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Rogers J, Sicouri G. A Single-Session Online Cognitive Bias Modification of Interpretations Modified for Adults With Anxiety and Depressive Symptoms. Behav Ther 2022; 53:967-980. [PMID: 35987552 DOI: 10.1016/j.beth.2022.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 03/14/2022] [Accepted: 04/03/2022] [Indexed: 11/29/2022]
Abstract
Anxiety and depression are common, co-occurring, and costly mental health disorders. Cognitive bias modification aims to modify biases to reduce associated symptoms. Few studies have targeted multiple biases associated with both anxiety and depression, and those that have lacked a control condition. This study piloted a single-session online cognitive bias modification (known as CBM-IA) designed to target two biases associated with anxiety and depression-interpretation bias and attribution style-in adults with varying levels of anxiety and depressive symptoms. Participants (18-26 years) with at least mild levels of anxiety/stress and depressive symptoms on the DASS-21 were randomly allocated to an intervention (n = 23) or a control (n = 22) condition. The training consisted of a single-session online CBM-IA to encourage positive interpretations and a positive attribution style. Interpretation bias, attribution style, anxious and depressive mood states, and anxiety, stress and depressive symptoms improved at posttraining and at follow-up, irrespective of condition. Changes in interpretation bias from pre- to posttraining were significantly associated with changes in anxious mood state. CBM-IA, as implemented in this single-session pilot study, did not significantly reduce targeted biases and symptoms compared to a control condition. This adds to the mixed evidence on the efficacy of single-session CBM-I for altering biases and symptoms.
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Affiliation(s)
| | - Gemma Sicouri
- Black Dog Institute, University of New South Wales; Macquarie University.
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Kavallari D, Lau JYF. Testing a Combined Cognitive Bias Hypothesis of Pain and Pain-related Worry in Young People. THE JOURNAL OF PAIN 2022; 23:1082-1091. [PMID: 35131447 DOI: 10.1016/j.jpain.2022.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 01/19/2022] [Accepted: 01/19/2022] [Indexed: 06/14/2023]
Abstract
Cognitive factors are thought to contribute and maintain pain experiences in young people. However, most of these factors have been assessed in isolation. Considering more than 1 cognitive factor could increase explanatory power and identify multiple targets for intervention. Here, we tested a Combined Cognitive Bias Hypothesis (CCBH) that suggests information-processing factors associate with each other and exert either additive and/or interactive influences on pain outcomes. We conducted secondary analysis of data from 243 adolescents aged 16 to 19 years, who had completed a task measuring pain-related attention control impairments (emotion-priming visual search task) and a task measuring biased interpretations towards threatening cues (Adolescent Interpretation of Bodily Threat task). These young people also completed measures of recent pain experiences and pain catastrophizing, which served as primary and secondary outcomes, respectively. Regression analyses revealed that difficulties with attention control (following presentation of pain-related stimuli) and tendencies to endorse threatening interpretations of ambiguous situations had significant additive effects on both pain outcomes. However, correlations between these factors were non-significant. They also did not interact to influence pain outcomes. These findings require replication in broader age ranges and clinical samples but potentially suggest that, measuring multiple cognitive factors increases explanatory power of youth pain outcomes. PERSPECTIVE: Weak attention control following exposure to pain cues and tendencies to endorse threat interpretations, uniquely and additively associate with self-reported pain experiences and pain catastrophizing in community youth. Measuring several cognitive factors simultaneously could improve our ability to explain pain outcomes in adolescent populations.
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Affiliation(s)
- Despoina Kavallari
- Psychology Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Jennifer Y F Lau
- Psychology Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Youth Resilience Unit, Institute of Population Health Sciences, Queen Mary University of London, London, UK.
