Soojung Baek
- Department of Educational Affairs, Anyang Juvenile Detention Center, Anyang, Republic of Korea
| | - SoSeo Ha
- Department of Psychology, Chung-Ang University, Seoul, Republic of Korea
| | - Jang-Han Lee
- Department of Psychology, Chung-Ang University, Seoul, Republic of Korea
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14
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Drysdale AT, Myers MJ, Harper JC, Guard M, Manhart M, Yu Q, Perino MT, Luby JL, Barch DM, Pine DS, Sylvester CM. A Novel Cognitive Training Program Targets Stimulus-Driven Attention to Alter Symptoms, Behavior, and Neural Circuitry in Pediatric Anxiety Disorders: Pilot Clinical Trial. J Child Adolesc Psychopharmacol 2023; 33:306-315. [PMID: 37669021 PMCID: PMC10616944 DOI: 10.1089/cap.2023.0020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/06/2023]
Abstract
Objective: Pediatric anxiety disorders are associated with increased stimulus-driven attention (SDA), the involuntary capture of attention by salient stimuli. Increased SDA is linked to increased activity in the right ventrolateral prefrontal cortex (rVLPFC), especially in the portion corresponding to the ventral attention network (VAN). In this study, we present a small clinical trial using a novel attention training program designed to treat pediatric anxiety by decreasing SDA and activity in the rVLPFC. Methods: Children ages 8-12 with anxiety disorders (n = 18) participated in eight sessions of attention training over a 4-week period. At baseline and after completing training, participants completed clinical anxiety measures and a battery of cognitive tasks designed to measure three different aspects of attention: SDA, goal-oriented attention, and threat bias. A subset of participants (n = 12) underwent baseline and post-training neuroimaging while engaged in an SDA task. Brain analyses focused on activity within the rVLPFC. Results: Parent (p < 0.001)-, child (p < 0.002)-, and clinician-rated (p < 0.02) anxiety improved significantly over the course of training. Training significantly altered SDA [F(1,92) = 8.88, corrected p-value (pcor) < 0.012, uncorrected p-value (puncor) < 0.004]. Anxiety improvement correlated with improvements in goal-directed attention [r(10) = 0.60, pcor < 0.12 puncor < 0.04]. Within an area of the rVLPFC corresponding to the cingulo-opercular network (CON), there was a main effect of training [F(1,20) = 6.75, pcor < 0.16, puncor < 0.02], with decreasing signal across training. There was a significant interaction between training and anxiety on this region's activity [F(1,20) = 9.48, pcor < 0.048, puncor < 0.006]. Post hoc testing revealed that post-training activity within this CON area correlated with residual anxiety [r(10) = 0.68, p < 0.02]. Conclusions: SDA and rVLPFC neural activity may be novel therapeutic targets in pediatric anxiety. After undergoing a training paradigm aimed at modifying this aspect of attention and its underlying neural circuitry, patients showed lower anxiety, changes in SDA and goal-oriented attention, and decreased activity in the CON portion of the rVLPFC.
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Affiliation(s)
- Andrew T. Drysdale
- Molecular Imaging and Neuropathology, New York State Psychiatric Institute, Columbia University Irving Medical Center, New York, New York, USA
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
| | - Michael J. Myers
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jennifer C. Harper
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Meg Guard
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Megan Manhart
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Qiongru Yu
- Department of Psychology and San Diego State University, San Diego, California, USA
- Department of Psychiatry, San Diego State University, San Diego, California, USA
| | - Michael T. Perino
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Joan L. Luby
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Deanna M. Barch
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Psychological and Brain Sciences, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Daniel S. Pine
- National Institute of Mental Health, Bethesda, Maryland, USA
| | - Chad M. Sylvester
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
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15
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Godara M, Sanchez-Lopez A, De Raedt R. The contextual goal dependent attentional flexibility (CoGoDAF) framework: A new approach to attention bias in depression. Behav Res Ther 2023; 167:104354. [PMID: 37343329 DOI: 10.1016/j.brat.2023.104354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 05/30/2023] [Accepted: 06/09/2023] [Indexed: 06/23/2023]
Abstract
Successful adaptation to the environment requires attentional prioritization of emotional information relevant to the current situational demands. Accordingly, the presence of an attention bias (AB) for both positive and negative information may allow preferential processing of stimuli in line with the current situational goals. However, AB for negative information sometimes becomes maladaptive, being antithetical to the current adaptive needs and goals of an individual, such as in the case of affective disorders such as depression. Although difficulties in flexible shifting between emotional stimuli in depression have increasingly become a topic of discussion in the field, an integrative approach towards biased versus flexible emotional attentional processes remains absent. In the present paper, we advance a novel and integrative view of conceptualizing potentially aberrant affective attention patterns in depression as a function of the current contextual features. We propose that flexible emotional attention takes place as a result of attention prioritization towards goal-relevant emotional stimuli depending upon the current context of the individual. Specifically, the roles of context, distal and proximal goals, and approach and avoidance motivation processes are considered in a unified manner. The empirical, clinical, and interventional implications of this integrative framework provide a roadmap for future psychological and neurobiological experimental and translational research.
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Affiliation(s)
- Malvika Godara
- Department of Experimental Clinical & Health Psychology, Ghent University, Belgium.
| | | | - Rudi De Raedt
- Department of Experimental Clinical & Health Psychology, Ghent University, Belgium
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16
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Ciesinski NK, Himelein-Wachowiak M, Krick LC, Sorgi-Wilson KM, Cheung JCY, McCloskey MS. A systematic review with meta-analysis of cognitive bias modification interventions for anger and aggression. Behav Res Ther 2023; 167:104344. [PMID: 37307657 PMCID: PMC10526745 DOI: 10.1016/j.brat.2023.104344] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 05/05/2023] [Accepted: 06/01/2023] [Indexed: 06/14/2023]
Abstract
Aggression and anger are associated with interpretation and attention biases. Such biases have become treatment targets for anger and aggressive behavior in cognitive bias modification (CBM) interventions. Several studies have evaluated the efficacy of CBM for the treatment of anger and aggressive behavior, with inconsistent results. The present study meta-analytically analyzed 29 randomized controlled trial studies (N = 2334) published in EBSCOhost and PubMed between March 2013 and March 2023 assessing the efficacy of CBM for anger and/or aggression. Included studies delivered CBMs that addressed either attention biases, interpretation biases, or both. Risk of publication bias and potential moderating effects of several participant-, treatment- and study-related factors were assessed. CBM significantly outperformed control conditions in the treatment of aggression (Hedge's G = -0.23, 95% CI [-0.35, -0.11], p < .001) and anger (Hedge's G = -0.18, 95% CI [-0.28, -0.07], p = .001) independent of treatment dose, participant demographic characteristics, and study quality, though overall effects were small. Follow-up analyses demonstrated that only CBMs targeting interpretation bias were efficacious for aggression outcomes, but not when baseline aggression was accounted for. Findings suggest that CBM demonstrates efficacy for the treatment aggressive behavior and to a lesser extent, anger.
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Affiliation(s)
| | | | - Lynette C Krick
- Department of Psychology and Neuroscience, Temple University, USA
| | | | - Joey C Y Cheung
- Department of Psychology and Neuroscience, Temple University, USA
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Alon Y, Azriel O, Pine DS, Bar-Haim Y. A randomized controlled trial of supervised remotely-delivered attention bias modification for posttraumatic stress disorder. Psychol Med 2023; 53:3601-3610. [PMID: 35132952 PMCID: PMC10248784 DOI: 10.1017/s003329172200023x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 01/03/2022] [Accepted: 01/17/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Many individuals with posttraumatic stress disorder (PTSD) have limited access to first-line treatments, warranting the development of remotely-delivered treatments. Attention bias modification (ABM), targeting perturbed threat-related attentional patterns, shows promise when delivered in-person. However, previous studies found ABM to be ineffective when delivered remotely. Randomized clinical trials usually applied two variations of ABM: ABM away from threat or attention control training (ACT) balancing attention between threat-related and neutral stimuli. We tested remotely-delivered ACT/ABM with tighter supervision and video-based interactions that resemble in-clinic protocols. We expected to replicate the results of in-clinic trials, in which ACT outperformed ABM for PTSD. METHODS In this double-blinded, parallel-group randomized controlled trial, 60 patients diagnosed with PTSD were randomized (ABM n = 30; ACT n = 30). Patients performed eight bi-weekly remotely-delivered supervised ABM/ACT sessions. Symptoms were assessed pre- and post-treatment with Clinician-Administered PTSD Scale 5 (CAPS-5) severity score and PTSD diagnosis as the primary outcomes. Current depressive episode, current anxiety-related comorbidity, and time elapsed since the trauma were examined as potential moderators of treatment outcome. RESULTS Significant decrease in CAPS-5 severity scores and PTSD diagnosis was observed following both ACT and ABM with no between-group difference. Patients without depression or whose trauma occurred more recently had greater symptom reduction in the ACT than the ABM group. CONCLUSIONS Contrary to our expectation, symptoms decreased similarly following ACT and ABM. Moderator analyses suggest advantage for ACT in non-depressed patients and patients whose trauma occurred more recently. Further refinements in remotely-delivered ABM/ACT may be needed.
