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Sicouri G, Daniel EK, Spoelma MJ, Salemink E, McDermott EA, Hudson JL. Cognitive bias modification of interpretations for anxiety and depression in children and adolescents: A meta-analysis. JCPP ADVANCES 2024; 4:e12207. [PMID: 38486951 PMCID: PMC10933640 DOI: 10.1002/jcv2.12207] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 10/19/2023] [Indexed: 03/17/2024] Open
Abstract
Background Evidence suggests that cognitive bias modification of interpretations (CBM-I) is effective in modifying interpretation biases and has a small effect on reducing anxiety in children and adolescents. However, most evidence to date is based on studies which report anxiety or general distress using ad-hoc Likert-type or Visual Analogue Scales, which are useful but do not reliably index symptoms of clinical importance. This meta-analysis aimed to establish the effects of CBM-I for children and adolescents on both anxiety and depression using psychometrically validated symptom measures, as well as state negative affect and negative and positive interpretation bias. Methods We identified studies through a systematic search. To be eligible for inclusion, studies needed to target interpretation biases, not combine CBM-I with another intervention, randomly allocate participants to CBM-I or a control condition, assess a mental health outcome (i.e., anxiety or depression symptoms using validated measures or state measures of negative affect) and/or interpretation bias and have a mean age less than 18 years. Results We identified 36 studies for inclusion in the meta-analysis. CBM-I had a small and non-significant unadjusted effect on anxiety symptoms (g = 0.16), no effect on depression symptoms (g = -0.03), and small and non-significant unadjusted effects on state negative affect both at post-training (g = 0.16) and following a stressor task (g = 0.23). In line with previous findings, CBM-I had moderate to large unadjusted effects on negative and positive interpretations (g = 0.78 and g = 0.52). No significant moderators were identified. Conclusions CBM-I is effective at modifying interpretation bias, however there were no effects on mental health outcomes. The substantial variability across studies and paucity of studies using validated symptom measures highlight the need to establish randomized controlled trial protocols that evaluate CBM-I in clinical youth samples to determine its future as a clinical intervention.
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Affiliation(s)
- Gemma Sicouri
- Black Dog InstituteUniversity of New South WalesSydneyNew South WalesAustralia
- School of PsychologyUniversity of New South WalesSydneyNew South WalesAustralia
| | - Emily K. Daniel
- Black Dog InstituteUniversity of New South WalesSydneyNew South WalesAustralia
| | - Michael J. Spoelma
- Black Dog InstituteUniversity of New South WalesSydneyNew South WalesAustralia
- Discipline of Psychiatry and Mental HealthSchool of Clinical MedicineFaculty of Medicine and HealthUniversity of New South WalesSydneyNew South WalesAustralia
| | - Elske Salemink
- Department of Clinical PsychologyUtrecht UniversityUtrechtthe Netherlands
| | - Emma A. McDermott
- Black Dog InstituteUniversity of New South WalesSydneyNew South WalesAustralia
| | - Jennifer L. Hudson
- Black Dog InstituteUniversity of New South WalesSydneyNew South WalesAustralia
- School of PsychologyUniversity of New South WalesSydneyNew South WalesAustralia
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Rapee RM, Creswell C, Kendall PC, Pine DS, Waters AM. Anxiety disorders in children and adolescents: A summary and overview of the literature. Behav Res Ther 2023; 168:104376. [PMID: 37499294 DOI: 10.1016/j.brat.2023.104376] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 07/10/2023] [Accepted: 07/17/2023] [Indexed: 07/29/2023]
Abstract
Considerable work has advanced understanding of the nature, causes, management, and prevention of anxiety disorders in children and adolescents over the past 30 years. Prior to this time the primary focus was on school refusal and specific phobias. It is now recognised that children and adolescents experience the full gamut of anxiety disorders in very similar ways to adults and that anxiety disorders in the paediatric years can predict a lifelong mental-health struggle. Given the vast array of specific studies in this field, the current review summarises current knowledge about these high prevalence disorders, points to overarching limitations, and suggests potentially important future directions. Following a brief historical overview, the review summarises knowledge about demographic and epidemiological characteristics, distal and proximal risk factors, current treatment directions, and prevention. There is still a great deal to learn about the causes and treatments of child and adolescent anxiety disorders. By amalgamating our current knowledge, this review provides a window to the research directions that are likely to lead to future advances.
