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Frommelt T, Bäumler L, Rohleder N, Schulte-Körne G, Platt B. Study protocol for a randomized controlled trial investigating the effect of online interpretation bias intervention on stress reactivity in the children of parents with depression: the CoCo study. BMC Psychiatry 2023; 23:378. [PMID: 37254177 DOI: 10.1186/s12888-023-04803-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 04/19/2023] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND Current preventive interventions for the children of parents with depression demonstrate modest effects on depression incidence. This may be because existing interventions tend to comprise general psychotherapeutic tools, rather than targeting the specific mechanisms underlying familial transmission. Improved theoretical models of familial transmission could enhance the development of targeted interventions. Although existing models assume that cognitive and biological vulnerability factors influence one another, the precise mechanisms are unknown. This project is the first to experimentally test whether negative interpretation bias has an impact on cortisol response in children of parents with depression. This study protocol reports a randomised controlled trial of an interpretation bias intervention which aims to shift participants' interpretation bias in a more positive direction and thereby alter their stress response. METHODS Children aged 10-14 years who have i) one parent with a current or previous depression diagnosis, with at least one episode occurring during the child's lifetime and ii) do not have a current or previous psychiatric diagnosis themselves, will be assigned to one of two conditions: an interpretation bias intervention (n = 50) or a structurally similar placebo intervention (n = 50). The interpretation bias intervention consists of a short lab-based cognitive reappraisal of interpretations training, a four-week app-based Cognitive Bias Modification of Interpretations intervention and interpretation bias specific if-then plans. Interpretation bias will be assessed before and after the intervention using the Scrambled Sentences Task. The effect of the intervention on participants' stress response will be assessed by salivary cortisol collected at five different time points: from immediately before until 45 min after administering the Trier Social Stressor Test for Children. Stress reactivity will be measured via baseline to peak cortisol and stress recovery will be measured via the 45 min cortisol marker. We hypothesise that children who participate in the interpretation bias intervention will display a positive shift in interpretation bias and this, in turn, will alter their stress response. Children who receive the placebo intervention are expected to show a smaller positive shift in interpretation bias and stress reactivity. DISCUSSION The findings of the present study will contribute to models of familial depression transmission as well as informing preventive interventions. If training a more positive interpretation bias subsequently alters participants' stress response, then incorporating such tools may increase the efficacy of existing preventive interventions. TRIAL REGISTRATION Deutsches Register Klinischer Studien DRKS00028842. Registered August 19, 2022.
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Affiliation(s)
- Tonya Frommelt
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, LMU University Hospital Munich, Nussbaumstr. 5, 80336, Munich, Germany.
| | - Leonie Bäumler
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, LMU University Hospital Munich, Nussbaumstr. 5, 80336, Munich, Germany
| | - Nicolas Rohleder
- Department of Psychology, Chair of Health Psychology, Friedrich-Alexander-University Erlangen-Nürnberg, Nägelsbachstr. 49a, 91052, Erlangen, Germany
| | - Gerd Schulte-Körne
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, LMU University Hospital Munich, Nussbaumstr. 5, 80336, Munich, Germany
| | - Belinda Platt
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, LMU University Hospital Munich, Nussbaumstr. 5, 80336, Munich, Germany
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Deng W, Everaert J, Bronstein MV, Joormann J, Cannon T. Social Interpretation Inflexibility and Functioning: Associations with Symptoms and Stress. JOURNAL OF SOCIAL AND CLINICAL PSYCHOLOGY 2023. [DOI: 10.1521/jscp.2023.42.1.29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
Introduction: Interpretation inflexibility has been implicated in a range of mental health problems, including depression, social anxiety, and paranoia. Inflexible interpretation of social situations may be particularly important as it can set the stage for problems in social functioning, a symptom cutting across all three groups of disorders. Methods: This study aimed to examine the interrelations among interpretation inflexibility, social functioning impairment, and affective and psychotic symptoms. The study also explored the potential moderating effects of COVID-related preoccupation, as an example of a major stressor, on these relationships. Results: Based on a sample recruited from the general population (N = 247), interpretation inflexibility was found to be associated with social functioning impairment, with affective symptoms and paranoia as statistical mediators of the association. These relationships were magnified by ambient stress during the COVID-19 pandemic—a moderated mediation that was found only in relation to affective symptoms but not paranoia. A parallel network analysis further confirmed the moderating effects of COVID-related preoccupation on the relation between interpretation inflexibility and depression. Limitations: Measuring ambient stress with a self-report question on COVID-related preoccupation may not be representative of the amount of distress an individual experienced during the pandemic. Also, our mediation models were performed on cross-sectional data, thus not necessarily implying a feed-forward causal mediational relationship. Conclusions: These findings highlight the importance of examining social functioning as a crucial outcome, as well as the differential role of stress in modulating social interpretation flexibility with respect to affective vs. psychotic symptoms.
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Rowlands K, Beaty T, Simic M, Grafton B, Hirsch C, Treasure J, Cardi V. Cognitive bias modification training of attention and interpretation to reduce expectations of social rejection in adolescents with eating disorders: A small efficacy randomized controlled trial. Int J Eat Disord 2022; 55:1506-1520. [PMID: 36147018 PMCID: PMC9825839 DOI: 10.1002/eat.23809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 08/23/2022] [Accepted: 08/23/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE This study aimed to investigate whether a computerized cognitive bias modification training delivered remotely would reduce expectations of rejection in adolescents with eating disorders. METHOD Sixty-seven adolescents aged 12-18 (99.5% female) with an eating disorder diagnosis (94% anorexia nervosa) and receiving specialist treatment were recruited. Participants were randomized to an intervention condition (n = 37) which included treatment as usual (TAU) supplemented by nine sessions of online cognitive bias modification training for social stimuli (CBMT + TAU), or a control condition (n = 30), which included TAU only. Participants were invited to complete assessments at baseline and post-intervention. RESULTS In the intervention condition, 22/37 participants completed six or more training sessions and post-intervention measures, the pre-defined criteria to be considered "completers." In the control condition, 28/30 participants completed the post-intervention measures. Participants who completed the intervention displayed a significantly greater reduction in negative interpretations of ambiguous social scenarios, with a medium effect size (p = .048, ηp2 = .090), and eating disorder psychopathology, with a medium effect size (p = .027, ηp2 = .105), compared to participants in the control condition. No significant between-group differences were found on emotional response to criticism, and anxiety and depression symptoms post-intervention (ps > .05; small effect sizes). DISCUSSION Enhancing treatment as usual with CBMT targeting expectations of social rejection might be feasible and effective to reduce expectations of social rejection and eating disorder psychopathology in adolescents with eating disorders. Training adaptations might be necessary to impact on emotional processing and comorbid psychological distress. PUBLIC SIGNIFICANCE Adolescents with eating disorders who completed a brief (4-week) online cognitive training intervention, alongside their usual treatment, reported greater reductions in expectations of social rejection and eating disorder psychopathology after the intervention, compared to a separate group of patients who received their usual treatment only. This brief and accessible intervention may be a helpful treatment adjunct for adolescents with eating disorders.
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Affiliation(s)
- Katie Rowlands
- Department of Psychological MedicineInstitute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUK
| | - Taryn Beaty
- Department of Psychological MedicineInstitute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUK
| | - Mima Simic
- Child and Adolescent Eating Disorders ServiceSouth London and Maudsley NHS Foundation TrustLondonUK
| | - Ben Grafton
- Centre for the Advancement of Research on EmotionSchool of Psychological Science, University of Western AustraliaCrawleyAustralia
| | - Colette Hirsch
- Psychology DepartmentInstitute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUK
| | - Janet Treasure
- Department of Psychological MedicineInstitute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUK
| | - Valentina Cardi
- Department of Psychological MedicineInstitute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUK,Department of General PsychologyUniversity of PadovaItaly
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Hodges TE, Lieblich SE, Rechlin RK, Galea LAM. Sex differences in inflammation in the hippocampus and amygdala across the lifespan in rats: associations with cognitive bias. Immun Ageing 2022; 19:43. [PMID: 36203171 PMCID: PMC9535862 DOI: 10.1186/s12979-022-00299-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 09/19/2022] [Indexed: 11/05/2022]
Abstract
Background Cognitive symptoms of major depressive disorder, such as negative cognitive bias, are more prevalent in women than in men. Cognitive bias involves pattern separation which requires hippocampal neurogenesis and is modulated by inflammation in the brain. Previously, we found sex differences in the activation of the amygdala and the hippocampus in response to negative cognitive bias in rats that varied with age. Given the association of cognitive bias to neurogenesis and inflammation, we examined associations between cognitive bias, neurogenesis in the hippocampus, and cytokine and chemokine levels in the ventral hippocampus (HPC) and basolateral amygdala (BLA) of male and female rats across the lifespan. Results After cognitive bias testing, males had more IFN-γ, IL-1β, IL-4, IL-5, and IL-10 in the ventral HPC than females in adolescence. In young adulthood, females had more IFN-γ, IL-1β, IL-6, and IL-10 in the BLA than males. Middle-aged rats had more IL-13, TNF-α, and CXCL1 in both regions than younger groups. Adolescent male rats had higher hippocampal neurogenesis than adolescent females after cognitive bias testing and young rats that underwent cognitive bias testing had higher levels of hippocampal neurogenesis than controls. Neurogenesis in the dorsal hippocampus was negatively associated with negative cognitive bias in young adult males. Conclusions Overall, the association between negative cognitive bias, hippocampal neurogenesis, and inflammation in the brain differs by age and sex. Hippocampal neurogenesis and inflammation may play greater role in the cognitive bias of young males compared to a greater role of BLA inflammation in adult females. These findings lay the groundwork for the discovery of sex-specific novel therapeutics that target region-specific inflammation in the brain and hippocampal neurogenesis. Supplementary Information The online version contains supplementary material available at 10.1186/s12979-022-00299-4. • Adolescent male rats had more hippocampal inflammation than females after cognitive bias testing. • Adult female rats had more basolateral amygdalar inflammation than males after cognitive bias testing. • HPC neurogenesis was negatively associated to cognitive bias in young adult male rats.
