Using attentional bias modification as a cognitive vaccine against depression

Young Children of Mothers with a History of Depression Show Attention Bias to Sad Faces: An Eye-tracking Study

Maternal depression is a predictor of the emergence of depression in the offspring. Attention bias (AB) to negative emotional stimuli in children may serve as a risk factor for children of depressed parents. The present study aimed to examine the effect of maternal major depressive disorder (MDD) history on AB to emotional faces in children at age four, before the age of onset for full-blown psychiatric symptoms. The study also compared AB patterns between mothers and their offspring. Fifty-eight mothers and their four-year-old children participated in this study, of which 27 high-risk (HR) children had mothers with MDD during their children's lifetime. Attention to emotional faces was measured in both children and their mothers using an eye-tracking visual search task. HR children exhibited faster detection and longer dwell time toward the sad than happy target faces. The low-risk (LR) children also displayed a sad bias but to a lesser degree. Children across both groups showed AB towards angry target faces, likely reflecting a normative AB pattern. Our findings indicate that AB to sad faces may serve as an early marker of depression risk. However, we provided limited support for the mother-child association of AB. Future research is needed to examine the longitudinal intergenerational transmission of AB related to depression and possible mechanisms underlying the emergence of AB in offspring of depressed parents.

Attentional biases to signals of negative information: Reliable measurement across three anxiety domains

Cognitive models propose that individuals with elevated vulnerability to experiencing negative emotion are characterised by biased attentional responding to negative information. Typically, methods of examining these biases have measured attention to pictures of emotional scenes, emotional faces, or rewarding or feared objects. Though these approaches have repeatedly yielded evidence of anxiety-linked biases, their measurement reliability is suggested to be poor. Recent research has shown that attentional responding to cues signalling negative information can be measured with greater reliability. However, whether such biases are associated with emotion vulnerability remains to be demonstrated. The present study conducted three experiments that recruited participants who varied in trait and state anxiety (N = 134), social anxiety (N = 122), or spider fear (N = 131) to complete an assessment of selective attention to cues signalling emotionally congruent negative information. Analyses demonstrated that anxiety and fear were associated with biased attentional responding to cues signalling negative information, and that such biases could be measured with acceptable reliability (rsplit-half = .69-.81). Implications for research on the relation between emotion and attention are discussed.

Cognitive predictors of stress-induced mood malleability in depression

BACKGROUND & OBJECTIVES

Basic attentional control, negative biases in attention and interpretation, and rumination are all cognitive processes associated with depression; however, less is known about their predictive role in depressive mood reactivity and -recovery in response to stress, and their relation to severity of depression.

DESIGN & METHODS

We experimentally induced stress based on an autobiographical imagery script in a sample of 92 participants with Major Depressive Disorder with or without comorbid anxiety disorders. We used simple regression analysis for investigating the roles of state- and trait rumination, attentional networks, and attentional and interpretation biases for predicting stress-induced depressive mood reactivity and -recovery, respectively, and whether they in parallel mediated the association between cognitive processes and depression severity.

RESULTS

Stress-induced depressive mood reactivity was predicted by better orienting ability and more state rumination. Better recovery was predicted by better orienting efficiency and lower negative interpretation bias. Furthermore, the relation between state rumination and depression severity was partially mediated by depressive mood reactivity, however limited by the lack of temporal precedence in the analysis.

CONCLUSIONS

We characterized the relation between cognitive processes and mood malleability in response to stress. Findings could refine theoretical models of depression if causality is established.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT04137367.

Estradiol effects on an emotional interference task in adolescents with current and remitted depression

Attentional biases to emotional stimuli are thought to reflect vulnerability for mood disorder onset and maintenance. This study examined the association between the endogenous sex hormone estradiol and emotional attentional biases in adolescent females with either current or remitted depression. Three groups of participants (mean age ± SD) completed the Emotional Interrupt Task: 1) 20 adolescent females (15.1 ± 1.83 years) currently diagnosed with Major Depressive Disorder (MDD), 2) 16 adolescent females (16.4 ± 1.31 years) who had experienced at least one episode of MDD in their lifetime but currently met criteria for MDD in remission, and 3) 30 adolescent female (15.4 ± 1.83 years) healthy controls. Attentional interference (AI) scores were calculated as differences in target response reaction time between trials with emotional facial expressions versus neutral facial expressions. Estradiol levels were assayed by Salimetrics LLC using saliva samples collected within 30 min of waking on assessment days. Robust multiple regression with product terms evaluated estradiol's main effect on AI scores, as well as hypothesized estradiol × diagnostic group interactions. Although neither mean estradiol levels nor mean AI scores in the current-MDD and remitted-MDD groups differed from controls, the relationship between estradiol and overall AI score differed between control adolescents and the remitted-MDD group. Specifically, the remitted-MDD adolescents performed worse (i.e., showed greater attentional interference) when they had higher estradiol; no significant relationship existed in the current-MDD group. Because this finding was driven by angry and not happy stimuli, it appears higher estradiol levels were associated with greater susceptibility to the attention-capturing effects of negatively-valenced emotional content in girls at risk for MDD from prior history.

The long-term effects of ABM on symptom severity in patients with recurrent depression: A randomized sham-controlled trial

BACKGROUND

The present study reports on long-term outcomes of ABM over one year in self-reported and clinician-rated depression symptoms, anxiety symptoms, and relapse rates.

METHODS

We conducted a double-blind randomized sham-controlled trial in 301 participants with recurrent major depression disorder between January 2015 and October 2016 (#NCT02658682). Participants were allocated to ABM or sham condition twice daily for 14 consecutive days. Long-term effects of ABM were assessed by BDI-II, HDRS and BAI at one-, six-, and 12-months follow-up. Relapse rates at 12-months follow-up were also assessed.

RESULTS

There was no long-term effect of ABM (as compared to sham) on clinician-rated depression symptoms, on anxiety symptoms, nor in relapse rates. By 12 months follow-up, there was a small effect on self-reported depression favoring ABM over sham.

LIMITATIONS

The lack of an assessment-only condition hinders comparison to natural trajectories of depression symptoms.

CONCLUSIONS

The overall long-term effect of ABM was limited, and currently there is no convincing evidence for implementing this as a viable treatment option in clinical populations. We speculate if the sham condition should be replaced by another control condition when investigating the clinical utility of ABM.

Mindfulness training modifies attentional bias to facial emotion and emotional symptoms

BACKGROUND

Mindfulness training has been shown to improve emotional symptoms such as anxiety and depressive symptoms. However, its cognitive-behavioral mechanism is still unclear. The present study aimed to investigate the effect of mindfulness training on attention to emotional faces and its role in the improvement in emotional symptoms.

