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Zainal NH, Hellberg SN, Kabel KE, Hotchkin CM, Baker AW. Cognitive behavioral therapy (CBT) plus attention bias modification (ABM) reduces anxiety sensitivity and depressive symptoms in panic disorder: A pilot randomized trial. Scand J Psychol 2023. [PMID: 36707979 DOI: 10.1111/sjop.12902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 01/04/2023] [Accepted: 01/05/2023] [Indexed: 01/29/2023]
Abstract
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.
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Affiliation(s)
- Nur Hani Zainal
- Department of Healthcare Policy, Harvard Medical School, Boston, MA, USA
| | - Samantha N Hellberg
- Department of Psychology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Katherine E Kabel
- Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Claire M Hotchkin
- Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Amanda W Baker
- Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
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2
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Shnier NL, Burton AL, Rapee RM, Modini M, Abbott MJ. Psychometric properties of the state Probability and Consequences Questionnaire for social anxiety disorder. J Anxiety Disord 2022; 92:102636. [PMID: 36209543 DOI: 10.1016/j.janxdis.2022.102636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 09/08/2022] [Accepted: 09/20/2022] [Indexed: 11/25/2022]
Abstract
Cognitive models of social anxiety propose that overestimation of the probability and cost of negative evaluation plays a central role in maintaining the disorder. However, there are currently no self-report state-based measures of probability and cost appraisals. The current paper examines the psychometric properties of the Probability and Consequences Questionnaire for social anxiety (PCQ-SA), which measures probability and consequence appraisals both in anticipation of, and in response to, an impromptu speech task. A total of 532 participants were recruited for the present study, consisting of 409 participants with a principal diagnosis of Social Anxiety Disorder (SAD), and 123 non-clinical controls. Results of exploratory and confirmatory factor analyses supported a two-factor solution for the PCQ-SA. The PCQ-SA demonstrated excellent internal consistency, excellent test-retest reliability, good convergent validity at both time points (i.e., pre and post speech task), and sensitivity to treatment. Finally, using Receiver Operating Characteristic Curve Analysis, clinical cut-off scores were calculated for probability and consequences at both time points, with the PCQ-SA scales showing good sensitivity, specificity, and positive and negative predictive values. Overall, the results provide evidence that the PCQ-SA possesses excellent psychometric properties. The PCQ-SA is suitable for use in clinical and research settings to assess key cognitive maintaining factors for SAD.
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Affiliation(s)
- Nadia L Shnier
- School of Psychology, The University of Sydney, Australia
| | - Amy L Burton
- School of Psychology, The University of Sydney, Australia.
| | - Ronald M Rapee
- Centre for Emotional Health, Department of Psychology, Macquarie University, Australia
| | - Matthew Modini
- School of Psychology, The University of Sydney, Australia; Concord Centre for Mental Health, Sydney Local Health District, Australia
| | - Maree J Abbott
- School of Psychology, The University of Sydney, Australia.
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3
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Winkler CD, Koval P, Phillips LJ, Felmingham KL. Does prediction error during exposure relate to clinical outcomes in cognitive behavior therapy for social anxiety disorder? A study protocol. Front Psychiatry 2022; 13:1000686. [PMID: 37082515 PMCID: PMC10111196 DOI: 10.3389/fpsyt.2022.1000686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 11/08/2022] [Indexed: 11/25/2022] Open
Abstract
Facing your fears, or exposure therapy, is an effective psychological intervention for anxiety disorders that is often thought to work through fear extinction learning. Fear extinction learning is a type of associative learning where fear reduces through repeated encounters with a feared situation or stimulus in the absence of aversive outcomes. Laboratory research suggests fear extinction learning is driven by threat prediction errors, defined as when fearful predictions do not eventuate. Threat prediction error and its relationship to exposure therapy outcomes haven't been studied enough in actual therapy settings. It remains unclear whether prediction error and extinction learning are central mechanisms of exposure therapy. We are conducting a longitudinal and observational study of how threat prediction error during exposure in social anxiety disorder (SAD) treatment relates to session-by-session symptom change and treatment outcome in addition to exposure surprise and learning outcome. We aim to recruit 65 adults with a primary diagnosis of SAD through an outpatient psychology clinic. Participants will receive 12 sessions of individual manualized cognitive behavioral therapy (CBT), adapted from an efficacious group protocol, that includes graded exposure. Exposure processes, including self-report measures of anxiety, threat prediction, threat outcomes, surprise, and learning outcome, will be measured with smartphone-based event-contingent ecological momentary assessments (EMAs) of all behavioral experiments completed during treatment. Clinical outcomes include self-reported social anxiety symptoms and social threat appraisals, at each session, post and 3-months after treatment. Prediction error will be operationalized as the mismatch between the threat prediction and threat outcome. The joint effect of threat prediction and threat outcome on session-by-session symptom change, treatment outcome, exposure surprise, and learning outcome will be explored using multilevel modeling. The present study will help determine whether threat prediction error during exposures in SAD treatment is related to theoretically implied clinical outcomes. This would contribute to the larger research aim of clarifying exposure therapy mechanisms.
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Affiliation(s)
- Christopher D. Winkler
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, VIC, Australia
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4
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Donohue HE, Rapee RM, Modini M, Norton AR, Abbott MJ. Measuring state pre-event and post-event rumination in Social Anxiety Disorder: Psychometric properties of the Socially Anxious Rumination Questionnaire (SARQ). J Anxiety Disord 2021; 82:102452. [PMID: 34271333 DOI: 10.1016/j.janxdis.2021.102452] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 06/01/2021] [Accepted: 07/06/2021] [Indexed: 11/25/2022]
Abstract
Cognitive models have consistently recognised pre-event and post-event rumination as maintaining factors in Social Anxiety Disorder (SAD). This study aimed to investigate the psychometric properties of a state-based measure of pre-event and post-event rumination in SAD: The Socially Anxious Rumination Questionnaire (SARQ), which was formerly known as the Thoughts Questionnaire. In particular, we examined the factor structure, internal consistency, test-retest reliability, construct validity, sensitivity to treatment response, clinical cut-off scores (relative to non-clinical participants), and associated test performance indicators of the SARQ. The sample comprised 505 adults with a principal diagnosis of SAD and 130 non-clinical controls. Pre-event and post-event rumination were assessed in relation to a three-minute impromptu speech. Results indicated single factors for the SARQ: Pre-event and SARQ: Post-event scales, along with excellent internal consistency, good test-retest reliability, sound sensitivity to cognitive-behavioural treatment response, and a clear ability to discriminate between individuals with a principal diagnosis of SAD and non-clinical controls. The findings justify the SARQ's use as a robust and reliable measure of state rumination for individuals with SAD that can be used both before and after encountering a social threat.
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Affiliation(s)
| | - Ronald M Rapee
- Centre for Emotional Health, Department of Psychology, Macquarie University, Australia
| | - Matthew Modini
- School of Psychology, The University of Sydney, Australia; Concord Centre for Mental Health, Sydney Local Health District, Australia
| | - Alice R Norton
- School of Psychology, The University of Sydney, Australia
| | - Maree J Abbott
- School of Psychology, The University of Sydney, Australia.
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5
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Hang Y, Xu L, Wang C, Zhang G, Zhang N. Can attention bias modification augment the effect of CBT for anxiety disorders? A systematic review and meta-analysis. Psychiatry Res 2021; 299:113892. [PMID: 33799125 DOI: 10.1016/j.psychres.2021.113892] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 03/18/2021] [Indexed: 01/19/2023]
Abstract
Attention Bias Modification (ABM) is a novel computerized therapy for anxiety disorders and is thought to augment the effect of Cognitive Behavior Therapy (CBT) as it may target different mechanisms. Recently, a growing number of studies have examined the combined effects of ABM and CBT on clinically anxious patients, with mixed results. This review examined the combined efficacy of ABM and CBT. A literature search was conducted in four main databases: PsycINFO, Embase, Pubmed and the Cochrane library, resulting in 11 randomized studies. The combination of ABM and CBT had small but significant effects on clinician-rated anxiety symptoms and attention bias towards threat compared to the control group, while ESs for anxiety (all measures), self-reported or parent-reported anxiety measures and depression symptoms were non-significant. Studies in which ABM was conducted as an integral part of each CBT session yielded greater reduction in anxiety symptoms than those conducting ABM and CBT at separate time points. Older participants and patients with social anxiety disorder tended to benefit less from the combination of ABM and CBT based on bias scores. This study may provide preliminary evidence that ABM and CBT have the potential to complement each other, especially when they are conducted integrally.
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Affiliation(s)
- Yaming Hang
- School of Psychology, Nanjing Normal University, Nanjing 210097, China; Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing 210029, China
| | - Li Xu
- School of Psychology, Nanjing Normal University, Nanjing 210097, China; Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing 210029, China
| | - Chun Wang
- School of Psychology, Nanjing Normal University, Nanjing 210097, China; Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing 210029, China; Cognitive Behavioral Therapy Institute of Nanjing Medical University, Nanjing 210029, China; Functional Brain Imaging Institute of Nanjing Medical University, Nanjing 210029, China.
| | - Guojia Zhang
- School of Psychology, Nanjing Normal University, Nanjing 210097, China; Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing 210029, China
| | - Ning Zhang
- Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing 210029, China; Cognitive Behavioral Therapy Institute of Nanjing Medical University, Nanjing 210029, China; Functional Brain Imaging Institute of Nanjing Medical University, Nanjing 210029, China
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6
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Yap D, Denefrio S, Dennis-Tiwary TA. Low working memory load facilitates attention bias modification training. Behav Res Ther 2021; 139:103828. [PMID: 33618124 DOI: 10.1016/j.brat.2021.103828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 12/27/2020] [Accepted: 02/06/2021] [Indexed: 10/22/2022]
Abstract
Implementations of attention bias modification training (ABMT) attempt to retrain attention away from rather than towards threat, thereby disrupting the anxiety-related attentional bias (AB). Yet, results of ABMT studies have been mixed due to limitations in knowledge of mechanisms underlying ABMT efficacy. Dual-process models of anxiety posit that ABMT works primarily through strengthening of the top-down cognitive control of attention to threat. If this is the case, introducing a working memory load (WML) during ABMT should reduce training efficacy. However, prior studies employing this method show mixed results (Booth, Mackintosh, Mobini, Oztop, & Nunn, 2014; Clarke et al., 2017) and fail to directly compare low and high WML with no WML or to account for individual differences in anxiety and working memory capacity (WMC). The present study (N = 306) assessed trait anxiety and WMC in neurotypical adults who were then randomly assigned to ABMT that trained attention toward or away from threat, with either no, low, or high WML, for a total of six training groups. Attentional bias was assessed before and after training. Results showed ABMT successfully trained attention under low WML, but not under high or no WML, suggesting that ABMT is facilitated by engaging but not overtaxing WML.
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Affiliation(s)
- David Yap
- Hunter College, The City University of New York, Department of Psychology, New York, NY, USA
| | - Samantha Denefrio
- Hunter College, The City University of New York, Department of Psychology, New York, NY, USA; The Graduate Center, The City University of New York, Department of Psychology, New York, NY, USA
| | - Tracy A Dennis-Tiwary
- Hunter College, The City University of New York, Department of Psychology, New York, NY, USA; The Graduate Center, The City University of New York, Department of Psychology, New York, NY, USA.
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7
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Yuan J, Zhang Q, Cui L. Disgust face captures more attention in individuals with high social anxiety when cognitive resources are abundant: Evidence from N2pc. Neuropsychologia 2020; 151:107731. [PMID: 33347915 DOI: 10.1016/j.neuropsychologia.2020.107731] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 12/12/2020] [Accepted: 12/15/2020] [Indexed: 11/16/2022]
Abstract
There is a debate about the relative contributions of top-down and bottom-up attention to the threat-related attentional bias. In this study we investigated the attentional bias in individuals with social anxiety under conditions of no, low and high visual working memory (WM) load. Event-related potential (ERP) and response time (RT) data were recorded while participants performed the dot-probe task and a concurrent change-detection task. The ERP results revealed that the maximum N2pc effect emerged in no visual WM load condition in individuals with social anxiety. The difference of N2pc effect between high socially anxious (HSA) and low socially anxious (LSA) groups was observed in no visual WM load condition, whereas this difference was eliminated under low and high load conditions. However, no significant main effects or interactions were observed in the behavioral index (reflected by Trial Level-Bias Score variability). Overall, the findings indicate the critical role of top-down attention on social anxiety-related attentional bias, which have important implication for attentional bias modification.