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Affiliation(s)
- Travis E. Hodges
- grid.17091.3e0000 0001 2288 9830Department of Psychology, University of British Columbia, Vancouver, Canada
| | - Stephanie E. Lieblich
- grid.17091.3e0000 0001 2288 9830Department of Psychology, University of British Columbia, Vancouver, Canada ,grid.17091.3e0000 0001 2288 9830Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada
| | - Rebecca K. Rechlin
- grid.17091.3e0000 0001 2288 9830Department of Psychology, University of British Columbia, Vancouver, Canada ,grid.17091.3e0000 0001 2288 9830Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada
| | - Liisa A. M. Galea
- grid.17091.3e0000 0001 2288 9830Department of Psychology, University of British Columbia, Vancouver, Canada ,grid.17091.3e0000 0001 2288 9830Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada ,grid.17091.3e0000 0001 2288 9830Graduate Program in Neuroscience, University of British Columbia, Vancouver, Canada
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Chen R, Zheng J, Li T, Zhang Q, Li C, Cui L. Cognitive bias modification of interpretation training for Chinese undergraduates with depressive symptoms. CURRENT PSYCHOLOGY 2022. [DOI: 10.1007/s12144-020-01094-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Hodges TE, Lee GY, Noh SH, Galea LA. Sex and age differences in cognitive bias and neural activation in response to cognitive bias testing. Neurobiol Stress 2022; 18:100458. [PMID: 35586750 PMCID: PMC9109184 DOI: 10.1016/j.ynstr.2022.100458] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 03/28/2022] [Accepted: 05/02/2022] [Indexed: 12/29/2022] Open
Abstract
Cognitive symptoms of depression, including negative cognitive bias, are more severe in women than in men. Current treatments to reduce negative cognitive bias are not effective and sex differences in the neural activity underlying cognitive bias may play a role. Here we examined sex and age differences in cognitive bias and functional connectivity in a novel paradigm. Male and female rats underwent an 18-day cognitive bias procedure, in which they learned to discriminate between two contexts (shock paired context A, no-shock paired context B), during either adolescence (postnatal day (PD 40)), young adulthood (PD 100), or middle-age (PD 210). Cognitive bias was measured as freezing behaviour in response to an ambiguous context (context C), with freezing levels akin to the shock paired context coded as negative bias. All animals learned to discriminate between the two contexts, regardless of sex or age. However, adults (young adults, middle-aged) displayed a greater negative cognitive bias compared to adolescents, and middle-aged males had a greater negative cognitive bias than middle-aged females. Females had greater neural activation of the nucleus accumbens, amygdala, and hippocampal regions to the ambiguous context compared to males, and young rats (adolescent, young adults) had greater neural activation in these regions compared to middle-aged rats. Functional connectivity between regions involved in cognitive bias differed by age and sex, and only adult males had negative correlations between the frontal regions and hippocampal regions. These findings highlight the importance of examining age and sex when investigating the underpinnings of negative cognitive bias and lay the groundwork for determining what age- and sex-specific regions to target in future cognitive bias studies.
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Affiliation(s)
- Travis E. Hodges
- Department of Psychology, University of British Columbia, Canada
| | - Grace Y. Lee
- Department of Psychology, University of British Columbia, Canada
| | - Sophia H. Noh
- Department of Psychology, University of British Columbia, Canada
| | - Liisa A.M. Galea
- Department of Psychology, University of British Columbia, Canada
- Graduate Program in Neuroscience, University of British Columbia, Canada
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Canada
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Busch HEC, Viana AG, Raines EM, Trent ES, Zvolensky MJ, Storch EA. Fearful Temperament, Catastrophizing, and Internalizing Symptoms in Clinically Anxious Youth. J Cogn Psychother 2022; 37:JCP-2021-0022.R1. [PMID: 35470150 DOI: 10.1891/jcp-2021-0022] [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: 11/25/2022]
Abstract
A fearful temperament in childhood is associated with child internalizing symptoms. However, the cognitive mechanisms explaining this association are poorly understood. We examined the effects of child fearful temperament on child internalizing symptoms and the underlying role of catastrophizing cognitions among clinically anxious youth. Children (N = 105; M age = 10.09 years, SD = 1.22; 56.7% female; 62% ethnic minority) completed a diagnostic interview; self-report measures of temperament, catastrophizing, and internalizing symptoms; and behaviorally-indexed measures of catastrophizing and anxiety. Indirect effects were found for child fearful temperament on child self-reported internalizing symptoms by way of self-reported (but not behaviorally-indexed) catastrophizing cognitions. Models predicting behaviorally-indexed child anxiety were not significant. Our findings suggest that targeting fearful temperament during childhood before catastrophizing cognitions develop may have clinical utility. Likewise, among children temperamentally at-risk, addressing catastrophic cognitions may prevent later internalizing psychopathology.
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Affiliation(s)
| | - Andres G Viana
- Department of Psychology, University of Houston, Houston, TX, 77204
- Texas Institute of Measurement, Evaluation, and Statistics, University of Houston, Houston, TX, 77204
| | | | - Erika S Trent
- Department of Psychology, University of Houston, Houston, TX, 77204
| | - Michael J Zvolensky
- Department of Psychology, University of Houston, Houston, TX, 77204
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Eric A Storch
- Menninger Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
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Rowlands K, Grafton B, Cerea S, Simic M, Hirsch C, Cruwys T, Yellowlees R, Treasure J, Cardi V. A multifaceted study of interpersonal functioning and cognitive biases towards social stimuli in adolescents with eating disorders and healthy controls. J Affect Disord 2021; 295:397-404. [PMID: 34500369 DOI: 10.1016/j.jad.2021.07.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 07/02/2021] [Accepted: 07/12/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Cognitive biases towards social stimuli have been identified as one of the putative modifiable mechanisms to remediate interpersonal difficulties in adolescents with mental disorders. However, evidence for these biases in adolescents with eating disorders is scarce. METHODS This study assessed interpersonal sensitivity, cognitive biases towards social stimuli, and quantity and quality of social group memberships in adolescents with eating disorders (n = 80), compared to healthy controls (n = 78), and examined whether a negative interpretation bias would mediate the relationship between interpersonal sensitivity, eating disorder symptoms and positive group memberships. RESULTS Adolescents with eating disorders displayed greater interpersonal awareness, negative interpretation biases of ambiguous social information and poorer quality relationships with their social groups compared to healthy controls. In a simple mediation model, interpersonal awareness predicted eating disorder symptoms, and this effect was partially mediated by a negative interpretation bias. CONCLUSIONS Psychological interventions which aim to reduce a negative interpretation bias might help to reduce the severity of eating disorder symptoms in adolescents with eating disorders.
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Affiliation(s)
- Katie Rowlands
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.
| | - Ben Grafton
- Centre for the Advancement of Research on Emotion, School of Psychological Science, University of Western Australia, Crawley, Australia
| | - Silvia Cerea
- Department of General Psychology, University of Padova, Italy
| | - Mima Simic
- Child and Adolescent Eating Disorders Service, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Colette Hirsch
- Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Tegan Cruwys
- Research School of Psychology, The Australian National University, Canberra ACT 2601, Australia
| | - Robyn Yellowlees
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Janet Treasure
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Valentina Cardi
- Department of General Psychology, University of Padova, Italy
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Nieto I, Vazquez C. Disentangling the mediating role of modifying interpretation bias on emotional distress using a novel cognitive bias modification program. J Anxiety Disord 2021; 83:102459. [PMID: 34358756 DOI: 10.1016/j.janxdis.2021.102459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 07/12/2021] [Accepted: 07/26/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Negative interpretation bias is a potential risk factor for emotional disorders. In this study, we tested a clinically inspired 4-session online Cognitive Bias Modification-Interpretation (CBM-IClin) program to modify negative interpretation biases. METHODS We randomized one hundred and twenty-one volunteer young adults (Mean age = 21.6 years, SD = 3.5; 85 % women) with varying levels of emotional distress to either an experimental or waitlist control group. Mediation analyses were used to disentangle the associations between the intervention, changes in interpretation biases (assessed by both a self-report and an experimental task), and changes in measures of cognitive vulnerability and symptoms of depression and anxiety. RESULTS The results showed that the CBM-IClin could change negative interpretation biases. Also, it had a direct effect on the change in negative memory bias, an indirect effect on the change in depression symptoms via the change in interpretation bias, and both direct and indirect effects on the change in self-reported dysfunctional attitudes. LIMITATIONS The study included a non-clinical sample of participants and it did not control for some potential confounding factors (e.g., attentional disorders). Furthermore, participants' engagement during the sessions at home was not supervised. CONCLUSIONS The CBM-IClin is a potential tool to prevent and intervene in emotional disorders in young adults and could complement other traditional CBM procedures or clinical interventions.