METHODS

Eighty participants were recruited and randomly divided into a training group (n = 40) that received eight weeks of mindfulness training and a control group (n = 40) that attended a mindfulness lecture. Before training (T1), immediately after training (T2), and three months after training (T3), all participants were asked to complete the Self-Rating Depression Scale (SDS) and the Self-Rating Anxiety Scale (SAS) to assess their emotional symptoms and a modified dot-probe task to measure their attention to emotional faces.

RESULTS

Mindfulness training significantly reduced anxiety and depressive symptoms at both T2 and T3. After training, the attentional bias toward happy faces increased, while the attentional bias toward sad faces decreased in the training group compared with the control group. Mediation analysis showed that the improvement in attentional bias toward sad faces partially mediated the effect of mindfulness training on depression at T2.

LIMITATIONS

Our participants were not a clinical sample (i.e., were not diagnosed with emotional disorders), and the time course of attention components was difficult to examine in the present study.

CONCLUSIONS

Mindfulness training can stably reduce anxious and depressive symptoms. However, it may have a temporary effect on attentional bias toward facial emotions, which plays a limited role in improving emotional symptoms.

Application of attentional bias modification to reduce attentional bias and emotional reactivity to stress in mildly depressed individuals

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.

The effect of attention bias modification on depressive symptoms in a comorbid sample: a randomized controlled trial

BACKGROUND

Studies investigating the long-term effect of attention bias modification (ABM) in clinical samples are lacking. This study investigates the 6-months follow-up effect of ABM on depressive symptoms in participant with major depressive disorder with and without comorbid disorders.

METHODS

We conducted a double-blind randomized sham-controlled trial in 101 participants between 19 November 2019, and 17 August 2021. Follow-up ended 3 April 2022. Participants were allocated to ABM or sham condition twice daily for 14 consecutive days. Primary outcomes were the total score on the Beck Depression Inventory-II (BDI-II) at 6 months, mean Brief State Rumination Inventory (BSRI) score post-treatment and reduction in BSRI post-treatment. Secondary outcome was change in attentional bias (AB). The trial was preregistered in ClinicalTrials.gov (#NCT04137367).

RESULTS

A total of 118 patients aged 18-65 years were assessed for eligibility, and 101 were randomized and subjected to intention-to-treat analyses. At 6 months, ABM had no effect on depression and anxiety compared to a sham condition. While rumination decreased during the intervention, there was no effect of condition on rumination and AB. Predictor analysis did not reveal differences between participants with ongoing major depressive episode or comorbid anxiety.

CONCLUSION

Compared to sham training, there was no effect of ABM on depressive symptoms at 6-months follow-up. Since the intervention failed at modifying AB, it is unclear whether changes in AB are related to long-term outcomes.

Combining antidepressants and attention bias modification in primary health care (DEPTREAT): Protocol for a pragmatic randomized controlled trial

BACKGROUND

Major depressive disorder (MDD) is a highly prevalent psychiatric condition associated with significant disability, mortality and economic burden. A large proportion of MDD patients are treated in primary health care in the local community. Attentional Bias Modification (ABM) training in combination with antidepressants could be an effective treatment. Here we test the hypothesis that adding an ABM procedure to regular treatment with antidepressants in primary health care will result in further improvement of symptoms compared to treatment with antidepressants alone (treatment as usual, TAU) and as compared to an active comparison condition.

METHODS

A total of 246 patients with a diagnosis of MDD will be included in this study. The study is a three-armed pragmatic randomized controlled trial comparing the efficacy of ABM as add-on to treatment with antidepressants in primary care (ABM condition) compared to standard antidepressant treatment (TAU condition). In a third group participants will complete the same schedule of intermediate assessments as the ABM condition in addition to TAU, but no ABM, thus controlling for the non-training-specific aspects of the ABM condition (Antidepressant active comparison group).

DISCUSSION

The clinical outcome of this study may help develop easily accessible, low-cost treatment of depression in primary health care. Moreover, the study aims to broaden our knowledge of optimal treatment for patients with a MDD by providing adjunct treatment to facilitate recovery and long-term gain.

Online Contingent Attention Training (OCAT): transfer effects to cognitive biases, rumination, and anxiety symptoms from two proof-of-principle studies

The aim of the present research was to develop and test the efficacy of a novel online contingent attention training (i.e., OCAT) to modify attention and interpretation biases, improve emotion regulation, and reduce emotional symptom levels in the face of major stressors. Two proof-of-principle studies were carried out. In study 1, 64 undergraduates who were about to start a major stressful period (i.e., final exams) were randomized to undergo 10 days of active OCAT or a sham-control training. Emotion regulation (habitual use of rumination and reappraisal) and symptom levels (depression and anxiety) were assessed before and after the intervention. In study 2, the same 2 × 2 mixed design was used with 58 individuals from the general population undergoing a major stressful situation (the lockdown period at the beginning of the COVID-19 pandemic in 2020). In both studies, the OCAT group showed significant improvements on attention towards negative information and interpretation biases in comparison to the sham-control group. Additionally, changes in cognitive biases transferred to reductions of participants' use of rumination and anxiety symptom levels. These results show preliminary evidence regarding the efficacy of the OCAT to target attention and interpretation biases as well as to improve emotion regulation processes and to buffer against the effects of major stressors.

Serious Games Based on Cognitive Bias Modification and Learned Helplessness Paradigms for the Treatment of Depression: Design and Acceptability Study

BACKGROUND

Depression is a debilitating mental health disorder, with a large treatment gap. Recent years have seen a surge in digital interventions to bridge this treatment gap. Most of these interventions are based on computerized cognitive behavioral therapy. Despite the efficacy of computerized cognitive behavioral therapy-based interventions, their uptake is low and dropout rates are high. Cognitive bias modification (CBM) paradigms provide a complementary approach to digital interventions for depression. However, interventions based on CBM paradigms have been reported to be repetitive and boring.

OBJECTIVE

In this paper, we described the conceptualization, design, and acceptability of serious games based on CBM paradigms and the learned helplessness paradigm.

METHODS

We searched the literature for CBM paradigms that were shown to be effective in reducing depressive symptoms. For each of the CBM paradigms, we ideated how to create a game so that the gameplay was engaging while the active therapeutic component remained unchanged.

RESULTS

We developed 5 serious games based on the CBM paradigms and the learned helplessness paradigm. The games include various core elements of gamification, such as goals, challenges, feedback, rewards, progress, and fun. Overall, the games received positive acceptability ratings from 15 users.

CONCLUSIONS

These games may help improve the effectiveness and engagement levels of computerized interventions for depression.

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

Background

Depression is a mental health disorder characterized by affective, somatic, and cognitive symptoms. Attention bias modification (ABM) has been widely used to treat depression. However, the results seem inconsistent. We conducted a systematic review and meta-analysis to investigate the efficacy of ABM for depression and to explore the optimal protocol of ABM.