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Affiliation(s)
- Jing Yuan
- Beijing Key Laboratory of Learning and Cognition and School of Psychology, Capital Normal University, Beijing, China; School of Teacher Education, Hebei Normal University for Nationalities, Chengde, China
| | - Qin Zhang
- Beijing Key Laboratory of Learning and Cognition and School of Psychology, Capital Normal University, Beijing, China
| | - Lixia Cui
- Beijing Key Laboratory of Learning and Cognition and School of Psychology, Capital Normal University, Beijing, China.
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8
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Basanovic J, Grafton B, Ford A, Hirani V, Glance D, MacLeod C, Almeida OP. Cognitive bias modification to prevent depression (COPE): results of a randomised controlled trial. Psychol Med 2020; 50:2514-2525. [PMID: 31544719 DOI: 10.1017/s0033291719002599] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
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.
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Affiliation(s)
- Julian Basanovic
- Centre for the Advancement of Research on Emotion, School of Psychological Science, The University of Western Australia, Western Australia, Australia
| | - Ben Grafton
- Centre for the Advancement of Research on Emotion, School of Psychological Science, The University of Western Australia, Western Australia, Australia
| | - Andrew Ford
- Medical School, The University of Western Australia, Western Australia, Australia
- Western Australian Centre for Health and Ageing, The University of Western Australia, Western Australia, Australia
- Department of Psychiatry, Royal Perth Hospital, Western Australia, Australia
| | - Varsha Hirani
- Medical School, The University of Western Australia, Western Australia, Australia
- Western Australian Centre for Health and Ageing, The University of Western Australia, Western Australia, Australia
| | - David Glance
- UWA Centre for Software Practice, The University of Western Australia, Western Australia, Australia
| | - Colin MacLeod
- Centre for the Advancement of Research on Emotion, School of Psychological Science, The University of Western Australia, Western Australia, Australia
| | - Osvaldo P Almeida
- Medical School, The University of Western Australia, Western Australia, Australia
- Western Australian Centre for Health and Ageing, The University of Western Australia, Western Australia, Australia
- Department of Psychiatry, Royal Perth Hospital, Western Australia, Australia
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9
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Baker AW, Hellberg SN, Jacoby RJ, Losiewicz OM, Orr S, Marques L, Simon NM. A pilot study augmenting cognitive behavioral therapy for panic disorder with attention bias modification: Clinical and psychophysiological outcomes. J Behav Ther Exp Psychiatry 2020; 68:101568. [PMID: 32224333 DOI: 10.1016/j.jbtep.2020.101568] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 03/09/2020] [Accepted: 03/12/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND OBJECTIVES Studies show that attentional bias towards threat is a key maintenance factor for panic disorder (PD). Attentional bias may be an important mechanism of symptom reduction, and thus, a useful target for optimizing outcomes. The current study examined whether an attention bias modification (ABM) task enhanced CBT outcomes. Multiple methods for assessing PD were used, including physiological measurement and clinician-rated assessment. METHODS Adults with panic disorder (N = 24) received seven sessions of CBT with either ABM or sham attention tasks. Psychophysiological reaction to a loud tones startle paradigm was assessed before and after treatment. RESULTS Across both groups, panic symptom severity decreased with CBT. The ABM group showed greater reductions in PD symptoms compared to the placebo group. Notably, however, changes in attentional bias were not associated with symptom reductions across groups. No significant group differences on psychophysiological assessment were observed. LIMITATIONS This study is limited by the small sample size, which rendered our power to investigate mediators and moderators insufficient. More research is needed to validate the effect of attention bias modification on attentional bias to threat. CONCLUSIONS This pilot study suggests that future research should investigate attentional bias in conjunction with CBT. A larger sample would provide opportunity to further investigate the mechanisms through which ABM works, along with potential moderating factors and the use of psychophysiological measurements in panic disorder.
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Affiliation(s)
- A W Baker
- Massachusetts General Hospital, One Bowdoin Square, Boston, MA, 02114, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA.
| | - S N Hellberg
- University of North Carolina Chapel Hill Department of Psychology and Neuroscience, 235 E. Cameron Avenue, Chapel Hill, NC, 27599-3270, USA.
| | - R J Jacoby
- Massachusetts General Hospital, One Bowdoin Square, Boston, MA, 02114, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA.
| | - O M Losiewicz
- Massachusetts General Hospital, One Bowdoin Square, Boston, MA, 02114, USA.
| | - S Orr
- Massachusetts General Hospital, One Bowdoin Square, Boston, MA, 02114, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA.
| | - L Marques
- Massachusetts General Hospital, One Bowdoin Square, Boston, MA, 02114, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA.
| | - N M Simon
- Massachusetts General Hospital, One Bowdoin Square, Boston, MA, 02114, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA; New York University Langone Health Department of Psychiatry, One Park Avenue, 8th floor, New York, NY, 10016, USA.
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10
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Wong QJJ, McEvoy PM, Rapee RM. The structure of social-evaluative threat detection in social anxiety disorder. J Anxiety Disord 2020; 74:102273. [PMID: 32682276 DOI: 10.1016/j.janxdis.2020.102273] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 07/01/2020] [Accepted: 07/09/2020] [Indexed: 11/15/2022]
Abstract
The integrated aetiological and maintenance (IAM) model of social anxiety disorder (SAD) conceptualises four social-evaluative cognitive processes (anticipatory processing, attention to the self, attention to threat in the environment, and post-event processing) as facets of a social-evaluative threat detection construct. The current study tested this by examining potential factor structures underlying the four social-evaluative cognitive processes. Baseline data from two randomised controlled trials, consisting of 306 participants with SAD who completed measures of the four social-evaluative cognitive processes in relation to a speech task, were subjected to confirmatory factor analysis. Model fit indices and bifactor model indices showed that the optimal factor structure was a bifactor model with a Social-evaluative Threat Detection General Factor and two group factors corresponding to anticipatory processing and post-event processing. Analyses also indicated that the Social-evaluative Threat Detection General Factor had moderate to large associations with other constructs in the IAM model, whereas the two group factors only had small associations with these constructs. These findings suggest that the four social-evaluative cognitive processes can be unified as facets of a social-evaluative threat detection process, consistent with the IAM model, although group factors for anticipatory processing and post-event processing need to be taken into account.
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Affiliation(s)
- Quincy J J Wong
- School of Psychology, Western Sydney University, Sydney, New South Wales, Australia.
| | - Peter M McEvoy
- Centre for Clinical Interventions, Perth, Western Australia, Australia; School of Psychology, Curtin University, Perth, Western Australia, Australia
| | - Ronald M Rapee
- Centre for Emotional Health, Macquarie University, Sydney, New South Wales, Australia
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11
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Pelissolo A, Abou Kassm S, Delhay L. Therapeutic strategies for social anxiety disorder: where are we now? Expert Rev Neurother 2019; 19:1179-1189. [PMID: 31502896 DOI: 10.1080/14737175.2019.1666713] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Introduction: Classical well-established treatments of social anxiety disorder (SAD) are now complemented by more recent therapeutic strategies. This review aims to summarize available therapies for SAD and discuss recent evidence-based findings on the management of this disorder.Areas covered: Recent guidelines recommend psychotherapy, particularly cognitive-behavioral therapy (CBT), and pharmacotherapy, as first-line treatments of patients with SAD, without a clear superiority of one option over the other. CBT includes classical approaches such as in vivo exposure to social situations and cognitive therapy, but new modalities and techniques have been recently developed: third-wave approaches, internet-delivered therapy, virtual reality exposure, and cognitive bias modification. Selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors have been also extensively studied and shown to be effective in SAD. Two alternative strategies have been developed to treat SAD with disappointing results: cognitive bias modification, and pharmacological augmentation of psychotherapy using D-cycloserine during exposure sessions.Expert opinion: Personalized treatments for SAD patients are now available. Innovative strategies such as online psychotherapy and virtual reality exposure are useful alternatives to CBT and SSRIs. Future developments and optimization of attention bias modification and of pharmacological augmentation of psychotherapy can be promising.
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Affiliation(s)
- Antoine Pelissolo
- AP-HP, Psychiatry Department, Hôpitaux Universitaires Henri-Mondor, Faculté de médecine, Créteil, France
| | - Sandra Abou Kassm
- Faculty of Medical Sciences, Psychiatry Department, Lebanese University, Beirut, Lebanon
| | - Lauriane Delhay
- AP-HP, Psychiatry Department, Hôpitaux Universitaires Henri-Mondor, Créteil, France
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12
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Price RB, Woody ML, Panny B, Siegle GJ. Pinpointing mechanisms of a mechanistic treatment: Dissociable roles for overt and covert attentional processes in acute and long-term outcomes following Attention Bias Modification. Clin Psychol Sci 2019; 7:1042-1062. [PMID: 31984167 PMCID: PMC6979372 DOI: 10.1177/2167702619842556] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
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.
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13
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Linke JO, Jones E, Pagliaccio D, Swetlitz C, Lewis KM, Silverman WK, Bar-Haim Y, Pine DS, Brotman MA. Efficacy and mechanisms underlying a gamified attention bias modification training in anxious youth: protocol for a randomized controlled trial. BMC Psychiatry 2019; 19:246. [PMID: 31391027 PMCID: PMC6686536 DOI: 10.1186/s12888-019-2224-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Accepted: 07/29/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Attention bias modification training (ABMT) and cognitive behavioral therapy (CBT) likely target different aspects of aberrant threat responses in anxiety disorders and may be combined to maximize therapeutic benefit. However, studies investigating the effect of ABMT in the context of CBT have yielded mixed results. Here, we propose an enhanced ABMT to target the attentional bias towards threat, in addition to classic CBT for anxiety disorders in youth. This enhanced ABMT integrates the modified dot-probe task used in previous studies, where a target is always presented at the previous location of the neutral and not the simultaneously presented threatening stimulus, with a visual search, where the targets are always presented distally of threatening distractors. These two training elements (modified dot-probe and visual search) are embedded in an engaging game to foster motivation and adherence. Our goal is to determine the efficacy of the enhanced ABMT in the context of CBT. Further, we aim to replicate two previous findings: (a) aberrant amygdala connectivity being the neurobiological correlate of the attentional bias towards threat at baseline; and (b) amygdala connectivity being a mediator of the ABMT effect. We will also explore moderators of treatment response (age, sex, depressive symptoms and irritability) on a behavioral and neuronal level. METHODS One hundred and twenty youth (8-17 years old) with a primary anxiety disorder diagnosis all receive CBT and are randomized to nine weeks of either active or control ABMT and symptom improvement will be compared between the two study arms. We will also recruit 60 healthy comparison youth, who along with eligible anxious youth, will be assessed with the dot-probe task during fMRI (anxious youth: before and after training; healthy volunteers: second measurement twelve weeks after initial assessment). DISCUSSION The present study will contribute to the literature by (1) potentially replicating that aberrant amygdala connectivity mediates the attentional bias towards threat in anxious youth; (2) determining the efficacy of enhanced ABMT; and (3) advancing our understanding of the mechanisms underlying ABMT. TRIAL REGISTRATION Clinicaltrials.gov: NCT03283930 Trial registration date: September 14th 2017. The trial registration took place retrospectively. Data acquisition started February 1st 2017.