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Affiliation(s)
- Inés Nieto
- Department of Clinical Psychology, School of Psychology, Complutense University of Madrid, Spain.
| | - Carmelo Vazquez
- Department of Clinical Psychology, School of Psychology, Complutense University of Madrid, Spain
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Schmidt NB, Vereenooghe L. Targeting hostile attributions in inclusive schools through online cognitive bias modification: A randomised experiment. Behav Res Ther 2021; 146:103949. [PMID: 34583306 DOI: 10.1016/j.brat.2021.103949] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 05/11/2021] [Accepted: 08/25/2021] [Indexed: 11/18/2022]
Abstract
The tendency to make hostile attributions in ambiguous social situations has been associated with aggression and may be targeted through cognitive bias modification for interpretations (CBM-I). Despite their high prevalence of aggression and internalising problems, children and young people with neurodevelopmental disorders (NDD) or special educational needs (SEN) are markedly absent from CBM-I studies. This pilot study investigates whether online CBM-I can reduce hostile attributions and reactive aggression in inclusive school pupils. In Study 1, 71 pupils (mean age = 12.2, SD = 1.5; 25.4% presented with NDD or SEN) were randomly allocated to complete three sessions of either CBM-I (n = 37) or active control training (n = 34). CBM-I involved interpreting ambiguous scenarios or faces in a non-hostile manner, whereas the control training involved attention and memory exercises without resolving ambiguity. Between-group comparison showed CBM-I to reduce both hostile attributions and reactive aggression. In Study 2, follow-up focus groups with 23 pupils demonstrated the acceptability of training content and delivery. Together, these findings show online CBM-I to be acceptable and effective at reducing both hostile attributions and reactive aggression in an inclusive setting. The possibility of intervention effects on behavioural outcomes and potential confounding variables require further investigation.
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Affiliation(s)
- Nora B Schmidt
- Faculty of Psychology and Sports Science, Bielefeld University, Germany.
| | - Leen Vereenooghe
- Faculty of Psychology and Sports Science, Bielefeld University, Germany
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Lau JYF, Watkins-Muleba R, Lee I, Pile V, Hirsch CR. Promoting helpful attention and interpretation patterns to reduce anxiety and depression in young people: weaving scientific data with young peoples' lived experiences. BMC Psychiatry 2021; 21:403. [PMID: 34429091 PMCID: PMC8386061 DOI: 10.1186/s12888-021-03320-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 05/19/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Anxiety and depression are common, disabling and frequently start in youth, underscoring the need for effective, accessible early interventions. Empirical data and consultations with lived experience youth representatives suggest that maladaptive cognitive patterns contribute to and maintain anxiety and depression in daily life. Promoting adaptive cognitive patterns could therefore reflect "active ingredients" in the treatment and/or prevention of youth anxiety and depression. Here, we described and compared different therapeutic techniques that equipped young people with a more flexible capacity to use attention and/or promoted a tendency to positive/benign (over threatening/negative) interpretations of uncertain situations. METHODS We searched electronic databases (PubMed, PsycINFO, EMBASE, and PsycARTICLES) for studies containing words relating to: intervention; youth; anxiety and/or depression and attention and/or interpretation, and selected studies which sought to reduce self-reported anxiety/depression in youth by explicitly altering attention and/or interpretation patterns. Ten young people with lived experiences of anxiety and depression and from diverse backgrounds were consulted on the relevance of these strategies in managing emotions in their daily lives and also whether there were additional strategies that could be targeted to promote adaptive thinking styles. RESULTS Two sets of techniques, each targeting different levels of responding with different strengths and weaknesses were identified. Cognitive bias modification training (CBM) tasks were largely able to alter attention and interpretation biases but the effects of training on clinical symptoms was more mixed. In contrast, guided instructions that teach young people to regulate their attention or to evaluate alternative explanations of personally-salient events, reduced symptoms but there was little experimental data establishing the intervention mechanism. Lived experience representatives suggested that strategies such as deliberately recalling positive past experiences or positive aspects of oneself to counteract negative thinking. DISCUSSION CBM techniques target clear hypothesised mechanisms but require further co-design with young people to make them more engaging and augment their clinical effects. Guided instructions benefit from being embedded in clinical interventions, but lack empirical data to support their intervention mechanism, underscoring the need for more experimental work. Feedback from young people suggest that combining complimentary techniques within multi-pronged "toolboxes" to develop resilient thinking patterns in youth is empowering.
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Affiliation(s)
- Jennifer Y. F. Lau
- grid.13097.3c0000 0001 2322 6764Psychology Department, IOPPN, King’s College London, Denmark Hill, London, SE5 8AF UK ,grid.4868.20000 0001 2171 1133Youth Resilience Research Unit, Queen Mary University of London, London, UK
| | - Rebecca Watkins-Muleba
- grid.13097.3c0000 0001 2322 6764Psychology Department, IOPPN, King’s College London, Denmark Hill, London, SE5 8AF UK
| | - Isabelle Lee
- grid.13097.3c0000 0001 2322 6764Psychology Department, IOPPN, King’s College London, Denmark Hill, London, SE5 8AF UK
| | - Victoria Pile
- grid.13097.3c0000 0001 2322 6764Psychology Department, IOPPN, King’s College London, Denmark Hill, London, SE5 8AF UK ,grid.4970.a0000 0001 2188 881XRoyal Holloway University of London, London, UK
| | - Colette R. Hirsch
- grid.13097.3c0000 0001 2322 6764Psychology Department, IOPPN, King’s College London, Denmark Hill, London, SE5 8AF UK
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Ren Z, Zhao Z, Yu X, Zhang L, Li X. Effects of cognitive bias modification for interpretation on hostile interpretation bias and self-reported aggression in juvenile delinquents. Int J Clin Health Psychol 2021; 21:100226. [PMID: 33680000 PMCID: PMC7893428 DOI: 10.1016/j.ijchp.2021.100226] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 01/04/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND/OBJECTIVE The social information processing model holds that aggressive behavior is closely related to the hostile interpretation of ambiguous social cues, suggesting the possibility that an intervention that reduces hostile interpretations could reduce aggression. This study in Mainland China evaluated the remediating effects of cognitive bias modification for interpretation (CBM-I) on the hostile interpretation bias and self-reported aggressive behaviors of male juvenile delinquents, taking into account initial hostile interpretation bias as a possible moderator of the intervention effect. METHOD Fifty-six male juvenile delinquents aged 16-18 were recruited and randomly assigned to the CBM-I group (n = 28) or the Waiting-List group (n = 28). Interpretation bias and self-reported aggressive behavior were assessed at pre-test and post-test. RESULTS The positive interpretations of participants in the CBM-I group were significantly increased compared with participants in the Waiting-List group. The intervention effect of CBM-I on self-reported physical aggression was significant only for juvenile delinquents with high pre-test hostile interpretation bias. CONCLUSIONS CBM-I can significantly improve the positive interpretation bias of juvenile delinquents, and reduce the self-reported physical aggression for some male juvenile delinquents. The results have implications for providing low-cost and high-efficiency intervention for juvenile delinquents' self-reported aggression behavior.
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Affiliation(s)
- 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, China
| | - 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, China
| | - Xianglian Yu
- 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, China
- Department of Education, Jianghan University, 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, 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, China
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Wei H, Liu M. Dramaturgical perspective mediates the association between parenting by lying in childhood and adolescent depression and the protective role of parent-child attachment. CHILD ABUSE & NEGLECT 2021; 114:104985. [PMID: 33582404 DOI: 10.1016/j.chiabu.2021.104985] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 01/25/2021] [Accepted: 01/28/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Recent findings reveal that individuals who experience parenting by lying in childhood may exhibit depression through adulthood. Questions remain regarding the cognitive mechanism underlying this association and whether depression manifests as early as adolescence. OBJECTIVE Our current study used a survey to test the associations among parenting by lying in childhood, adolescent depression, dramaturgical perspective, and parent-child attachment. PARTICIPANTS AND SETTING Adolescents (n = 964, Mage = 13.62, SDage = 1.04) were recruited from five secondary schools in a city in central China. A total of 446 (46.3 %) boys and 518 (53.7 %) girls participated in the survey. METHODS We used questionnaires to measure parenting by lying, dramaturgical perspective, parent-child attachment and depression. RESULTS A bias-corrected bootstrapping mediation test indicated that the process by which parenting by lying predicted depression through a dramaturgical perspective was significant,ab = .06, SE = .01, 95 % CI = [.027, .089]. Moderation analysis indicated that the interaction between parenting by lying and parent-child attachment was associated with depression (B = - .05, p < .05). CONCLUSIONS Parenting by lying in childhood was found to be positively associated with adolescent depression. The association was mediated by the child's use of a dramaturgical perspective and moderated by parent-child attachment. This study highlights an intriguing but under-researched parenting practice and extends our understanding of its association with adolescent depression. In practice, strengthening parent-child attachment can weaken the association between parenting by lying and depression.
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Affiliation(s)
- Hua Wei
- School of Educational Science, Xinyang Normal University, Xinyang 464000, China.
| | - Meiting Liu
- School of Law and Sociology, Xinyang Normal University, Xinyang 464000, China.
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Shapero BG, Gibb BE, Archibald A, Wilens TE, Fava M, Hirshfeld-Becker DR. Risk Factors for Depression in Adolescents With ADHD: The Impact of Cognitive Biases and Stress. J Atten Disord 2021; 25:340-354. [PMID: 30198368 DOI: 10.1177/1087054718797447] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: Youth diagnosed with ADHD are at heightened risk of depression. However, many do not develop depression. Individuals with specific cognitive biases are more likely to develop depression yet it remains untested whether these vulnerability-stress models apply to depression risk in youth with ADHD. Method: We examined whether interpretation and attention biases moderated the relation between stressful life events and depressive symptoms in a sample of adolescents (Mage = 14.42) with ADHD (n = 59) and without ADHD (n = 36). Results: Youth with ADHD experienced more stressful life events compared with those without ADHD. Interpretation biases moderated the association between stress and depressive symptoms in youth with and without ADHD. Attention biases moderated the association between stress and depressive symptoms in the non-ADHD youth only. Conclusion: These results enhance our understanding of vulnerability for depression in adolescence with ADHD and inform targeted prevention and treatment models during this critical developmental juncture.