Methods

Seven databases were systematically searched from their inceptions to 5 October 2022 to include randomized controlled trials (RCTs) of ABM for depression. Two independent reviewers selected the eligible articles, extracted data, and evaluated the risk of bias using version 2 of the Cochrane risk-of-bias tool (ROB 2.0) for randomized trials. The primary outcome was the evaluation of depressive symptoms using widely accepted and validated scales. The secondary outcomes included rumination and attentional control. Meta-analysis was conducted by using RevMan (version 5.4) and Stata (version 12.0). Subgroup analyses and meta-regressions were performed to identify the source of heterogeneity. The certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE).

Results

A total of 19 trials involving 20 datasets (1,262 participants) were included. The overall risk of bias in one study was rated as low risk of bias, three studies were considered as high, and the remaining studies were some concerns. Compared with attention control training (ACT), ABM had a greater effect in the improvement of depression (SMD = −0.48, 95% CI −0.80 to −0.17, I2 = 82%) and rumination (MD = −3.46, 95% CI −6.06 to −0.87, I2 = 0%). No significant differences were observed in the attentional control outcome between ABM and ACT (MD = 3.07, 95% CI −0.52 to 6.65, I2 = 0%). Subgroup analysis demonstrated that adults exhibited a greater decrease in depression scores than adolescents. ABM using the dot-probe task, training target stimulus presented by face, and training directions by left–right were associated with better antidepressant effects. ABM training delivered in the laboratory tended to yield a better effect than those conducted at home. Sensitivity analysis indicated that the results were robust. The certainty of the evidence for all outcomes was low or very low, and publication bias may exist.

Conclusion

Due to high heterogeneity and limited studies, not enough current evidence supported that ABM could be an effective intervention to relieve depressive symptoms. More rigorous RCTs are required to verify the benefits and to explore the optimal protocol of ABM training for depression.

Systematic Review Registration: [PROSPERO], identifier [No. CRD42021279163].

Excitatory brain stimulation over the left dorsolateral prefrontal cortex enhances voluntary distraction in depressed patients

BACKGROUND

While implicit distraction could ameliorate negative feelings in patients with major depressive disorders (MDD), it remains unclear whether patients could benefit from explicit, voluntary distraction. Meanwhile, though the dorsolateral prefrontal cortex (DLPFC) is established as a crucial brain region involved in attentional control, the causal relationship between the DLPFC and voluntary distraction is unexplored in patients.

METHODS

Combing explicit distraction and transcranial magnetic stimulation (TMS), this study investigated whether TMS-activated DLPFC facilitates voluntary distraction in MDD patients. Eighty patients diagnosed with current MDD underwent either active (n = 40) or sham (n = 40) TMS sessions, followed by receiving negative social feedback from other patients, during which they were requied to use distraction strategy to down-regulate their painful feelings. Electroencephalogram was recorded during the task.

RESULTS

Both the subjective emotional rating and the amplitude of late positive potential showed that depressed patients successfully down-regulate their negative emotions via voluntary distraction, and the TMS-activated left DLPFC produced a larger benefit of emotion regulation compared to the sham TMS group. Results also revealed that while emotion regulation effect was negatively associated with depressive symptoms in the sham TMS group, this correlation was largely diminished when patients' left DLPFC was activated by TMS during the voluntary distraction.

CONCLUSIONS

These findings demonstrated that distraction is valuable for emotion regulation in MDD patients and they could be beneficial in voluntary distraction by activating their left DLPFC using neural modulation techniques. This study has valuable implications for clinical treatement of emotional dysregulation in MDD patients.

Cognitive behavioral therapy (CBT) plus attention bias modification (ABM) reduces anxiety sensitivity and depressive symptoms in panic disorder: A pilot randomized trial

BACKGROUND

Cognitive bias theories propose that reducing threat hypervigilance in mental disorders can augment cognitive behavioral therapy (CBT) outcomes. However, no studies have tested whether adding attention bias modification (ABM) can effectively enhance CBT's effects on anxiety sensitivity (AS), electromyography (EMG), and skin conductance (SC) for panic disorder (PD). This pilot randomized controlled trial (RCT) thus aimed to evaluate the efficacy of CBT + ABM (vs. CBT plus attention training placebo; PBO) on those outcomes.

METHOD

This study is a secondary analysis (Baker et al., 2020). Adults with PD were randomized to receive CBT + ABM (n = 11) or CBT + PBO (n = 12). Before each of the first five CBT sessions, CBT + ABM and CBT + PBO participants completed a 15-min ABM task or attention training PBO, respectively. AS and depression severity as well as SC and EMG during habituation to a loud-tone startle paradigm were assessed. Hierarchical Bayesian analyses were conducted.

RESULTS

During pre-post-treatment and pre-follow-up, CBM + ABM (vs. CBT + PBO) led to a notably greater reduction in ASI-Physical (between-group d = -1.26 to -1.25), ASI-Cognitive (d = -1.16 to -1.10), and depression severity (d = -1.23 to -0.99). However, no between-group difference was observed for ASI-Social, EMG, or SC indices.

DISCUSSION

Adding a brief computerized ABM intervention to CBT for PD protocols may enhance therapeutic change.

Lack of speeded disengagement from facial expressions of disgust in remitted major depressive disorder: Evidence from an eye-movement study

Acute major depression is characterized by specific abnormalities in the way emotional material is attended to. In late stages of stimulus processing, clinically depressed and dysphoric individuals show difficulties to disengage attention from emotionally negative material. It is unclear, however, whether aberrant disengagement is a transitory attentional phenomenon tied to depressive symptoms, or whether it constitutes a more stable disposition that outlast the symptomatic episode. To address this issue, the current study examined 39 currently euthymic individuals previously affected by major depression (RMD) and 40 healthy control participants reporting no lifetime psychopathology (ND). We used a gaze-contingent eye tracking paradigm designed to separately assess the attentional components of engagement and disengagement when viewing facial expressions of sadness, disgust and happiness. Never-depressed healthy participants, but not remitted euthymic individuals, showed speeded disengagement from facial expressions of disgust. We propose that the lack of this distinct acceleration in previously depressed but fully remitted individuals might reflect an attentional disposition that carries over to euthymic phases of the disease. On the other hand, a tendency to disengage quickly from areas in the visual field that convey social disdain could potentially act as a protective, possibly mood-stabilizing bias in resilient individuals.