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Affiliation(s)
- Julia O. Linke
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, 9000 Rockville Pike, MSC-2670, Building 15K, Bethesda, MD 20892-2670 USA
| | - Emily Jones
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, 9000 Rockville Pike, MSC-2670, Building 15K, Bethesda, MD 20892-2670 USA
| | - David Pagliaccio
- Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, Columbia University, New York, NY USA
| | - Caroline Swetlitz
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, 9000 Rockville Pike, MSC-2670, Building 15K, Bethesda, MD 20892-2670 USA
| | - Krystal M. Lewis
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, 9000 Rockville Pike, MSC-2670, Building 15K, Bethesda, MD 20892-2670 USA
| | | | - Yair Bar-Haim
- School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Daniel S. Pine
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, 9000 Rockville Pike, MSC-2670, Building 15K, Bethesda, MD 20892-2670 USA
| | - Melissa A. Brotman
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, 9000 Rockville Pike, MSC-2670, Building 15K, Bethesda, MD 20892-2670 USA
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14
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Wong QJJ, McEvoy PM, Rapee RM. Repetitive Thinking in Social Anxiety Disorder: Are Anticipatory Processing and Post-Event Processing Facets of an Underlying Unidimensional Construct? Behav Ther 2019; 50:571-581. [PMID: 31030874 DOI: 10.1016/j.beth.2018.09.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 09/06/2018] [Accepted: 09/12/2018] [Indexed: 11/27/2022]
Abstract
Existing literature suggests that anticipatory processing and post-event processing-two repetitive thinking processes linked to social anxiety disorder (SAD)-might be better conceptualized as facets of an underlying unidimensional repetitive thinking construct. The current study tested this by examining potential factor structures underlying anticipatory processing and post-event processing. Baseline data from two randomized controlled trials, consisting of 306 participants with SAD who completed anticipatory processing and post-event processing measures in relation to a speech task, were subjected to confirmatory factor analysis. A bifactor model with a General Repetitive Thinking factor and two group factors corresponding to anticipatory processing and post-event processing best fit with the data. Further analyses indicated an optimal model would include only the General Repetitive Thinking factor (reflecting anticipatory processing and a specific aspect of post-event processing) and Post-event Processing group factor (reflecting another specific aspect of post-event processing that is separable), providing evidence against a unidimensional account of repetitive thinking in SAD. Analyses also indicated that the General Repetitive Thinking factor had moderately large associations with social anxiety and life interference (rs = .43 to .47), suggesting its maladaptive nature. The separable Post-event Processing group factor only had small associations with social anxiety (rs = .16 to .27) and was not related to life interference (r = .11), suggesting it may not, in itself, be a maladaptive process. Future research that further characterises the bifactor model components and tests their utility has the potential to improve the conceptualisation and assessment of repetitive thinking in SAD.
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Affiliation(s)
| | - Peter M McEvoy
- Centre for Clinical Interventions, Perth; Curtin University
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15
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Wong QJJ, Chen J, Gregory B, Baillie AJ, Nagata T, Furukawa TA, Kaiya H, Peters L, Rapee RM. Measurement equivalence of the Social Interaction Anxiety Scale (SIAS) and Social Phobia Scale (SPS) across individuals with social anxiety disorder from Japanese and Australian sociocultural contexts. J Affect Disord 2019; 243:165-174. [PMID: 30243196 DOI: 10.1016/j.jad.2018.09.028] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 08/13/2018] [Accepted: 09/11/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Cultural factors influence both the expression of social anxiety and the interpretation and functioning of social anxiety measures. This study aimed to test the measurement equivalence of two commonly used social anxiety measures across two sociocultural contexts using individuals with social anxiety disorder (SAD) from Australia and Japan. METHODS Scores on the straightforwardly-worded Social Interaction Anxiety Scale (S-SIAS) and the Social Phobia Scale (SPS) from two archival datasets of individual with SAD, one from Australia (n = 201) and one from Japan (n = 295), were analysed for measurement equivalence using a multigroup confirmatory factor analysis (CFA) framework. RESULTS The best-fitting factor models for the S-SIAS and SPS were not found to be measurement equivalent across the Australian and Japanese samples. Instead, only a subset of items was invariant. When this subset of invariant items was used to compare social anxiety symptoms across the Australian and Japanese samples, Japanese participants reported lower levels of fear of attracting attention, and similar levels of fear of overt evaluation, and social interaction anxiety, relative to Australian participants. LIMITATIONS We only analysed the measurement equivalence of two social anxiety measures using a specific operationalisation of culture. Future studies will need to examine the measurement equivalence of other measures of social anxiety across other operationalisations of culture. CONCLUSIONS When comparing social anxiety symptoms across Australian and Japanese cultures, only scores from measurement equivalent items of social anxiety measures should be used. Our study highlights the importance of culturally-informed assessment in SAD.
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Affiliation(s)
- Quincy J J Wong
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia; School of Social Sciences and Psychology, Western Sydney University, Sydney, Australia.
| | - Junwen Chen
- School of Psychology, Flinders University, Adelaide, Australia
| | - Bree Gregory
- School of Psychology, University of Sydney, Sydney, Australia
| | - Andrew J Baillie
- Faculty of Health Sciences, University of Sydney, Sydney, Australia
| | | | - Toshiaki A Furukawa
- Department of Health Promotion and Human Behavior and Department of Clinical Epidemiology, Kyoto University Graduate School of Medicine / School of Public Health, Kyoto, Japan
| | - Hisanobu Kaiya
- Akasaka Clinic for Psychosomatic Medicine and Psychiatry, Medical Corporation Warakukai, Tokyo, Japan
| | - Lorna Peters
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
| | - Ronald M Rapee
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
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Does Exposure Therapy Lead to Changes in Attention Bias and Approach-Avoidance Bias in Patients with Social Anxiety Disorder? COGNITIVE THERAPY AND RESEARCH 2018. [DOI: 10.1007/s10608-018-9934-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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17
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Notebaert L, Grafton B, Clarke PJ, Rudaizky D, Chen NT, MacLeod C. Emotion-in-Motion, a Novel Approach for the Modification of Attentional Bias: An Experimental Proof-of-Concept Study. JMIR Serious Games 2018; 6:e10993. [PMID: 30487121 PMCID: PMC6291684 DOI: 10.2196/10993] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 08/26/2018] [Accepted: 08/27/2018] [Indexed: 01/29/2023] Open
Abstract
Background Individuals with heightened anxiety vulnerability tend to preferentially attend to emotionally negative information, with evidence suggesting that this attentional bias makes a causal contribution to anxiety vulnerability. Recent years have seen an increase in the use of attentional bias modification (ABM) procedures to modify patterns of attentional bias; however, often this change in bias is not successfully achieved. Objective This study presents a novel ABM procedure, Emotion-in-Motion, requiring individuals to engage in patterns of attentional scanning and tracking within a gamified, complex, and dynamic environment. We aimed to examine the capacity of this novel procedure, as compared with the traditional probe-based ABM procedure, to produce a change in attentional bias and result in a change in anxiety vulnerability. Methods We administered either an attend-positive or attend-negative version of our novel ABM task or the conventional probe-based ABM task to undergraduate students (N=110). Subsequently, participants underwent an anagram stressor task, with state anxiety assessed before and following this stressor. Results Although the conventional ABM task failed to induce differential patterns of attentional bias or affect anxiety vulnerability, the Emotion-in-Motion training did induce a greater attentional bias to negative faces in the attend-negative training condition than in the attend-positive training condition (P=.003, Cohen d=0.87) and led to a greater increase in stressor-induced state anxiety faces in the attend-negative training condition than in the attend-positive training condition (P=.03, Cohen d=0.60). Conclusions Our novel, gamified Emotion-in-Motion ABM task appears more effective in modifying patterns of attentional bias and anxiety vulnerability. Candidate mechanisms contributing to these findings are discussed, including the increased stimulus complexity, dynamic nature of the stimulus presentation, and enriched performance feedback.
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Affiliation(s)
- Lies Notebaert
- Centre for the Advancement of Research on Emotion, School of Psychological Science, University of Western Australia, Crawley, Australia
| | - Ben Grafton
- Centre for the Advancement of Research on Emotion, School of Psychological Science, University of Western Australia, Crawley, Australia
| | - Patrick Jf Clarke
- Centre for the Advancement of Research on Emotion, School of Psychological Science, University of Western Australia, Crawley, Australia.,School of Psychology, Curtin University, Bently, Australia
| | - Daniel Rudaizky
- Centre for the Advancement of Research on Emotion, School of Psychological Science, University of Western Australia, Crawley, Australia
| | - Nigel Tm Chen
- School of Psychology, Curtin University, Bently, Australia
| | - Colin MacLeod
- Centre for the Advancement of Research on Emotion, School of Psychological Science, University of Western Australia, Crawley, Australia
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Salum GA, Petersen CS, Jarros RB, Toazza R, DeSousa D, Borba LN, Castro S, Gallegos J, Barrett P, Abend R, Bar-Haim Y, Pine DS, Koller SH, Manfro GG. Group Cognitive Behavioral Therapy and Attention Bias Modification for Childhood Anxiety Disorders: A Factorial Randomized Trial of Efficacy. J Child Adolesc Psychopharmacol 2018; 28:620-630. [PMID: 29969293 PMCID: PMC6421990 DOI: 10.1089/cap.2018.0022] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The objective of this study is to assess group differences in symptom reduction between individuals receiving group cognitive behavioral therapy (G-CBT) and attention bias modification (ABM) compared to their respective control interventions, control therapy (CT), and attention control training (ACT), in a 2 × 2 factorial design. METHODS A total of 310 treatment-naive children (7-11 years of age) were assessed for eligibility and 79 children with generalized, separation or social anxiety disorder were randomized and received G-CBT (n = 42) or CT (n = 37). Within each psychotherapy group, participants were again randomized to ABM (n = 38) or ACT (n = 41) in a 2 × 2 factorial design resulting in four groups: G-CBT + ABM (n = 21), G-CBT + ACT (n = 21), CT + ABM (n = 17), and CT + ACT (n = 20). Primary outcomes were responder designation as defined by Clinical Global Impression-Improvement (CGI-I) scale (≤2) and change on the Pediatric Anxiety Rating Scale (PARS). RESULTS There were significant improvements of symptoms in all groups. No differences in response rates or mean differences in PARS scores were found among groups: G-CBT + ABM group (23.8% response; 3.9 points, 95% confidence interval [CI] -0.3 to 8.1), G-CBT + ACT (42.9% response; 5.6 points, 95% CI 2.2-9.0), CT + ABM (47.1% response; 4.8 points 95% CI 1.08-8.57), and CT + ACT (30% response; 0.8 points, 95% CI -3.0 to 4.7). No evidence or synergic or antagonistic effects were found, but the combination of G-CBT and ABM was found to increase dropout rate. CONCLUSIONS We found no effect of G-CBT or ABM beyond the effects of comparison groups. Results reveal no benefit from combining G-CBT and ABM for anxiety disorders in children and suggest potential deleterious effects of the combination on treatment acceptability.
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Affiliation(s)
- Giovanni A. Salum
- Child and Adolescent Anxiety Program, Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Address correspondence to: Giovanni A. Salum, MD, PhD Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Ramiro Barcelos, 2350-room 2202, Porto Alegre 90035-003, Brazil
| | - Circe S. Petersen
- Center of Psychological Studies on at Risk Populations, Institute of Psychology, Porto Alegre, Brazil
| | - Rafaela B. Jarros
- Child and Adolescent Anxiety Program, Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Rudineia Toazza
- Child and Adolescent Anxiety Program, Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Diogo DeSousa
- Child and Adolescent Anxiety Program, Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Center of Psychological Studies on at Risk Populations, Institute of Psychology, Porto Alegre, Brazil
| | - Lidiane Nunes Borba
- Child and Adolescent Anxiety Program, Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Stela Castro
- Institute of Mathematics, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Julia Gallegos
- Department of Psychology, University of Monterrey, Monterrey, Mexico
| | - Paula Barrett
- Faculty of Social and Behavioral Sciences, School of Education, The University of Queensland, Brisbane, Australia
| | - Rany Abend
- School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Yair Bar-Haim
- School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Daniel S. Pine
- Emotion and Development Branch, Intramural Research Program, National Institute of Mental Health, Bethesda, Maryland
| | - Silvia H. Koller
- Center of Psychological Studies on at Risk Populations, Institute of Psychology, Porto Alegre, Brazil
| | - Gisele G. Manfro
- Child and Adolescent Anxiety Program, Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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Lazarov A, Marom S, Yahalom N, Pine DS, Hermesh H, Bar-Haim Y. Attention bias modification augments cognitive-behavioral group therapy for social anxiety disorder: a randomized controlled trial. Psychol Med 2018; 48:2177-2185. [PMID: 29258631 PMCID: PMC6013362 DOI: 10.1017/s003329171700366x] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Cognitive-behavioral group therapy (CBGT) is a first-line treatment for social anxiety disorder (SAD). However, since many patients remain symptomatic post-treatment, there is a need for augmenting procedures. This randomized controlled trial (RCT) examined the potential augmentation effect of attention bias modification (ABM) for CBGT. METHODS Fifty patients with SAD from three therapy groups were randomized to receive an 18-week standard CBGT with either ABM designed to shift attention away from threat (CBGT + ABM), or a placebo protocol not designed to modify threat-related attention (CBGT + placebo). Therapy groups took place in a large mental health center. Clinician and self-report measures of social anxiety and depression were acquired pre-treatment, post-treatment, and at 3-month follow-up. Attention bias was assessed at pre- and post-treatment. RESULTS Patients randomized to the CBGT + ABM group, relative to those randomized to the CBGT + placebo group, showed greater reductions in clinician-rated SAD symptoms post-treatment, with effects maintained at 3-month follow-up. Group differences were not evident for self-report or attention-bias measures, with similar reductions in both groups. Finally, reduction in attention bias did not mediate the association between group and reduction in Liebowitz Social Anxiety Scale Structured Interview (LSAS) scores. CONCLUSIONS This is the first RCT to examine the possible augmenting effect of ABM added to group-based cognitive-behavioral therapy for adult SAD. Training patients' attention away from threat might augment the treatment response to standard CBGT in SAD, a possibility that could be further evaluated in large-scale RCTs.
