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Rooney T, Sharpe L, Todd J, Michalski SC, Van Ryckeghem D, Crombez G, Colagiuri B. Beyond the modified dot-probe task: A meta-analysis of the efficacy of alternate attention bias modification tasks across domains. Clin Psychol Rev 2024; 110:102436. [PMID: 38696911 DOI: 10.1016/j.cpr.2024.102436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 02/25/2024] [Accepted: 04/25/2024] [Indexed: 05/04/2024]
Abstract
Attention biases towards disease-relevant cues have been implicated in numerous disorders and health conditions, such as anxiety, cancer, drug-use disorders, and chronic pain. Attention bias modification (ABM) has shown that changing attention biases can change related emotional processes. ABM most commonly uses a modified dot-probe task, which has received increasing criticism regarding its reliability and inconsistent findings. The purpose of the present review was thus to systematically review and meta-analyse alternative tasks used in ABM research. We sought to examine whether alternative tasks significantly changed attention biases and emotional outcomes, and critically examined whether relevant sample, task and intervention characteristics moderated each of these effect sizes. Seventy-four (completer n = 15,294) study level comparisons were included in the meta-analysis. Overall, alternative ABM designs had a medium effect on changing biases (g = 0.488), and a small, but significant effect on improving clinical outcomes (g = 0.117). We found this effect to be significantly larger for studies which successfully changed biases compared to those that did not. Across all tasks, it appeared that targeting engagement biases results in the largest change to attention biases. Importantly, we found tasks incorporating gaze-contingency - encouraging engagement with non-biased stimuli - show the most promise for improving emotional outcomes.
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Affiliation(s)
- Tessa Rooney
- School of Psychology, Faculty of Science, The University of Sydney, Australia.
| | - Louise Sharpe
- School of Psychology, Faculty of Science, The University of Sydney, Australia
| | - Jemma Todd
- School of Psychology, Faculty of Science, The University of Sydney, Australia
| | - Stefan Carlo Michalski
- Department of Developmental Disability Neuropsychiatry, Faculty of Medicine and Health, The University of New South Wales, Australia
| | - Dimitri Van Ryckeghem
- Department of Experimental-Clinical and Health Psychology, Ghent University, Belgium; Department of Clinical Psychological Science, Maastricht University, Maastricht, Netherlands; Department of Behavioural and Cognitive Sciences, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Geert Crombez
- Department of Experimental-Clinical and Health Psychology, Ghent University, Belgium
| | - Ben Colagiuri
- School of Psychology, Faculty of Science, The University of Sydney, Australia
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Baek S, Ha S, Lee JH. Application of attentional bias modification to reduce attentional bias and emotional reactivity to stress in mildly depressed individuals. Front Psychol 2023; 14:1273512. [PMID: 37965674 PMCID: PMC10641893 DOI: 10.3389/fpsyg.2023.1273512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 09/25/2023] [Indexed: 11/16/2023] Open
Abstract
This study aims to verify the effectiveness of attentional bias modification (ABM) in reducing attentional bias related to depression, particularly in the later stages of attention as a pattern of difficulty in disengagement from depression-relevant stimuli, and to assess its effects on emotional reactivity to stress. A total of 78 participants were separated into four groups based on their levels of depression (minimal and mild) and the types of ABM. The positive ABM (pABM) trained participants to disengage their attention from depression-relevant stimuli and directed their attention toward more positive stimuli, whereas the neutral ABM (nABM) was designed to have no effect. The participants underwent a free-viewing task by eye tracker both before and after ABM to observe changes in attentional bias. Subsequently, they reported their emotional response after a stress-inducing task. The group of mildly depressed participants receiving pABM showed significantly less attention to depression-relevant negative affective stimuli and reported significantly decreased negative emotional reactivity to stress compared to the other groups. pABM had an effect on decreasing difficulty in disengaging from depression-relevant negative affective words (DW). However, it did not increase the dwell time on positive affective words (PW) in the current study. This might be due to the short duration of the application of ABM. The current study conducted ABM twice in 1 day, and this might not be enough to increase the dwell time on PA. This study verified that the ABM effectively decreased the attentional bias of depression and its relevant symptom, emotional reactivity to stress.