A review of attentional bias modification trainings for depression

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

Preferences for seeking effort or reward information bias the willingness to work

Research suggests that the temporal order in which people receive information about costs and benefits whilst making decisions can influence their choices. But, do people have a preference for seeking information about costs or benefits when making effort-based decisions, and does this impact motivation? Here, participants made choices about whether to exert different levels of physical effort to obtain different magnitudes of reward, or rest for low reward. Prior to each effort-based choice, they also had to decide which information they wanted to see first: how much physical effort would be required, or how large the reward would be. We found no overall preference for seeking reward or effort information first, but motivation did change when people saw reward or effort information first. Seeking effort information first, both someone's average tendency to do so and their choice to see effort first on a given trial, was associated with reductions in the willingness to exert higher effort. Moreover, the tendency to prefer effort information first was associated with reduced vigorous exercise and higher levels of fatigue in everyday life. These findings highlight that preferences for seeking effort information may be a bias that reduces people's willingness to exert effort in the lab and in everyday life.

Gamification improves antidepressant effects of cognitive control training-A pilot trial

OBJECTIVE

Computerised cognitive trainings have been put forward to improve control over negatively biased information processing and associated depressive symptomatology. Yet, disease-related impairments of motivation and endurance, as well as insufficient accessibility hinder use of this promising therapeutic opportunity. Here, we developed an app (de:)press^© ) that utilizes a cognitive control training (paced auditory serial addition task) enriched with gamification and information elements. We compared a six-week training with de:)press^© to a non-gamified version (active control group).

METHODS

Thirty-two depressed participants were included. Each received either de:)press^© or the non-gamified version and was instructed to train three times per week for two weeks. Afterwards (four weeks) they were free to train at their own discretion. Depression severity was assessed during training and two follow-up sessions. Primary endpoint was defined as difference between groups [change of Montgomery-Åsberg Depression Rating Scale (MADRS)] four weeks after end of training.

RESULTS

Depression severity decreased in both groups. At primary endpoint, MADRS scores were significantly lower in the de:)press^© -group compared to the control group. No differences were observed at three months' follow-up. Intervention usability was consistently rated positively. Participants who had trained with de:)press^© maintained the recommended training frequency without further prompting. Besides transient fatigue or frustration, no adverse effects were observed.

CONCLUSION

This pilot demonstrates that gamification and information elements can substantially increase cognitive control training efficacy in alleviating depressive symptoms. Moreover, it provides first evidence for the feasibility and efficacy of de:)press^© as an add-on intervention to treat depression.

CLINICAL TRIAL REGISTRATION

The study is registered under ClinicalTrials.gov, identifier: NCT04400162.

Efficacy of attention bias modification via smartphones in a large population sample

Negative affective biases are a key feature of anxiety and depression that uphold and promote negative mood. Bias modification aims to reduce these biases using computerized training, but shows mixed success and has not been tested at scale. The aim was to determine whether bias modification delivered via smartphones can improve mood in a large sample. In total, 153 385 self-referring participants were randomly assigned to modification or sham bias training on a dot-probe or visual-search task. The primary outcome of interest was balance of mood, assessed on the Positive and Negative Affect Schedule. In total, 22 933 participants who provided at least two mood ratings were included in analyses. There was a large amount of participant attrition. In the remaining smaller sample, results supported the prediction that visual-search modification would result in improved mood (95%CI [0.10, 0.82]; p = 0.01, d = 0.05, N = 2588 after two ratings; 95%CI [1.75,6.54]; p = 0.001, d = 0.32, N = 118 after six ratings), which was not seen for the sham version (N = 4818 after two ratings; N = 138 after six ratings). Dot-probe modification was not associated with mood improvements (p = 0.52). Visual-search, but not dot-probe, bias modification slightly but significantly improved mood. Although this effect size is very small and subject to large participant drop-off, it might be worth considering an adjunct to current treatments.

Efficacy of attention bias modification via smartphones in a large population sample

Negative affective biases are a key feature of anxiety and depression that uphold and promote negative mood. Bias modification aims to reduce these biases using computerized training, but shows mixed success and has not been tested at scale. The aim was to determine whether bias modification delivered via smartphones can improve mood in a large sample. In total, 153 385 self-referring participants were randomly assigned to modification or sham bias training on a dot-probe or visual-search task. The primary outcome of interest was balance of mood, assessed on the Positive and Negative Affect Schedule. In total, 22 933 participants who provided at least two mood ratings were included in analyses. There was a large amount of participant attrition. In the remaining smaller sample, results supported the prediction that visual-search modification would result in improved mood (95%CI [0.10, 0.82]; p = 0.01, d = 0.05, N = 2588 after two ratings; 95%CI [1.75,6.54]; p = 0.001, d = 0.32, N = 118 after six ratings), which was not seen for the sham version (N = 4818 after two ratings; N = 138 after six ratings). Dot-probe modification was not associated with mood improvements (p = 0.52). Visual-search, but not dot-probe, bias modification slightly but significantly improved mood. Although this effect size is very small and subject to large participant drop-off, it might be worth considering an adjunct to current treatments.

An Eye-Tracking Study of Attention Biases in Children at High Familial Risk for Depression and Their Parents with Depression

Attention biases (AB) are a core component of cognitive models of depression yet it is unclear what role they play in the transgenerational transmission of depression. 44 children (9-14 years) with a high familial risk of depression (HR) were compared on multiple measures of AB with 36 children with a low familial risk of depression (LR). Their parents: 44 adults with a history of depression (HD) and 36 adults with no history of psychiatric disorder (ND) were also compared. There was no evidence of group differences in AB; neither between the HR and LR children, nor between HD and ND parents. There was no evidence of a correlation between parent and child AB. The internal consistency of the tasks varied greatly. The Dot-Probe Task showed unacceptable reliability whereas the behavioral index of the Visual-Search Task and an eye-tracking index of the Passive-Viewing Task showed better reliability. There was little correlation between the AB tasks and the tasks showed minimal convergence with symptoms of depression or anxiety. The null-findings of the current study contradict our expectations and much of the previous literature. They may be due to the poor psychometric properties associated with some of the AB indices, the unreliability of AB in general, or the relatively modest sample size. The poor reliability of the tasks in our sample suggest caution should be taken when interpreting the positive findings of previous studies which have used similar methods and populations.

Symptom severity moderates the outcome of attention bias modification for depression: An exploratory study

A recent meta-analysis has questioned the relevance of attention bias modification (ABM) for depression outcomes. However, there might be patient characteristics not yet accounted for, that are relevant to the outcome. In the context of personalized treatment, the lack of moderator studies have limited the potential for matching ABM-treatment to individual patient characteristics. Subjects (N = 301) were randomly assigned 1:1 to receive either active or placebo Attention Bias Modification (ABM) twice daily for 14 days in a double-blind design (placebo n = 148; ABM n = 153). The outcome was change in symptoms based on the Hamilton Depression Rating Scale (HDRS). Moderator variables were self-reported depression (Beck Depression Inventory-II; BDI-II), anxiety (Beck Anxiety Inventory; BAI) and attentional bias (AB) assessed at baseline. This trial was registered with ClinicalTrials.gov, number NCT02658682. Only BAI (p for interaction = .01, Bootstrap 95% CI [0.046, 0.337]) moderated the effects of ABM on change in clinician rated depressive symptoms. Interactions were significant for BAI scores ≥8. The relative effect of the intervention increased with the highest symptom load. ABM was not effective in patients with the lowest symptom load. Future research should validate this finding and continue investigating moderators of the ABM-intervention to further enhance personalization of treatment to individual symptom characteristics.

