Automaticity in anxiety disorders and major depressive disorder

Short-Term Memory Capacity Predicts Willingness to Expend Cognitive Effort for Reward

We must often decide whether the effort required for a task is worth the reward. Past rodent work suggests that willingness to deploy cognitive effort can be driven by individual differences in perceived reward value, depression, or chronic stress. However, many factors driving cognitive effort deployment-such as short-term memory ability-cannot easily be captured in rodents. Furthermore, we do not fully understand how individual differences in short-term memory ability, depression, chronic stress, and reward anticipation impact cognitive effort deployment for reward. Here, we examined whether these factors predict cognitive effort deployment for higher reward in an online visual short-term memory task. Undergraduate participants were grouped into high and low effort groups (n HighEffort = 348, n LowEffort = 81; n Female = 332, n Male = 92, M Age = 20.37, Range Age = 16-42) based on decisions in this task. After completing a monetary incentive task to measure reward anticipation, participants completed short-term memory task trials where they could choose to encode either fewer (low effort/reward) or more (high effort/reward) squares before reporting whether or not the color of a target square matched the square previously in that location. We found that only greater short-term memory ability predicted whether participants chose a much higher proportion of high versus low effort trials. Drift diffusion modeling showed that high effort group participants were more biased than low effort group participants toward selecting high effort trials. Our findings highlight the role of individual differences in cognitive effort ability in explaining cognitive effort deployment choices.

Threat of shock increases distractor susceptibility during the short-term maintenance of visual information

Elevated arousal in anxiety is thought to affect attention control. To test this, we designed a visual short-term memory (VSTM) task to examine distractor suppression during periods of threat and no-threat. We hypothesized that threat would impair performance when subjects had to filter out large numbers of distractors. The VSTM task required subjects to attend to one array of squares while ignoring a separate array. The number of target and distractor squares varied systematically, with high (four squares) and low (two squares) target and distractor conditions. This study comprised two separate experiments. Experiment 1 used startle responses and white noise as to directly measure threat-induced anxiety. Experiment 2 used BOLD to measure brain responses. For Experiment 1, subjects showed significantly larger startle responses during threat compared to safe period, supporting the validity of the threat manipulation. For Experiment 2, we found that accuracy was affected by threat, such that the distractor load negatively impacted accuracy only in the threat condition. We also found threat-related differences in parietal cortex activity. Overall, these findings suggest that threat affects distractor susceptibility, impairing filtering of distracting information. This effect is possibly mediated by hyperarousal of parietal cortex during threat.

Disorder-specific versus transdiagnostic cognitive mechanisms in anxiety and depression: Machine-learning-based prediction of symptom severity

INTRODUCTION

Psychiatric evaluation of anxiety and depression is currently based on self-reported symptoms and their classification into discrete disorders. Yet the substantial overlap between these disorders as well as their within-disorder heterogeneity may contribute to the mediocre success rates of treatments. The proposed research examines a new framework for diagnosis that is based on alterations in underlying cognitive mechanisms. In line with the Research Domain Criteria (RDoC) approach, the current study directly compares disorder-specific and transdiagnostic cognitive patterns in predicting the severity of anxiety and depression symptoms.

METHODS

The sample included 237 individuals exhibiting differing levels of anxiety and depression symptoms, as measured by the STAI-T and BDI-II. Random Forest regressors were used to analyze their performance on a battery of six computerized cognitive-behavioral tests targeting selective and spatial attention, expectancy, interpretation, memory, and cognitive control biases.

RESULTS

Unique anxiety-specific biases were found, as well as shared anxious-depressed bias patterns. These cognitive biases exhibited relatively high fitting rates when predicting symptom severity (questionnaire scores common range 0-60, MAE = 6.03, RMSE = 7.53). Interpretation and expectancy biases exhibited the highest association with symptoms, above all other individual biases.

LIMITATIONS

Although internal validation methods were applied, models may suffer from potential overfitting due to sample size limitations.

CONCLUSION

In the context of the ongoing dispute regarding symptom-centered versus transdiagnostic approaches, the current study provides a unique comparison of these two views, yielding a novel intermediate approach. The results support the use of mechanism-based dimensional diagnosis for adding precision and objectivity to future psychiatric evaluations.