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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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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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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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Krebs G, Pile V, Grant S, Degli Esposti M, Montgomery P, Lau JYF. Research Review: Cognitive bias modification of interpretations in youth and its effect on anxiety: a meta-analysis. J Child Psychol Psychiatry 2018; 59:831-844. [PMID: 29052837 DOI: 10.1111/jcpp.12809] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/03/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Emerging evidence suggests that cognitive bias modification of interpretations (CBM-I) is effective in altering interpretation biases and reducing anxiety in adults. Less is known about the impact of CBM-I in young people, but some recent findings, including a meta-analysis of combined cognitive bias modification of interpretation and attention techniques, have cast doubt on its clinical utility. Given the current debate, this meta-analysis sought to establish the independent effects of CBM-I on interpretations biases and anxiety in youth. METHODS Studies were identified through a systematic literature search of PsycINFO, Ovid MEDLINE, PsycARTICLES, Web of Science and EMBASE between January 1992 and March 2017. Eligible studies aimed to target interpretation biases; did not combine CBM-I with another intervention; included a control condition; randomly allocated participants to conditions; assessed interpretation bias and/or anxiety as an outcome; included individuals up to age 18; and did not present previously reported data. Reference lists of included articles were checked for further eligible studies, and authors were contacted for unpublished data. RESULTS We identified 26 studies meeting eligibility criteria that included in the meta-analysis. CBM-I had moderate effects on negative and positive interpretations (g = -0.70 and g = -0.52, respectively) and a small but significant effect on anxiety assessed after training (g = -0.17) and after a stressor (g = -0.34). No significant moderators were identified. CONCLUSIONS In contrast to previous meta-analytic findings, our results indicate that CBM-I has potential but weak anxiolytic effects in youth. Our findings suggest that it may be premature to disregard the potential value of CBM-I research and further research in this field is warranted.
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Affiliation(s)
- Georgina Krebs
- OCD & Related Disorders Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK.,Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Victoria Pile
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Sean Grant
- Centre for Evidence-Based Intervention, University of Oxford, Oxford, UK.,RAND Corporation, Santa Monica, CA, USA
| | | | - Paul Montgomery
- Department of Social Policy and Social Work, University of Birmingham, Birmingham, UK
| | - Jennifer Y F Lau
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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Heathcote LC, Koopmans M, Eccleston C, Fox E, Jacobs K, Wilkinson N, Lau JY. Negative Interpretation Bias and the Experience of Pain in Adolescents. THE JOURNAL OF PAIN 2016; 17:972-81. [DOI: 10.1016/j.jpain.2016.05.009] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 04/23/2016] [Accepted: 05/26/2016] [Indexed: 01/19/2023]
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Lau JYF. Commentary: A glass half full or half empty? Cognitive bias modification for mental health problems in children and adolescents--reflections on the meta-analysis by Cristea et al. (2015). J Child Psychol Psychiatry 2015; 56:735-737. [PMID: 26058924 DOI: 10.1111/jcpp.12436] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/19/2015] [Indexed: 11/28/2022]
Abstract
The last decade has cognitive bias modification (CBM) training paradigms, emerging first as an experimental test of the causal role of information-processing biases on mood and anxiety symptoms, and then, as the clinical implications of these findings were realised, as a potential clinical 'vaccine' that could be used to modify biases and reduce symptoms. CBM is an umbrella term for methods designed to modify cognitive factors that maintain psychiatric conditions such as anxiety and depression through simple repetitive learning. Two biases that have most often been targeted by these training programs are the tendency to orient attention towards threat and distortions in the interpretation of ambiguous situations. This commentary reflects on an accompanying meta-analysis by Crsitea et al., which pooled effect sizes from over 20 statistical comparisons between a CBM group and a control group on post-training measures of mental health (mostly anxiety and depression). Cristea et al. reported that any CBM training-associated difference on measures of anxiety and depression were weak and non-significant (although training effects were generally evident on measures of cognitive biases). Heterogeneity across studies was high, but with exception to the setting in which CBM was delivered (home, school, laboratory or mental health facility), there was no persuasive evidence for significant moderation of training effects by other key variables. In their conclusions the authors suggested that CBM had little clinical utility and that it was unclear whether positive results in any individual study arose from experimenter or participant bias. So if the glass is half empty, what should the next stage of CBM research usefully focus on?
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Affiliation(s)
- Jennifer Y F Lau
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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