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Affiliation(s)
- Benjamin G Shapero
- Massachusetts General Hospital, Boston, USA.,Harvard Medical School, Boston, MA, USA
| | | | | | - Timothy E Wilens
- Massachusetts General Hospital, Boston, USA.,Harvard Medical School, Boston, MA, USA
| | - Maurizio Fava
- Massachusetts General Hospital, Boston, USA.,Harvard Medical School, Boston, MA, USA
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15
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Sfärlea A, Buhl C, Loechner J, Neumüller J, Asperud Thomsen L, Starman K, Salemink E, Schulte-Körne G, Platt B. "I Am a Total…Loser" - The Role of Interpretation Biases in Youth Depression. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2020; 48:1337-1350. [PMID: 32654075 PMCID: PMC7445197 DOI: 10.1007/s10802-020-00670-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Negative interpretation biases have been found to characterize adults with depression and to be involved in the development and maintenance of the disorder. However, less is known about their role in youth depression. The present study investigated i) whether negative interpretation biases characterize children and adolescents with depression and ii) to what extent these biases are more pronounced in currently depressed youth compared to youth at risk for depression (as some negative interpretation biases have been found already in high-risk youth before disorder onset). After a negative mood induction interpretation biases were assessed with two experimental tasks: Ambiguous Scenarios Task (AST) and Scrambled Sentences Task (SST) in three groups of 9-14-year-olds: children and adolescents with a diagnosis of major depression (n = 32), children and adolescents with a high risk for depression (children of depressed parents; n = 48), as well as low-risk children and adolescents (n = 42). Depressed youth exhibited substantially more negative interpretation biases than both high-risk and low-risk groups (as assessed with both tasks), while the high-risk group showed more negative interpretation biases than the low-risk group only as assessed via the SST. The results indicate that the negative interpretation biases that are to some extent already present in high-risk populations before disorder onset are strongly amplified in currently depressed youth. The different findings for the two tasks suggest that more implicit interpretation biases (assessed with the SST) might represent cognitive vulnerabilities for depression whereas more explicit interpretation biases (assessed with the AST) may arise as a consequence of depressive symptomatology.
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Affiliation(s)
- Anca Sfärlea
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, LMU Munich, Nußbaumstr. 5a, 80336 Munich, Germany
| | - Christina Buhl
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, LMU Munich, Nußbaumstr. 5a, 80336 Munich, Germany
| | - Johanna Loechner
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, LMU Munich, Nußbaumstr. 5a, 80336 Munich, Germany
- Department of Clinical Psychology and Psychotherapy, LMU Munich, Munich, Germany
| | - Jakob Neumüller
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, LMU Munich, Nußbaumstr. 5a, 80336 Munich, Germany
| | - Laura Asperud Thomsen
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, LMU Munich, Nußbaumstr. 5a, 80336 Munich, Germany
| | - Kornelija Starman
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, LMU Munich, Nußbaumstr. 5a, 80336 Munich, Germany
| | - Elske Salemink
- Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands
| | - Gerd Schulte-Körne
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, LMU Munich, Nußbaumstr. 5a, 80336 Munich, Germany
| | - Belinda Platt
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, LMU Munich, Nußbaumstr. 5a, 80336 Munich, Germany
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16
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MacDonald EM, Koerner N, Antony MM, Vickers K, Mastorakos T, Kuo J. Investigating the therapeutic potential of cognitive bias modification for high anxiety sensitivity. J Behav Ther Exp Psychiatry 2020; 68:101521. [PMID: 31734573 DOI: 10.1016/j.jbtep.2019.101521] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 10/03/2019] [Accepted: 10/10/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND OBJECTIVES Individuals with high anxiety sensitivity (AS) display negative interpretive biases in response to uncomfortable but nondangerous physical sensations. Research suggests that modifying interpretation biases associated with AS leads to changes in AS. The present study sought to replicate and extend this research by addressing limitations of previous studies, increasing the amount of training and adding a follow-up period. METHOD Participants high in AS were randomly assigned to four sessions of computerized interpretation bias modification (CBM-I) training or four sessions of computerized "sham" training (control condition) over a 2-week period. The outcomes were AS, interpretive biases, and reactions to induced physical sensations. Assessments occurred at baseline, during training, immediately after the final training session, and 2 weeks after the final training; number of re-assessments varied by outcome. RESULTS The CBM-I condition did not outperform the control condition. At the end of the training period, the CBM-I condition displayed limited reductions in AS and interpretation biases. There were no changes in reactions to induced physical sensations. Similar results were found in the control condition for all outcomes. LIMITATIONS The control task and the dose of training may have obscured potential effects of CBM-I. CONCLUSIONS When considered within the context of previous research, the experimental effects and therapeutic potential of CBM-I for high AS appear to be minimal. However, methodological questions need to be resolved before such a conclusion can be considered definitive.
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Affiliation(s)
- Emma M MacDonald
- Department of Psychology, Ryerson University, 350 Victoria Street, Toronto, ON, M5B 2K3, Canada
| | - Naomi Koerner
- Department of Psychology, Ryerson University, 350 Victoria Street, Toronto, ON, M5B 2K3, Canada.
| | - Martin M Antony
- Department of Psychology, Ryerson University, 350 Victoria Street, Toronto, ON, M5B 2K3, Canada
| | - Kristin Vickers
- Department of Psychology, Ryerson University, 350 Victoria Street, Toronto, ON, M5B 2K3, Canada
| | - Tessie Mastorakos
- Department of Psychology, Ryerson University, 350 Victoria Street, Toronto, ON, M5B 2K3, Canada
| | - Janice Kuo
- Department of Psychology, Ryerson University, 350 Victoria Street, Toronto, ON, M5B 2K3, Canada
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Schmidt NB, Vereenooghe L. Inclusiveness of cognitive bias modification research toward children and young people with neurodevelopmental disorders: A systematic review. INTERNATIONAL JOURNAL OF DEVELOPMENTAL DISABILITIES 2020; 68:86-101. [PMID: 35309701 PMCID: PMC8928859 DOI: 10.1080/20473869.2020.1720156] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 01/17/2020] [Accepted: 01/18/2020] [Indexed: 06/14/2023]
Abstract
Cognitive bias modification (CBM) is increasingly used to target cognitive biases related to internalising or externalising problems, which are common in neurodevelopmental disorders (NDD). This systematic review assesses the available evidence for using CBM in children and young people with NDD, in particular regarding ambiguous interpersonal information, and the extent of their exclusion from this type of intervention research. PsycINFO, PsycARTICLES, MEDLINE, Cochrane Central Register of Controlled Trials and Science Citation Index were consulted using MeSH terms and synonyms of "neurodevelopmental disorders", "mental health problems", "cognitive bias", "modification" and "review". Data extraction focused on the efficacy of CBM for NDD, how CBM was delivered, whether studies adopted exclusion criteria relating to NDD and the rationale for such criteria. The search identified 2270 records, of which twenty-nine studies assessed CBM for interpretations and were included in the qualitative synthesis. Three studies targeted bias in NDD, whereas a third of studies explicitly excluded participants based on NDD-related criteria: most frequently intellectual impairment, reading or learning difficulties and autism spectrum disorder (ASD). Only one study provided a rationale for excluding NDD which related to the reading demands of their intervention. There is tentative evidence for the feasibility of using CBM to reduce interpretation bias in children and young people with mild intellectual disability, ASD or attention-deficit/hyperactivity disorder (ADHD). We recommend that CBM research should consider including participants with NDD, use CBM tasks and adaptations that enable this group's inclusion, or provide a sufficient rationale for their exclusion.
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Affiliation(s)
- Nora B. Schmidt
- Faculty of Psychology and Sports Science, Bielefeld University, Bielefeld, Germany
| | - Leen Vereenooghe
- Faculty of Psychology and Sports Science, Bielefeld University, Bielefeld, Germany
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Abstract
Abstract
Purpose of Review
Adolescent depression is a major public health concern associated with severe outcomes. A lack of efficacious interventions has triggered an increase in cognitive neuropsychology research to identify relevant treatment targets for new interventions. This review summarises key neurocognitive findings in adolescent depression and explores the potential of neurocognitive markers as treatment targets in new interventions.
Recent Findings
Studies support difficulties in the voluntary deployment of attention towards and away from emotional stimuli, negative interpretation biases and overgeneralised autobiographical memories in adolescent depression; however, little evidence is given to a general decline in executive function. There is consistent evidence for abnormalities in several distributed neural networks in adolescent depression, including dysfunction in and between the amygdala, medial prefrontal cortex and ventral striatum.
Summary
The relationships between different cognitive biases and abnormalities in specific neural networks remain unclear. Several new experimental interventions targeting these neurocognitive markers await evaluation.
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19
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Smith HL, McDermott KA, Carlton CN, Cougle JR. Predictors of Symptom Outcome in Interpretation Bias Modification for Dysphoria. Behav Ther 2019; 50:646-658. [PMID: 31030880 DOI: 10.1016/j.beth.2018.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 10/01/2018] [Accepted: 10/02/2018] [Indexed: 11/19/2022]
Abstract
Interpretation Bias Modification (IBM) interventions have been effective in reducing negative interpretation biases theorized to underlie depressive psychopathology. Although these programs have been highlighted as potential short-term interventions for depression, mixed evidence has been found for their effects on depressive symptoms. There is a need to examine attitudes towards training as well as individual difference factors that may impact symptom outcomes for IBM depression interventions. Seventy-two dysphoric young adults were randomly assigned to receive either an IBM targeting negative interpretation bias in personal evaluations or interpersonal situations or a healthy video control (HVC) condition. Compared to those who received HVC, participants in the IBM condition reported lower negative interpretation bias at posttreatment. No differences between conditions were found for symptom outcomes. Greater perceived treatment credibility and expectancy were associated with better treatment outcomes for both the IBM and HVC groups. Within the IBM group, a greater tendency toward assimilation with treatment scenarios was significantly associated with better treatment outcomes for both depressive and anger symptoms. This effect was unique from treatment credibility and expectancy. Pretreatment psychological reactance did not predict treatment response for either condition. Implications and future research directions are discussed.