Emotion Regulation as a Mediator in the Relationship Between Cognitive Biases and Depressive Symptoms in Depressed, At-risk and Healthy Children and Adolescents

Contemporary cognitive models of depression propose that cognitive biases for negative information at the level of attention (attention biases; AB) and interpretation (interpretation biases; IB) increase depression risk by promoting maladaptive emotion regulation (ER). So far, empirical support testing interactions between these variables is restricted to non-clinical and clinical adult samples. The aim of the current study was to extend these findings to a sample of children and adolescents. This cross-sectional study included 109 children aged 9–14 years who completed behavioural measures of AB (passive-viewing task) and IB (scrambled sentences task) as well as self-report measures of ER and depressive symptoms. In order to maximize the variance in these outcomes we included participants with a clinical diagnosis of depression as well as non-depressed youth with an elevated familial risk of depression and non-depressed youth with a low familial risk of depression. Path model analysis indicated that all variables (AB, IB, adaptive and maladaptive ER) had a direct effect on depressive symptoms. IB and AB also had significant indirect effects on depressive symptoms via maladaptive and adaptive ER. These findings provide initial support for the role of ER as a mediator between cognitive biases and depressive symptoms and provide the foundations for future experimental and longitudinal studies. In contrast to studies in adult samples, both adaptive as well as maladaptive ER mediated the effect of cognitive biases on depressive symptoms. This suggests potentially developmental differences in the role of ER across the lifespan.

Relationships between hope and mental health among women in prison

BACKGROUND

Previous research with non-offenders has linked a higher dispositional cognition of hope to lower levels of psychological symptoms and demonstrated mediating effects of attentional biases on the relationship between hope and psychological symptoms, but this has not been explored among offenders.

AIMS

Our aim was to investigate associations between a dispositional cognition of hope and habitual attentional processing styles and distress among women in prison. We hypothesised that higher levels of hope would be associated with more attention to positive information and less to negative information in the surroundings and, in turn, lower levels of depression, anxiety and stress symptoms in women in prison.

METHOD

In a cross-sectional study, we recruited consenting women serving a prison sentence who had been referred to psychological services. Participants completed a set of self-rating inventories individually, which scaled their levels of hope, attention to positive and negative information and symptoms of anxiety, stress and depression.

RESULTS

Two hundred and three women participated. Their average age was 35.68 years (range 21-67 years). Over half were recidivists (170, 58%). Overall, the higher the level of hope they had, the lower were the ratings of their psychological symptoms. Positive attentional bias was associated with higher hope and lower psychological distress. In contrast, negative attentional bias was related to lower hope and higher psychological distress ratings. In statistical models, both attentional biases appeared to be partial mediators of the relationship between hope and psychological distress.

CONCLUSIONS

Our findings among women in prison were consistent with those in non-forensic populations and not previously studied among prisoners. They suggest that it would be worth evaluating interventions to modify attentional styles as they may have value in increasing hope and reducing psychological symptoms and perhaps also harmful behaviours in this vulnerable population.

Cognitive neuropsychological theory of antidepressant action: a modern-day approach to depression and its treatment

Depression is a leading cause of disability worldwide and improving its treatment is a core research priority for future programmes. A change in the view of psychological and biological processes, from seeing them as separate to complementing one another, has introduced new perspectives on pathological mechanisms of depression and treatment mode of action. This review presents a theoretical model that incorporated this novel approach, the cognitive neuropsychological hypothesis of antidepressant action. This model proposes that antidepressant treatments decrease the negative bias in the processing of emotionally salient information early in the course of antidepressant treatment, which leads to the clinically significant mood improvement later in treatment. The paper discusses the role of negative affective biases in the development of depression and response to antidepressant treatments. It also discusses whether the model can be applied to other antidepressant interventions and its potential translational value, including treatment choice, prediction of response and drug development.

Negative Bias During Early Attentional Engagement in Major Depressive Disorder as Examined Using a Two-Stage Model: High Sensitivity to Sad but Bluntness to Happy Cues

Negative attentional bias has been well established in depression. However, there is very limited knowledge about whether this depression-relevant negative bias exits during initial attentional allocation, as compared with the converging evidence for the negative bias during sustained attention engagement. This study used both behavioral and electrophysiological measures to examine the initial attention engagement in depressed patients influenced by mood-congruent and mood-incongruent emotions. The dot-probe task was performed with a 100-ms exposure time of the emotional cues (emotional and neutral face pairs). The behavioral results showed that the patients responded faster following valid compared with invalid sad facial cues. Electrophysiological indexes in the frame of the two-stage model of attentional modulation by emotions provided cognitive mechanisms in distinct attention engagement stages: (1) the patients exhibited reduced P1 amplitudes following validly than invalidly happy cues than did the healthy controls, indicating a positive attenuation at an early stage of automatic attention orientation; and (2) the patients exhibited enhanced whereas the controls showed reduced P3 amplitudes following validly than invalidly sad cues, suggesting a mood-congruent negative potentiation in depression at the later stage of top-down voluntary control of attention. Depressed patients show a negative bias in early attentional allocation, reflected by preferred engagement with mood-congruent and diminished engagement with positive emotional cues/stimuli.

Cognitive bias modification to prevent depression (COPE): results of a randomised controlled trial

BACKGROUND

Although efficacious treatments for major depression are available, efficacy is suboptimal and recurrence is common. Effective preventive strategies could reduce disability associated with the disorder, but current options are limited. Cognitive bias modification (CBM) is a novel and safe intervention that attenuates biases associated with depression. This study investigated whether the delivery of a CBM programme designed to attenuate negative cognitive biases over a period of 1 year would decrease the incidence of major depression among adults with subthreshold symptoms of depression.

METHODS

Randomised double-blind controlled trial delivered an active CBM intervention or a control intervention over 52 weeks. Two hundred and two community-dwelling adults who reported subthreshold levels of depression were randomised (100 intervention, 102 control). The primary outcome of interest was the incidence of major depressive episode assessed at 11, 27 and 52 weeks. Secondary outcomes included onset of clinically significant symptoms of depression, change in severity of depression symptoms and change in cognitive biases.

RESULTS

Adherence to the interventions was modest though did not differ between conditions. Incidence of major depressive episodes was low. Conditions did not differ in the incidence of major depressive episodes. Likewise, conditions did not differ in the incidence of clinically significant levels of depression, change in the severity of depression symptoms or change in cognitive biases.