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Affiliation(s)
- Soojung Baek
- Department of Educational Affairs, Anyang Juvenile Detention Center, Anyang, Republic of Korea
| | - SoSeo Ha
- Department of Psychology, Chung-Ang University, Seoul, Republic of Korea
| | - Jang-Han Lee
- Department of Psychology, Chung-Ang University, Seoul, Republic of Korea
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Rapee RM, Creswell C, Kendall PC, Pine DS, Waters AM. Anxiety disorders in children and adolescents: A summary and overview of the literature. Behav Res Ther 2023; 168:104376. [PMID: 37499294 DOI: 10.1016/j.brat.2023.104376] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 07/10/2023] [Accepted: 07/17/2023] [Indexed: 07/29/2023]
Abstract
Considerable work has advanced understanding of the nature, causes, management, and prevention of anxiety disorders in children and adolescents over the past 30 years. Prior to this time the primary focus was on school refusal and specific phobias. It is now recognised that children and adolescents experience the full gamut of anxiety disorders in very similar ways to adults and that anxiety disorders in the paediatric years can predict a lifelong mental-health struggle. Given the vast array of specific studies in this field, the current review summarises current knowledge about these high prevalence disorders, points to overarching limitations, and suggests potentially important future directions. Following a brief historical overview, the review summarises knowledge about demographic and epidemiological characteristics, distal and proximal risk factors, current treatment directions, and prevention. There is still a great deal to learn about the causes and treatments of child and adolescent anxiety disorders. By amalgamating our current knowledge, this review provides a window to the research directions that are likely to lead to future advances.
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Affiliation(s)
- Ronald M Rapee
- Centre for Emotional Health, School of Psychological Sciences, Macquarie University, Sydney, Australia.
| | - Cathy Creswell
- Departments of Psychiatry and Experimental Psychology, University of Oxford, Oxford, UK
| | - Philip C Kendall
- Department of Psychology, Temple University, Child and Adolescent Anxiety Disorders Clinic, USA
| | - Daniel S Pine
- National Institute of Mental Health Intramural Research Program (NIMH-IRP), USA
| | - Allison M Waters
- School of Applied Psychology, Griffith University, Brisbane, Australia
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Pettit JW, Rey Y, Marin CE, Bechor M, Lebowitz ER, Vasey MW, Jaccard J, Abend R, Pine DS, Bar-Haim Y, Silverman WK. Attention Training as a Low-Intensity Treatment for Concerning Anxiety in Clinic-Referred Youth. Behav Ther 2023; 54:77-90. [PMID: 36608979 PMCID: PMC9825787 DOI: 10.1016/j.beth.2022.07.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 06/27/2022] [Accepted: 07/10/2022] [Indexed: 01/11/2023]
Abstract
Although youth anxiety treatment research has focused largely on severe and impairing anxiety levels, even milder anxiety levels, including levels that do not meet full criteria for a diagnosis, can be impairing and cause for concern. There is a need to develop and test viable treatments for these concerning anxiety levels to improve functioning and reduce distress. We present findings from a randomized controlled efficacy trial of attention bias modification treatment (ABMT) and attention control training (ACT) for youths with concerning anxiety levels. Fifty-three clinic-referred youths (29 boys, M age = 9.3 years, SD age = 2.6) were randomized to either ABMT or ACT. ABMT and ACT consisted of attention-training trials in a dot-probe task presenting angry and neutral faces; probes appeared in the location of neutral faces in 100% of ABMT trials and 50% of ACT trials. Independent evaluators provided youth anxiety severity ratings; youths and parents provided youth anxiety severity and global impairment ratings; and youths completed measures of attention bias to threat and attention control at pretreatment, posttreatment, and 2-month follow-up. In both arms, anxiety severity and global impairment were significantly reduced at posttreatment and follow-up. At follow-up, anxiety severity and global impairment were significantly lower in ACT compared with ABMT. Attention control, but not attention bias to threat, was significantly improved at follow-up in both arms. Changes in attention control and attention focusing were significantly associated with changes in anxiety severity. Findings support the viability of attention training as a low-intensity treatment for youths with concerning anxiety levels, including levels that do not meet full criteria for a diagnosis. Superior anxiety reduction effects in ACT highlight the critical need for mechanistic research on attention training in this population.