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Affiliation(s)
- Yaron Alon
- School of Psychological Sciences, Tel-Aviv University, Tel Aviv-Yafo, Israel
| | - Omer Azriel
- School of Psychological Sciences, Tel-Aviv University, Tel Aviv-Yafo, Israel
| | - Daniel S. Pine
- Section on Developmental Affective Neuroscience, National Institute of Mental Health, Bethesda, MD, USA
| | - Yair Bar-Haim
- School of Psychological Sciences, Tel-Aviv University, Tel Aviv-Yafo, Israel
- Sagol School of Neuroscience, Tel-Aviv University, Tel Aviv-Yafo, Israel
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18
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MacLeod C. The Attention Bias Modification Approach to Anxiety: Origins, Limitations, and Opportunities. Am J Psychiatry 2023; 180:328-330. [PMID: 37122269 DOI: 10.1176/appi.ajp.20230210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Affiliation(s)
- Colin MacLeod
- Centre for the Advancement of Research on Emotion, School of Psychological Science, University of Western Australia, Perth
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19
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MacLean RR, Heapy AA, Waters AJ, Wolkowicz N, Szollosy SK, Meyerovich J, Sofuoglu M. Integrating cognitive bias modification for pain and opioid cues into medication for opioid use disorder clinical care: Feasibility, acceptability, and preliminary results. Drug Alcohol Depend 2023; 246:109857. [PMID: 37004461 PMCID: PMC10189744 DOI: 10.1016/j.drugalcdep.2023.109857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 03/09/2023] [Accepted: 03/10/2023] [Indexed: 04/04/2023]
Abstract
BACKGROUND Despite high co-occurrence, chronic pain is often unaddressed in treatment for opioid use disorder (OUD) and little is known about mechanisms that may underlie associations between pain and opioid use. Using an attentional bias (AB) task with both pain and opioid cues, we evaluated a cognitive bias modification (CBM) task administered during regularly scheduled medications for OUD (mOUD) dosing visits. The current study evaluated the feasibility, acceptability, and preliminary efficacy of the CBM task. Outcomes for AB tasks used traditional mean-based score and trial-level bias scores (TLBS). METHODS In a double-blind, randomized controlled trial, 28 individuals with OUD and chronic pain engaged in mOUD were randomized to either CBM or an AB control condition and completed up to three tasks per week for four weeks. Standard AB task was completed at baseline and post-treatment. Participants completed feasibility and acceptability measures, and preliminary efficacy (i.e., change in AB) was assessed using ANOVA models. RESULTS Participants attended 83.3% of scheduled sessions and generally reported the task was enjoyable, credible, and easy to complete. Preliminary results demonstrated a condition by time interaction highlighting a reduction in AB in the CBM group but not the control group in opioid TLBS variability (F[1,26]=5.01, p = .034) and pain TLBS towards (F[1,26]=6.42, p = .018) and pain TLBS variability (F[1,26]=5.24, p = .03). CONCLUSIONS The current study supports integrating brief, computer-based tasks designed to reduce AB into mOUD clinical care. The preliminary results suggest that TLBS outcomes may be more sensitive to capture changes in AB; however, larger studies are required.
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Affiliation(s)
- R Ross MacLean
- VA Connecticut Healthcare System, West Haven, CT, USA; Yale University School of Medicine, New Haven, CT, USA.
| | - Alicia A Heapy
- VA Connecticut Healthcare System, West Haven, CT, USA; Yale University School of Medicine, New Haven, CT, USA
| | - Andrew J Waters
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Noah Wolkowicz
- VA Connecticut Healthcare System, West Haven, CT, USA; Yale University School of Medicine, New Haven, CT, USA
| | | | - Julia Meyerovich
- VA Connecticut Healthcare System, West Haven, CT, USA; Yale University School of Medicine, New Haven, CT, USA
| | - Mehmet Sofuoglu
- VA Connecticut Healthcare System, West Haven, CT, USA; Yale University School of Medicine, New Haven, CT, USA
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20
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Abudoush AN, Noureen A, Panagioti M, Poliakoff E, Van Ryckeghem DML, Hodkinson A, Husain N. What can we learn about selective attention processes in individuals with chronic pain using reaction time tasks? A systematic review and meta-analysis. Pain 2023:00006396-990000000-00285. [PMID: 37043743 DOI: 10.1097/j.pain.0000000000002885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 01/31/2023] [Indexed: 04/14/2023]
Abstract
ABSTRACT Information-processing biases such as attentional, interpretation, and memory biases are believed to play a role in exacerbating and maintaining chronic pain (CP). Evidence suggests that individuals with CP show attentional bias toward pain-related information. However, the selective attentional processes that underpin this bias are not always well outlined in the literature. To improve current understanding, a systematic review was performed using a descriptive synthesis of reaction time-based studies. A random-effects meta-analysis was added to explore whether the results of previous meta-analyses would be confirmed using studies with a larger sample size. For this review, 2008 studies were screened from 4 databases, of which 34 (participant n = 3154) were included in the review and a subset of 15 (participant n = 1339) were included in the meta-analysis. Review results were summarised by producing a descriptive synthesis for all studies. Meta-analysis results indicated a mild significant attentional bias toward sensory pain-related information (k = 15, g = 0.28, 95% CI [0.16, 0.39], I2 = 43.2%, P = 0.038), and preliminary evidence of significant moderate bias towards affective pain-related information (k = 3, g = 0.48, 95% CI [0.23, 0.72], I2 = 7.1%, P = 0.341) for CP groups compared with control groups. We explored the main tasks, stimuli, and CP subtypes used to address attentional biases and related processes. However, variation across studies did not allow for a decisive conclusion about the role of stimulus, task type, or related attentional processes. In addition, a table of CP attention-related models was produced and tested for reliability. Finally, other results and recommendations are discussed.
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Affiliation(s)
- Ahmad N Abudoush
- School of Health Sciences, Faculty of Biology Medicine and Health Sciences, The University of Manchester, Manchester, United Kingdom
- Department of Psychology, School of Arts, The University of Jordan, Amman, Jordan
| | - Amna Noureen
- Department of Applied Psychology, National University of Modern Languages, Islamabad, Pakistan
| | - Maria Panagioti
- School of Health Sciences, Faculty of Biology Medicine and Health Sciences, The University of Manchester, Manchester, United Kingdom
| | - Ellen Poliakoff
- School of Health Sciences, Faculty of Biology Medicine and Health Sciences, The University of Manchester, Manchester, United Kingdom
| | - Dimitri M L Van Ryckeghem
- Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands
- Department of Experimental-Clinical and Health Psychology, Ghent University, Ghent, Belgium
- Department of Behavioural and Cognitive Sciences, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Alexander Hodkinson
- School of Health Sciences, Faculty of Biology Medicine and Health Sciences, The University of Manchester, Manchester, United Kingdom
| | - Nusrat Husain
- School of Health Sciences, Faculty of Biology Medicine and Health Sciences, The University of Manchester, Manchester, United Kingdom
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21
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Woronko SE, Jessup SC, Armstrong T, Anwyl-Irvine AL, Dalmaijer ES, Olatunji BO. A novel probe of attentional bias for threat in specific phobia: Application of the "MouseView.js" approach. J Anxiety Disord 2023; 96:102700. [PMID: 36965222 DOI: 10.1016/j.janxdis.2023.102700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 02/27/2023] [Accepted: 03/15/2023] [Indexed: 03/27/2023]
Abstract
Although attentional bias for threat has been implicated in anxiety disorders, traditional attentional bias measures have been criticized for lack of reliability and validity, and eye tracking technologies can be cost-prohibitive. MouseView.js was recently developed to mimic eye tracking online by using the computer cursor as a proxy for gaze, and although it is equally reliable, MouseView.js' utility for capturing attentional bias for threat in anxiety-related disorders remains unclear. To fill this knowledge gap, snake phobic and non-phobic participants (N = 62) completed a behavioral avoidance task (BAT) and the MouseView.js task which consisted of 10-second exposures to blurred, side-by-side images of either pleasant-neutral or threat-neutral pairings and were instructed to freely move the mouse to reveal the images. Results demonstrated that snake phobic participants had significantly shorter average mouse dwell time on threat images than non-phobic individuals and showed a significant reduction in average dwell time on threat images following the first presentation of the threat-neutral pairing. Additionally, dwell time on threat images significantly mediated the group differences in steps completed on the BAT. Results highlight the utility of MouseView.js in capturing avoidant patterns of attentional bias for threat that may also partially drive avoidance in snake phobia. Implications for capturing attentional bias for threat in anxiety disorders more broadly are discussed.
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Affiliation(s)
- Sarah E Woronko
- Department of Psychology, Vanderbilt University, Nashville, TN, USA
| | - Sarah C Jessup
- Department of Psychology, Vanderbilt University, Nashville, TN, USA.
| | | | | | - Edwin S Dalmaijer
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK; School of Psychological Science, University of Bristol, Bristol, UK
| | - Bunmi O Olatunji
- Department of Psychology, Vanderbilt University, Nashville, TN, USA.