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Affiliation(s)
- Ronald M Rapee
- Centre for Emotional Health, School of Psychological Sciences, Macquarie University, Sydney, Australia.
| | - Cathy Creswell
- Departments of Psychiatry and Experimental Psychology, University of Oxford, Oxford, UK
| | - Philip C Kendall
- Department of Psychology, Temple University, Child and Adolescent Anxiety Disorders Clinic, USA
| | - Daniel S Pine
- National Institute of Mental Health Intramural Research Program (NIMH-IRP), USA
| | - Allison M Waters
- School of Applied Psychology, Griffith University, Brisbane, Australia
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3
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Mobach L, Rapee RM, Klein AM. The Role of Distorted Cognitions in Mediating Treatment Outcome in Children with Social Anxiety Disorder: A Preliminary Study. Child Psychiatry Hum Dev 2023; 54:558-569. [PMID: 34674074 PMCID: PMC9977708 DOI: 10.1007/s10578-021-01268-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/09/2021] [Indexed: 11/30/2022]
Abstract
This study examined whether distorted cognition changes during cognitive behavioural therapy (CBT) in children (N = 61; aged 7-12) with social anxiety disorder (SAD) and whether changes in distorted cognition from pre- to post-treatment predict SAD at 6-month follow-up. Baseline distorted cognition was also examined as a predictor of post-treatment outcome. Multiple informant SAD-measures were obtained pre-treatment, post-treatment and at 6-month follow-up. Children reported on interpretation bias and dysfunctional beliefs. A decrease in interpretation bias and dysfunctional beliefs was prospectively related to greater SAD change between post-treatment and 6-month follow-up. Child-reported SAD-change at post-treatment predicted greater change in dysfunctional beliefs at 6-month follow-up. Higher baseline interpretation bias predicted greater change in SAD-severity at post-treatment. Children with greater distorted cognition reductions during treatment, showed greater treatment gains at 6-month follow-up. Children who do not show this reduction may require additional efforts focused on distorted cognition to maximally benefit from treatment.
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Affiliation(s)
- Lynn Mobach
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, NSW, 2109, Australia.
- Department of Clinical Psychology, Behavioural Science Institute, Radboud University, Montessorilaan 3, 6525 HR, Nijmegen, the Netherlands.
| | - Ronald M Rapee
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, NSW, 2109, Australia
| | - Anke M Klein
- Department of Clinical Psychology, Behavioural Science Institute, Radboud University, Montessorilaan 3, 6525 HR, Nijmegen, the Netherlands
- Unit Developmental and Educational Psychology, Institute of Psychology, Leiden University, Leiden, the Netherlands
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Rogers J, Sicouri G. A Single-Session Online Cognitive Bias Modification of Interpretations Modified for Adults With Anxiety and Depressive Symptoms. Behav Ther 2022; 53:967-980. [PMID: 35987552 DOI: 10.1016/j.beth.2022.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 03/14/2022] [Accepted: 04/03/2022] [Indexed: 11/29/2022]
Abstract
Anxiety and depression are common, co-occurring, and costly mental health disorders. Cognitive bias modification aims to modify biases to reduce associated symptoms. Few studies have targeted multiple biases associated with both anxiety and depression, and those that have lacked a control condition. This study piloted a single-session online cognitive bias modification (known as CBM-IA) designed to target two biases associated with anxiety and depression-interpretation bias and attribution style-in adults with varying levels of anxiety and depressive symptoms. Participants (18-26 years) with at least mild levels of anxiety/stress and depressive symptoms on the DASS-21 were randomly allocated to an intervention (n = 23) or a control (n = 22) condition. The training consisted of a single-session online CBM-IA to encourage positive interpretations and a positive attribution style. Interpretation bias, attribution style, anxious and depressive mood states, and anxiety, stress and depressive symptoms improved at posttraining and at follow-up, irrespective of condition. Changes in interpretation bias from pre- to posttraining were significantly associated with changes in anxious mood state. CBM-IA, as implemented in this single-session pilot study, did not significantly reduce targeted biases and symptoms compared to a control condition. This adds to the mixed evidence on the efficacy of single-session CBM-I for altering biases and symptoms.
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Affiliation(s)
| | - Gemma Sicouri
- Black Dog Institute, University of New South Wales; Macquarie University.
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5
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Attention and interpretation cognitive bias change: A systematic review and meta-analysis of bias modification paradigms. Behav Res Ther 2022; 157:104180. [PMID: 36037642 DOI: 10.1016/j.brat.2022.104180] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 07/29/2022] [Accepted: 08/08/2022] [Indexed: 12/15/2022]
Abstract
This systematic review and meta-analysis examines the effect of Cognitive Bias Modification for attention (CBM-A) and interpretation (CBM-I) on reducing the targeted biases and investigates moderators of each approach. PsycINFO, PsychArticles, and PubMED databases were searched for randomized-controlled studies published before March 2020 with pre- and post-CBM cognitive bias outcome measures, resulting in 91 CBM-A (n = 5914 individuals) and 70 CBM-I samples (n = 4802 individuals). Random-effects models and Hedge's g calculation showed significant medium overall effects of bias reduction with moderate to high heterogeneity (CBM-A g = 0.49 [0.36, 0.64], I2 = 85.19%; CBM-I g = 0.58 [0.48, 0.68], I2 = 70.92%). Effect sizes did not differ between approaches and remained significant after trim-and-fill adjustment for possible publication bias. Moderator variables were investigated with meta-regression and subgroup analyses. Participant age, symptom type, control condition and number of trials moderated CBM-A; student and clinical status moderated CBM-I effect size. Results support attention and interpretation modification in controlled laboratory and variable (online) training settings for non-clinical and clinical samples across various symptom types (anxiety, depression, substance use, eating disorders). Further empirical evidence is necessary to determine optimal sample and methodological combinations most strongly associated with adaptive behavioral outcomes.