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Affiliation(s)
| | | | - Carla E Marin
- Yale Child Study Center, Yale University School of Medicine
| | | | - Eli R Lebowitz
- Yale Child Study Center, Yale University School of Medicine
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The Feasibility, Acceptability, and Efficacy of Positive Search Training for Irritable Youth: A Single-Case Experimental Design. BEHAVIOUR CHANGE 2022. [DOI: 10.1017/bec.2022.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Although irritability is common in youth, research on treatment is in its infancy. Threat biases are more pronounced in irritable compared to low irritable youth, similar to evidence found in anxious youth. Therefore, interventions targeting these biases may be promising for reducing irritability. This study utilised a multiple baseline case series design to determine the feasibility, acceptability, and efficacy of positive search training (PST) for irritable children. Three children were included who met criteria for a principal diagnosis of Disruptive Mood Dysregulation Disorder (DMDD), and a secondary diagnosis of Attention Deficit Hyperactivity Disorder (ADHD) or Major Depressive Disorder (MDD). PST was feasible with two of the three participants; one child refused to continue after one session. For the two participants who completed PST, acceptability was stable with moderate-to-high ratings of engagement and enjoyment, and high and stable treatment-relevant verbalisations of the key strategies. Both cases showed declines in DMDD severity across treatment and no longer met criteria at post-treatment. Both participants met criteria for Oppositional Defiant Disorder (ODD) at post-treatment (considered less severe for irritability than DMDD). Declines in parent-reported irritability occurred for both cases, however some returns to baseline were observed. Overall, PST for irritable youth shows promise as an acceptable and feasible intervention. Further studies are needed combining PST with strategies for secondary diagnoses, given its high comorbidity with disruptive behaviour disorders.
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Yu T, Xu J, Jiang Y, Hua H, Zhou Y, Guo X. School educational models and child mental health among K-12 students: a scoping review. Child Adolesc Psychiatry Ment Health 2022; 16:32. [PMID: 35477408 PMCID: PMC9047301 DOI: 10.1186/s13034-022-00469-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 04/11/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The promotion of mental health among children and adolescents is a public health imperative worldwide, and schools have been proposed as the primary and targeted settings for mental health promotion for students in grades K-12. This review sought to provide a comprehensive understanding of key factors involved in models of school education contributing to student mental health development, interrelationships among these factors and the cross-cultural differences across nations and societies. METHODS This scoping review followed the framework of Arksey and O'Malley and holistically reviewed the current evidence on the potential impacts of school-related factors or school-based interventions on student mental health in recent 5 years based on the PubMed, Web of Science, Embase and PsycExtra databases. RESULTS/FINDINGS After screening 558 full-texts, this review contained a total of 197 original articles on school education and student mental health. Based on the five key factors (including curriculum, homework and tests, physical activities, interpersonal relationships and after-school activities) identified in student mental development according to thematic analyses, a multi-component school educational model integrating academic, social and physical factors was proposed so as to conceptualize the five school-based dimensions for K-12 students to promote student mental health development. CONCLUSIONS The lessons learned from previous studies indicate that developing multi-component school strategies to promote student mental health remains a major challenge. This review may help establish appropriate school educational models and call for a greater emphasis on advancement of student mental health in the K-12 school context among different nations or societies.