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Affiliation(s)
- Amit Lazarov
- Department of Psychiatry, Columbia University Medical Center, 1051 Riverside Drive, New York, NY 10032, USA
| | - Sofi Marom
- Anxiety Disorders and Behavior Therapy Unit, Outpatient Department, Geha Mental Health Center, Tel-Aviv University, Tel-Aviv, Israel
| | - Naomi Yahalom
- Anxiety Disorders and Behavior Therapy Unit, Outpatient Department, Geha Mental Health Center, Tel-Aviv University, Tel-Aviv, Israel
| | - Daniel S. Pine
- Section on Developmental Affective Neuroscience, National Institute of Mental Health, Bethesda, Maryland, USA
| | - Haggai Hermesh
- Anxiety Disorders and Behavior Therapy Unit, Outpatient Department, Geha Mental Health Center and Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Yair Bar-Haim
- School of Psychological Sciences and Sagol School of Neuroscience, Tel Aviv University, Tel-Aviv, Israel
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20
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Woud ML, Blackwell SE, Cwik JC, Margraf J, Holmes EA, Steudte-Schmiedgen S, Herpertz S, Kessler H. Augmenting inpatient treatment for post-traumatic stress disorder with a computerised cognitive bias modification procedure targeting appraisals (CBM-App): protocol for a randomised controlled trial. BMJ Open 2018; 8:e019964. [PMID: 29961004 PMCID: PMC6042580 DOI: 10.1136/bmjopen-2017-019964] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Influential theories of post-traumatic stress disorder (PTSD) suggest that dysfunctional appraisals of trauma play a key role in the maintenance of symptoms, and this suggestion is increasingly supported by research. Experimental studies have indicated that a simple computerised cognitive training procedure, here termed cognitive bias modification-appraisals (CBM-App), can modify trauma-relevant appraisals and reduce analogue trauma symptoms among healthy volunteers. This suggests the possibility that CBM-App could improve outcomes in PTSD via targeting the key process of dysfunctional appraisals, for example, if applied as an adjunct to treatment. METHODS AND ANALYSIS The study is a randomised controlled trial with two parallel arms. It is planned to randomise 80 patients admitted for treatment for PTSD to an inpatient treatment clinic to complete either sessions of CBM-App or a sham-training control condition, the peripheral vision task. Both interventions comprise eight sessions scheduled over a 2-week period and are completed in addition to the standard treatment programme in the clinic. Outcome assessment occurs pretraining, after 1 week of training, post-training, at discharge from the inpatient clinic and 6 weeks and 3 months postdischarge. The primary outcome is dysfunctional trauma-relevant appraisals at post-training, measured using a scenario completion task. Secondary outcomes include symptom measures and hair cortisol. Outcome analyses will be primarily via mixed linear models and conducted with both intention to treat and per protocol samples. ETHICS AND DISSEMINATION The trial has been approved by the Ethics Committee for the Faculty of Psychology, Ruhr-Universität Bochum (approval no 204) and the Ethics Committee for the Faculty of Medicine, Ruhr-Universität Bochum (approval no 15-5477). Results will be published in peer-reviewed journals and will inform future clinical and experimental studies into targeting maladaptive appraisals for the reduction of PTSD symptoms. TRIAL REGISTRATION NUMBER NCT02687555.
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Affiliation(s)
- Marcella L Woud
- Department of Psychology, Mental Health Research and Treatment Center, Ruhr-Universität Bochum, Bochum, Germany
| | - Simon E Blackwell
- Department of Psychology, Mental Health Research and Treatment Center, Ruhr-Universität Bochum, Bochum, Germany
| | - Jan C Cwik
- Department of Psychology, Mental Health Research and Treatment Center, Ruhr-Universität Bochum, Bochum, Germany
| | - Jürgen Margraf
- Department of Psychology, Mental Health Research and Treatment Center, Ruhr-Universität Bochum, Bochum, Germany
| | - Emily A Holmes
- Department for Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Susann Steudte-Schmiedgen
- Department of Psychology, Technische Universität Dresden, Dresden, Germany
- Department of Psychotherapy and Psychosomatic Medicine, Technische Universität Dresden, Dresden, Germany
| | - Stephan Herpertz
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Hospital, Ruhr-Universität Bochum, Bochum, Germany
| | - Henrik Kessler
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Hospital, Ruhr-Universität Bochum, Bochum, Germany
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Naim R, Kivity Y, Bar-Haim Y, Huppert JD. Attention and interpretation bias modification treatment for social anxiety disorder: A randomized clinical trial of efficacy and synergy. J Behav Ther Exp Psychiatry 2018; 59:19-30. [PMID: 29127945 DOI: 10.1016/j.jbtep.2017.10.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 09/11/2017] [Accepted: 10/23/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND OBJECTIVES Attention bias modification treatment (ABMT) and cognitive bias modification of interpretation (CBM-I) both have demonstrated efficacy in alleviating social anxiety, but how they compare with each other, their combination, and with a combined control condition has not been studied. We examined their relative and combined efficacy compared to control conditions in a randomized controlled trial (RCT). METHODS Ninety-five adults diagnosed with social anxiety disorder (SAD), were randomly allocated to 4 groups: ABMT + CBM-I control (hereafter ABMT; n = 23), CBM-I + ABMT control (hereafter CBM-I; n = 24), combined ABMT + CBM-I (n = 23), and combined control (n = 25). Treatment included eight sessions over four weeks. Clinician-rated and self-reported measures of social anxiety symptoms, functional impairment, and threat-related attention and interpretive biases were evaluated at baseline, post-treatment, and 3-month follow-up. RESULTS ABMT yielded greater symptom reduction as measured by both clinician-ratings (Cohen's ds = 0.57-0.70) and self-reports (ds = 0.70-0.85) compared with the CBM-I, the combined ABMT + CBM-I, and the combined control conditions. Neither of the other conditions demonstrated superior symptom change compared to the control condition. No group differences were found for functioning or cognitive biases measures. LIMITATIONS Limitations mainly include the mix of active and control treatments applied across the different groups. Therefore, the net effect of each of the treatments by itself could not be clearly tested. CONCLUSIONS Results suggest superiority of ABMT compared to CBM-I and their combination in terms of symptom reduction. Possible interpretations and methodological issues underlying the observed findings are discussed.
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Affiliation(s)
- Reut Naim
- School of Psychological Sciences, Tel Aviv University, Israel.
| | - Yogev Kivity
- Department of Psychology, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yair Bar-Haim
- School of Psychological Sciences, Tel Aviv University, Israel; The Sagol School of Neuroscience, Tel Aviv University, Israel
| | - Jonathan D Huppert
- Department of Psychology, The Hebrew University of Jerusalem, Jerusalem, Israel
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22
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Rawdon C, Murphy D, Motyer G, Munafò MR, Penton-Voak I, Fitzgerald A. An investigation of emotion recognition training to reduce symptoms of social anxiety in adolescence. Psychiatry Res 2018; 263:257-267. [PMID: 29602534 DOI: 10.1016/j.psychres.2018.02.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 02/06/2018] [Accepted: 02/06/2018] [Indexed: 12/21/2022]
Abstract
This study aimed to examine the effect of emotion recognition training on social anxiety symptoms among adolescents, aged 15-18 years. The study included a screening session, which identified participants who scored above a cut-off on a self-report measure of social anxiety for enrolment into a randomized controlled trial (Clinical Trials ID: NCT02550379). Participants were randomized to an intervention condition designed to increase the perception of happiness over disgust in ambiguous facial expressions or a sham intervention control condition, and completed self-report measures of social anxiety, fear of negative evaluation, anxiety-related disorders, and depressive symptoms. The intervention group demonstrated a strong shift in the balance point at which they perceived happiness over disgust in ambiguous facial expressions. This increase in positive perception was not associated with any changes in the primary outcome of social anxiety; however, some evidence of improvement in symptomatology was observed on one of a number of secondary outcomes. Those in the intervention group had lower depression symptoms at 2-week follow-up, compared to those in the control group who received the sham intervention training. Potential reasons for why the shift in balance point measurement was not associated with a concurrent shift in symptoms of social anxiety are discussed.
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Affiliation(s)
- Caroline Rawdon
- School of Nursing and Human Sciences, Dublin City University, Glasnevin, Dublin 9, Ireland.
| | - Daria Murphy
- University College Dublin School of Psychology, Newman Building Belfield, Dublin 4 Dublin, Leinster Ireland.
| | - Gillian Motyer
- University College Dublin School of Psychology, Newman Building Belfield, Dublin 4 Dublin, Leinster Ireland.
| | - Marcus R Munafò
- School of Experimental Psychology, University of Bristol, 12a Priory Road, Bristol BS8 1TU, United Kingdom; MRC Integrative Epidemiology Unit, University of Bristol, 12a Priory Road, Bristol BS8 1TU, United Kingdom; National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, United Kingdom.
| | - Ian Penton-Voak
- School of Experimental Psychology, University of Bristol, 12a Priory Road, Bristol BS8 1TU, United Kingdom; National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, United Kingdom.
| | - Amanda Fitzgerald
- University College Dublin School of Psychology, Newman Building Belfield, Dublin 4 Dublin, Leinster Ireland.
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Heeren A, Billieux J, Philippot P, De Raedt R, Baeken C, de Timary P, Maurage P, Vanderhasselt MA. Impact of transcranial direct current stimulation on attentional bias for threat: a proof-of-concept study among individuals with social anxiety disorder. Soc Cogn Affect Neurosci 2017; 12:251-260. [PMID: 27531388 PMCID: PMC5390730 DOI: 10.1093/scan/nsw119] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 08/12/2016] [Indexed: 11/14/2022] Open
Abstract
Cognitive models posit that social anxiety disorder (SAD) is associated with and maintained by attentional bias (AB) for social threat. However, over the last years, it has been suggested that AB in SAD may result from a decreased activation of the left prefrontal cortex, and particularly of its dorsolateral part (dlPFC). Accordingly, a transient increase of neural activity within the left dlPFC via non-invasive brain stimulation decreases AB in non-anxious control participants. Yet, none of these studies focused on SAD. This is especially unfortunate as SAD constitutes the main target for which a genuine reduction of AB may be most appropriate. In this experiment, we sought to investigate the causal influence of left dlPFC neuromodulation on AB among 19 female individuals with a DSM-5 diagnosis of SAD. We adopted a double-blind within-subject protocol in which we delivered a single-session of anodal versus sham transcranial Direct Current Stimulation (tDCS) over the left dlPFC during the completion of a probe discrimination task assessing AB. Consistent with our hypothesis, participants demonstrated a significant decrease in AB during the anodal tDCS over the left DLPFC relative to the sham stimulation. These findings value tDCS as an innovative procedure to gain new insight into the underlying mechanisms of SAD.