CONCLUSIONS

Active CBM intervention did not decrease the incidence of major depressive episodes as compared to a control intervention. However, adherence to the intervention programme was modest and the programme failed to modify the expected mechanism of action.

Cloud-Based Functional Magnetic Resonance Imaging Neurofeedback to Reduce the Negative Attentional Bias in Depression: A Proof-of-Concept Study

Individuals with depression show an attentional bias toward negatively valenced stimuli and thoughts. In this proof-of-concept study, we present a novel closed-loop neurofeedback procedure intended to remediate this bias. Internal attentional states were detected in real time by applying machine learning techniques to functional magnetic resonance imaging data on a cloud server; these attentional states were externalized using a visual stimulus that the participant could learn to control. We trained 15 participants with major depressive disorder and 12 healthy control participants over 3 functional magnetic resonance imaging sessions. Exploratory analysis showed that participants with major depressive disorder were initially more likely than healthy control participants to get stuck in negative attentional states, but this diminished with neurofeedback training relative to controls. Depression severity also decreased from pre- to posttraining. These results demonstrate that our method is sensitive to the negative attentional bias in major depressive disorder and showcase the potential of this novel technique as a treatment that can be evaluated in future clinical trials.

Prioritized attentional processing: Acute stress, memory and stimulus emotionality facilitate attentional disengagement

Rapid attentional orienting toward relevant stimuli and efficient disengagement from irrelevant stimuli are critical for survival. Here, we examined the roles of memory processes, emotional arousal and acute stress in attentional disengagement. To this end, 64 healthy participants encoded negative and neutral facial expressions and, after being exposed to a stress or control manipulation, performed an attention task in which they had to disengage from these previously encoded as well as novel face stimuli. During the attention task, electroencephalography (EEG) and pupillometry data were recorded. Our results showed overall faster reaction times after acute stress and when participants had to disengage from emotionally negative or old facial expressions. Further, pupil dilations were larger in response to neutral faces. During disengagement, our EEG data revealed a reduced N2pc amplitude when participants disengaged from neutral compared to negative facial expressions when these were not presented before, as well as earlier onset latencies for the N400f (for disengagement from negative and old faces), the N2pc, and the LPP (for disengagement from negative faces). In addition, early visual processing of negative faces, as reflected in the P1 amplitude, was enhanced specifically in stressed participants. Our findings indicate that attentional disengagement is improved for negative and familiar stimuli and that stress facilitates not only attentional disengagement but also emotional processing in general. Together, these processes may represent important mechanisms enabling efficient performance and rapid threat detection.

Attentional bias modification is associated with fMRI response toward negative stimuli in individuals with residual depression: a randomized controlled trial

BACKGROUND

Attentional bias modification (ABM) may lead to more adaptive emotion perception and emotion regulation. Understanding the neural basis of these effects may lead to greater precision for the development of future treatments. Task-related functional MRI (fMRI) after ABM training has not been investigated in depression so far. The main aim of this randomized controlled trial was to explore differences in brain activity after ABM training, in response to emotional stimuli.

METHODS

A total of 134 people with previous depression, who had been treated for depression and had various degrees of residual symptoms, were randomized to 14 days of active ABM or a closely matched placebo training, followed by an fMRI emotion regulation task. The training procedure was a classical dot–probe task with emotional face stimuli. In the active ABM condition, the probes replaced the more positively valenced face of a given pair. As participants implicitly learned to predict the probe location, this would be likely to induce a more positive attentional bias. The placebo condition was identical, except for the contingency of the probe, which appeared equally behind positive and negative stimuli. We compared depression symptoms and subjective ratings of perceived negativity during fMRI between the training groups. We explored brain activation in predefined regions of interest and across the whole brain. We explored activation in areas associated with changes in attentional bias and degree of depression.

RESULTS

Compared with the placebo group, the ABM group showed reduced activation in the amygdala and the anterior cingulate cortex when passively viewing negative images. We found no group differences in predefined regions of interest associated with emotion regulation strategies. Response in the temporal cortices was associated with the degree of change in attentional bias and the degree of depressive symptoms in ABM versus placebo.

LIMITATIONS

These findings should be replicated in other samples of patients with depression, and in studies using fMRI designs that allow analyses of within-group variability from baseline to follow-up.

CONCLUSION

Attentional bias modification training has an effect on brain function in the circuitry associated with emotional appraisal and the generation of affective states.

CLINICALTRIALS.GOV IDENTIFIER

NCT02931487

Enhanced striatal and prefrontal activity is associated with individual differences in nonreinforced preference change for faces

Developing effective preference modification paradigms is crucial to improve the quality of life in a wide range of behaviors. The cue‐approach training (CAT) paradigm has been introduced as an effective tool to modify preferences lasting months, without external reinforcements, using the mere association of images with a cue and a speeded button response. In the current work for the first time, we used fMRI with faces as stimuli in the CAT paradigm, focusing on face‐selective brain regions. We found a behavioral change effect of CAT with faces immediately and 1‐month after training, however face‐selective regions were not indicative of behavioral change and thus preference change is less likely to rely on face processing brain regions. Nevertheless, we found that during training, fMRI activations in the ventral striatum were correlated with individual preference change. We also found a correlation between preference change and activations in the ventromedial prefrontal cortex during the binary choice phase. Functional connectivity among striatum, prefrontal regions, and high‐level visual regions was also related to individual preference change. Our work sheds new light on the involvement of neural mechanisms in the process of valuation. This could lead to development of novel real‐world interventions.

Attentional Disengagement Deficits Predict Brooding, but Not Reflection, Over a One-Year Period

A growing literature suggests that rumination is linked to attentional disengagement deficits in depression. This is particularly the case with brooding, a maladaptive form of rumination. However, research on the potential constructive association between attentional disengagement and self-reflection, a putative adaptive form of rumination, is sparse. Thus, the goal of the present study was to examine whether visual attentional disengagement deficits differentially predict dispositional brooding and self-reflection tendencies. Depressed participants (n = 17), those in remission from depression (n = 42), and their peers with no depression histories (n = 70) completed clinical interviews, the Ruminative Response Scale (RRS), and an eye-tracking task that measured attentional disengagement from pleasant (happy) and unpleasant (sad) facial images during a laboratory visit, and the RRS at 4 month intervals over a 1-year period. Results revealed that slow disengagement from sad faces, and rapid disengagement from happy faces, was specifically associated with brooding tendencies concurrently and across follow-up. Attentional disengagement was unrelated to self-reflection. The disengagement-brooding associations remained after controlling for depression status and anxiety disorder histories, suggesting that attentional control deficits may be a state-independent marker of brooding. Theoretical and clinical implications for these associations are discussed.