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Affiliation(s)
- Ting Yu
- The International Peace Maternity & Child Health Hospital, Shanghai Key Laboratory of Embryo Original Diseases, Shanghai Jiao Tong University School of Medicine, No. 910 Hengshan Road, Shanghai, 200030, China
| | - Jian Xu
- The International Peace Maternity & Child Health Hospital, Shanghai Key Laboratory of Embryo Original Diseases, Shanghai Jiao Tong University School of Medicine, No. 910 Hengshan Road, Shanghai, 200030, China.
| | - Yining Jiang
- The International Peace Maternity & Child Health Hospital, Shanghai Key Laboratory of Embryo Original Diseases, Shanghai Jiao Tong University School of Medicine, No. 910 Hengshan Road, Shanghai, 200030, China
| | - Hui Hua
- The International Peace Maternity & Child Health Hospital, Shanghai Key Laboratory of Embryo Original Diseases, Shanghai Jiao Tong University School of Medicine, No. 910 Hengshan Road, Shanghai, 200030, China
| | - Yulai Zhou
- The International Peace Maternity & Child Health Hospital, Shanghai Key Laboratory of Embryo Original Diseases, Shanghai Jiao Tong University School of Medicine, No. 910 Hengshan Road, Shanghai, 200030, China
| | - Xiangrong Guo
- The International Peace Maternity & Child Health Hospital, Shanghai Key Laboratory of Embryo Original Diseases, Shanghai Jiao Tong University School of Medicine, No. 910 Hengshan Road, Shanghai, 200030, China
- MOE-Shanghai Key Laboratory of Children's Environmental Health, Department of Child and Adolescent Healthcare, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China
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Masters M, Zimmer-Gembeck MJ, Farrell LJ, Modecki KL. Coping and emotion regulation in response to social stress tasks among young adolescents with and without social anxiety. APPLIED DEVELOPMENTAL SCIENCE 2021. [DOI: 10.1080/10888691.2021.1990060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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School-based depression and anxiety prevention programs: An updated systematic review and meta-analysis. Clin Psychol Rev 2021; 89:102079. [PMID: 34571372 DOI: 10.1016/j.cpr.2021.102079] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 07/27/2021] [Accepted: 08/24/2021] [Indexed: 11/22/2022]
Abstract
Depression and anxiety are often first experienced during childhood and adolescence, and interest in the prevention of these disorders is growing. The focus of this review was to assess the effectiveness of psychological prevention programs delivered in schools, and to provide an update to our previous review from five years ago (Werner-Seidler, Perry, Calear, Newby, & Christensen, 2017). Three electronic databases were systematically searched for published articles of randomised controlled trials (RCTs) evaluating the efficacy of school-based prevention programs until October 2020. There were 130 articles that met inclusion criteria, representing 118 unique trials and 45,924 participants. Small between-group effect sizes for depression (g = 0.21) and anxiety (g = 0.18) were detected immediately post-intervention. Subgroup analyses suggested that targeted prevention programs (for young people with risk factors or symptoms) were associated with significantly greater effect sizes relative to universal programs for depression, which was confirmed by meta-regression. There was also some evidence that external providers conferred some benefit over school-staff delivered programs. Overall, study quality was moderate and no association between risk of bias and effect size was detected. School-delivered psychological prevention programs have small effects in reducing symptoms of depression and anxiety. Refinement of these programs, and knowledge about how they can be sustainably delivered in schools beyond the trial period is now needed for population-level preventive effects. Systematic Review Registration Number: PROPSERO - CRD42020188323.