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Busch HEC, Viana AG, Raines EM, Trent ES, Zvolensky MJ, Storch EA. Fearful Temperament, Catastrophizing, and Internalizing Symptoms in Clinically Anxious Youth. J Cogn Psychother 2022; 37:JCP-2021-0022.R1. [PMID: 35470150 DOI: 10.1891/jcp-2021-0022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A fearful temperament in childhood is associated with child internalizing symptoms. However, the cognitive mechanisms explaining this association are poorly understood. We examined the effects of child fearful temperament on child internalizing symptoms and the underlying role of catastrophizing cognitions among clinically anxious youth. Children (N = 105; M age = 10.09 years, SD = 1.22; 56.7% female; 62% ethnic minority) completed a diagnostic interview; self-report measures of temperament, catastrophizing, and internalizing symptoms; and behaviorally-indexed measures of catastrophizing and anxiety. Indirect effects were found for child fearful temperament on child self-reported internalizing symptoms by way of self-reported (but not behaviorally-indexed) catastrophizing cognitions. Models predicting behaviorally-indexed child anxiety were not significant. Our findings suggest that targeting fearful temperament during childhood before catastrophizing cognitions develop may have clinical utility. Likewise, among children temperamentally at-risk, addressing catastrophic cognitions may prevent later internalizing psychopathology.
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Affiliation(s)
| | - Andres G Viana
- Department of Psychology, University of Houston, Houston, TX, 77204
- Texas Institute of Measurement, Evaluation, and Statistics, University of Houston, Houston, TX, 77204
| | | | - Erika S Trent
- Department of Psychology, University of Houston, Houston, TX, 77204
| | - Michael J Zvolensky
- Department of Psychology, University of Houston, Houston, TX, 77204
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Eric A Storch
- Menninger Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
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Cordier R, Speyer R, Mahoney N, Arnesen A, Mjelve LH, Nyborg G. Effects of interventions for social anxiety and shyness in school-aged children: A systematic review and meta-analysis. PLoS One 2021; 16:e0254117. [PMID: 34242303 PMCID: PMC8270412 DOI: 10.1371/journal.pone.0254117] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 06/20/2021] [Indexed: 11/19/2022] Open
Abstract
In school, shyness is associated with psychosocial difficulties and has negative impacts on children's academic performance and wellbeing. Even though there are different strategies and interventions to help children deal with shyness, there is currently no comprehensive systematic review of available interventions. This systematic review and meta-analysis aim to identify interventions for shy children and to evaluate the effectiveness in reducing psychosocial difficulties and other impacts. The methodology and reporting were guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement and checklist. A total of 4,864 studies were identified and 25 of these met the inclusion criteria. These studies employed interventions that were directed at school-aged children between six and twelve years of age and described both pre- and post-intervention measurement in target populations of at least five children. Most studies included an intervention undertaken in a school setting. The meta-analysis revealed interventions showing a large effect in reducing negative consequences of shyness, which is consistent with extant literature regarding shyness in school, suggesting school-age as an ideal developmental stage to target shyness. None of the interventions were delivered in a classroom setting, limiting the ability to make comparisons between in-class interventions and those delivered outside the classroom, but highlighting the effectiveness of interventions outside the classroom. The interventions were often conducted in group sessions, based at the school, and involved activities such as play, modelling and reinforcement and clinical methods such as social skills training, psychoeducation, and exposure. Traditionally, such methods have been confined to a clinic setting. The results of the current study show that, when such methods are used in a school-based setting and involve peers, the results can be effective in reducing negative effects of shyness. This is consistent with recommendations that interventions be age-appropriate, consider social development and utilise wide, school-based programs that address all students.
