Positive online attentional training as a means of modifying attentional and interpretational biases among the clinically depressed: An experimental study using eye tracking

Towards implementation of cognitive bias modification in mental health care: State of the science, best practices, and ways forward

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.

Patterns of attentional biases in children and emotional symptoms during the COVID-19 pandemic: a two-wave longitudinal study

BACKGROUND

It is unknown how the patterns of negative and positive attentional biases in children predict fear of COVID-19, anxiety symptoms, and depression symptoms during the COVID-19 pandemic. The study identified profiles of negative and positive attentional biases in children and examined their association with emotional symptoms during the COVID-19 pandemic.

METHOD

264 children (girls: 53.8% and boys: 46.2%) of 9-10 years born in Hong Kong or mainland China from a primary school in Shenzhen, People's Republic of China were involved in a two-wave longitudinal study. Children completed the COVID-19 Fear Scale, the Revised Child Anxiety and Depression Scale, and the Attention to Positive and Negative Information Scale to measure fear of COVID-19, anxiety and depression symptoms, and negative and positive attentional biases in classrooms. After six months, they completed the second assessment of fear of COVID-19, anxiety symptoms, and depression symptoms in classrooms. Latent profile analysis was conducted to reveal distinct profiles of attentional biases in children. A series of repeated MANOVA was performed to examine the association of profiles of attentional biases to fear of COVID-19, anxiety symptoms, and depression symptoms across 6 months.

RESULTS

Three profiles of negative and positive attentional biases were revealed in children. Children with a "moderate positive and high negative attentional biases" profile had significantly higher fear of the COVID-19 pandemic, anxiety symptoms, and depression symptoms than children with a "high positive and moderate negative attentional biases" profile. Children with a "low positive and negative attentional biases" profile were not significantly different in fear of COVID-19, anxiety symptoms, and depression symptoms than those with the other two profiles.

CONCLUSIONS

Patterns of negative and positive attentional biases were related to emotional symptoms during the COVID-19 pandemic. It might be important to consider children's overall patterns of negative and positive attentional biases to identify children at risk of higher emotional symptoms.

Attention bias modification for depression: A systematic review and meta-analysis

Background

Depression 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.

Methods

Seven 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).

Results

A 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.

Conclusion

Due 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].

An eye-tracking study of biased attentional processing of emotional faces in severe alcohol use disorder

BACKGROUND

Social cognition impairments in severe alcohol use disorder (SAUD) are increasingly established. However, fundamental aspects of social cognition, and notably the attentional processing of socio-affective information, remain unexplored, limiting our understanding of underlying mechanisms. Here, we determined whether patients with SAUD show attentional biases to specific socio-affective cues, namely emotional faces.

METHOD

In a modified dot-probe paradigm, 30 patients with SAUD and 30 demographically matched healthy controls (HC) were presented with pairs of neutral-emotional (angry, disgusted, happy, sad) faces while having their eye movements recorded. Indices of early/automatic (first fixations, latency to first fixations) and later/controlled (number of fixations, dwell-time) processes were computed.

RESULTS

Patients with SAUD did not differ from HC in their attention to angry/disgusted/sad vs. neutral faces. However, patients with SAUD fixated/dwelled less on happy vs. neutral faces in the first block of stimuli than HC, who presented an attentional bias to happy faces.

LIMITATIONS

Sample-size was determined to detect medium-to-large effects and subtler ones may have been missed. Further, our cross-sectional design provides no explanation as to whether the evidenced biases precede or are a consequence of SAUD.

CONCLUSIONS

These results extend the social cognition literature in SAUD to the attentional domain, by evidencing the absence of a controlled attentional bias toward positive social cues in SAUD. This may reflect reduced sensitivity to social reward and could contribute to higher order social cognition difficulties and social dysfunction.

Cognitive bias modification for adult's depression: A systematic review and meta-analysis

Objects

This study aimed to elucidate the effect of cognitive bias modification on depression.

Methods

This research included 10 randomized studies searching four major databases: PubMed, Embase, PsycINFO, and Cochrane Library, with a total sample size of 467. Moreover, they were examined for quality and possible publication bias.

Results

Cognitive bias modification (CBM) had statistically significant results, g = -0.64, 95% CI = [-0.97-0.32]. The interpretation of cognitive bias modification shows the highest effect size, g = -1.45, 95% CI = [-2.05-0.88]. When the training place is located in the laboratory, the training effect is significant, g = -1.11, 95% CI = [-1.62-0.61]. The difference is statistically significant when the training environment was changed to home, g = -0.28, 95% CI = [-0.51-0.05]. CBM has a statistical effect on moderate-to-severe depression, g = -0.70, 95% CI = [-1.04-0.36].

