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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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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: 12] [Impact Index Per Article: 6.0] [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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Bosmans G, Borelli JL. Attachment and the Development of Psychopathology: Introduction to the Special Issue. Brain Sci 2022; 12:brainsci12020174. [PMID: 35203937 PMCID: PMC8870158 DOI: 10.3390/brainsci12020174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 01/25/2022] [Indexed: 11/16/2022] Open
Abstract
When Bowlby [...]
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Affiliation(s)
- Guy Bosmans
- Clinical Psychology, Katholieke Universiteit Leuven, 3000 Leuven, Belgium
- Correspondence:
| | - Jessica L. Borelli
- Department of Psychological Science, University of California Irvine, Irvine, CA 92617, USA;
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Gastelle M, Kerns KA. A Systematic Review of Representational and Behavioral Measures of Parent-Child Attachment Available for Middle Childhood. Hum Dev 2021. [DOI: 10.1159/000521393] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
A variety of parent-child attachment measures, representing a range of conceptual approaches, have been adapted for use in middle childhood. A recent surge in studies using the new methods makes a comprehensive review of these measures timely. This systematic review of 67 studies covers representational and behavioral measures of parent-child attachment used with children 9-12 years old. This paper aims to evaluate parent-child attachment measurements with an emphasis on understanding their theoretical bases in addition to considering the available validity evidence. Findings identify several independently well-validated representational measures, and they highlight a continued need to investigate direct comparisons of the measures, as very little research has considered how the measures relate to each other, both conceptually and empirically. Behavioral measures of attachment in middle childhood, which are relatively new, are identified as potentially important in developing a better understanding of attachment measurement in this age group.
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Doolan EL, Bryant RA. Modifying insecure attachment style with cognitive bias modification. J Behav Ther Exp Psychiatry 2021; 73:101664. [PMID: 34087690 DOI: 10.1016/j.jbtep.2021.101664] [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: 01/03/2020] [Revised: 03/22/2021] [Accepted: 05/19/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVES Attachment theory suggests that internal working models developed from early experiences with attachment figures biases cognitive appraisals a person makes of themselves and others. The current paper investigates whether attachment-related interpretative biases can be altered using Cognitive Bias Modification (CBM-I). METHODS Eighty anxiously attached participants were randomly assigned to receive either secure or insecure CBM-I training. To measure training effects on attachment-related interpretation bias, participants read scenarios involving attachment figures whereby the availability of the attachment figure was undetermined, followed by test sentences that assigned an attachment-secure or -insecure interpretation to the situations. Participants rated the similarity of these sentences to the previously read ambiguous situations. RESULTS Participants who received secure CBM-I training ascribed higher similarity ratings to secure sentence interpretations of ambiguous scenarios compared to insecure sentence interpretations. Attachment anxiety increased after CBM-I training for those who received insecure training, but did not differ for those who received secure training. LIMITATIONS This study was limited to healthy participants and did not include clinical participants. These findings need to be replicated by assessing the effects of CBM-I over an extended period. CONCLUSIONS CBM-I training may provide a viable means of modulating attachment anxiety. If validated with more potent strategies for secure attachment training, this approach could have significant implications for the treatment of affective disorders characterized by insecure attachments.
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Increasing secure base script knowledge among parents with Attachment and Biobehavioral Catch-up. Dev Psychopathol 2021; 33:554-564. [PMID: 33487189 DOI: 10.1017/s0954579420001765] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
This study evaluated whether Attachment and Biobehavioral Catch-up (ABC), a parenting intervention, altered the attachment representations of parents (average age of 34.2 years) who had been referred to Child Protective Services (CPS) due to risk for child maltreatment when their children were infants. Approximately 7 years after completing the intervention, parents who had been randomized to receive ABC (n = 43) exhibited greater secure base script knowledge than parents who had been randomized to receive a control intervention (n = 51). Low-risk parents (n = 79) exhibited greater secure base script knowledge than CPS-referred parents who had received a control intervention. However, levels of secure base script knowledge did not differ between low-risk parents and CPS-referred parents who had received the ABC intervention. In addition, secure base script knowledge was positively associated with parental sensitivity during interactions with their 8-year-old children among low-risk and CPS-referred parents. Mediational analyses supported the idea that the ABC intervention enhanced parents' sensitivity 7 years later indirectly via increases in parents' secure base script knowledge.