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Affiliation(s)
- Reinie Cordier
- Department of Social Work, Education and Community Wellbeing, Northumbria University, Newcastle upon Tyne, United Kingdom
- Faculty of Health Sciences, School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Perth, Australia
| | - Renée Speyer
- Faculty of Health Sciences, School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Perth, Australia
- Department of Special Needs Education, University of Oslo, Oslo, Norway
- Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Centre, Leiden, Netherlands
| | - Natasha Mahoney
- Faculty of Health Sciences, School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Perth, Australia
| | - Anne Arnesen
- The Norwegian Center for Child Behavioral Development (NUBU), Oslo, Norway
| | - Liv Heidi Mjelve
- Department of Special Needs Education, University of Oslo, Oslo, Norway
| | - Geir Nyborg
- Department of Special Needs Education, University of Oslo, Oslo, Norway
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8
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Etkin RG, Lebowitz ER, Silverman WK. Using Evaluative Criteria to Review Youth Anxiety Measures, Part II: Parent-Report. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2021; 50:155-176. [PMID: 33739908 DOI: 10.1080/15374416.2021.1878898] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
This Evidence Base Update of parent-report measures of youth anxiety symptoms is a companion piece to our update on youth self-report anxiety symptom measures (Etkin et al., 2021). We rate the psychometric properties of the parent-report measures as Adequate, Good, or Excellent using criteria developed by Hunsley and Mash (2008) and Youngstrom et al. (2017). Our review reveals that the evidence base for parent-report measures is considerably less developed compared with the evidence base for youth self-report measures. Nevertheless, several measures, the parent-report Screen for Child Anxiety-Related Emotional Disorders, Multidimensional Anxiety Scale for Children, and Spence Children's Anxiety Scale, were found to have Good to Excellent psychometric properties. We conclude our review with suggestions about which parent-report youth anxiety measures are best suited to perform different assessment functions and directions for additional research to expand and strengthen the evidence base.
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Savulich G, Edwards A, Assadi S, Guven H, Leathers-Smith E, Shergill S, Yiend J. Biased interpretation in paranoia and its modification. J Behav Ther Exp Psychiatry 2020; 69:101575. [PMID: 32505999 DOI: 10.1016/j.jbtep.2020.101575] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 03/25/2020] [Accepted: 04/27/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND AND OBJECTIVES Cognitive models of psychosis implicate interpretation biases as one of the mechanisms involved in the formation and maintenance of symptoms. First we measured the strength of association between interpretation biases and psychosis-relevant traits. Next we manipulated these biases and quantified the effects of doing so on psychosis-relevant outcomes. METHODS Experiment 1 used two measures of interpretation bias in a healthy sample (n = 70). Experiment 2 used a novel cognitive bias modification procedure (CMB-pa) in individuals with moderate trait paranoia (n = 60). RESULTS Experiment 1 revealed that over a third of the variance in interpretation bias could be explained by the combined effect of trait measures of paranoia/psychosis. In Experiment 2, CBM-pa produced training-congruent changes in the interpretation of new ambiguous information and influenced the interpretation, attribution and distress associated with a real-life social event. LIMITATIONS The potentially confounding effects of elevated anxiety and depression on interpretation bias and the restricted range of outcome measures to assess the wider effects of CBM-pa. CONCLUSIONS These studies are consistent with interpretation biases contributing to the maintenance of paranoia. CBM-pa could next be adapted and evaluated to test its efficacy as a therapeutic intervention.
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Affiliation(s)
- George Savulich
- Department of Psychiatry and Behavioural and Clinical Neuroscience Institute, University of Cambridge, School of Clinical Medicine, UK.
| | - Annabel Edwards
- Department of Psychosis Studies, Institute of Psychiatry, Psychology, & Neuroscience, King's College London, UK
| | - Sara Assadi
- Department of Psychosis Studies, Institute of Psychiatry, Psychology, & Neuroscience, King's College London, UK
| | - Husniye Guven
- Department of Psychosis Studies, Institute of Psychiatry, Psychology, & Neuroscience, King's College London, UK
| | - Emily Leathers-Smith
- Department of Psychosis Studies, Institute of Psychiatry, Psychology, & Neuroscience, King's College London, UK
| | - Sukhi Shergill
- Department of Psychosis Studies, Institute of Psychiatry, Psychology, & Neuroscience, King's College London, UK
| | - Jenny Yiend
- Department of Psychosis Studies, Institute of Psychiatry, Psychology, & Neuroscience, King's College London, UK.
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10
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Makover HB, Kendall PC, Olino T, Carper MM, Albano AM, Piacentini J, Peris T, Langley AK, Gonzalez A, Ginsburg GS, Compton S, Birmaher B, Sakolsky D, Keeton C, Walkup J. Mediators of youth anxiety outcomes 3 to 12 years after treatment. J Anxiety Disord 2020; 70:102188. [PMID: 32078966 PMCID: PMC10783175 DOI: 10.1016/j.janxdis.2020.102188] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 12/13/2019] [Accepted: 01/07/2020] [Indexed: 01/16/2023]
Abstract
OBJECTIVE Test changes in perceived coping efficacy, negative self-statements, and interpretive biases to threat during treatment as potential mediators of the relationship between randomly assigned treatment conditions and long-term anxiety follow-ups. Age at randomization was also tested as a moderator of mediational relationships. METHOD Participants included 319 youth (ages 7-17) from the Child/Adolescent Multimodal Study (CAMS) who participated in a naturalistic follow-up beginning an average of 6.5 years after the end of the CAMS intervention. The intervention conditions included cognitive behavioral therapy (CBT; Coping Cat), pharmacotherapy (sertraline), combined CBT and sertraline, and pill placebo. Putative mediators were measured four times during the intervention phase. Follow-up consisted of four annual assessments of current anxiety. RESULTS Reductions on a measure of interpretive bias to threat over the course of the combined condition intervention, as compared to the placebo condition, mediated anxiety outcomes at the first follow-up visit. This mediated effect was not significant for the CBT-only or sertraline-only conditions when compared to the placebo condition. No other significant mediated effects were found for putative mediators. Age did not significantly moderate any mediated effects. CONCLUSION Changes in youth-reported interpretive biases to threat over the course of combined youth anxiety interventions, as compared to a placebo intervention, may be associated with lower anxiety an average of 6.5 years following treatment.