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22
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Xia HS, Li YX, Zhang QY, Zhong DL, Liu XB, Gou XY, Fan J, Zhao J, Zhang Y, Ai SC, Huang JX, Li J, Jin RJ. Attention bias modification for depression: A systematic review and meta-analysis. Front Psychiatry 2023; 14:1098610. [PMID: 36970284 PMCID: PMC10036757 DOI: 10.3389/fpsyt.2023.1098610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 02/03/2023] [Indexed: 03/12/2023] Open
Abstract
BackgroundDepression is a mental health disorder characterized by affective, somatic, and cognitive symptoms. Attention bias modification (ABM) has been widely used to treat depression. However, the results seem inconsistent. We conducted a systematic review and meta-analysis to investigate the efficacy of ABM for depression and to explore the optimal protocol of ABM.MethodsSeven databases were systematically searched from their inceptions to 5 October 2022 to include randomized controlled trials (RCTs) of ABM for depression. Two independent reviewers selected the eligible articles, extracted data, and evaluated the risk of bias using version 2 of the Cochrane risk-of-bias tool (ROB 2.0) for randomized trials. The primary outcome was the evaluation of depressive symptoms using widely accepted and validated scales. The secondary outcomes included rumination and attentional control. Meta-analysis was conducted by using RevMan (version 5.4) and Stata (version 12.0). Subgroup analyses and meta-regressions were performed to identify the source of heterogeneity. The certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE).ResultsA total of 19 trials involving 20 datasets (1,262 participants) were included. The overall risk of bias in one study was rated as low risk of bias, three studies were considered as high, and the remaining studies were some concerns. Compared with attention control training (ACT), ABM had a greater effect in the improvement of depression (SMD = −0.48, 95% CI −0.80 to −0.17, I2 = 82%) and rumination (MD = −3.46, 95% CI −6.06 to −0.87, I2 = 0%). No significant differences were observed in the attentional control outcome between ABM and ACT (MD = 3.07, 95% CI −0.52 to 6.65, I2 = 0%). Subgroup analysis demonstrated that adults exhibited a greater decrease in depression scores than adolescents. ABM using the dot-probe task, training target stimulus presented by face, and training directions by left–right were associated with better antidepressant effects. ABM training delivered in the laboratory tended to yield a better effect than those conducted at home. Sensitivity analysis indicated that the results were robust. The certainty of the evidence for all outcomes was low or very low, and publication bias may exist.ConclusionDue to high heterogeneity and limited studies, not enough current evidence supported that ABM could be an effective intervention to relieve depressive symptoms. More rigorous RCTs are required to verify the benefits and to explore the optimal protocol of ABM training for depression.Systematic Review Registration: [PROSPERO], identifier [No. CRD42021279163].
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Affiliation(s)
- Hai-sha Xia
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yu-xi Li
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Qing-yun Zhang
- Department of Rehabilitation, The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, China
| | - Dong-ling Zhong
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xiao-bo Liu
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xin-yun Gou
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Jin Fan
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Jing Zhao
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yue Zhang
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Shuang-chun Ai
- Department of rehabilitation, Mianyang Hospital of Traditional Chinese Medicine, Mianyang, China
| | - Jia-xi Huang
- Mental Health Center, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, China
- *Correspondence: Jia-xi Huang, ; Juan Li, ; Rong-jiang Jin,
| | - Juan Li
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- *Correspondence: Jia-xi Huang, ; Juan Li, ; Rong-jiang Jin,
| | - Rong-jiang Jin
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- *Correspondence: Jia-xi Huang, ; Juan Li, ; Rong-jiang Jin,
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23
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Dennis Tiwary TA, Cho H, Myruski S. Effects of attention bias modification for anxiety: Neurophysiological indices and moderation by symptom severity. Clin Neurophysiol 2023; 147:45-57. [PMID: 36642007 PMCID: PMC9974920 DOI: 10.1016/j.clinph.2022.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 12/06/2022] [Accepted: 12/15/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Attention bias modification (ABM) aims to decrease anxiety symptom severity through the reduction of threat-related attention bias (AB). Individual differences in treatment response and poor measurement reliability of AB have called its clinical promise into question. The current study examined whether individual differences in anxiety severity at baseline moderated treatment response, and employed both behavioral and neurophysiological metrics of AB. METHODS Participants (N = 99) were randomly assigned to four weeks of ABM or placebo control training (PT). Self-reported anxiety symptom severity, and AB metrics and ERPs generated during the dot probe task were collected at baseline (Time 1), one-week post-intervention (Time 5), and at a three-month follow-up (Time 6). RESULTS ABM, relative to PT, reduced ERPs indexing attention discrimination (N170) and increased ERPs indexing salience tracking (P3). Increases in P3 were associated with ABM-related reductions in anxiety. Anxiety severity was reduced following ABM, but only among those with higher baseline anxiety symptom severity. CONCLUSIONS ABM effectively reduced symptom severity among those with higher levels of anxiety, and modulated neurophysiological indices of AB. SIGNIFICANCE Results provide evidence for attention-relevant ERPs as outcomes of ABM treatment responsivity and suggest that ABM may be most beneficial for those with more severe anxiety symptoms.
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Affiliation(s)
- Tracy A Dennis Tiwary
- Department of Psychology, Hunter College, City University of New York, USA; Department of Psychology, The Graduate Center, City University of New York, USA.
| | - Hyein Cho
- Department of Neurology, NYU Grossman School of Medicine, USA
| | - Sarah Myruski
- Department of Psychology, The Pennsylvania State University, USA
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24
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Zheng J, Cao F, Chen Y, Yu L, Yang Y, Katembu S, Xu Q. Time course of attentional bias in social anxiety: Evidence from visuocortical dynamics. Int J Psychophysiol 2023; 184:110-117. [PMID: 36621629 DOI: 10.1016/j.ijpsycho.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 12/23/2022] [Accepted: 01/01/2023] [Indexed: 01/07/2023]
Abstract
Threat-related attentional bias is thought to have a causal influence on the etiology of social anxiety. However, there is uncertainty on whether attention dwells on or diverts away from threats, and the measurements typically utilized to explore attentional bias cannot continuously quantify changes in attention. Here, we used steady-state visual evoked potentials (ssVEPs) as a continuous neurophysiological measure of visual attentional processing to examine the time course of attentional bias in social anxiety. Participants with high (n = 18) and low (n = 18) social anxiety passively viewed two faces flickering at 15 and 20 Hz frequency to evoke ssVEPs, and completed Attentional Control Scale. The results showed that angry faces, as compared to happy and neutral faces, elicited larger ssVEP amplitudes for the time window of 180-500 ms after facial stimuli onset only in the high socially anxious individuals, and the effect extended to the next two periods of 500-1000 ms and 1000-1500 ms. The ssVEP amplitudes differed most when individuals with high social anxiety viewed angry-neutral expression combinations. Additionally, attentional control was negatively correlated with social anxiety and threat-related attentional bias. The results suggested that individuals with social anxiety initially oriented attention toward the threat and subsequently exhibited difficulty in disengaging attention from it, possibly due to impaired attentional control.
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Affiliation(s)
- Junmeng Zheng
- Department of Psychology, Ningbo University, Ningbo, China
| | - Feizhen Cao
- Philosophy and Social Science Laboratory of Reading and Development in Children and Adolescents (South China Normal University), Ministry of Education, Guangzhou, China
| | - Yanling Chen
- Department of Psychology, Ningbo University, Ningbo, China
| | - Linwei Yu
- Department of Psychology, Ningbo University, Ningbo, China
| | - Yaping Yang
- Department of Psychology, Ningbo University, Ningbo, China
| | - Stephen Katembu
- Department of Psychology, Humboldt Universität zu Berlin, Berlin, Germany
| | - Qiang Xu
- Department of Psychology, Ningbo University, Ningbo, China.
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25
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Internet-based cognitive behavioural therapy combined with attentional bias modification training in generalized anxiety disorder: a randomized, controlled multi-session experiment. Behav Cogn Psychother 2023; 51:32-45. [PMID: 36278480 DOI: 10.1017/s1352465822000480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Although attentional bias modification training (ABM) and cognitive behavioural therapy (CBT) are two effective methods to decrease the symptoms of generalized anxiety disorders (GAD), to date, no randomized controlled trials have yet evaluated the effectiveness of an intervention combining internet-based cognitive behavioural therapy (ICBT) and ABM for adults with GAD. AIMS This study aimed to investigate the effectiveness of an intervention combining ICBT and ABM for adults with GAD. METHOD Sixty-three participants diagnosed with GAD were randomly assigned to the treatment group (ICBT with ABM; 31 participants) or the control group (ICBT with ABM placebo; 32 participants), and received 8 weeks of treatment and three evaluations. The CBT, ABM and ABM-placebo training were conducted via the internet. The evaluations were conducted at baseline, 8 weeks later, and 1 month later, respectively. RESULTS Both the treatment and control groups reported significantly reduced anxiety symptoms and attentional bias, with no clear superiority of either intervention. However, the treatment group showed a greater reduction in negative automatic thoughts than the control group after treatment and at 1-month follow-up (η2 = 0.123). CONCLUSION The results suggest that although not differing in therapeutic efficacy, the intervention combining ICBT and ABM is superior to the intervention combining ICBT and ABM-placebo in the reduction of negative automatic thoughts. ABM may be a useful augmentation of ICBT on reducing anxiety symptoms.