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Affiliation(s)
- Alexandre Heeren
- Department of Psychology, Harvard University, Cambridge, MA, USA.,Psychological Science Research Institute, Université Catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Joël Billieux
- Psychological Science Research Institute, Université Catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Pierre Philippot
- Psychological Science Research Institute, Université Catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Rudi De Raedt
- Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Chris Baeken
- Department of Psychiatry and Medical Psychology, Ghent University, Ghent, Belgium.,Faculty of Medicine and Pharmacy, Free University Brussels, Brussels, Belgium
| | - Philippe de Timary
- Psychological Science Research Institute, Université Catholique de Louvain, Louvain-la-Neuve, Belgium.,Institute of Neuroscience, Université Catholique de Louvain, Brussels, Belgium.,Department of Adult Psychiatry, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Pierre Maurage
- Psychological Science Research Institute, Université Catholique de Louvain, Louvain-la-Neuve, Belgium.,Institute of Neuroscience, Université Catholique de Louvain, Brussels, Belgium
| | - Marie-Anne Vanderhasselt
- Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium.,Department of Psychiatry and Medical Psychology, Ghent University, Ghent, Belgium.,Faculty of Medicine and Pharmacy, University Hospital Brussel (UZ Brussel), Brussels, Belgium
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24
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Grafton B, MacLeod C, Rudaizky D, Holmes EA, Salemink E, Fox E, Notebaert L. Confusing procedures with process when appraising the impact of cognitive bias modification on emotional vulnerability †. Br J Psychiatry 2017; 211:266-271. [PMID: 29092835 DOI: 10.1192/bjp.bp.115.176123] [Citation(s) in RCA: 118] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Revised: 03/06/2017] [Accepted: 03/22/2017] [Indexed: 11/23/2022]
Abstract
If meta-analysis is to provide valuable answers, then it is critical to ensure clarity about the questions being asked. Here, we distinguish two important questions concerning cognitive bias modification research that are not differentiated in the meta-analysis recently published by Cristea et al (2015) in this journal: (1) do the varying procedures that investigators have employed with the intention of modifying cognitive bias, on average, significantly impact emotional vulnerability?; and (2) does the process of successfully modifying cognitive bias, on average, significantly impact emotional vulnerability? We reanalyse the data from Cristea et al to address this latter question. Our new analyses demonstrate that successfully modifying cognitive bias does significantly alter emotional vulnerability. We revisit Cristea et al's conclusions in light of these findings.
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Affiliation(s)
- Ben Grafton
- Ben Grafton, PhD, Centre for the Advancement of Research on Emotion, School of Psychology, University of Western Australia; Colin MacLeod, PhD, Centre for the Advancement of Research on Emotion, School of Psychology, University of Western Australia, School of Psychology, Babes-Bolyai University, Romania; Daniel Rudaizky, PhD, Centre for the Advancement of Research on Emotion, School of Psychology, University of Western Australia; Emily A. Holmes, PhD, Medical Research Council, Cognition and Brain Sciences Unit, Cambridge, UK, and Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden; Elske Salemink, PhD, Developmental Psychology, University of Amsterdam, Amsterdam, The Netherlands; Elaine Fox, PhD, Oxford Centre for Emotion and Affective Neuroscience, and Department of Experimental Psychology, University of Oxford, UK; Lies Notebaert, PhD, Centre for the Advancement of Research on Emotion, School of Psychology, University of Western Australia
| | - Colin MacLeod
- Ben Grafton, PhD, Centre for the Advancement of Research on Emotion, School of Psychology, University of Western Australia; Colin MacLeod, PhD, Centre for the Advancement of Research on Emotion, School of Psychology, University of Western Australia, School of Psychology, Babes-Bolyai University, Romania; Daniel Rudaizky, PhD, Centre for the Advancement of Research on Emotion, School of Psychology, University of Western Australia; Emily A. Holmes, PhD, Medical Research Council, Cognition and Brain Sciences Unit, Cambridge, UK, and Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden; Elske Salemink, PhD, Developmental Psychology, University of Amsterdam, Amsterdam, The Netherlands; Elaine Fox, PhD, Oxford Centre for Emotion and Affective Neuroscience, and Department of Experimental Psychology, University of Oxford, UK; Lies Notebaert, PhD, Centre for the Advancement of Research on Emotion, School of Psychology, University of Western Australia
| | - Daniel Rudaizky
- Ben Grafton, PhD, Centre for the Advancement of Research on Emotion, School of Psychology, University of Western Australia; Colin MacLeod, PhD, Centre for the Advancement of Research on Emotion, School of Psychology, University of Western Australia, School of Psychology, Babes-Bolyai University, Romania; Daniel Rudaizky, PhD, Centre for the Advancement of Research on Emotion, School of Psychology, University of Western Australia; Emily A. Holmes, PhD, Medical Research Council, Cognition and Brain Sciences Unit, Cambridge, UK, and Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden; Elske Salemink, PhD, Developmental Psychology, University of Amsterdam, Amsterdam, The Netherlands; Elaine Fox, PhD, Oxford Centre for Emotion and Affective Neuroscience, and Department of Experimental Psychology, University of Oxford, UK; Lies Notebaert, PhD, Centre for the Advancement of Research on Emotion, School of Psychology, University of Western Australia
| | - Emily A Holmes
- Ben Grafton, PhD, Centre for the Advancement of Research on Emotion, School of Psychology, University of Western Australia; Colin MacLeod, PhD, Centre for the Advancement of Research on Emotion, School of Psychology, University of Western Australia, School of Psychology, Babes-Bolyai University, Romania; Daniel Rudaizky, PhD, Centre for the Advancement of Research on Emotion, School of Psychology, University of Western Australia; Emily A. Holmes, PhD, Medical Research Council, Cognition and Brain Sciences Unit, Cambridge, UK, and Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden; Elske Salemink, PhD, Developmental Psychology, University of Amsterdam, Amsterdam, The Netherlands; Elaine Fox, PhD, Oxford Centre for Emotion and Affective Neuroscience, and Department of Experimental Psychology, University of Oxford, UK; Lies Notebaert, PhD, Centre for the Advancement of Research on Emotion, School of Psychology, University of Western Australia
| | - Elske Salemink
- Ben Grafton, PhD, Centre for the Advancement of Research on Emotion, School of Psychology, University of Western Australia; Colin MacLeod, PhD, Centre for the Advancement of Research on Emotion, School of Psychology, University of Western Australia, School of Psychology, Babes-Bolyai University, Romania; Daniel Rudaizky, PhD, Centre for the Advancement of Research on Emotion, School of Psychology, University of Western Australia; Emily A. Holmes, PhD, Medical Research Council, Cognition and Brain Sciences Unit, Cambridge, UK, and Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden; Elske Salemink, PhD, Developmental Psychology, University of Amsterdam, Amsterdam, The Netherlands; Elaine Fox, PhD, Oxford Centre for Emotion and Affective Neuroscience, and Department of Experimental Psychology, University of Oxford, UK; Lies Notebaert, PhD, Centre for the Advancement of Research on Emotion, School of Psychology, University of Western Australia
| | - Elaine Fox
- Ben Grafton, PhD, Centre for the Advancement of Research on Emotion, School of Psychology, University of Western Australia; Colin MacLeod, PhD, Centre for the Advancement of Research on Emotion, School of Psychology, University of Western Australia, School of Psychology, Babes-Bolyai University, Romania; Daniel Rudaizky, PhD, Centre for the Advancement of Research on Emotion, School of Psychology, University of Western Australia; Emily A. Holmes, PhD, Medical Research Council, Cognition and Brain Sciences Unit, Cambridge, UK, and Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden; Elske Salemink, PhD, Developmental Psychology, University of Amsterdam, Amsterdam, The Netherlands; Elaine Fox, PhD, Oxford Centre for Emotion and Affective Neuroscience, and Department of Experimental Psychology, University of Oxford, UK; Lies Notebaert, PhD, Centre for the Advancement of Research on Emotion, School of Psychology, University of Western Australia
| | - Lies Notebaert
- Ben Grafton, PhD, Centre for the Advancement of Research on Emotion, School of Psychology, University of Western Australia; Colin MacLeod, PhD, Centre for the Advancement of Research on Emotion, School of Psychology, University of Western Australia, School of Psychology, Babes-Bolyai University, Romania; Daniel Rudaizky, PhD, Centre for the Advancement of Research on Emotion, School of Psychology, University of Western Australia; Emily A. Holmes, PhD, Medical Research Council, Cognition and Brain Sciences Unit, Cambridge, UK, and Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden; Elske Salemink, PhD, Developmental Psychology, University of Amsterdam, Amsterdam, The Netherlands; Elaine Fox, PhD, Oxford Centre for Emotion and Affective Neuroscience, and Department of Experimental Psychology, University of Oxford, UK; Lies Notebaert, PhD, Centre for the Advancement of Research on Emotion, School of Psychology, University of Western Australia
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25
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Wong QJJ, Gregory B, McLellan LF, Kangas M, Abbott MJ, Carpenter L, McEvoy PM, Peters L, Rapee RM. Anticipatory Processing, Maladaptive Attentional Focus, and Postevent Processing for Interactional and Performance Situations: Treatment Response and Relationships With Symptom Change for Individuals With Social Anxiety Disorder. Behav Ther 2017; 48:651-663. [PMID: 28711115 DOI: 10.1016/j.beth.2017.03.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 03/29/2017] [Accepted: 03/29/2017] [Indexed: 10/19/2022]
Abstract
Anticipatory processing, maladaptive attentional focus, and postevent processing are key cognitive constructs implicated in the maintenance of social anxiety disorder (SAD). The current study examined how treatment for SAD concurrently affects these three cognitive maintaining processes and how these processes are associated with each other as well as with symptom change from pre- to posttreatment. The sample consisted of 116 participants with SAD receiving group cognitive behavioral therapy. All three cognitive maintaining processes were measured relative to a speech task and again relative to a conversation task. Across both tasks, the three cognitive process variables demonstrated decreases from pre- to posttreatment. Within the same task, a slower rate of decrease in a specific cognitive process variable from pre- to posttreatment was predicted from higher pretreatment levels of either one or both of the other cognitive process variables. Additionally, higher levels of pretreatment conversation-related anticipatory processing and maladaptive attentional focus predicted a slower rate of decrease in social anxiety symptoms from pre- to posttreatment. Results are consistent with cognitive models of SAD and have important implications for enhancing existing treatments.
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26
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Yang R, Cui L, Li F, Xiao J, Zhang Q, Oei TPS. Effects of Cognitive Bias Modification Training via Smartphones. Front Psychol 2017; 8:1370. [PMID: 28855880 PMCID: PMC5557816 DOI: 10.3389/fpsyg.2017.01370] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 07/28/2017] [Indexed: 11/13/2022] Open
Abstract
Background and Objectives: Negative cognitive biases have been linked to anxiety and mood problems. Accumulated data from laboratory studies show that positive and negative interpretation styles with accompanying changes in mood can be induced through cognitive bias modification (CBM) paradigms. Despite the therapeutic potential of positive training effects, few studies have explored training paradigms administered via smartphones. The current study aimed to compare the effectiveness of three different types of training programmes (cognitive bias modification-attention, CBM-A; cognitive bias modification-interpretation, CBM-I; attention and interpretation modification, AIM) administered via smart-phones by using a control condition (CC). Methods:Seventy-six undergraduate participants with high social anxiety (Liebowitz Social Anxiety Scale, LSAS ≥ 30) were randomly assigned to four groups: CBM-A (n = 20), CBM-I (n = 20), AIM (n = 16), and CC (n = 20). Results: The results showed that the effects of CBM training, CBM-I training, or AIM training vs. CC for attention yielded no significant differences in dot-probe attention bias scores. The CBM-I group showed significantly less threat interpretation and more benign interpretation than the CC group on interpretation bias scores. Conclusions: The present results supported the feasibility of delivering CBM-I via smartphones, but the effectiveness of CBM-A and AIM training via smartphones was limited.