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Affiliation(s)
- Heather B Makover
- Department of Psychology, Temple University, 1301 North 13th Street, Philadelphia, PA, 19122, USA.
| | - Philip C Kendall
- Department of Psychology, Temple University, 1301 North 13th Street, Philadelphia, PA, 19122, USA.
| | - Thomas Olino
- Department of Psychology, Temple University, 1301 North 13th Street, Philadelphia, PA, 19122, USA
| | - Matthew M Carper
- Department of Psychology, Temple University, 1301 North 13th Street, Philadelphia, PA, 19122, USA
| | - Anne Marie Albano
- Columbia University Clinic for Anxiety and Related Disorders, 1775 Broadway, Suite 601, New York, NY, 10019, USA
| | - John Piacentini
- UCLA Semel Institute, 760 Westwood Blvd, Rm 67-439, Los Angeles, CA, 90024, USA
| | - Tara Peris
- UCLA Semel Institute, 760 Westwood Blvd, Rm 67-439, Los Angeles, CA, 90024, USA
| | - Audra K Langley
- UCLA Semel Institute, 760 Westwood Blvd, Rm 67-439, Los Angeles, CA, 90024, USA
| | - Araceli Gonzalez
- UCLA Semel Institute, 760 Westwood Blvd, Rm 67-439, Los Angeles, CA, 90024, USA
| | - Golda S Ginsburg
- The Johns Hopkins University School of Medicine, Division of Child and Adolescent Psychiatry, 550 North Broadway, Suite 202, Baltimore, MD, 21205, USA
| | - Scott Compton
- Duke University Medical Center, Department of Psychiatry and Behavioral Sciences, DUMC Box 3527, Durham, NC, 27710, USA
| | - Boris Birmaher
- University of Pittsburgh Medical Center, Western Psychiatric Institute and Clinic, 3811 O'Hara Street, Pittsburgh, PA, 15213, USA
| | - Dara Sakolsky
- University of Pittsburgh Medical Center, Western Psychiatric Institute and Clinic, 3811 O'Hara Street, Pittsburgh, PA, 15213, USA
| | - Courtney Keeton
- The Johns Hopkins University School of Medicine, Division of Child and Adolescent Psychiatry, 550 North Broadway, Suite 202, Baltimore, MD, 21205, USA
| | - John Walkup
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences at Northwestern University Feinberg School of Medicine, 446 East Ontario, Suite 7-200, Chicago, IL, 60611, USA
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Schmidt NB, Vereenooghe L. Inclusiveness of cognitive bias modification research toward children and young people with neurodevelopmental disorders: A systematic review. INTERNATIONAL JOURNAL OF DEVELOPMENTAL DISABILITIES 2020; 68:86-101. [PMID: 35309701 PMCID: PMC8928859 DOI: 10.1080/20473869.2020.1720156] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 01/17/2020] [Accepted: 01/18/2020] [Indexed: 06/14/2023]
Abstract
Cognitive bias modification (CBM) is increasingly used to target cognitive biases related to internalising or externalising problems, which are common in neurodevelopmental disorders (NDD). This systematic review assesses the available evidence for using CBM in children and young people with NDD, in particular regarding ambiguous interpersonal information, and the extent of their exclusion from this type of intervention research. PsycINFO, PsycARTICLES, MEDLINE, Cochrane Central Register of Controlled Trials and Science Citation Index were consulted using MeSH terms and synonyms of "neurodevelopmental disorders", "mental health problems", "cognitive bias", "modification" and "review". Data extraction focused on the efficacy of CBM for NDD, how CBM was delivered, whether studies adopted exclusion criteria relating to NDD and the rationale for such criteria. The search identified 2270 records, of which twenty-nine studies assessed CBM for interpretations and were included in the qualitative synthesis. Three studies targeted bias in NDD, whereas a third of studies explicitly excluded participants based on NDD-related criteria: most frequently intellectual impairment, reading or learning difficulties and autism spectrum disorder (ASD). Only one study provided a rationale for excluding NDD which related to the reading demands of their intervention. There is tentative evidence for the feasibility of using CBM to reduce interpretation bias in children and young people with mild intellectual disability, ASD or attention-deficit/hyperactivity disorder (ADHD). We recommend that CBM research should consider including participants with NDD, use CBM tasks and adaptations that enable this group's inclusion, or provide a sufficient rationale for their exclusion.