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26
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Fadardi JS, Memarian S, Parkinson J, Cox WM, Stacy AW. Scary in the eye of the beholder: Attentional bias and attentional retraining for social anxiety. J Psychiatr Res 2023; 157:141-151. [PMID: 36463629 DOI: 10.1016/j.jpsychires.2022.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 10/20/2022] [Accepted: 11/12/2022] [Indexed: 11/21/2022]
Abstract
UNLABELLED Consistent with cognitive models of social anxiety, socially anxious individuals show cognitive biases that magnify their perceived level of threat in the environment. OBJECTIVES The first objective was to determine whether attentional bias for socially threatening stimuli occurs after concomitant depression has been controlled. The second objective was to test the effectiveness of the Attention Control Training Program for Social Anxiety (ACTP-SA) for reducing social anxiety attentional bias and improving therapeutic indices in people with social anxiety. METHOD In the first study, socially anxious (N = 30) and non-anxious individuals (N = 30) completed the Beck Depression Inventory-II, Spielberger's State-Trait Anxiety Inventory, Conner's Social Phobia Inventory, a social-anxiety Stroop test, and a clinical interview. In the second study, individuals with social anxiety (N = 30) were randomly assigned to an experimental group that received 4 sessions of ACTP-SA, or to a sham-intervention control condition. At the post-test and a 3-month follow-up, both groups completed the same measures as in Study 1. RESULTS In Study 1, socially anxious individuals showed higher attentional bias for threatening stimuli than the controls, after depression had been controlled for. In Study 2, participants in the experimental group, compared with the controls, showed greater reductions in attentional bias, social anxiety, and trait anxiety at post-test and follow-up. CONCLUSIONS The results underscore the importance of information processing biases in social anxiety and the benefits of attentional bias training as a complementary intervention for modifying symptoms of social anxiety.
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Affiliation(s)
- Javad S Fadardi
- Claremont Graduate University, United States; Bangor University, UK; Ferdowsi University of Mashhad, Iran.
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Bovy L, Ikani N, van de Kraats LNM, Dresler M, Tendolkar I, Vrijsen JN. The effects of daily autobiographical memory training on memory bias, mood and stress resilience in dysphoric individuals. Sci Rep 2022; 12:20873. [PMID: 36463266 PMCID: PMC9719463 DOI: 10.1038/s41598-022-25379-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 11/29/2022] [Indexed: 12/05/2022] Open
Abstract
Negative memory bias refers to the enhanced recall of negative memories and is a prominent cognitive factor causing and maintaining depression. Surprisingly few studies modify this negative recall. The current study used a smartphone-based autobiographical memory training to increase positive memory recall and thereby alter negative memory bias. A total of 96 dysphoric (≥ 13 BDI-II) participants were randomly allocated to a positive, sham or no-training condition, conducted over a period of 6 days. Positive memory bias (i.e., recalled event evaluation) significantly increased from pre- to post-training after positive and sham intervention, suggesting an unspecific training effect. No transfer to memory specificity, implicit memory bias or depressive symptoms was found, nor was the training effect modulated by pre-existing level of positive memory bias. A post-hoc follow-up measurement during the initial COVID-19 crisis revealed that subjects who benefitted most from either of the trainings maintained their stress levels better during a natural stressful period, compared to those who responded least to the training. Future studies should carefully consider the impact of sham training design. Moreover, it is important to examine transfer effects of bias training as practice in daily life.
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Affiliation(s)
- Leonore Bovy
- grid.10417.330000 0004 0444 9382Donders Institute of Cognition and Behaviour, Radboud University Medical Center, Centre for Cognitive Neuroimaging, Nijmegen, The Netherlands
| | - Nessa Ikani
- grid.10417.330000 0004 0444 9382Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands ,grid.5590.90000000122931605Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
| | - Livia N. M. van de Kraats
- grid.10417.330000 0004 0444 9382Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Martin Dresler
- grid.10417.330000 0004 0444 9382Donders Institute of Cognition and Behaviour, Radboud University Medical Center, Centre for Cognitive Neuroimaging, Nijmegen, The Netherlands
| | - Indira Tendolkar
- grid.10417.330000 0004 0444 9382Donders Institute of Cognition and Behaviour, Radboud University Medical Center, Centre for Cognitive Neuroimaging, Nijmegen, The Netherlands ,grid.10417.330000 0004 0444 9382Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Janna N. Vrijsen
- grid.10417.330000 0004 0444 9382Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands ,grid.491369.00000 0004 0466 1666Depression Expertise Centre, Pro Persona Mental Health Care, Nijmegen, The Netherlands
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Price RB, Spotts C, Panny B, Griffo A, Degutis M, Cruz N, Bell E, Do-Nguyen K, Wallace ML, Mathew SJ, Howland RH. A Novel, Brief, Fully Automated Intervention to Extend the Antidepressant Effect of a Single Ketamine Infusion: A Randomized Clinical Trial. Am J Psychiatry 2022; 179:959-968. [PMID: 36128684 PMCID: PMC9722511 DOI: 10.1176/appi.ajp.20220216] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Intravenous ketamine, which displays rapid antidepressant properties, is posited to reverse depression by rapidly enhancing neuroplasticity. The authors tested whether an automated, computer-based approach could efficiently leverage enhanced neuroplasticity to extend the durability of rapid clinical response. METHODS A total of 154 adults (ages 18-60) with treatment-resistant unipolar depression were randomized in a double-blind, parallel-arm design to receive an active/active treatment combination (ketamine plus active "automated self-association training" [ASAT]; N=53) or one of two control arms that lacked either the active drug component (saline plus active ASAT; N=51) or the active behavioral component (ketamine plus sham ASAT; N=50). One day after a single infusion of intravenous ketamine (0.5 mg/kg over 40 minutes) or inert placebo (saline), active ASAT-targeting self-worth through automated "evaluative conditioning" training delivered by computer-or sham ASAT (consisting of identical computer tasks that included no positive or self-referential stimuli) was given, delivered twice daily over 4 consecutive days (eight sessions, ≤20 minutes per session). The prespecified primary outcome measure throughout the main (30-day) study period was score on the Montgomery-Åsberg Depression Rating Scale (MADRS). RESULTS Ketamine rapidly and significantly reduced depression scores at 24 hours postinfusion (group-by-time interaction: standardized beta [β]=-1.30, 95% CI=-1.89, -0.70; t=-4.29, df=150). In intent-to-treat linear mixed models, depression scores in the ketamine+ASAT group remained significantly and stably low over the 30-day study period relative to those of the saline+ASAT group (β=-0.61, 95% CI=-0.95, -0.28; t=-3.62, df=148). By contrast, depression scores following ketamine+sham treatment followed a significant, increasing linear trajectory from 24 hours to 30 days, approaching the levels observed in the saline+ASAT group (group-by-time interaction relative to the saline+ASAT group: β=0.015, 95% CI=0.003, 0.03; t=2.35, df=568). CONCLUSIONS After priming the brain with ketamine, training positive self-associations could provide an efficient, low-cost, portable, noninvasive, and highly dissemination-ready strategy for leveraging and extending ketamine's rapid antidepressant effects.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Sanjay J. Mathew
- Baylor College School of Medicine Baylor College of Medicine and Michael E. Debakey VA Medical Center, Houston, Texas
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The questionable validity of attention bias variability: Evidence from two conceptually unrelated cognitive tasks. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2022; 10:100411. [PMID: 36684713 PMCID: PMC9851093 DOI: 10.1016/j.jadr.2022.100411] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Background Attention bias variability is thought to measure fluctuations in attention towards and away from threat-related information and is elevated in affective disorders. However, recent evidence suggests that attention bias variability may quantify general reaction time variability rather than attention bias behavior per se. Methods The current study calculated "attention bias variability" from two conceptually unrelated cognitive tasks: the dot-probe task (measuring attentional bias) and the arrow flanker task (measuring cognitive control). Results Attention bias variability measures were correlated across these unrelated tasks. Yet, when general reaction time variability was controlled, attention bias variability across tasks was no longer correlated. In addition, the reliability of attention bias variability measures decreased when controlling for general reaction time variability. Finally, although attention bias variability calculated from the dot-probe task initially correlated with anxious symptoms, this association was no longer significant when controlling for general reaction time variability. Limitations Our sample was comprised of high trait anxious individuals. Replication in clinical samples is warranted. Conclusions These findings collectively provide strong empirical evidence that attention bias variability is not a valid measure of attention-related behavior, but reflective of general reaction time variability more broadly.