Attentional bias in depression: understanding mechanisms to improve training and treatment

One of the most common symptoms of depression is the tendency to attend to negative stimuli in the world and negative thoughts in mind. This symptom is especially nefarious because it is also a cause - biasing processing to negatively valenced information, thus worsening mood, and exacerbating the condition. Here we attempt to systematize the diverse body of recent research on the negative attentional bias from across cognitive and clinical psychology in order to identify recurring themes and devise potential mechanistic explanations. We leverage theoretical progress in our understanding of healthy attention systems in terms of internal versus external components. With this lens, we review approaches to training attention that might reduce the negative attentional bias, including behavioral interventions and real-time neurofeedback. Although extant findings are somewhat mixed, these approaches provide hope and clues for the next generation of treatments.

Increase value and reduce waste in research on psychological therapies

A seminal Lancet series focused on increasing value and reducing waste in biomedical research, providing a transferrable template to diagnose problems in research. Our goal was to document how some of these sources of waste apply to mental health and particularly psychological treatments research. We synthesize and critically evaluate empirical findings in relation to four major sources: i) defining research priorities; ii) research design, methods and analysis; iii) accessibility of research information; iv) accuracy and usability of research reports. We demonstrate that each source of waste considered is well-represented and amply documented within this field. We describe hype and insufficient consideration of what is known in defining research priorities, persistent risk of bias, particularly due to selective outcome reporting, for psychotherapy trials across mental disorders, intellectual and financial biases, direct and indirect evidence of publication bias, largely inexistent adoption of data sharing, issues of multiplicity and fragmentation of data and findings, and insufficient adoption of reporting guidelines. We expand on a few general solutions, including supporting meta-research, properly testing interventions to increase research quality, placing open science at the center of psychological treatment research and remaining vigilant particularly regarding the strains of research currently prioritized, such as experimental psychopathology.

Pinpointing mechanisms of a mechanistic treatment: Dissociable roles for overt and covert attentional processes in acute and long-term outcomes following Attention Bias Modification

Biased patterns of attention towards threat are implicated as key mechanisms in anxiety which can be modified through automated intervention (Attention Bias Modification; ABM). Intervention refinement and personalized dissemination efforts are substantially hindered by gaps in understanding the precise attentional components that underlie ABM's effects on symptoms-particularly with respect to longer-term outcomes. Seventy adults with transdiagnostic anxiety were randomized to receive 8 sessions of active ABM (n=49) or sham training (n=21). Reaction time and eyetracking data, collected at baseline, post-training, and 1-month follow-up, dissociated multiple core attentional processes, spanning overt and covert processes of engagement and disengagement. Self-reported symptoms were collected out to 1-year follow-up. Covert disengagement bias was specifically reduced by ABM, unlike all other indices. Overt disengagement bias at baseline predicted acute post-ABM outcomes, while covert engagement bias was non-specifically predictive of symptom trajectories out to 1-year follow-up. Results suggest unique and dissociable roles for each discrete mechanism.

Picture This! Bringing joy into Focus and Developing Healthy Habits of Mind: Rationale, design, and implementation of a randomized control trial for young adults

Research shows that daily experiences of awe, curiosity, gratitude, joy, and love can put the average person on a trajectory of growth, success, and positive social connection, and can also prevent those who are suffering from following a downward spiral. Nonetheless, data show that most people are not functioning at optimal capacity. In fact, just 20% of people may be categorized as "flourishing," with the vast majority of people merely "languishing," at risk for mental health issues, or with clinical levels of mental health concerns. Despite the success of the Positive Psychology movement and the proliferation of Positive Psychology Interventions, the field remains in need of high quality studies that test potential mechanisms of change. The Picture This! intervention, informed by Positive Psychology principles, was designed to improve well-being and decrease depressive symptoms in young adults. This paper details the rationale, design, and implementation of a 4-group randomized control trial (RCT) to test the effectiveness of Picture This!. Specific indices of mental health and well-being (e.g., depressive symptoms, gratitude) were measured at baseline and at the conclusion of the intervention along with potential mechanisms of change (i.e., attentional bias, cognitive style), while positive emotion and general well-being were assessed daily over the 21-day intervention period. If successful, this intervention may provide critical behavioral, cognitive, and attentional tools that, once internalized, can be drawn upon for years to come.

Acceptance and Commitment Therapy Preceded by Attention Bias Modification on Residual Symptoms in Depression: A 12-Month Follow-Up

Depression is a highly recurrent disorder with limited treatment alternatives for reducing risk of subsequent episodes. Acceptance and commitment therapy (ACT) and attention bias modification (ABM) separately have shown some promise in reducing depressive symptoms. This study investigates (a) if group-based ACT had a greater impact in reducing residual symptoms of depression over a 12-month follow-up than a control condition, and (b) if preceding ACT with ABM produced added benefits. This multisite study consisted of two phases. In phase 1, participants with a history of depression, currently in remission (N = 244), were randomized to either receive 14 days of ABM or a control condition. In phase 2, a quasi- experimental design was adopted, and only phase-1 participants from the Sørlandet site (N = 124) next received an 8-week group-based ACT intervention. Self-reported and clinician-rated depression symptoms were assessed at baseline, immediately after phase 1 and at 1, 2, 6, and 12 months after the conclusion of phase 1. At 12-month follow-up, participants who received ACT exhibited fewer self-reported and clinician-rated depressive symptoms. There were no significant differences between ACT groups preceded by ABM or a control condition. There were no significant differences between ACT groups preceded by ABM or a control condition. Group-based ACT successfully decreased residual symptoms in depression over 12 months, suggesting some promise in preventing relapse.

Attentional control and estimation of the probability of positive and negative events

People high in negative affect tend to think negative events are more likely than positive events ("probability bias"). Studies have found that weak attentional control exaggerates another negative affect-related cognitive bias - attentional bias - but it is not clear why this might be. We therefore wanted to know whether weak attentional control would be related to probability bias too. Four studies, with predominantly female student samples (N = 857), revealed correlations of around -.38 between attentional control and probability bias. This remained significant when trait anxiety and depression were controlled; there were no interactions between attentional control and negative affect. Studies 3 and 4 found that attentional control's relationship with probability bias was partly mediated by emotion regulation ability. These results suggest attentional control is important for regulating affect-related cognitive biases, and for emotion regulation in general. Furthermore, because cognitive biases are thought to be important for maintaining emotional disorders, these results are also consistent with weak attentional control being a risk factor for these disorders.

Heart Rate Variability and Cognitive Bias Feedback Interventions to Prevent Post-deployment PTSD: Results from a Randomized Controlled Trial

Introduction

There is a long history of pre-deployment PTSD prevention efforts in the military and effective pre-deployment strategies to prevent post-deployment PTSD are still needed.