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Verhees MWFT, van IJzendoorn MH, Bakermans-Kranenburg MJ, Ceulemans E, de Winter S, Santens T, Alaerts K, Casteels K, Salemink E, Verhaeghe J, Bosmans G. Combining oxytocin and cognitive bias modification training in a randomized controlled trial: Effects on trust in maternal support. J Behav Ther Exp Psychiatry 2020; 66:101514. [PMID: 31610435 DOI: 10.1016/j.jbtep.2019.101514] [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: 05/18/2018] [Revised: 07/03/2019] [Accepted: 09/22/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND OBJECTIVES Research on the social effects of intranasal oxytocin in children is scarce. Oxytocin has been proposed to have clearer beneficial effects when added to social learning paradigms. The current study tested this proposition in middle childhood by assessing effects of cognitive bias modification (CBM) training and oxytocin on trust in maternal support. METHODS Children (N = 100, 8-12 years) were randomly assigned to one of two training conditions: CBM training aimed at increasing trust or neutral placebo training. Within each training condition, half the participants received oxytocin and half a placebo. Main and interaction effects were assessed on measures of trust-related interpretation bias and trust. We explored whether child characteristics moderated intervention effects. RESULTS Children in the CBM training were faster to interpret maternal behaviour securely versus insecurely. Effects did not generalize to interpretation bias measures or trust. There were no main or interaction effects of oxytocin. Exploratory moderation analyses indicated that combining CBM training with oxytocin had less positive effects on trust for children with more internalizing problems. LIMITATIONS As this was the first study combining CBM and oxytocin, replication of the results is needed. CONCLUSIONS This study combined a social learning paradigm with oxytocin in children. CBM training was effective at an automatic level of processing. Oxytocin did not enhance CBM effects or independently exert effects. Research in larger samples specifying when oxytocin might have beneficial effects is necessary before oxytocin can be used as intervention option in children.
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Affiliation(s)
| | - Marinus H van IJzendoorn
- Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, the Netherlands; Primary Care Unit, School of Clinical Medicine, University of Cambridge, UK
| | | | - Eva Ceulemans
- Quantitative Psychology and Individual Differences Research Unit, KU Leuven, Leuven, Belgium
| | - Simon de Winter
- Parenting and Special Education Research Unit, KU Leuven, Leuven, Belgium
| | - Tara Santens
- Parenting and Special Education Research Unit, KU Leuven, Leuven, Belgium
| | - Kaat Alaerts
- Research Group for Neuromotor Rehabilitation, KU Leuven, Leuven, Belgium
| | - Kristina Casteels
- Department of Pediatrics, University Hospitals Leuven, Leuven, Belgium; Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Elske Salemink
- Department of Developmental Psychology, University of Amsterdam, Amsterdam, the Netherlands
| | - Johan Verhaeghe
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Guy Bosmans
- Parenting and Special Education Research Unit, KU Leuven, Leuven, Belgium; Clinical Psychology Research Unit, KU Leuven, Leuven, Belgium
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Bosmans G, Verhees MWFT, De Winter S. A Further Validation of the Cognitive Bias Modification Effect on Trust in Middle Childhood. Behav Ther 2019; 50:1164-1172. [PMID: 31735250 DOI: 10.1016/j.beth.2019.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 02/02/2019] [Accepted: 04/16/2019] [Indexed: 10/26/2022]
Abstract
Recent middle childhood research suggests that children's trust in maternal support can be manipulated using Cognitive Bias Modification (CBM) aimed at changing children's interpretation of ambiguous maternal support-related behavior. The current study with 60 children (40 girls, Mage = 10.62, SDage = 1.20) aimed to replicate previous research and to test whether the CBM effect is specific to trust or generalizes to other child evaluations of maternal behavior. More specifically, CBM effects on children's evaluation of parenting behavior were tested. Trust and maternal parenting behaviors were assessed using children's self-report. Results largely replicated previous findings, including the positive effect of CBM on children's trust in maternal support. Suggesting that this effect was specific for trust, the CBM manipulation did not affect children's appraisal of maternal parenting behavior. This finding supports the validity of CBM effects.
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Bodner N, Bosmans G, Sannen J, Verhees M, Ceulemans E. Unraveling middle childhood attachment-related behavior sequences using a micro-coding approach. PLoS One 2019; 14:e0224372. [PMID: 31661519 PMCID: PMC6818776 DOI: 10.1371/journal.pone.0224372] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 10/13/2019] [Indexed: 11/19/2022] Open
Abstract
Attachment theory states that children learn to trust in their parent's availability and support if they repeatedly experience that their parents respond sensitively to their needs during distress. Attachment is thus developed and shaped by day-to-day interactions, while at the same time, each interaction is a momentary expression of the attachment relation. How attachment-related behaviors of mother and child follow upon each other during interactions in middle childhood, and how these sequences differ in function of attachment quality, has hardly been studied up to now. To fill this gap, we analyzed the micro-coded interaction of 55 mother-child dyads (27 girls, 28 boys, mean age: 10.3) after a standardized stress-induction. Results reveal that all mother-child dyads show a loop between positive mother and child behaviors. This pattern is complemented with a loop of negative mother and child behaviors in low-trust and more avoidantly attached children: these children tend to handle negative mother behavior less well as they show more negative behavior and less positive behavior in response to negative maternal behavior. More anxiously attached children also show less positive behavior, but react positively on collaborative interactions. The micro-coded interactions thus reveal important insights that inform practitioners and advance attachment theory.