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Affiliation(s)
- Nora B. Schmidt
- Faculty of Psychology and Sports Science, Bielefeld University, Bielefeld, Germany
| | - Leen Vereenooghe
- Faculty of Psychology and Sports Science, Bielefeld University, Bielefeld, Germany
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12
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A Situational Context Training for Socially Anxious Children. COGNITIVE THERAPY AND RESEARCH 2019. [DOI: 10.1007/s10608-019-10060-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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13
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Content-specific interpretation biases in clinically anxious children. Behav Res Ther 2019; 121:103452. [DOI: 10.1016/j.brat.2019.103452] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 07/26/2019] [Accepted: 08/09/2019] [Indexed: 11/19/2022]
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14
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Pereira-Soares TF, Nunes-Baptista M. Children and Young Anxiety ScaleCYAS: Scale Development and Psychometric Properties in Brazilian Sample. Int J Psychol Res (Medellin) 2019; 12:37-47. [PMID: 32612793 PMCID: PMC7318388 DOI: 10.21500/20112084.4203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 07/15/2019] [Accepted: 07/29/2019] [Indexed: 11/21/2022] Open
Abstract
The aim of the study was to search for evidence of validity based on the relationship with external variables, and incrementally for the Child-Youth Anxiety Scale (CYAS). The convenience sample consists of 500 children and adolescents aged 10 to 18 years. The correlation between the scores of the CYAS factors and the scores of the instruments of the other constructs ADHD (MTA-SNAP-IV), anxiety (OQPS), rumination (QRR) and mood states (BRUMS) was initially performed, finding medium and strong correlations, which shows a satisfactory linear relation between the constructs to attest validity based on the relation with external variables. Structural Equation Modeling (SEM) was also performed with total MTA-SNAP-IV and its factors as criterion. In the modeling, it was possible to observe that, when introduced in the models, the CYAS becomes the latent variable with the greatest contribution, decreasing and canceling the OQPS contribution. These results affirm incremental validity for the CYAS.
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Affiliation(s)
- Thiago Francisco Pereira-Soares
- Post-Graduation Program in Psychology, São Francisco University. Rua Registro, 188, Jardim Baronesa, Campinas São Paulo Brazil. CEP 13100-308.São Francisco UniversityBrazil
| | - Makilim Nunes-Baptista
- Doc. of the Stricto Sensu Post-Graduation Program in Psychology, São Francisco University. Road of Rhodia, 7250, house 33, village Holandia, Campinas-São Paulo Brazil. CEP 1308-902. São Francisco UniversityBrazil
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Weymouth BB, Fosco GM, Mak HW, Mayfield K, LoBraico EJ, Feinberg ME. Implications of interparental conflict for adolescents' peer relationships: A longitudinal pathway through threat appraisals and social anxiety symptoms. Dev Psychol 2019; 55:1509-1522. [PMID: 31070436 PMCID: PMC6586495 DOI: 10.1037/dev0000731] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The goal of this study was to broaden the developmental understanding of the implications of interparental conflict (IPC) and threat appraisals of conflict for adolescents' relationships with peers. Guided by the cognitive contextual framework and evolutionary perspectives, we evaluated a developmental model in which adolescents who are exposed to IPC perceive these conflicts as threatening to their well-being or that of their family. In turn, threat appraisals of IPC increase risk that adolescents experience worries and fears about the peer context (i.e., social anxiety), leading to decreased support from friends and increased feelings of loneliness and engagement with antisocial peers. Autoregressive analyses were conducted with a sample of 768 two-parent families across four measurement occasions. Exposure to IPC was related to increases in youths' perceived threat, which increased their risk for social anxiety symptoms. Consistent with our hypothesis, heightened social anxiety symptoms undermined youths' subsequent functioning in the peer context. Specifically, youth with greater adolescent social anxiety symptoms experienced increased feelings of loneliness and decreased perceptions of friendship support. Significant indirect effects were substantiated for adolescent loneliness and friendship support. Findings did not vary as a function of adolescent gender. The findings highlight the enduring implications of IPC and threat appraisals of IPC for youths' functioning, which can be expanded beyond broad measures of youth psychopathology, and the critical role of social anxiety symptoms as an explanatory mechanism in this process. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Krebs G, Pile V, Grant S, Degli Esposti M, Montgomery P, Lau JYF. Research Review: Cognitive bias modification of interpretations in youth and its effect on anxiety: a meta-analysis. J Child Psychol Psychiatry 2018; 59:831-844. [PMID: 29052837 DOI: 10.1111/jcpp.12809] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/03/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Emerging evidence suggests that cognitive bias modification of interpretations (CBM-I) is effective in altering interpretation biases and reducing anxiety in adults. Less is known about the impact of CBM-I in young people, but some recent findings, including a meta-analysis of combined cognitive bias modification of interpretation and attention techniques, have cast doubt on its clinical utility. Given the current debate, this meta-analysis sought to establish the independent effects of CBM-I on interpretations biases and anxiety in youth. METHODS Studies were identified through a systematic literature search of PsycINFO, Ovid MEDLINE, PsycARTICLES, Web of Science and EMBASE between January 1992 and March 2017. Eligible studies aimed to target interpretation biases; did not combine CBM-I with another intervention; included a control condition; randomly allocated participants to conditions; assessed interpretation bias and/or anxiety as an outcome; included individuals up to age 18; and did not present previously reported data. Reference lists of included articles were checked for further eligible studies, and authors were contacted for unpublished data. RESULTS We identified 26 studies meeting eligibility criteria that included in the meta-analysis. CBM-I had moderate effects on negative and positive interpretations (g = -0.70 and g = -0.52, respectively) and a small but significant effect on anxiety assessed after training (g = -0.17) and after a stressor (g = -0.34). No significant moderators were identified. CONCLUSIONS In contrast to previous meta-analytic findings, our results indicate that CBM-I has potential but weak anxiolytic effects in youth. Our findings suggest that it may be premature to disregard the potential value of CBM-I research and further research in this field is warranted.