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Xiao W, Zheng X, Luo Y, Peng J. Reducing anxiety and attentional bias with reward association learning and attentional bias modification. Front Psychol 2022; 13:982909. [PMID: 36507005 PMCID: PMC9728586 DOI: 10.3389/fpsyg.2022.982909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 10/17/2022] [Indexed: 11/24/2022] Open
Abstract
The current study examined the effects of a reward associative learning procedure and the traditional threat-avoidance ABM paradigm on anxiety and attentional bias. In reward training, participants were given high rewards for correct responses to neutral target and low rewards for correct responses to negative target. In reward control training, participants received no cues of rewards after their responses. High trait anxious individuals (N = 76) first completed a session of reward training or reward control training, followed by four sessions of ABM training or ABM control training. Generalized anxiety disorder symptom (GAD-7) and attentional bias in a dot-probe task were assessed during pre-and post-training. Results indicated that the effect of ABM training on reducing anxiety was only obtained in the reward training condition. Participants who received reward training showed significantly less attentional bias compared with those receiving reward control training. There was no significant training effect of ABM on atttentiona bias. Results suggested that reward training reduced general anxiety and attentional bias. Traditional ABM training reduced anxiety only when combined with reward training. Attentional bias in anxiety are modifiable through reward training.
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Affiliation(s)
- Wen Xiao
- Teacher Education School, Shaoguan University, Shaoguan, Guangdong, China
| | - Xiaoqi Zheng
- Teacher Education School, Shaoguan University, Shaoguan, Guangdong, China
| | - Yuejia Luo
- Faculty of Psychology, Beijing Normal University, Beijing, China
| | - Jiaxin Peng
- Teacher Education School, Shaoguan University, Shaoguan, Guangdong, China,*Correspondence: Jiaxin Peng,
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David OA, Magurean S. Positive Attention Bias Trained during the Rethink Therapeutic Online Game and Related Improvements in Children and Adolescents' Mental Health. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9111600. [PMID: 36360328 PMCID: PMC9688550 DOI: 10.3390/children9111600] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 10/11/2022] [Accepted: 10/20/2022] [Indexed: 12/02/2022]
Abstract
Attentional bias towards positive stimuli is considered a resilience factor for mental health and well-being. The aim of the present study was to analyze the effects of an attentional bias training for positive faces in a preventive therapeutic game for children and adolescents. The sample of 54, which consisted of children and adolescents aged between 10-16 years, played the REThink game, which included an attentional bias training level based on the visual search paradigm, where children had the task to quickly find the happy face among other angry faces. We measured mental health, and positive and negative emotions and analyzed their associations between changes in attention bias. Attentional bias indicators demonstrated acceptable reliability and results showed that increases in attentional bias towards positive faces were associated with improvements in children and adolescents' conduct problems, hyperactivity, and peer relationship problems. Overall, our results support the protective role of training attentional bias towards positive faces as part of a preventive therapeutic game for children and adolescents.
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Pupil size as a robust marker of attentional bias toward nicotine-related stimuli in smokers. Psychon Bull Rev 2022; 30:596-607. [PMID: 36229711 PMCID: PMC9559544 DOI: 10.3758/s13423-022-02192-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2022] [Indexed: 12/02/2022]
Abstract
Spatial attention can be magnetically attracted by behaviorally salient stimuli. This phenomenon occasionally conflicts with behavioral goals, leading to maladaptive consequences, as in the case of addiction, in which attentional biases have been described and linked with clinically meaningful variables, such as craving level or dependence intensity. Here, we sought to probe the markers of attentional priority in smokers through eye-tracking measures, by leveraging the established link between eye movements and spatial attention. We were particularly interested in potential markers related to pupil size, because pupil diameter reflects a range of autonomic, affective, and cognitive/attentional reactions to behaviorally significant stimuli and is a robust marker of appetitive and aversive learning. We found that changes in pupil size to nicotine-related visual stimuli could reliably predict, in cross-validated logistic regression, the smoking status of young smokers (showing pupil constriction) better than more traditional proxy measures. The possibility that pupil constriction may reflect a bias toward central vision, for example, attentional capture, is discussed in terms of sensory tuning with respect to nicotine-related stimuli. Pupil size was more sensitive at lower nicotine dependence levels, and at increased abstinence time (though these two variables were collinear). We conclude that pupillometry can provide a robust marker for attentional priority computation and useful indications regarding motivational states and individual attitudes toward conditioned stimuli.
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Shamai-Leshem D, Linetzky M, Bar-Haim Y. Attention Biases in Previously Depressed Individuals: A Meta-Analysis and Implications for Depression Recurrence. COGNITIVE THERAPY AND RESEARCH 2022. [DOI: 10.1007/s10608-022-10331-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Attention and interpretation cognitive bias change: A systematic review and meta-analysis of bias modification paradigms. Behav Res Ther 2022; 157:104180. [PMID: 36037642 DOI: 10.1016/j.brat.2022.104180] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 07/29/2022] [Accepted: 08/08/2022] [Indexed: 12/15/2022]
Abstract
This systematic review and meta-analysis examines the effect of Cognitive Bias Modification for attention (CBM-A) and interpretation (CBM-I) on reducing the targeted biases and investigates moderators of each approach. PsycINFO, PsychArticles, and PubMED databases were searched for randomized-controlled studies published before March 2020 with pre- and post-CBM cognitive bias outcome measures, resulting in 91 CBM-A (n = 5914 individuals) and 70 CBM-I samples (n = 4802 individuals). Random-effects models and Hedge's g calculation showed significant medium overall effects of bias reduction with moderate to high heterogeneity (CBM-A g = 0.49 [0.36, 0.64], I2 = 85.19%; CBM-I g = 0.58 [0.48, 0.68], I2 = 70.92%). Effect sizes did not differ between approaches and remained significant after trim-and-fill adjustment for possible publication bias. Moderator variables were investigated with meta-regression and subgroup analyses. Participant age, symptom type, control condition and number of trials moderated CBM-A; student and clinical status moderated CBM-I effect size. Results support attention and interpretation modification in controlled laboratory and variable (online) training settings for non-clinical and clinical samples across various symptom types (anxiety, depression, substance use, eating disorders). Further empirical evidence is necessary to determine optimal sample and methodological combinations most strongly associated with adaptive behavioral outcomes.
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35
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Wang Y, Zhang X, Gao J, Zhang L, Jiang J. The effect of immersive virtual reality-based attentional bias modification on anxiety mitigation in healthy population. Psych J 2022; 11:956-967. [PMID: 35922380 DOI: 10.1002/pchj.581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 06/02/2022] [Indexed: 11/06/2022]
Abstract
The present study compared an immersive virtual reality-based attentional bias modification (immersive VR-ABM) with the desktop version of the VR-ABM and an immersive virtual reality-based game (immersive VR-game) to examine the possible effect of the immersive presence on self-reported emotional reactions to a stressful task. One hundred and twenty participants were randomly assigned into three groups, and each group received a three-turn induction-intervention training. Anxiety symptoms were assessed at pre-induction, post-induction, and post-training. Results showed that virtual reality-based anxiety was induced and alleviated successfully in all three groups, but only the immersive VR-ABM group showed an accumulated effect on self-reported anxiety across sessions. The attentional bias based on probe latencies indicated no significant change in either the immersive or desktop VR-ABM groups. The present findings support the hypothesized VR-ABM's effect on self-reported anxiety at the immersive presence. The practical implications of using immersive VR-ABM are discussed for obtaining ecological validity.
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Affiliation(s)
- Yamin Wang
- Beijing Key Laboratory of Learning and Cognition, College of Psychology, Capital Normal University, Haidian, China
| | - Xiaoxiang Zhang
- Beijing Key Laboratory of Learning and Cognition, College of Psychology, Capital Normal University, Haidian, China
| | - Jidong Gao
- Beijing Key Laboratory of Learning and Cognition, College of Psychology, Capital Normal University, Haidian, China
| | - Leran Zhang
- Beijing Key Laboratory of Learning and Cognition, College of Psychology, Capital Normal University, Haidian, China
| | - Jinhang Jiang
- Beijing Key Laboratory of Learning and Cognition, College of Psychology, Capital Normal University, Haidian, China
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Draheim C, Pak R, Draheim AA, Engle RW. The role of attention control in complex real-world tasks. Psychon Bull Rev 2022; 29:1143-1197. [PMID: 35167106 PMCID: PMC8853083 DOI: 10.3758/s13423-021-02052-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2021] [Indexed: 11/15/2022]
Abstract
Working memory capacity is an important psychological construct, and many real-world phenomena are strongly associated with individual differences in working memory functioning. Although working memory and attention are intertwined, several studies have recently shown that individual differences in the general ability to control attention is more strongly predictive of human behavior than working memory capacity. In this review, we argue that researchers would therefore generally be better suited to studying the role of attention control rather than memory-based abilities in explaining real-world behavior and performance in humans. The review begins with a discussion of relevant literature on the nature and measurement of both working memory capacity and attention control, including recent developments in the study of individual differences of attention control. We then selectively review existing literature on the role of both working memory and attention in various applied settings and explain, in each case, why a switch in emphasis to attention control is warranted. Topics covered include psychological testing, cognitive training, education, sports, police decision-making, human factors, and disorders within clinical psychology. The review concludes with general recommendations and best practices for researchers interested in conducting studies of individual differences in attention control.
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Affiliation(s)
- Christopher Draheim
- Department of Psychology, Lawrence University, Appleton, WI, USA.