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Affiliation(s)
- Nadja Bodner
- Quantitative Psychology and Individual Differences Research Group, Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | - Guy Bosmans
- Clinical Psychology Research Group, Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | - Jasmien Sannen
- Parenting and Special Education Research Unit, Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | - Martine Verhees
- Parenting and Special Education Research Unit, Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
- Clinical Child and Family Studies, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Eva Ceulemans
- Quantitative Psychology and Individual Differences Research Group, Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
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Vandesande S, Bosmans G, Sterkenburg P, Schuengel C, Van Den Noortgate W, Maes B. Comfort provided by parents versus strangers after eliciting stress in children with severe or profound intellectual disabilities: does it make a difference? Attach Hum Dev 2019; 22:425-447. [PMID: 31476969 DOI: 10.1080/14616734.2019.1659835] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The relationships between children with severe or profound intellectual disabilities (ID) and their parents may fulfil attachment functions, such as regulating emotional responses to stress. This study examined the extent to which children with severe or profound ID differentiate between their parents and a stranger as a resource for stress-regulation. A home-based experimental paradigm was conducted and video-recorded in 38 families. Children (1-8 years) were exposed to four naturalistic stressors followed by comfort, randomly provided by the parents or the stranger. Emotional behaviour (arousal and valence) and the skin conductance level were simultaneously recorded. With regard to both emotional behaviour and skin conductance, children significantly differentiated between their parents as attachment figures and the stranger during stress and comfort, despite their impairments on various developmental domains. Behavioural observation and physiology show complementary manifestations of parent-child attachment in this population.
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Affiliation(s)
- Sien Vandesande
- Special Education and Parenting, KU Leuven , Leuven, Belgium
| | - Guy Bosmans
- Special Education and Parenting, KU Leuven , Leuven, Belgium
| | - Paula Sterkenburg
- Department of Clinical Child and Family Studies, Vrije Universiteit Amsterdam , Amsterdam, The Netherlands
| | - Carlo Schuengel
- Department of Clinical Child and Family Studies, Vrije Universiteit Amsterdam , Amsterdam, The Netherlands
| | | | - Bea Maes
- Special Education and Parenting, KU Leuven , Leuven, Belgium
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Attachment-related attention bias plays a causal role in trust in maternal support. J Exp Child Psychol 2019; 185:176-190. [DOI: 10.1016/j.jecp.2019.04.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 02/23/2019] [Accepted: 04/22/2019] [Indexed: 11/17/2022]
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Krans J, Bosmans G, Salemink E, De Raedt R. Cognitive Bias Modification of Expectancies (CBM-E): Effects on Interpretation Bias and Autobiographical Memory, and Relations with Social and Attachment Anxiety. COGNITIVE THERAPY AND RESEARCH 2019. [DOI: 10.1007/s10608-019-10032-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Verhees MWFT, Ceulemans E, Bosmans G. Strengthening Attachment-Based Therapies: A Case for Cognitive Bias Modification? J Am Acad Child Adolesc Psychiatry 2019; 58:732-733. [PMID: 31229182 DOI: 10.1016/j.jaac.2019.01.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 01/09/2019] [Accepted: 05/10/2019] [Indexed: 10/26/2022]
Abstract
A recent article published in the Journal describes the effectiveness of attachment-based family therapy in decreasing suicidal ideation and depressive symptoms in adolescents. 1Because insecure attachment is a transdiagnostic risk factor in the development of psychological problems in children and adolescents, improving attachment relationships is an important therapeutic endeavor. In their article, Diamond et al. suggest that programs such as attachment-based family therapy might become more effective or "fortified by integrating more specific cognitive and emotional skills training." 1In the current letter, we want to argue that such a claim is theoretically meaningful, how such fortification might be achieved, and which training components might be added. Most importantly, we want to plea for clinical research that puts this claim to a test.
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Affiliation(s)
| | - Eva Ceulemans
- Quantitative Psychology and Individual Differences Research Unit, KU Leuven, Belgium
| | - Guy Bosmans
- Parenting and Special Education Research Unit, KU Leuven, Belgium
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