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Nicolaidou I, Stavrou E, Leonidou G. Building Primary-School Children's Resilience through a Web-Based Interactive Learning Environment: Quasi-Experimental Pre-Post Study. JMIR Pediatr Parent 2021; 4:e27958. [PMID: 34106080 PMCID: PMC8191731 DOI: 10.2196/27958] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 04/10/2021] [Accepted: 04/22/2021] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Resilience is a person's mental ability to deal with challenging situations adaptively and is a crucial stress management skill. Psychological resilience and finding ways to cope in crises is a highly relevant topic considering the COVID-19 pandemic, which enforced quarantine, social distancing measures, and school closures worldwide. Parents and children are currently living with increased stress due to COVID-19. We need to respond with immediate ways to strengthen children's resilience. Internet-based cognitive behavioral therapy interventions for children's stress management overcome accessibility issues such as the inability to visit mental health experts owing to COVID-19 movement restrictions. An interactive learning environment was created, based on the preventive program "Friends," to overcome accessibility issues associated with delivering cognitive behavioral therapy-based interventions in formal and informal education settings. OBJECTIVE This study aimed to examine the effectiveness of a web-based learning environment on resilience in (1) reducing anxiety symptoms and (2) increasing emotion recognition and recognition of stress management techniques among 9-10-year-old children. We also aimed to evaluate the learning environment's usability. METHODS A quasi-experimental pretest-posttest control group design was used. In total, 20 fourth graders in the experimental group interacted with the learning environment over 6 weekly 80-minute sessions. Further, 21 fourth graders constituted the control group. The main data sources were (1) a psychometric tool to measure children's anxiety symptoms, namely the Greek translation of the original Spence Children's Anxiety Scale, (2) 3 open-ended questions assessing emotion recognition and recognition of stress management techniques, and (3) the System Usability Scale to measure the usability of the learning environment. RESULTS In both groups, there was a small but nonsignificant postintervention reduction in reported anxiety symptoms, except for obsessive-compulsive disorder symptoms in the experimental group. A paired samples t test revealed that students' reported symptom scores of obsessive-compulsive disorder significantly decreased from 1.06 (SD 0.68) to 0.76 (SD 0.61) (t19= 5.16; P=.01). The experimental group revealed a significant increase in emotion recognition (t19=-6.99; P<.001), identification of somatic symptoms of stress (t19=-7.31; P<.001), and identification of stress management techniques (t19=-6.85; P<.001). The learning environment received a satisfactory usability score. The raw average system usability score was 76.75 (SD 8.28), which is in the 80th percentile rank and corresponds to grade B. CONCLUSIONS This study shows that interactive learning environments might deliver resilience interventions in an accessible and cost-effective manner in formal education, potentially even in distance-learning conditions owing to the COVID-19 pandemic. Interactive learning environments on resilience are also valuable tools for parents who can use them with their children at home, for informal learning, using mobile devices. As such, they could be a promising first-step, low-intensity intervention that children and the youth can easily access.
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Affiliation(s)
- Iolie Nicolaidou
- Department of Communication and Internet Studies, Cyprus University of Technology, Limassol, Cyprus
| | - Evi Stavrou
- Department of Communication and Internet Studies, Cyprus University of Technology, Limassol, Cyprus
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Abstract
Depression is both prevalent and costly, and many individuals do not adequately respond to existing psychopharmacological and behavioral interventions. The current article describes the use of neuroscience in augmenting behavioral interventions for depression in two primary areas: anhedonia and cognitive deficits/biases. Neuroscience research has increased our understanding of the neural bases of reward processing and regulation of positive affect, and anhedonia among depressed samples can be related to deficits in each of these domains. Treatments that specifically target reward processing and regulation of positive affect in order to reduce anhedonia represent a recent advance in the field. Depression is also associated with aberrant processes relating to working memory, autobiographical memory, attentional bias, and interpretive bias. Neuroscience findings have increasingly been leveraged to augment the efficacy of cognitive-training and bias-modification interventions in these domains. The use of neuroscience to inform the development and augmentation of behavioral interventions for depression is a promising avenue of continued research.
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