- School of Psychology, Georgia Institute of Technology, Atlanta, GA, USA.
| | - Richard Pak
- Department of Psychology, Clemson University, Clemson, SC, USA
| | - Amanda A Draheim
- Department of Psychology, Lawrence University, Appleton, WI, USA
| | - Randall W Engle
- School of Psychology, Georgia Institute of Technology, Atlanta, GA, USA
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Halvorson MA, Lengua LJ, Smith GT, King KM. Pathways of personality and learning risk for addictive behaviors: A systematic review of mediational research on the Acquired Preparedness model. J Pers 2022; 91:613-637. [PMID: 35900782 DOI: 10.1111/jopy.12761] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 07/08/2022] [Accepted: 07/25/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The Acquired Preparedness (AP) model proposes that impulsive personality traits predispose some individuals to learn certain behavior-outcome associations (expectancies), and that these expectancies in turn influence the escalation of risky behaviors. This theory has been applied to the development of behaviors such as drinking, drug use, gambling, and disordered eating. In the current study, we aimed to summarize empirical tests of this model over the 20 years since it was proposed. METHOD We used a descriptive approach to summarize tests of mediation across 50 studies involving n=21,715 total participants. RESULTS We observed a consistent effect of personality on expectancies (median effect size = .22), of expectancies on behavior (.24), and a small mediated effect (.05) of personality on behavior via expectancies. Impulsive traits that involve positive or negative affect showed the most consistent support for AP, as did positive expectancies. Most studies testing AP focused on alcohol, but research on other behaviors also showed support for AP. CONCLUSIONS The literature appears to support a small mediated effect consistent with the AP model. Future research should continue to clarify which AP pathways are most influential in explaining risky behaviors, and supplement correlational research with experimental and quasi-experimental designs.
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Affiliation(s)
| | | | | | - Kevin M King
- Department of Psychology, University of Washington
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38
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Zhao Z, Yu X, Ren Z, Zhang L, Li X. The remediating effect of Attention Bias Modification on aggression in young offenders with antisocial tendency: A randomized controlled trial. J Behav Ther Exp Psychiatry 2022; 75:101711. [PMID: 34923371 DOI: 10.1016/j.jbtep.2021.101711] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 10/31/2021] [Accepted: 11/20/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND OBJECTIVES An attention bias toward hostile stimuli is associated with an increased risk of aggressive behavior. Thus, reducing hostile attention bias may help to reduce aggression in young offenders. We evaluated the remediating effects of Attention Bias Modification (ABM) on hostile attention bias and aggressive behavior in Chinese male young offenders with antisocial tendencies. METHODS Institutionalized male young offenders (ages 16-18) were recruited and randomly assigned to ABM (n = 28), placebo (n = 28), or waiting list (n = 28). The ABM group received four weeks of training using visual search of emotional faces; the placebo group underwent similar training using visual search of neutral objects. Before and after treatment, aggressive behavior, attention bias toward positive stimuli and hostile stimuli were assessed. RESULTS Linear mixed models and hierarchical multiple regression analyses showed that the intervention effect of ABM was moderated by participants' initial attention bias. Young offenders with a high level of initial hostile attention bias, or with a low level of initial positive attention bias, benefitted most from ABM. LIMITATIONS The small sample size impedes investigation of the mechanism of the intervention's effects. Further research can determine whether the current results can be extrapolated to the population of female young offenders. CONCLUSION The results of the present study suggest that ABM is helpful for young offenders who show the greatest bias toward hostile stimuli and away from positive stimuli. These findings highlight the importance of matching the intervention and the participant. TRIAL REGISTRATION osf.io/vj5rk.
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Affiliation(s)
- Ziyi Zhao
- Key Laboratory of Adolescent Cyberpsychology and Behavior (CCNU), Ministry of Education, Key Laboratory of Human Development and Mental Health of Hubei Province, School of Psychology, Central China Normal University, Wuhan, China.
| | - Xianglian Yu
- Department of Education, Jianghan University, Wuhan, China.
| | - Zhihong Ren
- Key Laboratory of Adolescent Cyberpsychology and Behavior (CCNU), Ministry of Education, Key Laboratory of Human Development and Mental Health of Hubei Province, School of Psychology, Central China Normal University, Wuhan, China.
| | - Lin Zhang
- Key Laboratory of Adolescent Cyberpsychology and Behavior (CCNU), Ministry of Education, Key Laboratory of Human Development and Mental Health of Hubei Province, School of Psychology, Central China Normal University, Wuhan, China.
| | - Xu Li
- Key Laboratory of Adolescent Cyberpsychology and Behavior (CCNU), Ministry of Education, Key Laboratory of Human Development and Mental Health of Hubei Province, School of Psychology, Central China Normal University, Wuhan, China.
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Carlson JM, Fang L, Koster EH, Andrzejewski JA, Gilbertson H, Elwell KA, Zuidema TR. Neuroplastic changes in anterior cingulate cortex gray matter volume and functional connectivity following attention bias modification in high trait anxious individuals. Biol Psychol 2022; 172:108353. [DOI: 10.1016/j.biopsycho.2022.108353] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 03/11/2022] [Accepted: 05/09/2022] [Indexed: 12/21/2022]
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40
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Health anxiety and attentional control interact to predict uncertainty-related attentional biases. J Behav Ther Exp Psychiatry 2022; 74:101697. [PMID: 34678633 DOI: 10.1016/j.jbtep.2021.101697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 09/13/2021] [Accepted: 10/15/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Current theories of health anxiety and a growing body of empirical literature suggest that those high in health anxiety symptoms might find uncertainty itself threatening and demonstrate attentional biases for uncertainty-related information (ABU). Moreover, a dual processes model of attention would suggest that individual differences in attentional control might modify such a relationship. The present study was designed to explore this proposed health anxiety-ABU relationship and also to consider attentional control as a moderator of theoretical and clinical relevance. METHODS Undergraduate participants (N = 148) completed a self-report measure of health anxiety symptoms and two performance-based tasks to assess ABU and attentional control. RESULTS Hierarchical regression analyses showed a significant interaction between health anxiety and attention control in predicting attentional disengagement from, but not engagement with, uncertainty-related words. Specifically, results of the simple slopes analysis suggested that those with elevated health anxiety symptoms and better attentional control may use top-down attentional control processes to disengage their attention from distressing uncertainty-related stimuli faster than those with worse attentional control. LIMITATIONS The analogue sample is a study limitation. CONCLUSIONS Results provide new insights into the nature of attentional biases within health anxiety. Results are discussed in light of recent work on attentional control and avoidance-based psychopathology.
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Basel D, Aviram T, Lazarov A. Lack of an Attention Bias Away From Relatively Negative Faces in Dysphoria Is Not Related to Biased Emotion Identification. Behav Ther 2022; 53:182-195. [PMID: 35227397 DOI: 10.1016/j.beth.2021.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 07/18/2021] [Accepted: 07/19/2021] [Indexed: 11/24/2022]
Abstract
Eye-tracking-based attention research has consistently shown a lack of a normative attentional bias away from dysphoric face stimuli in depression, characterizing the attention system of non-depressed individuals. However, this more equal attention allocation pattern could also be related to biased emotion identification, namely, an inclination of depressed individuals to attribute negative emotions to non-negative stimuli when processing mood-congruent stimuli. Here, we examined emotion identification as a possible mechanism associated with attention allocation when processing emotional faces in depression. Attention allocation and emotion identification of participants with high (HD; n = 30) and low (LD; n = 30) levels of depression symptoms were assessed using two corresponding tasks previously shown to yield significant findings in depression, using the same face stimuli (sad, happy, and neutral faces) across both tasks. We examined group differences on each task and possible between-task associations. Results showed that while LD participants dwelled longer on relatively positive faces compared with relatively negative faces on the attention allocation task, HD participants showed no such bias, dwelling equally on both. Trait anxiety did not affect these results. No group differences were noted for emotion identification, and no between-task associations emerged. Present results suggest that depression is characterized by a lack of a general attention bias toward relatively positive faces over relatively negative faces, which is not related to a corresponding bias in emotion identification.
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Weisberg RB, Gonsalves MA, Ramadurai R, Braham H, Fuchs C, Beard C. Development of a cognitive bias modification intervention for anxiety disorders in primary care. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2022; 61 Suppl 1:73-92. [PMID: 33629751 PMCID: PMC11363222 DOI: 10.1111/bjc.12281] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 11/30/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVES There is a great need for low-intensity, scalable treatments in primary care, where most anxious patients first present for treatment. We describe Stage IA treatment development and a Stage IB feasibility trial of cognitive bias modification (CBM) for transdiagnostic anxiety in primary care. METHODS The online intervention, Mental Habits, comprised eight sessions of a personalized CBM targeting attention and interpretation biases. Coaches assisted patients in using the website, monitored progress via a dashboard, and shared information with primary care providers. We evaluated Mental Habits in an open trial (N = 14) and a randomized controlled trial (RCT) (N = 40) in primary care patients with anxiety disorders. RESULTS We compared results to a priori benchmarks of clinically meaningful outcomes. In the open trial, Mental Habits met feasibility, acceptability, and efficacy benchmarks. In the pilot RCT, there was greater dropout at one study site which ultimately closed. In the intent-to-treat analyses, Mental Habits met the benchmark for self-report, but not the interview measure of anxiety. Symptom Tracking did not meet the benchmark for self-report or interview measures of anxiety. In per-protocol analyses, Mental Habits exceeded the benchmark for both self-report and interview measures, whereas Symptom Tracking met the benchmark for self-report. Interpretation bias improved in the Mental Habits group, but not in Symptom Tracking. No effects were observed for attention bias. CONCLUSION The online CBM intervention demonstrated good acceptability and, when delivered at a stable primary care clinic, preliminary effectiveness in primary care. A larger RCT is warranted to test effectiveness. PRACTITIONER POINTS A personalized, transdiagnostic Cognitive Bias Modification (CBM) intervention for anxiety in primary care is acceptable to primary care patients with social anxiety disorder, generalized anxiety disorder, and/or panic disorder /agoraphobia. With training and supervision from licensed mental health clinicians, bachelor's-level coaches can assist primary care patients to self-administer CBM. Offering a low-intensity, self-directed anxiety intervention in primary care can greatly expand the reach of anxiety treatment, with minimal need for additional resources. Interpretation bias may be an important clinical target for primary care patients with anxiety.