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Affiliation(s)
- Ranming Yang
- Beijing Key Laboratory of Learning and Cognition and Department of Psychology, Capital Normal UniversityBeijing, China.,Criminal Justice College, China University of Political Science and LawBeijing, China
| | - Lixia Cui
- Beijing Key Laboratory of Learning and Cognition and Department of Psychology, Capital Normal UniversityBeijing, China
| | - Feng Li
- Beijing Key Laboratory of Learning and Cognition and Department of Psychology, Capital Normal UniversityBeijing, China
| | - Jing Xiao
- Beijing Key Laboratory of Learning and Cognition and Department of Psychology, Capital Normal UniversityBeijing, China
| | - Qin Zhang
- Beijing Key Laboratory of Learning and Cognition and Department of Psychology, Capital Normal UniversityBeijing, China
| | - Tian P S Oei
- School of Psychology and CBT Unit, Toowong Private Hospital, University of QueenslandBrisbane, QLD, Australia.,Psychology Section, James Cook UniversitySingapore, Singapore
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27
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Byrow Y, Peters L. The influence of attention biases and adult attachment style on treatment outcome for adults with social anxiety disorder. J Affect Disord 2017; 217:281-288. [PMID: 28441619 DOI: 10.1016/j.jad.2017.04.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 03/27/2017] [Accepted: 04/16/2017] [Indexed: 01/04/2023]
Abstract
BACKGROUND Attention biases figure prominently in CBT models of social anxiety and are thought to maintain symptoms of social anxiety disorder (SAD). Studies have shown that individual differences in pre-treatment attention biases predict cognitive behavioural therapy (CBT) outcome. However, these findings have been inconsistent as to whether vigilance towards threat predicts better or poorer treatment outcome. Adult attachment style is an individual characteristic that may influence the relationship between attention bias and SAD. This study investigates the relationship between attention biases and CBT treatment outcome for SAD. Furthermore, we examined the influence of adult attachment style on this relationship. METHOD Participants with a primary diagnosis of SAD completed a passive viewing (measuring vigilance towards threat) and a novel difficulty to disengage (measuring difficulty to disengage attention) eye-tracking task prior to attending 12 CBT group sessions targeting SAD. Symptom severity was measured at pre- and post-treatment. Regression analyses were conducted on a sample of 50 participants. RESULTS Greater vigilance for threat than avoidance of threat at pre-treatment predicted poorer treatment outcomes. Greater difficulty disengaging from happy faces, compared to neutral faces, predicted poorer treatment outcomes. Attachment style did not moderate these relationships. LIMITATIONS The associations between attention biases and specific components of CBT treatment were not examined. The novel findings regarding difficulty to disengage attention require replication. CONCLUSIONS The findings have implications for the theoretical models of SAD and for the treatment of SAD.
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Affiliation(s)
- Yulisha Byrow
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia.
| | - Lorna Peters
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
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28
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Mogg K, Waters AM, Bradley BP. Attention Bias Modification (ABM): Review of Effects of Multisession ABM Training on Anxiety and Threat-Related Attention in High-Anxious Individuals. Clin Psychol Sci 2017; 5:698-717. [PMID: 28752017 PMCID: PMC5513441 DOI: 10.1177/2167702617696359] [Citation(s) in RCA: 99] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Accepted: 02/01/2017] [Indexed: 11/18/2022]
Abstract
Attention bias modification (ABM) aims to reduce anxiety by reducing attention bias (AB) to threat; however, effects on anxiety and AB are variable. This review examines 34 studies assessing effects of multisession-ABM on both anxiety and AB in high-anxious individuals. Methods include ABM-threat-avoidance (promoting attention-orienting away from threat), ABM-positive-search (promoting explicit, goal-directed attention-search for positive/nonthreat targets among negative/threat distractors), and comparison conditions (e.g., control-attention training combining threat-cue exposure and attention-task practice without AB-modification). Findings indicate anxiety reduction often occurs during both ABM-threat-avoidance and control-attention training; anxiety reduction is not consistently accompanied by AB reduction; anxious individuals often show no pretraining AB in orienting toward threat; and ABM-positive-search training appears promising in reducing anxiety. Methodological and theoretical issues are discussed concerning ABM paradigms, comparison conditions, and AB assessment. ABM methods combining explicit goal-directed attention-search for nonthreat/positive information and effortful threat-distractor inhibition (promoting top-down cognitive control during threat-cue exposure) warrant further evaluation.
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29
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Liu H, Li X, Han B, Liu X. Effects of cognitive bias modification on social anxiety: A meta-analysis. PLoS One 2017; 12:e0175107. [PMID: 28384301 PMCID: PMC5383070 DOI: 10.1371/journal.pone.0175107] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 03/21/2017] [Indexed: 12/14/2022] Open
Abstract
Background Cognitive bias modification (CBM), a set of techniques for modifying bias in information processing—is considered a novel intervention for social anxiety disorder (SAD), which has drawn considerable interest from researchers. However, the effects of CBM on SAD are not consistent. Some studies have demonstrated significant positive effects compared to control groups, while others have found no such effects. Aims We conducted a meta-analysis aimed at quantitatively assessing the effects of CBM on SAD at post-test. Method Through a systematic literature search by two independent raters, 34 articles (36 randomized studies) including 2,550 participants were identified. A multilevel modeling approach was employed to assess the effects of CBM on SAD, and to explore the potentially crucial procedures and sample characteristics that enhance the effectiveness of benign training. Results In general, there were small but significant effects of CBM on the primary symptoms of SAD (g = 0.17), cognitive bias (CB) toward threat (g = 0.32), and reactivity in stressful situations (g = 0.25), but non-significant effects on secondary symptoms. However, the interpretation modification program was more effective than was attentional bias modification in reducing SAD primary symptoms and negative CB. Laboratory training procedures produced larger primary symptom reductions compared to Internet-based training, whereas the percentage of contingency and feedback about training performance boosted cognitive effects only. Finally, the following groups were more likely to benefit from CBM: younger participants (primary symptoms and cognitive effects), women (primary symptom effects), and samples with stronger CB (stressor effects). The quality of the randomized controlled trials was less than desirable, as there was some indication of publication bias in our study. Conclusions Current findings broadly supported cognitive theories of SAD that consider a bidirectional or mutually reinforcing relationship between symptoms and CBs. However, the small therapeutic effect observed here indicates that it is necessary to develop more reliable and efficient CBM interventions that are specific to SAD.
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Affiliation(s)
- Haining Liu
- Key Lab of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Psychology Department of Chengde Medical University, Chengde, China
- University of Chinese Academy of Sciences, Beijing, China
| | - Xianwen Li
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - Buxin Han
- Key Lab of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- University of Chinese Academy of Sciences, Beijing, China
- * E-mail:
| | - Xiaoqian Liu
- Key Lab of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- University of Chinese Academy of Sciences, Beijing, China
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30
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Capron DW, Norr AM, Allan NP, Schmidt NB. Combined "top-down" and "bottom-up" intervention for anxiety sensitivity: Pilot randomized trial testing the additive effect of interpretation bias modification. J Psychiatr Res 2017; 85:75-82. [PMID: 27837660 DOI: 10.1016/j.jpsychires.2016.11.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 09/24/2016] [Accepted: 11/03/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Anxiety disorders contribute substantially to the overall public health burden. Anxiety sensitivity (AS), a fear of anxiety-related sensations, is one of the few known malleable risk factors for anxiety pathology. Previous AS reduction treatments have primarily utilized "top-down" (e.g., psychoeducation) interventions. The goal of the current study was to evaluate the effect of adding a "bottom-up" (interpretation bias modification; CBM-I) intervention to an AS psychoeducation intervention. DESIGN Single-site randomized controlled trial. Participants completed either a 1) Psychoeducation + active CBM-I or 2) Psychoeducation + control CBM-I intervention. Change in AS was assessed post-intervention and at a one-month follow-up. PARTICIPANTS Individuals with elevated levels of AS. INTERVENTION Single-session computer-delivered intervention for AS. RESULTS Accounting for baseline ASI-3 scores, post-intervention ASI-3 scores were significantly lower in the combined condition than in the psychoeducation + control CBM-I condition (β = 0.24, p < 0.05; d = 0.99). The active CBM-I plus psychoeducation AS intervention was successful in reducing overall AS (59% post-intervention; p < 0.05, Cohen's d = 0.99) and these reductions were maintained through one-month post-intervention (52%; p < 0.05, Cohen's d = 1.18). Participants in the active condition reported significantly lower rates of panic responding to a vital-capacity CO2 challenge (OR = 6.34, 95% CI = 1.07-37.66). Lastly, change in interpretation bias significantly mediated the relationship between treatment condition and post-treatment AS reductions. CONCLUSIONS The current intervention was efficacious in terms of immediate and one-month AS reductions. Given its brevity, low-cost, low-stigma and portability, this intervention could lead to reducing the burden of anxiety disorders.
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Affiliation(s)
- Daniel W Capron
- Department of Psychology, University of Southern Mississippi, Hattiesburg, MS, USA; Department of Psychology, Florida State University, Tallahassee, FL, USA.
| | - Aaron M Norr
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - Nicholas P Allan
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - Norman B Schmidt
- Department of Psychology, Florida State University, Tallahassee, FL, USA
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31
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Wong QJJ, Gregory B, Gaston JE, Rapee RM, Wilson JK, Abbott MJ. Development and validation of the Core Beliefs Questionnaire in a sample of individuals with social anxiety disorder. J Affect Disord 2017; 207:121-127. [PMID: 27721185 DOI: 10.1016/j.jad.2016.09.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 09/08/2016] [Accepted: 09/22/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Prominent cognitive models of social anxiety have consistently emphasised the importance of beliefs about the self in the aetiology and maintenance of social anxiety. The present study sought to develop and validate a new measure of core beliefs about the self for SAD, the Core Beliefs Questionnaire (CBQ). METHODS Three versions of the CBQ were developed: a Trait version (fundamental absolute statements about the self), a Contingent version (statements about the self related to a specific social-evaluative situation), and an Other version (statements about how others view the self in social-evaluative situations generally). The psychometric features of the scales were examined in clinical (n=269) and non-clinical (n=67) samples. RESULTS Exploratory factor analysis yielded a one factor model for all three versions of the questionnaire. Total scores differentiated individuals with SAD from individuals without a psychiatric condition, and demonstrated excellent internal consistency. The three CBQ versions had positive associations with social anxiety while controlling for depression, although zero-order correlations indicated the Trait version was more strongly related to depression than social anxiety, the Contingent version was similarly related to depression and social anxiety, and the Other version was more strongly related to social anxiety than depression. Scores on all three versions of the CBQ reduced from pre- to post-treatment and this change predicted treatment outcome. LIMITATIONS This is the first validation study of the CBQ. CONCLUSIONS This study provides initial support for the reliability and validity of the CBQ.
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Affiliation(s)
- Quincy J J Wong
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, NSW 2109, Australia.
| | - Bree Gregory
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, NSW 2109, Australia
| | - Jonathan E Gaston
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, NSW 2109, Australia
| | - Ronald M Rapee
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, NSW 2109, Australia
| | - Judith K Wilson
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, NSW 2109, Australia
| | - Maree J Abbott
- School of Psychology, University of Sydney, Sydney, NSW 2006, Australia
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32
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Lopes FM, Viacava KR, Bizarro L. Attentional bias modification based on visual probe task: methodological issues, results and clinical relevance. TRENDS IN PSYCHIATRY AND PSYCHOTHERAPY 2016; 37:183-93. [PMID: 26689386 DOI: 10.1590/2237-6089-2015-0011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 03/09/2015] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Attentional bias, the tendency that a person has to drive or maintain attention to a specific class of stimuli, may play an important role in the etiology and persistence of mental disorders. Attentional bias modification has been studied as a form of additional treatment related to automatic processing. OBJECTIVES This systematic literature review compared and discussed methods, evidence of success and potential clinical applications of studies about attentional bias modification (ABM) using a visual probe task. METHODS The Web of Knowledge, PubMed and PsycInfo were searched using the keywords attentional bias modification, attentional bias manipulation and attentional bias training. We selected empirical studies about ABM training using a visual probe task written in English and published between 2002 and 2014. RESULTS Fifty-seven studies met inclusion criteria. Most (78%) succeeded in training attention in the predicted direction, and in 71% results were generalized to other measures correlated with the symptoms. CONCLUSIONS ABM has potential clinical utility, but to standardize methods and maximize applicability, future studies should include clinical samples and be based on findings of studies about its effectiveness.