Positive reappraisal coping mediates the relationship between parental abuse and lack of affection on adulthood generalized anxiety severity

Exposure to parental abuse and lack of parental affection during childhood are risk factors for adulthood psychopathology. Tendency to engage in positive reappraisal may be a plausible mechanism underlying this relationship. The current study examined if positive reappraisal coping mediated the relationship between maternal/paternal abuse/affection and adulthood generalized anxiety disorder (GAD) symptoms. Participant data (N = 3294) from the Midlife Development in the United States study was collected in three waves, spaced nine years apart. Longitudinal structural equation mediation modeling examined whether positive reappraisal coping at Time 2 mediated the relationship between maternal/paternal abuse/affection at Time 1 and GAD symptoms at Time 3, controlling for GAD symptoms at Time 1. Positive reappraisal coping mediated maternal/paternal childhood abuse - GAD symptom severity and maternal/paternal childhood affection - GAD severity relations. Maternal and paternal abuse was associated with lower positive reappraisal tendencies, predicting increased GAD symptom severity. Conversely, higher maternal/paternal affection was associated with increased positive reappraisal, predicting lower GAD severity. Incremental prediction revealed that childhood abuse to GAD severity via positive reappraisal path was significant for maternal but not paternal abuse, whereas affection from both parents remained significant. Positive reappraisal coping may be a possible mechanism linking childhood experiences to adulthood GAD severity.

Loneliness is related to smaller gray matter volumes in ACC and right VLPFC in people with major depression: a UK biobank study

The anterior cingulate cortex (ACC) and right ventrolateral prefrontal cortex (VLPFC) are thought to have important roles in loneliness (feeling of social isolation/exclusion) experience or regulation and in the pathophysiology of their disturbance in major depressive disorder (MDD). However, the structural abnormalities of these regions and the correlates with loneliness in MDD across the healthy population have not fully been clarified. The study analyzed the link between loneliness and gray matter volumes (GMVs) in the ACC and right VLPFC among 1,005 patients with MDD and 7,247 healthy controls (HCs) using UK Biobank data. Significant reductions in GMV in the right VLPFC were found in MDD males compared to HCs. MDD males also showed a higher association between loneliness and reduced GMVs in the right VLPFC and bilateral ACC than HCs. No such associations were found in MDD females. The findings suggest that loneliness may influence brain structures crucial for emotion experience and regulation, particularly in middle-older aged men with MDD. This highlights the potential adverse effects of loneliness on brain structure in MDD and suggests that social engagement could have a positive impact.

Threat of shock increases distractor susceptibility during the short-term maintenance of visual information

BACKGROUND

Work on anxiety related attention control deficits suggests that elevated arousal impacts the ability to filter out distractors. To test this, we designed a task to look at distractor suppression during periods of threat. We administered trials of a visual short-term memory (VSTM) task, during periods of unpredictable threat, and hypothesized that threat would impair performance during trials where subjects were required to filter out large numbers of distractors.

METHOD

Experiment 1 involved fifteen healthy participants who completed one study visit. They performed four runs of a VSTM task comprising 32 trials each. Participants were presented with an arrow indicating left or right, followed by an array of squares. They were instructed to remember the target side and disregard the distractors on the off-target side. A subsequent target square was shown, and participants indicated whether it matched one of the previously presented target squares. The trial conditions included 50% matches and 50% mismatches, with an equal distribution of left and right targets. The number of target and distractor squares varied systematically, with high (4 squares) and low (2 squares) target and distractor conditions. Trials alternated between periods of safety and threat, with startle responses recorded using electromyography (EMG) following white noise presentations. Experiment 2 involved twenty-seven healthy participants who completed the same VSTM task inside an MRI scanner during a single study visit. The procedure mirrored that of Experiment 1, except for the absence of white noise presentations.

RESULTS

For Experiment 1, subjects showed significantly larger startle responses during threat compared to safe period, supporting the validity of the threat manipulation. However, results suggested that the white noise probes interfered with performance. For Experiment 2, we found that both accuracy was affected by threat, such that distractor load negatively impacted accuracy only in the threat condition.

CONCLUSION

Overall, these findings suggest that threat affects distractor susceptibility during the short-term maintenance of visual information. The presence of threat makes it more difficult to filter out distracting information. We believe that this is related to hyperarousal of parietal cortex, which has been observed during unpredictable threat.