Conclusion

We found that CBM had a moderate therapeutic effect on depression, whether the setting was at home or in the lab. Especially when the interpretation of cognitive bias modification (CBM-I) was used, we got the highest effect value. Furthermore, CBM has a statistical effect on moderate-to-severe depression.

A review of attentional bias modification trainings for depression

Negative attentional bias is a basic character of depression. The attentional bias modification training (ABMT), being a highly promising and easy-to-use depression intervention technique, has attracted much attention to alleviate depressive symptoms in recent years. However, the effectiveness of ABMT programs was mixed across studies, since it remained unclear the underlying mechanisms of ABMT on alleviating depressive symptoms. We systematically analyzed the main ABMT paradigms to clarify possible mechanisms of effective training and reasons of ineffective training. Valid ABMT programs might alleviate depressive symptoms through regulating self-related rumination or two subcomponents of attentional bias: facilitated attention and impaired attentional disengagement. The reasons for the invalidity of ABMT mainly included the suboptimal design of training procedures, mixed effects of participants' personal characteristics, and the unclear relationship between attentional bias and depression. The ABMT is promising for alleviating depressive symptoms, but training procedures are required to be improved to obtain stable training effects.

Media multitasking, depression, and anxiety of college students: Serial mediating effects of attention control and negative information attentional bias

BACKGROUND

The COVID-19 epidemic provides an environment for frequent media multitasking, which might associate with an increase in depression and anxiety. Since many studies have found that media multitasking negatively affects cognitive capacity, we propose a cognitive perspective to explore how media multitasking may associate with mental health. This study examined the potential mediating role of attention control and negative information attentional bias in the relationship between media multitasking and anxiety and depression.

METHODS

Participants (n = 567) were recruited from college students in China. They completed an online survey that included the Media Multitasking Inventory (MMI), Attention Control Scale (ACS), Attention to Positive and Negative Information Scale (APNI), Generalized Anxiety Disorder Scale (GAD-7), and Patient Health Questionnaire (PHQ-9). After exploring the correlations between the measures, serial mediation models were examined.

RESULTS

The results indicated significant positive correlations between media multitasking and anxiety and depression. Media multitasking, anxiety, and depression were negatively correlated with attention focusing, while positively correlated with negative information attention bias. Media multitasking did not correlate with attention shifting. Mediation modeling demonstrated that attention focusing and negative information attention bias played a serial mediating role in the relationship between media multitasking and anxiety and depression. However, the results did not support the serial mediation model through attention shifting and negative information attention bias.

CONCLUSION

Media multitasking does not directly influence anxiety and depression, while attention focusing and negative information attention bias play serial mediating roles in their relationship. This study highlights the potential cognitive mechanisms between media multitasking and anxiety and depression, providing theoretical support for interventions in individual mental health during the epidemic.

Attentional bias towards interpersonal aggression in depression - an eye movement study

Depressed individuals exhibit an attentional bias towards mood-congruent stimuli, yet evidence for biased processing of threat-related information in human interaction remains scarce. Here, we tested whether an attentional bias towards interpersonally aggressive pictures over interpersonally neutral pictures could be observed to a greater extent in depressed participants than in control participants. Eye movements were recorded while the participants freely viewed visually matched interpersonally aggressive and neutral pictures, which were presented in pairs. Across the groups, participants spent more time looking at neutral pictures than at aggressive pictures, probably reflecting avoidance behavior. When the participants could anticipate the stimulus valence, depressed participants - but not controls - showed an early attentional bias towards interpersonally aggressive pictures, as indexed by their longer first fixation durations on aggressive pictures than on neutral pictures. Our results thus preliminarily suggest both an early attentional bias towards interpersonal aggression, which is present, in depressed participants, also when aggression contents are anticipated, and a later attentional avoidance of aggression. The early depression-related bias in information processing may have maladaptive effects on the way depressed individuals perceive and function in social interaction and can, therefore, maintain depressed mood.

From cognitive targets to symptom reduction: overview of attention and interpretation bias modification research

Cognitive bias modification (CBM) is a class of mechanised psychological interventions designed to target specific aberrant cognitive processes considered key in the aetiology and/or maintenance of specific psychiatric disorders. In this review, we outline a multistage translational process that allows tracking progress in CBM research. This process involves four steps: (1) the identification of reliable cognitive targets and establishing their association with specific disorders; (2) clinical translations designed to rectify the identified cognitive targets; (3) verification of effective target engagement and (4) testing of clinical utility in randomised controlled trials. Through the prism of this multistage process, we review progress in clinical CBM research in two cognitive domains: attention and interpretation; in six psychiatric conditions: anxiety disorders, major depressive disorder, post-traumatic stress disorder, addictive disorders, eating disorders and obsessive-compulsive disorder. The review highlights achievement as well as shortcomings of the CBM approach en route to becoming a recognised evidence-supported therapy for these disorders.