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Affiliation(s)
- Georgina Krebs
- OCD & Related Disorders Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK.,Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Victoria Pile
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Sean Grant
- Centre for Evidence-Based Intervention, University of Oxford, Oxford, UK.,RAND Corporation, Santa Monica, CA, USA
| | | | - Paul Montgomery
- Department of Social Policy and Social Work, University of Birmingham, Birmingham, UK
| | - Jennifer Y F Lau
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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Biases in Interpretation as a Vulnerability Factor for Children of Parents With an Anxiety Disorder. J Am Acad Child Adolesc Psychiatry 2018; 57:462-470. [PMID: 29960691 DOI: 10.1016/j.jaac.2018.04.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 02/27/2018] [Accepted: 05/07/2018] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Children of parents with an anxiety disorder have a higher risk of developing an anxiety disorder than children of parents without an anxiety disorder. Parental anxiety is not regarded as a causal risk factor itself, but is likely to be mediated via other mechanisms, for example via cognitive factors. We investigated whether children of parents with an anxiety disorder would show an interpretation bias corresponding to the diagnosis of their parent. We also explored whether children's interpretation biases were explained by parental anxiety and/or children's levels of anxiety. METHOD In total, 44 children of parents with a panic disorder (PD), 27 children of parents with a social anxiety disorder (SAD), 7 children of parents with SAD/PD, and 84 children of parents without an anxiety disorder (controls) participated in this study. Parents and children filled out the Screen for Child Anxiety Related Disorders (SCARED) questionnaire, and children performed two ambiguous scenario tasks: one with and one without video priming. RESULTS Children of parents with PD displayed significantly more negative interpretations of panic scenarios and social scenarios than controls. Negative interpretations of panic scenarios were explained by parental PD diagnosis and children's anxiety levels. These effects were not found for children of parents with SAD. Priming did not affect interpretation. CONCLUSION Our results showed that children of parents with PD have a higher chance of interpreting ambiguous situations more negatively than children of parents without anxiety disorders. More research is needed to study whether this negative bias predicts later development of anxiety disorders in children.
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Klein AM, Salemink E, de Hullu E, Houtkamp E, Papa M, van der Molen M. Cognitive Bias Modification Reduces Social Anxiety Symptoms in Socially Anxious Adolescents with Mild Intellectual Disabilities: A Randomized Controlled Trial. J Autism Dev Disord 2018; 48:3116-3126. [PMID: 29680962 PMCID: PMC6096836 DOI: 10.1007/s10803-018-3579-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The goal of this study was to examine the effects of Cognitive Bias Modification training for Interpretation (CBM-I) in socially anxious adolescents with Mild Intellectual Disabilities (MID). A total of 69 socially anxious adolescents with MID were randomly assigned to either a positive or a neutral control-CMB-I-training. Training included five sessions in a 3-week period, and each session consisted of 40 training items. Adolescents in the positive training group showed a significant reduction in negative interpretation bias on the two interpretation bias tasks after training compared to adolescents in the control-training group. Furthermore, in contrast to the control-training group, adolescents in the positive training reported a significant reduction of their social anxiety symptoms 10 weeks post-training.
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Affiliation(s)
- Anke M Klein
- Clinical, Neuro, and Developmental Psychology, VU Amsterdam, Amsterdam, The Netherlands.