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Affiliation(s)
- Risa B. Weisberg
- VA Boston Healthcare System, Massachusetts, USA
- Department of Psychiatry, Boston University School of Medicine, Massachusetts, USA
- Department of Family Medicine, Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Meghan A. Gonsalves
- Neuroscience Graduate Program, Brown University, Providence, Rhode Island, USA
| | - Ramya Ramadurai
- Department of Psychiatry, McLean Hospital, Belmont, Massachusetts, USA
| | | | - Cara Fuchs
- Department of Psychiatry, Boston University School of Medicine, Massachusetts, USA
- Boston Medical Center, Massachusetts, USA
| | - Courtney Beard
- Department of Psychiatry, McLean Hospital, Belmont, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
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Todd J, Rudaizky D, Clarke P, Sharpe L. Cognitive Biases in Type 2 Diabetes and Chronic Pain. THE JOURNAL OF PAIN 2022; 23:112-122. [PMID: 34280571 DOI: 10.1016/j.jpain.2021.06.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 06/20/2021] [Accepted: 06/25/2021] [Indexed: 11/26/2022]
Abstract
The aim of the present study was to investigate the role of cognitive processing biases in Type 2 diabetes (T2D) and chronic pain, 2 conditions that are highly co-morbid. The final sample comprised 333 individuals (86 with T2D and chronic pain, 65 with chronic pain, 76 with T2D, 106 without any form of diabetes or pain). Participants completed questionnaires assessing pain and diabetes-related outcomes, as well as measures of interpretation bias, attentional bias, and attentional bias variability. In a 2 (pain status) x 2 (T2D status) x 3 (bias valence) ANOVA design, interpretation biases were found to be stronger in individuals with chronic pain than individuals without pain, although there were no differences according to T2D status. No group differences in attentional biases were found. Among individuals with T2D, greater interpretation bias was associated with better blood glucose control, but also greater fear of hypoglycemia. For individuals with chronic pain, greater interpretation bias and attentional bias variability was associated with worse pain outcomes. Whilst interpretation bias may be present in chronic pain, it also appears to indicate better glycemic control in individuals with T2D. These findings suggest a more dynamic approach to understanding cognitive bias is needed, to consider when these biases are more or less adaptive, so that they can be better harnessed to improve outcomes for individuals with T2D who experience chronic pain. PERSPECTIVE: These findings suggest that cognitive biases can be associated with psychopathology in chronic pain and in T2D, but can also potentially be adaptive in those with T2D. Diabetes management interventions may require a careful balance between promoting sufficient concern to motivate engagement in adaptive diabetes self-management, whilst also minimizing fear of hypoglycemia.
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Affiliation(s)
- Jemma Todd
- School of Psychology, University of Sydney, Sydney, Australia; School of Psychological Science, University of Western Australia, Perth, Australia.
| | - Daniel Rudaizky
- School of Psychological Science, University of Western Australia, Perth, Australia; School of Psychology, Curtin University, Perth, Australia
| | - Patrick Clarke
- School of Psychology, Curtin University, Perth, Australia
| | - Louise Sharpe
- School of Psychology, University of Sydney, Sydney, Australia
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Wei M, Roodenrys S. A scoping review on the extent and nature of anxiety-related research within the research domain criteria (RDoC) framework: Limited coverage using non-disorder-specific search terms. NEW IDEAS IN PSYCHOLOGY 2021. [DOI: 10.1016/j.newideapsych.2021.100901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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No change in electrocortical measures of performance monitoring in high trait anxious individuals following multi-session attention bias modification training. NEUROIMAGE: REPORTS 2021. [DOI: 10.1016/j.ynirp.2021.100067] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Overman MJ, Browning M, O'Shea J. Inducing Affective Learning Biases with Cognitive Training and Prefrontal tDCS: A Proof-of-Concept Study. COGNITIVE THERAPY AND RESEARCH 2021; 45:869-884. [PMID: 34720259 PMCID: PMC8550254 DOI: 10.1007/s10608-020-10146-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2020] [Indexed: 11/27/2022]
Abstract
Background Cognitive models of mood disorders emphasize a causal role of negative affective biases in depression. Computational work suggests that these biases may stem from a belief that negative events have a higher information content than positive events, resulting in preferential processing of and learning from negative outcomes. Learning biases therefore represent a promising target for therapeutic interventions. In this proof-of-concept study in healthy volunteers, we assessed the malleability of biased reinforcement learning using a novel cognitive training paradigm and concurrent transcranial direct current stimulation (tDCS). Methods In two studies, young healthy adults completed two sessions of negative (n = 20) or positive (n = 20) training designed to selectively increase learning from loss or win outcomes, respectively. During training active or sham tDCS was applied bilaterally to dorsolateral prefrontal cortex. Analyses tested for changes both in learning rates and win- and loss-driven behaviour. Potential positive/negative emotional transfer of win/loss learning was assessed by a facial emotion recognition task and mood questionnaires. Results Negative and positive training increased learning rates for losses and wins, respectively. With negative training, there was also a trend for win (but not loss) learning rates to decrease over successive task blocks. After negative training, there was evidence for near transfer in the form of an increase in loss-driven choices when participants performed a similar (untrained) task. There was no change in far transfer measures of emotional face processing or mood. tDCS had no effect on any aspect of behaviour. Discussion and Conclusions Negative training induced a mild negative bias in healthy adults as reflected in loss-driven choice behaviour. Prefrontal tDCS had no effect. Further research is needed to assess if this training procedure can be adapted to enhance learning from positive outcomes and whether effects translate to affective disorders. Electronic supplementary material The online version of this article (10.1007/s10608-020-10146-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Margot Juliëtte Overman
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX3 9DU England
| | - Michael Browning
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX England.,Oxford Health NHS Foundation Trust, Warneford Hospital, Warneford Lane, Oxford, OX3 7JX England
| | - Jacinta O'Shea
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX3 9DU England.,Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX England.,Oxford Centre for Human Brain Activity (OHBA), Wellcome Centre for Integrative Neuroimaging, Department of Psychiatry, University of Oxford, Oxford, OX3 7JX England
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Manoli A, Liversedge SP, Sonuga-Barke EJS, Hadwin JA. The Differential Effect of Anxiety and ADHD Symptoms on Inhibitory Control and Sustained Attention for Threat Stimuli: A Go/No-Go Eye-Movement Study. J Atten Disord 2021; 25:1919-1930. [PMID: 32513052 PMCID: PMC8427811 DOI: 10.1177/1087054720930809] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: This study examined the synergistic effects of ADHD and anxiety symptoms on attention and inhibitory control depending on the emotional content of the stimuli. Method: Fifty-four typically developing individuals (27 children/adolescents and 27 adults) completed an eye-movement based emotional Go/No-Go task, using centrally presented (happy, angry) faces and neutral/symbolic stimuli. Sustained attention was measured through saccade latencies and saccadic omission errors (Go trials), and inhibitory control through saccadic commission errors (No-Go trials). ADHD and anxiety were assessed dimensionally. Results: Elevated ADHD symptoms were associated with more commission errors and slower saccade latencies for angry (vs. happy) faces. In contrast, angry faces were linked to faster saccade onsets when anxiety symptoms were high, and this effect prevailed when both anxiety and ADHD symptoms were high. Conclusion: Social threat impacted performance in individuals with sub-clinical anxiety and ADHD differently. The effects of anxiety on threat processing prevailed when both symptoms were high.
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Affiliation(s)
- Athina Manoli
- Queen Mary University of London, London, UK,Athina Manoli, Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, Old Anatomy Building, London EC1M 6BQ, UK.