Neural representations of ambiguous affective stimuli and resilience to anxiety in emerging adults

The tendency to interpret ambiguous stimuli as threatening has been associated with a range of anxiety disorders. Responses to ambiguity may be particularly relevant to mental health during the transition from adolescence to adulthood ("emerging adulthood"), when individuals encounter unfamiliar challenges and navigate novel social situations. However, it remains unclear whether neural representations of ambiguity relate to risk for anxiety. The present study sought to examine whether multivariate representations of ambiguity - and their similarity to representations of threat - relate to appraisals of ambiguity or anxiety in a sample of emerging adults. Participants (N = 41) viewed threatening (angry), nonthreatening (happy), and ambiguous (surprised) facial stimuli while undergoing fMRI. Outside of the scanner, participants were presented with the same stimuli and categorized the ambiguous faces as positive or negative. Using representational similarity analyses (RSA), we investigated whether the degree of pattern similarity in responses to ambiguous, nonthreatening, and threatening faces within the amygdala related to appraisals of ambiguous stimuli and anxiety symptomatology. We found that individuals who evidenced greater similarity (i.e., less differentiation) in neural representations of ambiguous and nonthreatening faces within the left amygdala reported lower concurrent anxiety. Additionally, trial-level pattern similarity predicted subsequent appraisals of ambiguous stimuli. These findings provide insight into how neural representations of ambiguity relate to risk or resilience for the development of anxiety.

Brain mechanisms underlying the emotion processing bias in treatment-resistant depression

Depression is associated with a cognitive bias towards negative information and away from positive information. This biased emotion processing may underlie core depression symptoms, including persistent feelings of sadness or low mood and a reduced capacity to experience pleasure. The neural mechanisms responsible for this biased emotion processing remain unknown. Here, we had a unique opportunity to record stereotactic electroencephalography (sEEG) signals in the amygdala and prefrontal cortex (PFC) from 5 treatment-resistant depression (TRD) patients and 12 epilepsy patients (as control) while they participated in an affective bias task in which happy and sad faces were rated. First, compared with the control group, patients with TRD showed increased amygdala responses to sad faces in the early stage (around 300 ms) and decreased amygdala responses to happy faces in the late stage (around 600 ms) following the onset of faces. Further, during the late stage of happy face processing, alpha-band activity in PFC as well as alpha-phase locking between the amygdala and PFC were significantly greater in TRD patients compared to the controls. Second, after deep brain stimulation (DBS) delivered to bilateral subcallosal cingulate (SCC) and ventral capsule/ventral striatum (VC/VS), atypical amygdala and PFC processing of happy faces in TRD patients remitted toward the normative pattern. The increased amygdala activation during the early stage of sad face processing suggests an overactive bottom-up processing system in TRD. Meanwhile, the reduced amygdala response during the late stage of happy face processing could be attributed to inhibition by PFC through alpha-band oscillation, which can be released by DBS in SCC and VC/VS.

Effects of Mass Shootings on Mental Illness Stigma in the United States

Although the vast majority of people with mental illness (PWMI) are not violent, Americans tend to think they are more dangerous than the general population. Because negative media portrayals may contribute to stigma, we used time-series analyses to examine changes in the public's perceived dangerousness of PWMI around six mass shootings whose perpetrators were reported to have a mental illness. From 2011 to 2019, 38,094 U.S. participants completed an online study assessing implicit and explicit perceived dangerousness of PWMI. There were large, upward spikes in perceived dangerousness the week of the Sandy Hook mass shooting that were relatively short-lived. However, there was not a consistent pattern of effects for other events analyzed, and any other spikes observed were smaller. Effects tended to be larger for explicit versus implicit perceived dangerousness. Sandy Hook seemed to temporarily worsen perceived dangerousness of PWMI, but this pattern was not observed for other mass shootings.

Individuals fearing positivity do not perceive positive affect treatments as strong fits: A novel experimental finding and replication

BACKGROUND AND OBJECTIVES

Positive affect treatments, which hold great promise to connect with those who are otherwise resistant to depression treatments, attempt to upregulate positive emotions. These treatments have potential advantages over standard therapies because they target cross-diagnostic core symptoms (e.g., anhedonia) that may respond better to interventions aimed at increased positivity. However, the extent to which these treatments are a perceived fit by individuals for whom they were developed (i.e., individuals who are afraid of, avoid, or experience less positivity) is unclear.

METHODS

We conducted two independent studies utilizing a cross-sectional, experimental design to examine perceived treatment fit. Participants (Study 1: N = 416; Study 2: N = 321) read counterbalanced treatment descriptions of (1) positive affect treatment and (2) psychodynamic psychotherapy and answered questions regarding perceived treatment fit, effectiveness, and preference of the two treatments.

RESULTS

Our findings suggest that individuals fearful of happiness perceived a prospective depression treatment specifically targeting positivity as a poorer fit, demonstrating an opposite pattern to the overall samples' treatment preference in both studies. Thus, as predicted by Reward Devaluation Theory, those fearing positivity exhibited avoidance behaviors for treatments that are to an extent designed, and might otherwise be most effective, for them.

LIMITATIONS

The current study utilized a college student sample.