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20
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LeMoult J, Colich N, Joormann J, Singh MK, Eggleston C, Gotlib IH. Interpretation Bias Training in Depressed Adolescents: Near- and Far-Transfer Effects. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2019; 46:159-167. [PMID: 28299526 DOI: 10.1007/s10802-017-0285-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Depressed adolescents are characterized by negative interpretation biases. Although investigators have used cognitive bias modification for interpretation (CBM-I) to experimentally manipulate interpretation biases in depressed adults, the near- and far-transfer effects are not well understood in adolescents diagnosed with Major Depressive Disorder (MDD). In this study, we extend previous research by investigating the near- and far-transfer effects of 6 sessions of Positive versus Neutral CBM-I on independent measures of interpretation bias (near-transfer effects) and on attention biases and clinical symptoms (far-transfer effects) in a sample of adolescents with MDD (n = 46). At post-training, adolescents who received Positive CBM-I interpreted ambiguous scenarios more positively than did participants who received Neutral CBM-I, providing evidence of training effectiveness. There was no evidence, however, of near- or far-transfer effects. These findings raise concerns about the malleability of interpretation biases in adolescent depression and suggest that further work is needed to establish the clinical utility of CBM-I for adolescents with MDD.
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Affiliation(s)
- Joelle LeMoult
- University of British Columbia, 2136 West Mall, Vancouver, BC, V6T 1Z4, Canada.
| | - Natalie Colich
- Stanford University, Bldg. 420, Jordan Hall, Stanford, CA, 94305, USA
| | - Jutta Joormann
- Yale University, Box 208205, New Haven, CT, 06520-8205, USA
| | - Manpreet K Singh
- Stanford University, Bldg. 420, Jordan Hall, Stanford, CA, 94305, USA
| | - Caitlin Eggleston
- University of California, Berkeley, Room 3210, Tolman Hall #1650, Berkeley, CA, 94720-1650, USA
| | - Ian H Gotlib
- Stanford University, Bldg. 420, Jordan Hall, Stanford, CA, 94305, USA
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21
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Smith EM, Reynolds S, Orchard F, Whalley HC, Chan SW. Cognitive biases predict symptoms of depression, anxiety and wellbeing above and beyond neuroticism in adolescence. J Affect Disord 2018; 241:446-453. [PMID: 30145516 DOI: 10.1016/j.jad.2018.08.051] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 07/23/2018] [Accepted: 08/12/2018] [Indexed: 01/23/2023]
Abstract
BACKGROUND Adolescence represents a period of vulnerability to affective disorders. Neuroticism is considered a heritable risk factor for depression, but is not directly amenable to intervention. Therefore, it is important to identify the contributions of modifiable risk factors. Negative cognitive biases are implicated in the onset and maintenance of affective disorders in adults, and may represent modifiable risk factors in adolescence. AIM(S) This study sought to assess to what extent cognitive biases are able to predict depression, anxiety and wellbeing beyond that of neuroticism in adolescents. METHODS Adolescents (N = 99), recruited from Scottish secondary schools (54.5% female; mean age = 14.7), ensured a sample representing the breadth of the mental health spectrum. In line with prevalence estimates, 18% of this sample demonstrated clinical levels of depression symptoms. Cognitive biases of autobiographical memory, self-referential memory, ambiguous scenarios interpretation, facial expression recognition, rumination and dysfunctional attitudes were assessed. Depression, anxiety, and wellbeing were indexed using the Mood and Feelings Questionnaire, Spence Children's Anxiety Scale and the BBC Subjective Wellbeing Scale. RESULTS Regression analyses demonstrated neuroticism to significantly predict depression, anxiety and wellbeing. The addition of cognitive biases resulted in a significant increase of explained variance with final models explaining just over 50% of variances of depression, anxiety and wellbeing. CONCLUSION These findings demonstrate that cognitive biases explain mental health symptoms over and above that of neuroticism. Depressive symptomology was particularly related to self-referential memory bias, while anxiety was predicted by interpretive bias. The key clinical implication is that targeting specific biases based on diagnostic features may be of particular benefit in alleviating distress and promoting wellbeing.
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Affiliation(s)
- Eilidh M Smith
- Department of Clinical Psychology, University of Edinburgh, Doorway 6 Medical Quad, Teviot Place, Edinburgh EH8 9AG, United Kingdom.
| | | | | | - Heather C Whalley
- Department of Clinical Psychology, University of Edinburgh, Doorway 6 Medical Quad, Teviot Place, Edinburgh EH8 9AG, United Kingdom
| | - Stella Wy Chan
- Department of Clinical Psychology, University of Edinburgh, Doorway 6 Medical Quad, Teviot Place, Edinburgh EH8 9AG, United Kingdom.
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22
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Vrijsen JN, Fischer VS, Müller BW, Scherbaum N, Becker ES, Rinck M, Tendolkar I. Cognitive bias modification as an add-on treatment in clinical depression: Results from a placebo-controlled, single-blinded randomized control trial. J Affect Disord 2018; 238:342-350. [PMID: 29908472 DOI: 10.1016/j.jad.2018.06.025] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 05/29/2018] [Accepted: 06/04/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND Only 60% of depressed patients respond sufficiently to treatment, so there is a dire need for novel approaches to improve treatment effects. Cognitive Bias Modification (CBM) may be an effective and easily implemented computerized add-on to treatment-as-usual. Therefore, we investigated the effects of a positivity-attention training and a positivity-approach training compared to control trainings. METHODS In a blinded randomized-controlled design, 139 depressed inpatients received either the CBM Attention Dot-Probe Training (DPT) or the CBM Approach-Avoidance Training (AAT), next to treatment as usual. N = 121 finished all four training sessions. Both trainings had an active and a control condition. In both active conditions, patients were trained to preferentially process generally positive pictures over neutral pictures. Depressive symptom severity was assessed before and after CBM, and positivity bias was measured at the start and end of each session. RESULTS Clinician-rated depressive symptom severity decreased more in patients who received the active condition of the DPT or the AAT compared to patients in the control conditions. Significant change in positivity bias was found for the DPT (not the AAT), but did not mediate the effect of the training on depressive symptoms. CONCLUSIONS The results suggest that both types of CBM (i.e., DPT and AAT) may provide a fitting add-on treatment option for clinical depression. The working mechanisms and optimal dose of CBM trainings, plus their possible combination, should be examined in more detail.
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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; Pro Persona Mental Health Care, Depression Expertise Center, Nijmegen, The Netherlands.
| | - Verena S Fischer
- LVR-Hospital Essen, Department for Psychiatry and Psychotherapy, Faculty of Medicine, University of Duisburg-Essen, Germany
| | - Bernhard W Müller
- LVR-Hospital Essen, Department for Psychiatry and Psychotherapy, Faculty of Medicine, University of Duisburg-Essen, Germany; Department of Psychology, University of Wuppertal, Germany
| | - Norbert Scherbaum
- LVR-Hospital Essen, Department for Psychiatry and Psychotherapy, Faculty of Medicine, University of Duisburg-Essen, Germany
| | - Eni S Becker
- Behavioural Science Institute, Radboud University Nijmegen, The Netherlands
| | - Mike Rinck
- Behavioural Science Institute, Radboud University Nijmegen, The Netherlands
| | - Indira Tendolkar
- Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands; LVR-Hospital Essen, Department for Psychiatry and Psychotherapy, Faculty of Medicine, University of Duisburg-Essen, Germany
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de Voogd L, Wiers RW, de Jong PJ, Zwitser RJ, Salemink E. A randomized controlled trial of multi-session online interpretation bias modification training: Short- and long-term effects on anxiety and depression in unselected adolescents. PLoS One 2018; 13:e0194274. [PMID: 29543838 PMCID: PMC5854362 DOI: 10.1371/journal.pone.0194274] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 02/28/2018] [Indexed: 11/30/2022] Open
Abstract
Introduction Negatively biased interpretations play an important role in anxiety and depression, which are highly prevalent in adolescence, and changing such biases might thus reduce or prevent emotional disorders. We investigated the short- and long-term effects of an online interpretation bias modification training in unselected adolescents to explore its potential in preventing anxiety and depression. Methods Participants (N = 173) were randomly allocated to eight online sessions of interpretation or placebo training. Interpretation bias was assessed pre- and post-training. Primary outcomes of anxiety and depression, and secondary measures of emotional resilience were assessed pre- and post-training and at three, six, and twelve months follow-up. Results Compared to placebo, interpretation training marginally increased positive interpretations. Irrespective of training condition, symptoms of anxiety and depression showed a decline post-training and at follow-up, and indices of resilience showed an increase. Change in interpretation bias, baseline interpretation bias, stressful life events, or number of training sessions completed did not moderate the effects on anxiety or depression. Conclusions Results suggest that interpretation training as implemented in this study has no added value in reducing symptoms or enhancing resilience in unselected adolescents.