Materials and Methods

This randomized controlled trial included three arms: heart rate variability biofeedback (HRVB), cognitive bias modification for interpretation (CBM-I), and control. The hypothesis was that pre-deployment resilience training would result in lower post-deployment PTSD symptoms compared with control. Army National Guard soldiers (n = 342) were enrolled in the Warriors Achieving Resilience (WAR) study and analyzed. The outcome was PTSD symptom severity using the PTSD Checklist - Military version (PCL) measured at pre-deployment, 3- and 12-month post-deployment. Due to the repeated measures for each participant and cluster randomization at the company level, generalized linear mixed models were used for the analysis. This study was approved by the Army Human Research Protection Office, Central Arkansas Veterans Healthcare System Institutional Review Board (IRB), and Southeast Louisiana Veterans Health Care System IRB.

Results

Overall, there was no significant intervention effect. However, there were significant intervention effects for subgroups of soldiers. For example, at 3-months post-deployment, the HRVB arm had significantly lower PCL scores than the control arm for soldiers with no previous combat zone exposure who were age 30 and older and for soldiers with previous combat zone exposure who were 45 and older (unadjusted effect size -0.97 and -1.03, respectively). A significant difference between the CBM-I and control arms was found for soldiers without previous combat zone exposure between ages 23 and 42 (unadjusted effect size -0.41). Similarly, at 12-months post-deployment, the HRVB arm had significantly lower PCL scores in older soldiers.

Conclusion

Pre-deployment resilience training was acceptable and feasible and resulted in lower post-deployment PTSD symptom scores in subgroups of older soldiers compared with controls. Strengths of the study included cluster randomization at the company level, use of iPod device to deliver the resilience intervention throughout the deployment cycle, and minimal disruption of pre-deployment training by using self-paced resilience training. Weaknesses included self-report app use, study personnel not able to contact soldiers during deployment, and in general a low level of PTSD symptom severity throughout the study. In future studies, it would important for the study team and/or military personnel implementing the resilience training to be in frequent contact with participants to ensure proper use of the resilience training apps.

Effects of Attentional Bias Modification on residual symptoms in depression: a randomized controlled trial

BACKGROUND

Following treatment, many depressed patients have significant residual symptoms. However, large randomised controlled trials (RCT) in this population are lacking. When Attention bias modification training (ABM) leads to more positive emotional biases, associated changes in clinical symptoms have been reported. A broader and more transparent picture of the true advantage of ABM based on larger and more stringent clinical trials have been requested. The current study evaluates the early effect of two weeks ABM training on blinded clinician-rated and self-reported residual symptoms, and whether changes towards more positive attentional biases (AB) would be associated with symptom reduction.

METHOD

A total of 321 patients with a history of depression were included in a preregistered randomized controlled double-blinded trial. Patients were randomised to an emotional ABM paradigm over fourteen days or a closely matched control condition. Symptoms based on the Hamilton Rating Scale for Depression (HRSD) and Beck Depression Inventory II (BDI-II) were obtained at baseline and after ABM training.

RESULTS

ABM training led to significantly greater decrease in clinician-rated symptoms of depression as compared to the control condition. No differences between ABM and placebo were found for self-reported symptoms. ABM induced a change of AB towards relatively more positive stimuli for participants that also showed greater symptom reduction.

CONCLUSION

The current study demonstrates that ABM produces early changes in blinded clinician-rated depressive symptoms and that changes in AB is linked to changes in symptoms. ABM may have practical potential in the treatment of residual depression.

TRIAL REGISTRATION

ClinicalTrials.gov ID: NCT02658682 (retrospectively registered in January 2016).

Attentional bias modification reduces clinical depression and enhances attention toward happiness

Difficulty in clinical antidepressant treatment leads to the pursuit of alternative treatments, such as cognitive-behavior therapy (CBT). CBT combined with regular antidepressants have indicated an optimal therapeutic effect in clinic. Attentional bias is important in the occurrence and remission of depression, however, few studies have explored the effect of attentional bias modification (ABM) on depression, and inconsistent results have been obtained due to the heterogeneity in the targeted populations, training tasks, strategies, and materials. Hence, the current study aimed to explore the therapeutic effect of ABM on depression in clinical depression. Study I was designed to explore the optimal training methods regarding task (dot-probe vs. cue-target), material (faces vs. self-referent words), and strategy (mixed ABM toward positive and away from negative stimuli vs. positive ABM toward positive stimuli) in unselected undergraduates once daily for 10 days (N = 309). Study II was carried out to observe the effect of 10 days ABM toward positive and away from negative faces (based on Study I) on clinical depression (N = 32). Depression level was assessed via a self-reporting questionnaire and a structured interview, while attentional bias was tested by cue-target task and attention to positive and negative inventory (APNI). In unselected undergraduates (Study I), two strategies significantly reduced the self-reporting depression scores: mixed ABM toward positive stimuli and away from negative stimuli with emotional faces, and positive ABM toward positive materials only with self-referent words. In patients with major depressive disorder (MDD) (Study II), the mixed ABM with emotional faces resulted in enhanced attentional bias toward happy materials in the cue-target task and APNI, which predicted a delayed depression reduction in clinical depression at the one-month follow-up investigation. Our finding confirms the literature and broadens the knowledge with the evidence of the optimal therapeutic effect of ABM combined with regular antidepressants in clinical depression. The findings that a quick enhancement in positive attentional bias, predicting a later therapeutic effect on clinical depression reduction, indicate a potential mechanism that could underlie the therapeutic process of ABM in depression. The findings that two training strategies are effective in depression reduction suggest that different strategies should be utilized to treat different types of depression. This study offers a potential way to cure depression and could be further practiced in clinic.

Depressive Symptoms in Late Pregnancy Disrupt Attentional Processing of Negative-Positive Emotion: An Eye-Movement Study

This study investigated biases for negative-positive information in component processes of visual attention (initial shift vs. maintenance of gaze) among women in late pregnancy with or without depressive symptoms. Eye movements were recorded while participants viewed a series of picture pairs depicting negative, positive, and neutral scenes. Initial orienting (latency and percentage of first fixation) and gaze duration were computed. Compared with neutral pictures, the group with major depressive symptoms (MDS) were less able to sense the positive emotion-related pictures and were over-responsive to negative emotion-related pictures. The group with suspicious depressive symptoms (SDS) had an attention bias toward both positive and negative emotion-related pictures. The group with no depressive symptoms (NDS) had an attention bias toward positive emotion-related pictures and had an initial attention avoidance tendency for negative emotion-related pictures. The initial gaze direction bias score for negative emotion-related pictures was positively correlated with the severity of depressive symptoms. Therefore, women with a risk of perinatal depression have a significant bias toward negative stimuli. Hypervigilant emotion processing during pregnancy may increase a woman's susceptibility to depression during late pregnancy. Attention away from negative information or attention toward positive information may provide a way of buffering emotional responses.