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Tan PZ, Rozenman M, Chang SW, Jurgiel J, Truong HV, Piacentini J, Loo SK. The ERN as a neural index of changes in performance monitoring following attention training in pediatric obsessive-compulsive disorder. Biol Psychol 2021; 166:108206. [PMID: 34662675 DOI: 10.1016/j.biopsycho.2021.108206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 10/10/2021] [Accepted: 10/11/2021] [Indexed: 10/20/2022]
Abstract
Evidence of associations between obsessive compulsive disorder (OCD) and alterations in neural indices of performance monitoring, i.e., elevated neural activity following errors, have accelerated interest in the error-related negativity (ERN) as a biomarker for pediatric OCD. The study investigates the degree to which attention bias training is linked to changes in neural measures of performance monitoring (ERN, correct response negativity or CRN) and whether pre-to-post training changes in these neural indices are associated with symptom changes in youth with OCD. The sample included 36 youth (8-17 years) diagnosed with OCD who completed a 12-session attention training program and pre- and post-training EEG assessment of performance monitoring using cognitive and emotional flanker tasks. The emotional flanker task was individualized to each participant's negative ratings of stimuli at pre-treatment to enhance salience of threat-related stimuli across youth. Results indicated that unlike participants who received attentional control protocol (CON), those who received attentional bias modification protocol (ABM) showed significant attenuations in neural activity following erroneous and correct responses in the emotional flanker task. The ERN amplitude during the cognitive flanker task was unchanged in both ABM and CON groups. Attenuations in the ERN were also linked to decreases in social anxiety and depressive symptoms. Findings highlight the relevance of including emotionally-salient tasks when investigating potential neural mechanisms of treatments and suggest that alterations in neural processes underlying performance monitoring can be targeted via attention training programs in pediatric OCD.
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Affiliation(s)
- Patricia Z Tan
- Department of Mental Health, VA Greater Los Angeles Healthcare System, Los Angeles, CA; Jane and Terry Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavior, David Geffen School of Medicine, University of California Los Angeles, USA
| | | | - Susanna W Chang
- Jane and Terry Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavior, David Geffen School of Medicine, University of California Los Angeles, USA
| | - Joseph Jurgiel
- Jane and Terry Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavior, David Geffen School of Medicine, University of California Los Angeles, USA
| | - Holly V Truong
- Jane and Terry Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavior, David Geffen School of Medicine, University of California Los Angeles, USA
| | - John Piacentini
- Jane and Terry Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavior, David Geffen School of Medicine, University of California Los Angeles, USA
| | - Sandra K Loo
- Jane and Terry Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavior, David Geffen School of Medicine, University of California Los Angeles, USA
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Cheval B, Finckh A, Maltagliati S, Fessler L, Cullati S, Sander D, Friese M, Wiers RW, Boisgontier MP, Courvoisier DS, Luthy C. Cognitive-bias modification intervention to improve physical activity in patients following a rehabilitation programme: protocol for the randomised controlled IMPACT trial. BMJ Open 2021; 11:e053845. [PMID: 34548372 PMCID: PMC8458354 DOI: 10.1136/bmjopen-2021-053845] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 09/05/2021] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Being physically active is associated with a wide range of health benefits in patients. However, many patients do not engage in the recommended levels of physical activity (PA). To date, interventions promoting PA in patients mainly rely on providing knowledge about the benefits associated with PA to develop their motivation to be active. Yet, these interventions focusing on changing patients' conscious goals have proven to be rather ineffective in changing behaviours. Recent research on automatic factors (eg, automatic approach tendencies) may provide additional targets for interventions. However, the implementation and evaluation of intervention designed to change these automatic bases of PA are rare. Consequently, little is known about whether and how interventions that target automatically activated processes towards PA can be effective in changing PA behaviours. The Improving Physical Activity (IMPACT) trial proposes to fill this knowledge gap by investigating the effect of a cognitive-bias modification intervention aiming to modify the automatic approach towards exercise-related stimuli on PA among patients. METHODS AND ANALYSIS The IMPACT trial is a single-centre, placebo (sham controlled), triple-blinded, phase 3 randomised controlled trial that will recruit 308 patients enrolled in a rehabilitation programme in the Division of General Medical Rehabilitation at the University Hospital of Geneva (Switzerland) and intends to follow up them for up to 1 year after intervention. Immediately after starting a rehabilitation programme, patients will be randomised (1:1 ratio) to receive either the cognitive-bias modification intervention consisting of a 12-session training programme performed over 3 weeks or a control condition (placebo). The cognitive-bias modification intervention aims to improve PA levels through a change in automatic approach tendencies towards PA and sedentary behaviours. The primary outcome is the sum of accelerometer-based time spent in light-intensity, moderate-intensity and vigorous-intensity PA over 1 week after the cognitive-bias modification intervention (in minutes per week). Secondary outcomes are related to changes in (1) automatic approach tendencies and self-reported motivation to be active, (2) physical health and (3) mental health. Sedentary behaviours and self-reported PA will also be examined. The main time point of the analysis will be the week after the end of the intervention. These outcomes will also be assessed during the rehabilitation programme, as well as 1, 3, 6 and 12 months after the intervention for secondary analyses. ETHICS AND DISSEMINATION The study will be conducted in accordance with the Declaration of Helsinki. This trial was approved by the Ethics Committee of Geneva Canton, Switzerland (reference number: CCER2019-02257). All participants will give an informed consent to participate in the study. Results will be published in relevant scientific journals and be disseminated in international conferences. TRIAL REGISTRATION DETAILS The clinical trial was registered at the German clinical trials register (reference number: DRKS00023617); Pre-results.
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Affiliation(s)
- Boris Cheval
- Swiss Center for Affective Sciences, University of Geneva, Geneva, Switzerland
- Laboratory for the Study of Emotion Elicitation and Expression (E3Lab), Department of Psychology, University of Geneva, Geneva, Switzerland
| | - Axel Finckh
- Division of Rheumatology, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Silvio Maltagliati
- Laboratory SENS, Department of Sport Science, University Grenoble Alpes, Saint-Martin-d'Heres, France
| | - Layan Fessler
- Laboratory SENS, Department of Sport Science, University Grenoble Alpes, Saint-Martin-d'Heres, France
| | - Stéphane Cullati
- Population Health Laboratory, Department of Medicine, University of Fribourg, Fribourg, Switzerland
- Department of Readaptation and Geriatrics, University of Geneva, Geneva, Switzerland
| | - David Sander
- Swiss Center for Affective Sciences, University of Geneva, Geneva, Switzerland
- Laboratory for the Study of Emotion Elicitation and Expression (E3Lab), Department of Psychology, University of Geneva, Geneva, Switzerland
| | - Malte Friese
- Department of Psychology, Saarland University, Saarbrucken, Germany
| | - Reinout W Wiers
- Department of Psychology and center for Urban Mental Health, University of Amsterdam, Amsterdam, The Netherlands
| | - Matthieu P Boisgontier
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
- Bruyère Research Institute, Ottawa, Ontario, Canada
| | | | - Christophe Luthy
- Division of General Medical Rehabilitation, University Hospitals of Geneva, Geneva, Switzerland
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Caldieraro MA, Laufer-Silva T, Cassano P. Dosimetry and Clinical Efficacy of Transcranial Photobiomodulation for Major Depression Disorder: Could they Guide Dosimetry for Alzheimer's Disease? J Alzheimers Dis 2021; 83:1453-1469. [PMID: 34487045 DOI: 10.3233/jad-210586] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Major depressive disorder (MDD) is prevalent and has significant impact on individuals and society. Cognitive symptoms are frequent in MDD and insufficiently treated by antidepressant medications. Transcranial photobiomodulation (t-PBM) is a novel device therapy which shows promise as an antidepressant and pro-cognitive treatment. To date, despite the encouraging results, the optimal stimulation parameters of t-PBM to treat MDD are not established, and clinical studies are very heterogeneous in terms of these parameters. While the literature provides guidance on the appropriate fluence to achieve therapeutic results, little is known on the other parameters. OBJECTIVE To evaluate the relationship between different parameters and the antidepressant effect of t-PBM. METHODS We reviewed clinical studies on MDD and on depressive symptoms comorbid with other diseases. We calculated the standardized effect size of the change in symptoms severity before and after t-PBM and we performed a descriptive analysis of the reviewed papers. RESULTS The greatest effect sizes for the antidepressant effect were found in studies using pulse-wave t-PBM with high peak irradiance (but low average irradiance) over large skin surface. One well-designed and sufficiently powered, double-blind, sham-controlled trial indicated that t-PBM with low irradiance over a small skin surface is ineffective to treat depression. CONCLUSION The use of t-PBM for Alzheimer's disease and for dementia is still at its inception; these dosimetry lessons from the use of t-PBM for depression might serve as guidance.
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Affiliation(s)
- Marco Antonio Caldieraro
- Centro de Pesquisa Experimental (CPE) e Centro de Pesquisa Clínica (CPC), Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre -RS, Brasil.,Universidade Federal do Rio Grande do Sul, Faculdade de Medicina, Departamento de Psiquiatria e Medicina Legal, Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, Porto Alegre -RS, Brasil
| | - Tatiana Laufer-Silva
- Centro de Pesquisa Experimental (CPE) e Centro de Pesquisa Clínica (CPC), Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre -RS, Brasil.,Universidade Federal do Rio Grande do Sul, Faculdade de Medicina, Departamento de Psiquiatria e Medicina Legal, Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, Porto Alegre -RS, Brasil
| | - Paolo Cassano
- Harvard Medical School, Boston, MA, USA.,MGH Division of Neuropsychiatry, Massachusetts General Hospital, Boston, MA, USA
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