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Affiliation(s)
- Leone de Voogd
- Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
- * E-mail:
| | - Reinout W. Wiers
- Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Peter J. de Jong
- Department of Clinical Psychology, University of Groningen, Groningen, The Netherlands
| | - Robert J. Zwitser
- Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Elske Salemink
- Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
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Abstract
Interpretation Bias Modification (IBM) is gaining attention in the literature as an intervention that alters cognitive biases and reduces associated symptoms. Forty, primarily college-aged, non-treatment-seeking adults with major depressive disorder (MDD) were randomly assigned to receive either IBM targeting hostile interpretation bias (IBM-H) or a healthy video control (HVC) condition. Compared to those in HVC, participants in IBM-H reported more benign interpretations and fewer hostile interpretations at posttreatment. No difference in depressive interpretation bias was found between groups at posttreatment. IBM-H led to improved anger control at posttreatment and follow-up compared to HVC, though no effects of condition were found on trait anger or depressive symptoms. The IBM-H group perceived their treatment as less credible than the HVC group. For individuals with high expectancy of treatment success, IBM-H led to lower posttreatment depressive symptoms compared to HVC, while findings trended in the opposite direction for those with low expectancy of success. Overall, these preliminary findings point to boundary conditions for the efficacy of IBM protocols for anger and depression and potential improvements to be made to future IBM protocols.
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25
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Cougle JR, Summers BJ, Allan NP, Dillon KH, Smith HL, Okey SA, Harvey AM. Hostile interpretation training for individuals with alcohol use disorder and elevated trait anger: A controlled trial of a web-based intervention. Behav Res Ther 2017; 99:57-66. [PMID: 28941810 DOI: 10.1016/j.brat.2017.09.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 09/09/2017] [Accepted: 09/15/2017] [Indexed: 10/18/2022]
Abstract
High trait anger is associated with more severe alcohol use problems, and alcohol has been found to facilitate aggressive behavior among individuals with high trait anger. Treatments focused on a sample with alcohol use disorder with elevated anger could reduce alcohol use problems, as well as violence and aggression. We sought to examine the efficacy of interpretation bias modification for hostility (IBM-H) in a sample with high trait anger and alcohol use disorder (AUD). Fifty-eight individuals with AUD and elevated trait anger were randomly assigned to eight web-based sessions (two per week) of IBM-H or a healthy video control condition (HVC). Measures of interpretation bias, anger, and alcohol use were administered at pre- and post-treatment and at one-month follow-up. IBM-H led to greater improvements in interpretation bias compared to HVC at post and follow-up. IBM-H also led to greater reductions in trait anger than HVC, though this was an indirect effect mediated by changes in interpretation bias. Further, IBM-H led to lower anger expression than HVC; this was a direct (non-mediated) effect. Lastly, both conditions reported decreases in alcohol use and consequences following treatment, though there were no significant differences between them. These findings provide initial support for the utility of IBM-H as a brief non-confrontational intervention for AUD with elevated trait anger. Limitations and future research directions are discussed.
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Affiliation(s)
- Jesse R Cougle
- Department of Psychology, Florida State University, United States.
| | - Berta J Summers
- Department of Psychology, Florida State University, United States
| | | | - Kirsten H Dillon
- Department of Psychiatry and Behavioral Sciences, Duke University, United States
| | - Hillary L Smith
- Department of Psychology, Florida State University, United States
| | - Sarah A Okey
- Department of Psychology, Florida State University, United States
| | - Ashleigh M Harvey
- Department of Psychology, University of Wisconsin-Milwaukee, United States
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Dalili MN, Schofield-Toloza L, Munafò MR, Penton-Voak IS. Emotion recognition training using composite faces generalises across identities but not all emotions. Cogn Emot 2017; 31:858-867. [PMID: 27071005 PMCID: PMC5448393 DOI: 10.1080/02699931.2016.1169999] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 02/05/2016] [Accepted: 03/19/2016] [Indexed: 10/28/2022]
Abstract
Many cognitive bias modification (CBM) tasks use facial expressions of emotion as stimuli. Some tasks use unique facial stimuli, while others use composite stimuli, given evidence that emotion is encoded prototypically. However, CBM using composite stimuli may be identity- or emotion-specific, and may not generalise to other stimuli. We investigated the generalisability of effects using composite faces in two experiments. Healthy adults in each study were randomised to one of four training conditions: two stimulus-congruent conditions, where same faces were used during all phases of the task, and two stimulus-incongruent conditions, where faces of the opposite sex (Experiment 1) or faces depicting another emotion (Experiment 2) were used after the modification phase. Our results suggested that training effects generalised across identities. However, our results indicated only partial generalisation across emotions. These findings suggest effects obtained using composite stimuli may extend beyond the stimuli used in the task but remain emotion-specific.
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Affiliation(s)
- Michael N. Dalili
- MRC Integrative Epidemiology Unit (IEU), University of Bristol, Bristol, UK
- School of Experimental Psychology, University of Bristol, Bristol, UK
| | | | - Marcus R. Munafò
- MRC Integrative Epidemiology Unit (IEU), University of Bristol, Bristol, UK
- School of Experimental Psychology, University of Bristol, Bristol, UK
- UK Centre for Tobacco Control Studies, University of Bristol, Bristol, UK
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Imagine the bright side of life: A randomized controlled trial of two types of interpretation bias modification procedure targeting adolescent anxiety and depression. PLoS One 2017; 12:e0181147. [PMID: 28715495 PMCID: PMC5513454 DOI: 10.1371/journal.pone.0181147] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 06/23/2017] [Indexed: 11/20/2022] Open
Abstract
Introduction Anxiety and depression are highly prevalent during adolescence and characterized by negative interpretation biases. Cognitive bias modification of interpretations (CBM-I) may reduce such biases and improve emotional functioning. However, as findings have been mixed and the traditional scenario training is experienced as relatively boring, a picture-based type of training might be more engaging and effective. Methods The current study investigated short- and long-term effects (up to 6 months) and users’ experience of two types of CBM-I procedure in adolescents with heightened symptoms of anxiety or depression (N = 119, aged 12–18 year). Participants were randomized to eight online sessions of text-based scenario training, picture-word imagery training, or neutral control training. Results No significant group differences were observed on primary or secondary emotional outcomes. A decrease in anxiety and depressive symptoms, and improvements in emotional resilience were observed, irrespective of condition. Scenario training marginally reduced negative interpretation bias on a closely matched assessment task, while no such effects were found on a different task, nor for the picture-word or control group. Subjective evaluations of all training paradigms were relatively negative and the imagery component appeared particularly difficult for adolescents with higher symptom levels. Conclusions The current results question the preventive efficacy and feasibility of both CBM-I procedures as implemented here in adolescents.
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Klein AM, de Voogd L, Wiers RW, Salemink E. Biases in attention and interpretation in adolescents with varying levels of anxiety and depression. Cogn Emot 2017; 32:1478-1486. [PMID: 28366048 DOI: 10.1080/02699931.2017.1304359] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This is the first study to investigate multiple cognitive biases in adolescence simultaneously, to examine whether anxiety and depression are associated with biases in attention and interpretation, and whether these biases are able to predict unique variance in self-reported levels of anxiety and depression. A total of 681 adolescents performed a Dot Probe Task (DPT), an Emotional Visual Search Task (EVST), and an Interpretation Recognition Task. Attention and interpretation biases were significantly correlated with anxiety. Mixed results were reported with regard to depression: evidence was found for an interpretation bias, and for an attention bias as measured with the EVST but not with the DPT. Furthermore, interpretation and attention biases predicted unique variance in anxiety and depression scores. These results indicate that attention and interpretation biases are unique processes in anxiety and depression. They also suggest that anxiety and depression are partly based on similar underlying cognitive mechanisms.
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Affiliation(s)
- Anke M Klein
- a Developmental Psychology , University of Amsterdam , Amsterdam , The Netherlands
| | - Leone de Voogd
- a Developmental Psychology , University of Amsterdam , Amsterdam , The Netherlands
| | - Reinout W Wiers
- a Developmental Psychology , University of Amsterdam , Amsterdam , The Netherlands
| | - Elske Salemink
- a Developmental Psychology , University of Amsterdam , Amsterdam , The Netherlands
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Orchard F, Apetroaia A, Clarke K, Creswell C. Cognitive bias modification of interpretation in children with social anxiety disorder. J Anxiety Disord 2017; 45:1-8. [PMID: 27866085 PMCID: PMC5240849 DOI: 10.1016/j.janxdis.2016.10.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2015] [Revised: 08/17/2016] [Accepted: 10/28/2016] [Indexed: 11/25/2022]
Abstract
Negative (or a lack of positive) interpretation of ambiguous social situations has been hypothesised to maintain social anxiety disorder in children, yet there is currently limited evidence to support this. Cognitive Bias Modification of Interpretation (CBM-I) provides a means to explore the causal influence of interpretation bias on social anxiety disorder, and has been associated with a reduction in social anxiety symptoms in adults. Seven to twelve year old children with a diagnosis of social anxiety disorder completed CBM-I training, adapted from materials designed for socially anxious children in the community, or no training. Effects on interpretation bias and social anxiety were assessed. The adapted CBM-I training was not associated with significant changes in benign or negative interpretation. Unsurprisingly given the lack of successful interpretation training, there were no significant changes in child or parent reported social anxiety symptoms, clinician-rated severity or diagnoses and change in interpretation was not significantly associated with change in social anxiety. These findings contrast with some studies with community populations although it is possible that more intensive CBM-I training is required to fully test this hypothesis among clinical groups.