CONCLUSION

These empirical findings may ultimately inform psychoeducation of why positive affect treatments, which are in direct contrast with clients' preferences, may be the very treatments they need the most.

A brief transdiagnostic group (the take control course) compared to individual low-intensity CBT for depression and anxiety: a randomized non-inferiority trial

Few studies have examined brief transdiagnostic groups. The Take Control Course (TCC) was developed for patients with mild to moderate common mental health problems. We examined whether TCC is non-inferior to individual low-intensity cognitive behaviour therapy (CBT) in a single-blind individually randomised parallel non-inferiority trial. The primary outcomes were depression (PHQ9) and anxiety (GAD7) at 6-month follow-up (primary outcome point) and 12-month follow-up. The non-inferiority margin that we set, based on previous trials, corresponds to approximately 3 points on the PHQ9 and approximately 2.5 points on the GAD7. Intention-to-treat (ITT) and per-protocol (PP) analyses of 6-month data of 156 randomised patients indicated that TCC was non-inferior to individual low-intensity CBT on anxiety (ITT Coefficient = 0.24; 95% CI: -1.45 to 1.92; d = 0.04; p = .79), and depression (ITT Coefficient = 0.82; 95% CI: -1.06 to 2.69; d = 0.14; p = .39) outcomes, and functioning (ITT Coefficient = 0.69; 95% CI: -2.56 to 3.94; d = 0.08; p = .68). The findings at 12 months were inconclusive and require further testing. This randomised trial provides preliminary support that TCC is not less effective than short-term individual CBT within Improving Access to Psychological Therapies (IAPT) services.

Biased Maintenance of Attention on Sad Faces in Clinically Depressed Youth: An Eye-Tracking Study

The role of negative attention biases (AB), central to cognitive models of adult depression, is yet unclear in youth depression. We investigated negative AB in depressed compared to healthy youth and tested whether AB are more pronounced in depressed than at-risk youth. Negative AB was assessed for sad and angry faces with an eye-tracking paradigm [Passive Viewing Task (PVT)] and a behavioural task [Visual Search Task (VST)], comparing three groups of 9-14-year-olds: youth with major depression (MD; n = 32), youth with depressed parents (high-risk; HR; n = 49) and youth with healthy parents (low-risk; LR; n = 42). The PVT revealed MD participants to maintain attention longer on sad faces compared to HR, but not LR participants. This AB correlated positively with depressive symptoms. The VST revealed no group differences. Our results provide preliminary evidence for a negative AB in maintenance of attention on disorder-specific emotional information in depressed compared to at-risk youth.

Using expectation violation models to improve the outcome of psychological treatments

Expectations are a central maintaining mechanism in mental disorders and most psychological treatments aim to directly or indirectly modify clinically relevant expectations. Therefore, it is crucial to examine why patients with mental disorders maintain dysfunctional expectations, even in light of disconfirming evidence, and how expectation-violating situations should be created in treatment settings to optimize treatment outcome and reduce the risk of treatment failures. The different psychological subdisciplines offer various approaches for understanding the underlying mechanisms of expectation development, persistence, and change. Here, we convey recommendations on how to improve psychological treatments by considering these different perspectives. Based on our expectation violation model, we argue that the outcome of expectation violation depends on several characteristics: features of the expectation-violating situation; the dynamics between the magnitude of expectation violation and cognitive immunization processes; dealing with uncertainties during and after expectation change; controlled and automatic attention processes; and the costs of expectation changes. Personality factors further add to predict outcomes and may offer a basis for personalized treatment planning. We conclude with a list of recommendations derived from basic psychology that could contribute to improved treatment outcome and to reduced risks of treatment failures.

A systematic review of the literature on interpretation bias and its physiological correlates

An important, yet under-explored area of interpretation bias research concerns the examination of potential physiological correlates and sequalae of this bias. Developing a better understanding of the physiological processes that underpin interpretation biases will extend current theoretical frameworks underlying interpretation bias, as well as optimising the efficacy of cognitive bias modification for interpretation (CBM-I) interventions aimed at improving symptoms of emotional disorders. To this end, systematic searches were conducted across the Web of Science, PsycInfo and Pubmed databases to identify physiological markers of interpretation bias. In addition, grey literature database searches were conducted to compliment peer-reviewed research and to counter publication bias. From a combined initial total of 898 records, 15 studies were included in qualitative synthesis (1 of which obtained from the grey literature). Eligible studies were assessed using a quality assessment tool adapted from the Quality Checklist for Healthcare Intervention Studies. The searches revealed seven psychophysiological markers of interpretation bias, namely event-related potentials, heart rate and heart rate variability, respiratory sinus arrythmia, skin conductance response, pupillometry, and electromyography. The respective theoretical and practical implications of the research are discussed, followed by recommendations for future research.