- Developmental Psychology, University of Amsterdam, Nieuwe Achtergracht 129B, Amsterdam, The Netherlands.
| | - Elske Salemink
- Developmental Psychology, University of Amsterdam, Nieuwe Achtergracht 129B, Amsterdam, The Netherlands
| | - Eva de Hullu
- Clinical Psychology, Open University, Heerlen, The Netherlands
| | - Esther Houtkamp
- Clinical, Neuro, and Developmental Psychology, VU Amsterdam, Amsterdam, The Netherlands
| | - Marlissa Papa
- Clinical, Neuro, and Developmental Psychology, VU Amsterdam, Amsterdam, The Netherlands
| | - Mariët van der Molen
- Clinical, Neuro, and Developmental Psychology, VU Amsterdam, Amsterdam, The Netherlands
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Examining the Mechanisms of Therapeutic Change in a Cognitive-Behavioral Intervention for Anxious Children: The Role of Interpretation Bias, Perceived Control, and Coping Strategies. Child Psychiatry Hum Dev 2018; 49:73-85. [PMID: 28500435 DOI: 10.1007/s10578-017-0731-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This study examined the role of theoretically meaningful mediators of therapeutic change-interpretation bias, perceived control, and coping strategies-in a cognitive-behavioral intervention for anxious youth. This is one of the few studies that examined the change in potential mediator and outcome variables by means of a longitudinal design that included four assessment points: pretreatment, in-treatment, post-treatment, and at 4-months follow-up. Forty-seven 8- to 12-year-old children with a principal DSM-IV diagnosis of anxiety disorder participated in the study. On each assessment point, questionnaires assessing the mediator variables and a standardized anxiety scale were administered to the children. The results showed that perceived control and interpretation bias (but not coping strategies) accounted for a significant proportion in the variability of various types of anxiety symptoms, providing a preliminary support for the notion that these cognitive dimensions' act as mechanisms of therapeutic change in cognitive-behavioral therapy for anxious children.
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Halldorsson B, Creswell C. Social anxiety in pre-adolescent children: What do we know about maintenance? Behav Res Ther 2017; 99:19-36. [PMID: 28881221 DOI: 10.1016/j.brat.2017.08.013] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 08/18/2017] [Accepted: 08/28/2017] [Indexed: 10/18/2022]
Abstract
The cognitive theory of social anxiety disorder (SAD) is one of the most widely accepted accounts of the maintenance of the disorder in adults, yet it remains unknown if, or to what extent, the same cognitive and behavioral maintenance mechanisms that occur in adult SAD also apply to SAD among pre-adolescent children. In contrast to the adult literature, current models of SAD in children mostly account for etiology and maintenance processes are given limited attention. Consequently, their clinical utility for the treatment of SAD in children may be limited. This narrative review, first, critically examines the different theoretical conceptualizations of the maintenance of social anxiety in the child and adult literature and illustrates how these have resulted in different treatment approaches and clinical understanding. Second, it reviews the available evidence relating to hypotheses about the maintenance of SAD in children as derived from adult cognitive and etiological models. Third, it highlights the need to attend directly to child specific maintenance mechanisms in SAD, to draw on cognitive theory, and to account for the influence of childhood-specific contextual (e.g. family and school-based interactions) and developmental factors on children's social experiences.
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Affiliation(s)
- Brynjar Halldorsson
- School of Psychology and Clinical Language Sciences, University of Reading, UK.
| | - Cathy Creswell
- School of Psychology and Clinical Language Sciences, University of Reading, UK
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Oglesby ME, Allan NP, Schmidt NB. Randomized control trial investigating the efficacy of a computer-based intolerance of uncertainty intervention. Behav Res Ther 2017; 95:50-57. [DOI: 10.1016/j.brat.2017.05.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 05/03/2017] [Accepted: 05/10/2017] [Indexed: 11/30/2022]
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Imagine the bright side of life: A randomized controlled trial of two types of interpretation bias modification procedure targeting adolescent anxiety and depression. PLoS One 2017; 12:e0181147. [PMID: 28715495 PMCID: PMC5513454 DOI: 10.1371/journal.pone.0181147] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 06/23/2017] [Indexed: 11/20/2022] Open
Abstract
Introduction Anxiety and depression are highly prevalent during adolescence and characterized by negative interpretation biases. Cognitive bias modification of interpretations (CBM-I) may reduce such biases and improve emotional functioning. However, as findings have been mixed and the traditional scenario training is experienced as relatively boring, a picture-based type of training might be more engaging and effective. Methods The current study investigated short- and long-term effects (up to 6 months) and users’ experience of two types of CBM-I procedure in adolescents with heightened symptoms of anxiety or depression (N = 119, aged 12–18 year). Participants were randomized to eight online sessions of text-based scenario training, picture-word imagery training, or neutral control training. Results No significant group differences were observed on primary or secondary emotional outcomes. A decrease in anxiety and depressive symptoms, and improvements in emotional resilience were observed, irrespective of condition. Scenario training marginally reduced negative interpretation bias on a closely matched assessment task, while no such effects were found on a different task, nor for the picture-word or control group. Subjective evaluations of all training paradigms were relatively negative and the imagery component appeared particularly difficult for adolescents with higher symptom levels. Conclusions The current results question the preventive efficacy and feasibility of both CBM-I procedures as implemented here in adolescents.
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Spence SH, Rapee RM. The etiology of social anxiety disorder: An evidence-based model. Behav Res Ther 2016; 86:50-67. [DOI: 10.1016/j.brat.2016.06.007] [Citation(s) in RCA: 137] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 06/07/2016] [Accepted: 06/29/2016] [Indexed: 12/16/2022]
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