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Affiliation(s)
- Faith Orchard
- School of Psychology and Clinical Language Sciences, University of Reading, Whiteknights Road, Reading, RG6 6AL, United Kingdom.
| | - Adela Apetroaia
- Newham College University Centre, London, E15 4HT, United Kingdom
| | - Kiri Clarke
- Division of Psychology and Language Sciences, University College London, London, WC1E 6BT, United Kingdom
| | - Cathy Creswell
- School of Psychology and Clinical Language Sciences, University of Reading, Whiteknights Road, Reading, RG6 6AL, United Kingdom
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Gold AK, Montana RE, Sylvia LG, Nierenberg AA, Deckersbach T. Cognitive Remediation and Bias Modification Strategies in Mood and Anxiety Disorders. Curr Behav Neurosci Rep 2016; 3:340-349. [PMID: 27917364 PMCID: PMC5127202 DOI: 10.1007/s40473-016-0090-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
PURPOSE OF REVIEW Cognitive impairments and biases, which are prevalent in patients with mood and anxiety disorders, can affect quality of life and functioning. Traditional treatments are only insufficiently addressing these impairments and biases. We review the cognitive impairments and biases present in these disorders as well as treatments targeting these domains. RECENT FINDINGS Interventions aimed at improving cognitive impairments and biases may help improve cognitive deficits and overall functioning in patients with mood and anxiety disorders. Direct comparisons of treatments for cognitive impairments or biases versus more traditional psychosocial interventions have produced diverse results. SUMMARY Overall, treatments for cognitive impairments and cognitive biases warrant additional study in clinical trials. Future research should explore cognitive remediation and cognitive bias modification adjunctive to psychosocial treatments to optimize patient outcomes in mood and anxiety disorders.
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Affiliation(s)
- Alexandra K. Gold
- Department of Psychiatry, Massachusetts General Hospital, 50 Staniford Street, Suite 580 Boston, MA 02114
| | - Rebecca E. Montana
- Department of Psychiatry, Massachusetts General Hospital, 50 Staniford Street, Suite 580 Boston, MA 02114
| | - Louisa G. Sylvia
- Department of Psychiatry, Massachusetts General Hospital, 50 Staniford Street, Suite 580 Boston, MA 02114
- Harvard Medical School, 25 Shattuck Street, Boston, MA 02115
| | - Andrew A. Nierenberg
- Department of Psychiatry, Massachusetts General Hospital, 50 Staniford Street, Suite 580 Boston, MA 02114
- Harvard Medical School, 25 Shattuck Street, Boston, MA 02115
| | - Thilo Deckersbach
- Department of Psychiatry, Massachusetts General Hospital, 50 Staniford Street, Suite 580 Boston, MA 02114
- Harvard Medical School, 25 Shattuck Street, Boston, MA 02115
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Magnitude of negative interpretation bias depends on severity of depression. Behav Res Ther 2016; 83:26-34. [DOI: 10.1016/j.brat.2016.05.007] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 04/06/2016] [Accepted: 05/25/2016] [Indexed: 11/21/2022]
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Platt B, Waters AM, Schulte-Koerne G, Engelmann L, Salemink E. A review of cognitive biases in youth depression: attention, interpretation and memory. Cogn Emot 2016; 31:462-483. [PMID: 26785312 DOI: 10.1080/02699931.2015.1127215] [Citation(s) in RCA: 98] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Depression is one of the most common mental health problems in childhood and adolescence. Although data consistently show it is associated with self-reported negative cognitive styles, less is known about the mechanisms underlying this relationship. Cognitive biases in attention, interpretation and memory represent plausible mechanisms and are known to characterise adult depression. We provide the first structured review of studies investigating the nature and causal role of cognitive biases in youth depression. Key questions are (i) do cognitive biases characterise youth depression? (ii) are cognitive biases a vulnerability factor for youth depression? and (iii) do cognitive biases play a causal role in youth depression? We find consistent evidence for positive associations between attention and interpretation biases and youth depression. Stronger biases in youth with an elevated risk of depression support cognitive-vulnerability models. Preliminary evidence from cognitive bias modification paradigms supports a causal role of attention and interpretation biases in youth depression but these paradigms require testing in clinical samples before they can be considered treatment tools. Studies of memory biases in youth samples have produced mixed findings and none have investigated the causal role of memory bias. We identify numerous areas for future research in this emerging field.
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Affiliation(s)
- Belinda Platt
- a Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy , Ludwig-Maximilian University of Munich , Nussbaumstrasse 5a, Munich , Germany
| | - Allison M Waters
- b School of Applied Psychology , Griffith University , 176 Messines Ridge Road, Mt Gravatt, QLD , Australia
| | - Gerd Schulte-Koerne
- a Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy , Ludwig-Maximilian University of Munich , Nussbaumstrasse 5a, Munich , Germany
| | - Lina Engelmann
- a Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy , Ludwig-Maximilian University of Munich , Nussbaumstrasse 5a, Munich , Germany
| | - Elske Salemink
- c Department of Developmental Psychology , University of Amsterdam , Weesperplein 4, Amsterdam , Netherlands
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Training less threatening interpretations over the Internet: Does the number of missing letters matter? J Behav Ther Exp Psychiatry 2015; 49:53-60. [PMID: 25579609 PMCID: PMC4486638 DOI: 10.1016/j.jbtep.2014.12.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 12/16/2014] [Accepted: 12/21/2014] [Indexed: 11/21/2022]
Abstract
BACKGROUND AND OBJECTIVES Cognitive Bias Modification to reduce threat interpretations (CBM-I) trains individuals to resolve ambiguous scenarios via completion of word fragments that assign benign meanings to scenarios. The current study tested: 1) whether Internet-based CBM-I can shift interpretations to be more positive/less negative, and 2) whether varying the number of letters missing in the word fragments (assumed to increase task difficulty) moderates CBM-I's effects. METHODS Participants (N = 350) completed a brief online version of CBM-I, followed by assessments of interpretation bias, fear of negative evaluation, and anticipatory anxiety. Participants were randomly assigned to 1 of 5 conditions: control (half of scenarios ended positively, half negatively), or 4 positive conditions (all scenarios ended positively, but word fragments varied on number of letters missing, from 0 to 3). RESULTS Relative to the control condition, all positive conditions led to more positive/less negative interpretations. When analyses were re-run with only a highly socially anxious subset of the sample (n = 100), conditions in which the final word of scenarios was missing 0, 1, or 2 letters led to more positive/less negative interpretations compared to the control condition, but the condition missing 3 letters did not differ from the control condition. There were no differences between conditions on other outcome measures. LIMITATIONS Training was brief, and an unselected sample was used. CONCLUSIONS Results suggest a brief Internet-based CBM-I paradigm can shift interpretation bias, but not necessarily other anxiety-relevant outcomes. Making the task too difficult may blunt effects for highly socially anxious individuals.
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Möbius M, Tendolkar I, Lohner V, Baltussen M, Becker ES. Refilling the half-empty glass--Investigating the potential role of the Interpretation Modification Paradigm for Depression (IMP-D). J Behav Ther Exp Psychiatry 2015; 49:37-43. [PMID: 25832771 DOI: 10.1016/j.jbtep.2015.03.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Revised: 01/26/2015] [Accepted: 03/02/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND OBJECTIVES Cognitive biases are known to cause and maintain depression. However, little research has been done on techniques targeting interpretation tendencies found in depression, despite the promising findings of anxiety studies. This paper presents two experiments, investigating the suitability of an Interpretation Modification Paradigm for Depression (IMP-D) in healthy individuals, which has already proven its effectiveness in anxiety (Beard & Amir, 2008). Different from other paradigms, the IMP-D aims at modifying an interpretation bias on response- and on a more implicit reaction time-level, making this task less susceptible to demand effects. METHODS The Word-Sentence Association Paradigm for Depression (Hindash & Amir, 2011) was modified and administered in healthy volunteers (experiment I: N = 81; experiment II: N = 105). To enhance a positive interpretation bias, endorsing benign and rejecting negative interpretations of ambiguous scenarios was reinforced through feedback. This intervention was compared to the opposite training (both experiments) and a control training (experiment II only). RESULTS Both experiments revealed a significant increase in bias towards benign interpretations on the level of overt decisions, while only in the first experiment a change was found on a reaction time level. These modifications are not reflected in group-differences in emotional vulnerability. LIMITATIONS Possible limitations regarding the reliability of inter-dependent response and reaction time measures are discussed. CONCLUSIONS The IMP-D is able to modify interpretation biases, but adaptations are required to maximize its beneficial effects.
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Affiliation(s)
- Martin Möbius
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands.
| | - Indira Tendolkar
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands; Radboud University Medical Centre, Department of Psychiatry, Nijmegen, The Netherlands; University Hospital Essen, Department of Psychiatry and Psychotherapy, Essen, Germany
| | - Valerie Lohner
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
| | - Mirte Baltussen
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
| | - Eni S Becker
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
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Chan SWY, Lau JYF, Reynolds SA. Is cognitive bias modification training truly beneficial for adolescents? J Child Psychol Psychiatry 2015; 56:1239-48. [PMID: 25471444 DOI: 10.1111/jcpp.12368] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/21/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Cognitive Bias Modification (CBM) has been shown to change interpretation biases commonly associated with anxiety and depression and may help ameliorate symptoms of these disorders. However, its evidence base for adolescents is scarce. Previous results have been hard to interpret because of methodological issues. In particular, many studies have used negative bias training as the control condition. This would tend to inflate any apparent benefits of CBM compared to a neutral control. Most studies also only examined the effects of a single training session and lacked follow-up assessment or ecologically valid outcome measures. METHOD Seventy-four adolescents, aged 16-18 years, were randomised to two sessions of CBM training or neutral control. Interpretation bias and mood were assessed three times: at baseline, immediately post-training and 1 week post-training. A controlled experimental stressor was also used, and responses to everyday stressors were recorded for 1 week after training to assess responses to psychological challenges. Feedback for the training programme was collected. RESULTS The CBM group reported a greater reduction in negative affect than control participants. However, other hypothesised advantages of CBM were not demonstrated. Regardless of training group, participants reported increased positive interpretations, decreased negative interpretations, reduced depressive symptoms and no change in trait anxiety. The two groups did not differ in their stress reactivity. After controlling for group differences in training performance, all the mood effects disappeared. CONCLUSIONS When tested under stringent experimental conditions the effects of CBM in healthy adolescents appear to be minimal. Future studies should concentrate on participants with elevated cognitive biases and/or mood symptoms who may be more sensitive to CBM.