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Affiliation(s)
| | | | - Lisiane Bizarro
- Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
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33
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Anxiety and attention to threat: Cognitive mechanisms and treatment with attention bias modification. Behav Res Ther 2016; 87:76-108. [DOI: 10.1016/j.brat.2016.08.001] [Citation(s) in RCA: 161] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 07/23/2016] [Accepted: 08/01/2016] [Indexed: 01/09/2023]
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34
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MacLeod C, Grafton B. Anxiety-linked attentional bias and its modification: Illustrating the importance of distinguishing processes and procedures in experimental psychopathology research. Behav Res Ther 2016; 86:68-86. [PMID: 27461003 DOI: 10.1016/j.brat.2016.07.005] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Revised: 07/14/2016] [Accepted: 07/18/2016] [Indexed: 12/21/2022]
Affiliation(s)
- Colin MacLeod
- Centre for the Advancement of Research on Emotion, School of Psychology, University of Western Australia, Australia.
| | - Ben Grafton
- Centre for the Advancement of Research on Emotion, School of Psychology, University of Western Australia, Australia
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Carleton RN, Teale Sapach MJN, Oriet C, LeBouthillier DM. Online attention modification for social anxiety disorder: replication of a randomized controlled trial. Cogn Behav Ther 2016; 46:44-59. [PMID: 27684541 DOI: 10.1080/16506073.2016.1214173] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Social anxiety disorder (SAD) models posit vigilance for external social threat cues and exacerbated self-focused attention as key in disorder development and maintenance. Evidence indicates a modified dot-probe protocol may reduce symptoms of SAD; however, the efficacy when compared to a standard protocol and long-term maintenance of treatment gains remains unclear. Furthermore, the efficacy of such protocols on SAD-related constructs remains relatively unknown. The current investigation clarified these associations using a randomized control trial replicating and extending previous research. Participants with SAD (n = 113; 71% women) were randomized to complete a standard (i.e. control) or modified (i.e. active) dot-probe protocol consisting of 15-min sessions twice weekly for four weeks. Self-reported symptoms were measured at baseline, post-treatment, and 4-month and 8-month follow-ups. Hierarchical linear modeling indicated significant self-reported reductions in symptoms of social anxiety, fear of negative evaluation, trait anxiety, and depression, but no such reductions in fear of positive evaluation. Symptom changes did not differ based on condition and were maintained at 8-month follow-up. Attentional biases during the dot-probe task were not related to symptom change. Overall, our results replicate support for the efficacy of both protocols in reducing symptoms of SAD and specific related constructs, and suggest a role of exposure, expectancy, or practice effects, rather than attention modification, in effecting such reductions. The current results also support distinct relationships between fears of negative and positive evaluation and social anxiety. Further research focused on identifying the mechanisms of change in attention modification protocols appears warranted.
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Affiliation(s)
| | | | - Chris Oriet
- a Department of Psychology , University of Regina , Regina , Canada
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Winer ES, Salem T. Reward devaluation: Dot-probe meta-analytic evidence of avoidance of positive information in depressed persons. Psychol Bull 2016; 142:18-78. [PMID: 26619211 PMCID: PMC4688138 DOI: 10.1037/bul0000022] [Citation(s) in RCA: 105] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Cognitive theories of depression and anxiety have traditionally emphasized the role of attentional biases in the processing of negative information. The dot-probe task has been widely used to study this phenomenon. Recent findings suggest that biased processing of positive information might also be an important aspect of developing psychopathological symptoms. However, despite some evidence suggesting persons with symptoms of depression and anxiety may avoid positive information, many dot-probe studies have produced null findings. The present review used conventional and novel meta-analytic methods to evaluate dot-probe attentional biases away from positive information and, for comparison, toward negative information, in depressed and anxious individuals. Results indicated that avoidance of positive information is a real effect exhibiting substantial evidential value among persons experiencing psychopathology, with individuals evidencing primary symptoms of depression clearly demonstrating this effect. Different theoretical explanations for these findings are evaluated, including those positing threat-processing structures, even-handedness, self-regulation, and reward devaluation, with the novel theory of reward devaluation emphasized and expanded. These novel findings and theory suggest that avoidance of prospective reward helps to explain the cause and sustainability of depressed states. Suggestions for future research and methodological advances are discussed.
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Affiliation(s)
| | - Taban Salem
- Department of Psychology, Mississippi State University
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For whom the bell tolls: Neurocognitive individual differences in the acute stress-reduction effects of an attention bias modification game for anxiety. Behav Res Ther 2015; 77:105-17. [PMID: 26745621 DOI: 10.1016/j.brat.2015.12.008] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 11/15/2015] [Accepted: 12/15/2015] [Indexed: 11/24/2022]
Abstract
The efficacy of attention bias modification training (ABMT) for anxiety is debated, in part because individual differences in task engagement and pre-training threat bias impact training efficacy. In the present study, an engaging, gamified ABMT mobile application, or "app," was utilized in 42 (21 females) trait-anxious adults. EEG was recorded during pre- and post-training threat bias assessment to generate scalp-recorded event-related potentials (ERPs) reflecting neurocognitive responses to threat. Following app play (ABMT versus placebo), subjective anxiety and stress responses (observed and self-reported) were measured. ABMT, versus placebo, resulted in improved behavioral performance during the stress task for females, and in potentiation of the N2 ERP to threat for males, suggesting increased attention control. Training groups did not differ in self-reported anxiety. ABMT also resulted in improved performance during the stress task among those evidencing specific pre-training ERP responses: decreased P1, suggesting less attention allocation, but potentiated N170, suggesting enhanced attention selection and discrimination. Differences in behavioral threat bias did not moderate training effects. Results suggest that efficient allocation of attention to threat combined with enhanced discrimination between threat and non-threat may facilitate stress-reduction effects of ABMT. Targeting neurocognitive responses to threat to personalize ABMT and develop more effective methods of treatment delivery, such as gamification, are discussed.
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Everaert J, Mogoaşe C, David D, Koster EHW. Attention bias modification via single-session dot-probe training: Failures to replicate. J Behav Ther Exp Psychiatry 2015; 49:5-12. [PMID: 25468204 DOI: 10.1016/j.jbtep.2014.10.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Revised: 10/28/2014] [Accepted: 10/28/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND AND OBJECTIVES Across three experiments we investigated transfer effects of single-session attention bias modification via dot-probe training. METHODS In experiment 1, participants received training either toward or away from negative images or no-training, and transfer to an affective task-switching task was examined. In two other experiments, participants were trained to orient attention toward either positive or negative words (experiment 2a) or facial expressions (experiment 2b), and transfer to an interpretation bias task was examined. RESULTS In all experiments, the dot-probe training procedure did not effectively modify biases in attention allocation at the training condition level, but produced a large variability in individual attention bias acquisition within and across conditions. Individual differences in pre-training attention bias and attention bias acquisition were not related to performance on the affective task-switching task or the interpretation tasks. LIMITATIONS The present investigations are limited by the lack of effectiveness of ABM at the condition level, the order in which transfer tasks were administered, and the restricted range of affective symptoms that could moderate training and transfer effects. CONCLUSIONS The findings from three experiments provided no evidence for single-session dot-probe ABM procedures to effectively manipulate attention bias toward negative, away from negative, or toward positive stimuli at a training condition level. At the individual differences level of analysis, again no evidence was found for transfer of attention training. The observations invite further empirical scrutiny into factors that moderate attentional plasticity in response to dot-probe ABM procedures to optimize the conditions for effective implementation and transfer of training.
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Affiliation(s)
- Jonas Everaert
- Ghent University, Department of Experimental Clinical and Health Psychology, Henri Dunantlaan 2, 9000 Ghent, Belgium.
| | - Cristina Mogoaşe
- Babeş-Bolyai University, Department of Clinical Psychology and Psychotherapy, Republicii Street 37, 400015 Cluj-Napoca, Cluj, Romania; Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.
| | - Daniel David
- Babeş-Bolyai University, Department of Clinical Psychology and Psychotherapy, Republicii Street 37, 400015 Cluj-Napoca, Cluj, Romania; Mount Sinai School of Medicine, NY, USA.
| | - Ernst H W Koster
- Ghent University, Department of Experimental Clinical and Health Psychology, Henri Dunantlaan 2, 9000 Ghent, Belgium.
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Waters AM, Zimmer-Gembeck MJ, Craske MG, Pine DS, Bradley BP, Mogg K. Look for good and never give up: A novel attention training treatment for childhood anxiety disorders. Behav Res Ther 2015; 73:111-23. [DOI: 10.1016/j.brat.2015.08.005] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 06/25/2015] [Accepted: 08/14/2015] [Indexed: 11/26/2022]
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Sigurjónsdóttir Ó, Sigurðardóttir S, Björnsson AS, Kristjánsson Á. Barking up the wrong tree in attentional bias modification? Comparing the sensitivity of four tasks to attentional biases. J Behav Ther Exp Psychiatry 2015; 48:9-16. [PMID: 25665514 DOI: 10.1016/j.jbtep.2015.01.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2014] [Revised: 01/13/2015] [Accepted: 01/14/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND OBJECTIVES Attentional bias modification (ABM) is a potentially exciting new development in the treatment of anxiety disorders. However, reported therapeutic benefits have not always been replicated. To gauge the sensitivity of tasks used in ABM treatment and assessment, we used a counterbalanced within-subject design to measure their discriminant sensitivity to neutral and threatening facial expressions, comparing them with other well-known tasks that measure visual attention. METHODS We compared two tasks often used in the assessment and treatment of attention bias (the dot-probe and the spatial cueing paradigms) with two well-known visual attention tasks (the irrelevant singleton and attentional blink paradigms), measuring their sensitivity to processing differences between threatening and neutral expressions for non-clinical observers. RESULTS The dot-probe, spatial cueing and irrelevant singleton paradigms showed little or no sensitivity to processing differences between facial expressions while the attentional blink task proved very sensitive to such differences. Furthermore, the attentional blink task provided an intriguing picture of the temporal dynamics of attentional biases that the other paradigms cannot do. LIMITATIONS These results need to be replicated with larger samples, including a comparison of a group of individuals diagnosed with social anxiety disorder and normal controls. CONCLUSIONS Our results indicate that the sensitivity of putative attentional bias measures should be assessed experimentally for more powerful assessment and treatment of such biases. If the attentional blink task is indeed particularly sensitive to attentional biases, as our findings indicate, it is not unreasonable to expect that interventions based on this task may be more effective than those based on the tasks that are currently used.
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Affiliation(s)
| | - Sólrún Sigurðardóttir
- University of Iceland, Department of Psychology, Sturlugata 3, 101 Reykjavík, Iceland.
| | - Andri S Björnsson
- University of Iceland, Department of Psychology, Sturlugata 3, 101 Reykjavík, Iceland.
| | - Árni Kristjánsson
- University of Iceland, Department of Psychology, Sturlugata 3, 101 Reykjavík, Iceland.
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41
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Attention bias modification for social anxiety: A systematic review and meta-analysis. Clin Psychol Rev 2015; 40:76-90. [DOI: 10.1016/j.cpr.2015.06.001] [Citation(s) in RCA: 191] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Revised: 05/31/2015] [Accepted: 06/04/2015] [Indexed: 11/17/2022]
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Barry TJ, Vervliet B, Hermans D. An integrative review of attention biases and their contribution to treatment for anxiety disorders. Front Psychol 2015. [PMID: 26217284 PMCID: PMC4495309 DOI: 10.3389/fpsyg.2015.00968] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Models of exposure therapy, one of the key components of cognitive behavioral therapy for anxiety disorders, suggest that attention may play an important role in the extinction of fear and anxiety. Evidence from cognitive research suggests that individual differences may play a causal role in the onset and maintenance of anxiety disorders and so it is also likely to influence treatment. We review the evidence concerning attention and treatment outcomes in anxiety disorders. The evidence reviewed here suggests that that attention biases assessed at pre-treatment might actually predict improved response to treatment, and in particular that prolonged engagement with threat as measured in tasks such as the dot probe is associated with greater reductions in anxious symptoms following treatment. We examine this research within a fear learning framework, considering the possible role of individual differences in attention in the extinction of fear during exposure. Theoretical, experimental and clinical implications are discussed, particularly with reference to the potential for attention bias modification programs in augmenting treatment, and also with reference to how existing research in this area might inform best practice for clinicians.