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Affiliation(s)
- Stella W Y Chan
- Section of Clinical Psychology, University of Edinburgh, Edinburgh, UK.,University of East Anglia, Norwich, UK
| | - Jennifer Y F Lau
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Shirley A Reynolds
- University of East Anglia, Norwich, UK.,School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
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Cristea IA, Mogoașe C, David D, Cuijpers P. Practitioner Review: Cognitive bias modification for mental health problems in children and adolescents: a meta-analysis. J Child Psychol Psychiatry 2015; 56:723-734. [PMID: 25640876 DOI: 10.1111/jcpp.12383] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/24/2014] [Indexed: 12/21/2022]
Abstract
BACKGROUND Despite accumulating research and bold claims about the efficacy of cognitive bias modification (CBM) for young populations, no meta-analysis has attempted to synthesize the research literature so far. We examined whether there was empirical evidence for the clinical efficacy of CBM interventions in youths, while also considering the methodological quality of this evidence. METHODS Studies were identified through systematic searches in bibliographical databases (PubMed, PsychInfo, Cochrane Library and EMBASE to June 2014). We included randomized controlled trials of CBM interventions, and considered both clinical outcomes and targeted biases. We examined the quality of the trials, as well as potential publication bias and possible moderators. RESULTS We identified 23 trials that reported on four types of outcomes: mental health, anxiety, depression and bias. Effect sizes were small and nonsignificant for all symptom outcomes considered. We found a moderate significant effect size for bias outcomes (Hedges' g of 0.53), with significant heterogeneity. There were no differences between types of CBM interventions, or between one versus multiple-session applications. A small but significant effect size for mental health problems arose when the intervention was delivered in schools. The quality of almost all of the included studies was suboptimal and the vast majority did not include information needed for allowing quality assessment. CONCLUSIONS We conducted the first meta-analysis of CBM interventions for children and adolescents and found no effects for mental health outcomes, but we did find moderate and significant effects on the targeted biases. Our results cast serious doubts on CBM interventions having any clinical utility for nonadult populations. Demand characteristics might play an important part in CBM research.
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Affiliation(s)
- Ioana A Cristea
- Department of Clinical Psychology and Psychotherapy, Babeş-Bolyai University, Cluj-Napoca, Romania.,Clinical Psychology Branch, Department of Surgical, Medical, Molecular and Critical Pathology, University of Pisa, Pisa, Italy
| | - Cristina Mogoașe
- Department of Clinical Psychology and Psychotherapy, Babeş-Bolyai University, Cluj-Napoca, Romania
| | - Daniel David
- Department of Clinical Psychology and Psychotherapy, Babeş-Bolyai University, Cluj-Napoca, Romania.,Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Pim Cuijpers
- Department of Clinical Psychology, VU University, Amsterdam, The Netherlands.,EMGO Institute for Health and Care Research, VU University and VU University Medical Centre, Amsterdam, The Netherlands
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Cox WM, Klinger E, Fadardi JS. The motivational basis of cognitive determinants of addictive behaviors. Addict Behav 2015; 44:16-22. [PMID: 25499579 DOI: 10.1016/j.addbeh.2014.11.019] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Revised: 11/12/2014] [Accepted: 11/13/2014] [Indexed: 10/24/2022]
Abstract
If a person expects that (a) drinking alcohol or using another addictive substance will enhance positive affect or reduce negative affect, and (b) there is a strong likelihood that these desirable consequences will occur if the substance is used, that person is likely to form a goal of using the substance. The theoretical framework presented here predicts that when that happens, the person will have a current concern for using the substance, with the person thereby sensitized to environmental stimuli related to procuring and using the substance. One indication of the sensitization is selective attention to substance-related stimuli, which is correlated with urges to use and actual use of the substance. Accordingly, interventions have been developed for helping substance users to overcome substance-related attentional bias. The results are promising for reducing both the attentional bias and the substance use. Finally, we discuss other cognitive-modification and motivational techniques that have been evaluated with promising results.
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Computerised therapies for anxiety and depression in children and young people: A systematic review and meta-analysis. Behav Res Ther 2015; 67:1-18. [DOI: 10.1016/j.brat.2015.01.009] [Citation(s) in RCA: 190] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 01/06/2015] [Accepted: 01/25/2015] [Indexed: 01/23/2023]
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Dai B, Li J, Chen T, Li Q. Interpretive bias of ambiguous facial expressions in older adults with depressive symptoms. Psych J 2015; 4:28-37. [DOI: 10.1002/pchj.85] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 12/06/2014] [Indexed: 01/21/2023]
Affiliation(s)
- Bibing Dai
- Center on Aging Psychology, Key Laboratory of Mental Health; Institute of Psychology, Chinese Academy of Sciences; Beijing China
- Institute of Psychology; Tianjin Medical University; Tianjin China
- Department of Radiology; Tianjin Medical University General Hospital; Tianjin China
| | - Juan Li
- Center on Aging Psychology, Key Laboratory of Mental Health; Institute of Psychology, Chinese Academy of Sciences; Beijing China
| | - Tingji Chen
- Center on Aging Psychology, Key Laboratory of Mental Health; Institute of Psychology, Chinese Academy of Sciences; Beijing China
| | - Qi Li
- Key Laboratory of Behavioral Science; Institute of Psychology, Chinese Academy of Sciences; Beijing China
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Blackwell SE, Browning M, Mathews A, Pictet A, Welch J, Davies J, Watson P, Geddes JR, Holmes EA. Positive Imagery-Based Cognitive Bias Modification as a Web-Based Treatment Tool for Depressed Adults: A Randomized Controlled Trial. Clin Psychol Sci 2015; 3:91-111. [PMID: 25984421 PMCID: PMC4359210 DOI: 10.1177/2167702614560746] [Citation(s) in RCA: 125] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 07/25/2014] [Indexed: 12/21/2022]
Abstract
Depression is a global health problem requiring treatment innovation. Targeting neglected cognitive aspects may provide a useful route. We tested a cognitive-training paradigm using positive mental imagery (imagery cognitive bias modification, imagery CBM), developed via experimental psychopathology studies, in a randomized controlled trial. Training was delivered via the Internet to 150 individuals with current major depression. Unexpectedly, there was no significant advantage for imagery CBM compared with a closely matched control for depression symptoms as a whole in the full sample. In exploratory analyses, compared with the control, imagery CBM significantly improved anhedonia over the intervention and improved depression symptoms as a whole for those participants with fewer than five episodes of depression and those who engaged to a threshold level of imagery. Results suggest avenues for improving imagery CBM to inform low-intensity treatment tools for depression. Anhedonia may be a useful treatment target for future work.
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Affiliation(s)
| | | | - Andrew Mathews
- Department of Psychology, University of California, Davis ; Institute of Psychiatry, King's College London
| | - Arnaud Pictet
- Department of Psychiatry, University of Oxford ; Department of Psychology, University of Geneva
| | - James Welch
- Department of Computer Science, University of Oxford
| | - Jim Davies
- Department of Computer Science, University of Oxford
| | - Peter Watson
- Medical Research Council Cognition and Brain Sciences Unit
| | | | - Emily A Holmes
- Medical Research Council Cognition and Brain Sciences Unit ; Department of Psychiatry, University of Oxford
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Joormann J, Waugh CE, Gotlib IH. Cognitive Bias Modification for Interpretation in Major Depression: Effects on Memory and Stress Reactivity. Clin Psychol Sci 2015; 3:126-139. [PMID: 25593790 DOI: 10.1177/2167702614560748] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Interpreting ambiguous stimuli in a negative manner is a core bias associated with depression. Investigators have used cognitive bias modification for interpretation (CBM-I) to demonstrate that it is possible to experimentally induce and modify these biases. This study extends previous research by examining whether CBM-I affects not only interpretation, but also memory and physiological stress response in individuals diagnosed with Major Depressive Disorder (MDD). We found that CBM-I was effective in inducing an interpretive bias. Participants also exhibited memory biases that corresponded to their training condition and demonstrated differential physiological responding in a stress task. These results suggest that interpretation biases in depression can be modified, and that this training can lead to corresponding changes in memory and to decreases in stress reactivity. Findings from this study highlight the importance of examining the relations among different cognitive biases in MDD and the possibility of modifying cognitive biases.
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Fu X, Du Y, Au S, Lau JYF. Single-Session Cognitive Bias Modification of Interpretations Training in High-Anxious Adolescents. J Cogn Psychother 2015; 29:253-272. [PMID: 32755951 DOI: 10.1891/0889-8391.29.3.253] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Anxiety disorders in youths are globally prevalent and carry impairing, long-lasting effects. Interpreting ambiguous cues negatively may be causally related to adolescent anxiety. Extending cognitive bias modification of interpretations (CBM-I) training, which counters anxiety by encouraging positive interpretations, to anxious adolescents could inform the design of new interventions. The study investigates whether single-session CBM-I training (a) altered interpretation biases and negative mood in adolescents selected for high anxiety and (b) whether these training-associated changes were larger than those reported in low-anxious adolescents. Seventy-seven Chinese adolescents received either positive or control training. Positive training encouraged endorsement of positive interpretations of ambiguous scenarios while on control training trials, half of the scenarios were resolved positively and half negatively. A single session of CBM-I altered interpretation biases across all individuals, F(1, 52) = 10.63, p < .01, η2 = .17. However, no training effects on mood measures emerged (all ps > .05). Training effects were not consistently moderated by baseline trait anxiety. Multisession CBM-I may be needed for mood changes to occur.
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Woud ML, Becker ES. Editorial for the Special Issue on Cognitive Bias Modification Techniques: An Introduction to a Time Traveller’s Tale. COGNITIVE THERAPY AND RESEARCH 2014. [DOI: 10.1007/s10608-014-9605-0] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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