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Affiliation(s)
- Tom J Barry
- Centre for the Psychology of Learning and Experimental Psychopathology, Faculty of Psychology and Educational Sciences, University of Leuven Leuven, Belgium
| | - Bram Vervliet
- Centre for the Psychology of Learning and Experimental Psychopathology, Faculty of Psychology and Educational Sciences, University of Leuven Leuven, Belgium
| | - Dirk Hermans
- Centre for the Psychology of Learning and Experimental Psychopathology, Faculty of Psychology and Educational Sciences, University of Leuven Leuven, Belgium
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A randomized controlled trial of attention modification for social anxiety disorder. J Anxiety Disord 2015; 33:35-44. [PMID: 26047059 DOI: 10.1016/j.janxdis.2015.03.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 03/21/2015] [Accepted: 03/22/2015] [Indexed: 01/17/2023]
Abstract
Social Anxiety Disorder (SAD) models implicate social threat cue vigilance (i.e., attentional biases) in symptom development and maintenance. A modified dot-probe protocol has been shown to reduce SAD symptoms, in some but not all studies, presumably by modifying an attentional bias. The current randomized controlled trial was designed to replicate and extend such research. Participants included treatment-seeking adults (n = 108; 58% women) who met diagnostic criteria for SAD. Participants were randomly assigned to a standard (i.e., control) or modified (i.e., active) dot-probe protocol condition and to participate in-lab or at home. The protocol involved twice-weekly 15-min sessions, for 4 weeks, with questionnaires completed at baseline, post-treatment, 4-month follow-up, and 8-month follow-up. Symptom reports were assessed with repeated measures mixed hierarchical modeling. There was a main effect of time from baseline to post-treatment wherein social anxiety symptoms declined significantly (p < .05) but depression and trait anxiety did not (p > .05). There were no significant interactions based on condition or participation location (ps > .05). Reductions were maintained at 8-month follow-up. Symptom reductions were not correlated with threat biases as indexed by the dot-probe task. The modified and standard protocol both produced significant sustained symptom reductions, whether administered in-lab or at home. There were no robust differences based on protocol type. As such, the mechanisms for benefits associated with modified dot-probe protocols warrant additional research.
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44
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Relationships Between Probability Estimates, Cost Estimates, and Social Anxiety During CBT for Social Anxiety Disorder. COGNITIVE THERAPY AND RESEARCH 2015. [DOI: 10.1007/s10608-015-9692-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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45
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Rapee RM, Peters L, Carpenter L, Gaston JE. The Yin and Yang of support from significant others: Influence of general social support and partner support of avoidance in the context of treatment for social anxiety disorder. Behav Res Ther 2015; 69:40-7. [PMID: 25863601 DOI: 10.1016/j.brat.2015.03.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Revised: 03/10/2015] [Accepted: 03/26/2015] [Indexed: 10/23/2022]
Abstract
Support from social networks is generally considered to protect against mental disorder but in some circumstances support for negative behaviours (such as avoidance) may be counterproductive. Given the critical interplay between social anxiety disorder and social interactions, it is surprising that the relationship of support from significant others to this disorder has received so little attention. The current study evaluated the reciprocal relationships between perceived social support and perceived partner support for avoidance behaviours (avoidance support) among a sample of 131 participants with social anxiety disorder who were assessed three times within the context of a treatment outcome study. A new measure of partner support for avoidance behaviours was developed, called the Avoidance Support Measure, and showed adequate internal consistency and construct validity. Correlations at baseline showed significant negative relationships between perceived social support and social anxiety and significant positive relationships between avoidance support and social anxiety. Path analysis showed that perceived social support at Times 1 and 2 negatively predicted future social anxiety at Times 2 and 3. On the other hand, only a single predictive relationship involving avoidance support was significant and showed that social anxiety at Time 1 positively predicted avoidance support at Time 2. These early results point to the different ways that support from significant others might relate to social anxiety and suggest that further work in this area may be fruitful.
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Affiliation(s)
- Ronald M Rapee
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia.
| | - Lorna Peters
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
| | - Leigh Carpenter
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
| | - Jonathan E Gaston
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
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46
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Amir N, Kuckertz JM, Najmi S, Conley SL. Preliminary Evidence for the Enhancement of Self-Conducted Exposures for OCD using Cognitive Bias Modification. COGNITIVE THERAPY AND RESEARCH 2015; 39:424-440. [PMID: 26366021 DOI: 10.1007/s10608-015-9675-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Exposure and Response Prevention (ERP) is the most effective treatment for OCD but it is not accessible to most patients. Attempts to increase the accessibility of ERP via self-directed ERP (sERP) programs such as computerized delivery and bibliotherapy have met with noncompliance, presumably because patients find the exposure exercises unacceptable. Previous research suggests that Cognitive Bias Modification (CBM) interventions may help individuals approach feared situations. The goal of the current study was to test the efficacy of a treatment program for OCD that integrates sERP with CBM. Twenty-two individuals meeting diagnostic criteria for OCD enrolled in our 7-week treatment program. Results suggest that sERP with CBM led to significant reduction of OCD symptoms and functional impairment. Indeed, the magnitude of the effect of this novel treatment, that requires only an initial session with a clinician trained in ERP for OCD, was comparable to that of the gold standard clinician-administered ERP. Moreover, preliminary evidence suggests that CBM interventions targeting interpretation bias may be most effective, whereas those targeting attention and working memory bias may not be so.
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Affiliation(s)
- Nader Amir
- Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego
| | - Jennie M Kuckertz
- Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego
| | - Sadia Najmi
- Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego
| | - Sara L Conley
- Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego
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Bartoszek G, Winer ES. Spider-fearful individuals hesitantly approach threat, whereas depressed individuals do not persistently approach reward. J Behav Ther Exp Psychiatry 2015; 46:1-7. [PMID: 25164091 DOI: 10.1016/j.jbtep.2014.07.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2014] [Revised: 07/23/2014] [Accepted: 07/29/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND AND OBJECTIVES Much research documents that anxiety is related to the avoidance of threatening information. Research is also beginning to suggest that depression is related to a lack of approach toward positive information. However, many questions remain regarding the specificity and robustness of these effects. The goal of the present study was to examine specific motivational patterns differentiating between anxiety and depression. METHODS The current study used the approach-avoidance task (AAT) to further investigate these phenomena. Spider-fearful, depressed, and non-fearful/non-depressed (control) participants pulled or pushed a joystick lever in response to positive, neutral, and negative (spider and spider-unrelated) pictures. Unlike in previous AAT studies, duration times (DTs) of joystick movements were examined in addition to reaction times (RTs). RESULTS As hypothesized, in contrast to depressed and control groups, spider-fearful participants exhibited avoidance tendencies by evidencing slower RTs when pulling the joystick in response to spider versus neutral pictures. As further hypothesized, depressed participants exhibited diminished approach motivation as evidenced by their pulling positive pictures for a shorter duration than neutral pictures, in comparison to the control group. LIMITATIONS Participants in our study were from a non-clinical student sample and further research is required for generalization to spider phobia and major depressive disorder. CONCLUSION These findings inform theoretical understanding of the specific motivational tendencies of anxiety and depression, and introduce a modification of the AAT that, if incorporated in clinical settings, would increase the specificity and success of cognitive bias modifications.
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Affiliation(s)
- Gregory Bartoszek
- University of Illinois at Chicago, Department of Psychology, 1007 West Harrison Street, Chicago, IL 60607, USA.
| | - E Samuel Winer
- Mississippi State University, PO Box 6161, Mississippi State, MS 39762, USA
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48
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Kuckertz JM, Amir N. Attention bias modification for anxiety and phobias: current status and future directions. Curr Psychiatry Rep 2015; 17:9. [PMID: 25620791 DOI: 10.1007/s11920-014-0545-x] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Attention bias modification (ABM) was introduced over a decade ago as a computerized method of manipulating attentional bias and has been followed by intense interest in applying ABM for clinical purposes. While meta-analyses support ABM as a method of modifying attentional biases and reducing anxiety symptoms, there have been notable discrepancies in findings published within the last several years. In this review, we comment on recent research that may help explain some of the inconsistencies across ABM studies. More relevant to the future of ABM research, we highlight areas in which continuing research is needed. We suggest that ABM appears to be a promising treatment for anxiety disorders, but relative to other interventions, ABM is in its infancy. Thus, research is needed in order to improve ABM as a clinical treatment and advance the psychological science of ABM.
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Affiliation(s)
- Jennie M Kuckertz
- Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, 6386 Alvarado Ct., Suite 301, San Diego, CA, 92120, USA,
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49
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Cristea IA, Kok RN, Cuijpers P. Efficacy of cognitive bias modification interventions in anxiety and depression: meta-analysis. Br J Psychiatry 2015; 206:7-16. [PMID: 25561486 DOI: 10.1192/bjp.bp.114.146761] [Citation(s) in RCA: 328] [Impact Index Per Article: 36.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Cognitive bias modification (CBM) interventions are strongly advocated in research and clinical practice. AIMS To examine the efficiency of CBM for clinically relevant outcomes, along with study quality, publication bias and potential moderators. METHOD We included randomised controlled trials (RCTs) of CBM interventions that reported clinically relevant outcomes assessed with standardised instruments. RESULTS We identified 49 trials and grouped outcomes into anxiety and depression. Effect sizes were small considering all the samples, and mostly non-significant for patient samples. Effect sizes became non-significant when outliers were excluded and after adjustment for publication bias. The quality of the RCTs was suboptimal. CONCLUSIONS CBM may have small effects on mental health problems, but it is also very well possible that there are no significant clinically relevant effects. Research in this field is hampered by small and low-quality trials, and by risk of publication bias. Many positive outcomes are driven by extreme outliers.
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Affiliation(s)
- Ioana A Cristea
- Ioana A. Cristea, PhD, Department of Clinical Psychology and Psychotherapy, Babeʂ-Bolyai University, Cluj-Napoca, Romania and Clinical Psychology Branch, Department of Surgical, Medical, Molecular and Critical Pathology, University of Pisa, Pisa, Italy; Robin N. Kok, MSc, Department of Clinical Psychology and the EMGO institute for Health and Care Research, Faculty of Psychology and Education, VU University Amsterdam, Amsterdam, The Netherlands and Centre for Mental Health Research, The Australian National University, Acton, Australia; Pim Cuijpers, PhD, Department of Clinical Psychology, VU University and EMGO Institute for Health and Care Research, VU University and VU University Medical Centre, Amsterdam, The Netherlands and Leuphana University, Lüneburg, Germany
| | - Robin N Kok
- Ioana A. Cristea, PhD, Department of Clinical Psychology and Psychotherapy, Babeʂ-Bolyai University, Cluj-Napoca, Romania and Clinical Psychology Branch, Department of Surgical, Medical, Molecular and Critical Pathology, University of Pisa, Pisa, Italy; Robin N. Kok, MSc, Department of Clinical Psychology and the EMGO institute for Health and Care Research, Faculty of Psychology and Education, VU University Amsterdam, Amsterdam, The Netherlands and Centre for Mental Health Research, The Australian National University, Acton, Australia; Pim Cuijpers, PhD, Department of Clinical Psychology, VU University and EMGO Institute for Health and Care Research, VU University and VU University Medical Centre, Amsterdam, The Netherlands and Leuphana University, Lüneburg, Germany
| | - Pim Cuijpers
- Ioana A. Cristea, PhD, Department of Clinical Psychology and Psychotherapy, Babeʂ-Bolyai University, Cluj-Napoca, Romania and Clinical Psychology Branch, Department of Surgical, Medical, Molecular and Critical Pathology, University of Pisa, Pisa, Italy; Robin N. Kok, MSc, Department of Clinical Psychology and the EMGO institute for Health and Care Research, Faculty of Psychology and Education, VU University Amsterdam, Amsterdam, The Netherlands and Centre for Mental Health Research, The Australian National University, Acton, Australia; Pim Cuijpers, PhD, Department of Clinical Psychology, VU University and EMGO Institute for Health and Care Research, VU University and VU University Medical Centre, Amsterdam, The Netherlands and Leuphana University, Lüneburg, Germany
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50
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Validation of a novel attentional bias modification task: the future may be in the cards. Behav Res Ther 2014; 65:93-100. [PMID: 25594940 DOI: 10.1016/j.brat.2014.12.007] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Revised: 08/22/2014] [Accepted: 12/12/2014] [Indexed: 11/21/2022]
Abstract
Attentional bias modification (ABM) is a promising therapeutic tool aimed at changing patterns of attentional selectivity associated with heightened anxiety. A number of studies have successfully implemented ABM using the modified dot-probe task. However others have not achieved the attentional change required to achieve emotional benefits, highlighting the need for new ABM methods. The current study compared the effectiveness of a newly developed ABM task against the traditional dot-probe ABM task. The new person-identity-matching (PIM) task presented participants with virtual cards, each depicting a happy and angry person. The task encourages selective attention toward or away from threat by requiring participants to make matching judgements between two cards, based either on the identities of the happy faces, or of the angry faces. Change in attentional bias achieved by both ABM tasks was measured by a dot-probe assessment task. Their impact on emotional vulnerability was assessed by measuring negative emotional reactions to a video stressor. The PIM task succeeded in modifying attentional bias, and exerting an impact on emotional reactivity, whereas this was not the case for the dot-probe task. These results are considered in relation to the potential clinical utility of the current task in comparison to traditional ABM methodologies.
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