Maternal depressive symptoms and maternal child-directed speech: A systematic review

BACKGROUND

Up to 1 in 5 children are exposed to maternal depressive symptoms. Children exposed to maternal depressive symptoms have poorer language skills than children not exposed to maternal depressive symptoms. Due to the crucial role of children's language skills in school readiness and academic achievement, it is imperative to understand the factors that underlie the relation between maternal depressive symptoms and children's language skills. Previous reviews have examined the mechanistic role of social-pragmatic features of mother-child interactions. However, the literature on the relation between maternal depressive symptoms and data-providing aspects of mother-child interactions, including child-directed speech, has yet to be consolidated. In this systematic review, we present maternal child-directed speech as a potential pathway through which maternal depressive symptoms influence children's language skills.

METHODS

Following PRISMA guidelines, three database searches produced 546 articles related to maternal depressive symptoms, child-directed speech, and children's language skills, ten of which examined the relation between maternal depressive symptoms and child-directed speech.

RESULTS

Findings revealed that increases in maternal depressive symptoms may be associated with decreases in amount of child-directed speech but not necessarily with decreases in the complexity of child-directed speech.

LIMITATIONS

The studies in this review varied in sample size, the inclusion of important sociodemographic factors, and the operationalization of depression and child-directed speech, thereby limiting conclusions, especially about whether maternal depressive symptoms are associated with the complexity of child-directed speech.

CONCLUSIONS

This review has implications for prevention and intervention efforts aimed at optimizing children's language skills; child-directed speech is modifiable, and mothers experiencing depressive symptoms may benefit from resources encouraging rich child-directed speech.

Disentangling the mediating role of modifying interpretation bias on emotional distress using a novel cognitive bias modification program

BACKGROUND

Negative interpretation bias is a potential risk factor for emotional disorders. In this study, we tested a clinically inspired 4-session online Cognitive Bias Modification-Interpretation (CBM-I_Clin) program to modify negative interpretation biases.

METHODS

We randomized one hundred and twenty-one volunteer young adults (Mean age = 21.6 years, SD = 3.5; 85 % women) with varying levels of emotional distress to either an experimental or waitlist control group. Mediation analyses were used to disentangle the associations between the intervention, changes in interpretation biases (assessed by both a self-report and an experimental task), and changes in measures of cognitive vulnerability and symptoms of depression and anxiety.

RESULTS

The results showed that the CBM-I_Clin could change negative interpretation biases. Also, it had a direct effect on the change in negative memory bias, an indirect effect on the change in depression symptoms via the change in interpretation bias, and both direct and indirect effects on the change in self-reported dysfunctional attitudes.

LIMITATIONS

The study included a non-clinical sample of participants and it did not control for some potential confounding factors (e.g., attentional disorders). Furthermore, participants' engagement during the sessions at home was not supervised.

CONCLUSIONS

The CBM-I_Clin is a potential tool to prevent and intervene in emotional disorders in young adults and could complement other traditional CBM procedures or clinical interventions.

Whole-Brain Resting-State Functional Connectivity Patterns Associated With Pediatric Anxiety and Involuntary Attention Capture

BACKGROUND

Pediatric anxiety disorders are linked to dysfunction in multiple functional brain networks, as well as to alterations in the allocation of spatial attention. We used network-level analyses to characterize resting-state functional connectivity (rs-fc) alterations associated with 1) symptoms of anxiety and 2) alterations in stimulus-driven attention associated with pediatric anxiety disorders. We hypothesized that anxiety was related to altered connectivity of the frontoparietal, default mode, cingulo-opercular, and ventral attention networks and that anxiety-related connectivity alterations that include the ventral attention network would simultaneously be related to deviations in stimulus-driven attention.

METHODS

A sample of children (n = 61; mean = 10.6 years of age), approximately half of whom met criteria for a current anxiety disorder, completed a clinical assay, an attention task, and rs-fc magnetic resonance imaging scans. Network-level analyses examined whole-brain rs-fc patterns associated with clinician-rated anxiety and with involuntary capture of attention. Post hoc analyses controlled for comorbid symptoms.

RESULTS

Elevated clinician-rated anxiety was associated with altered connectivity within the cingulo-opercular network, as well as between the cingulo-opercular network and the ventral attention, default mode, and visual networks. Connectivity between the ventral attention and cingulo-opercular networks was associated with variation in both anxiety and stimulus-driven attention.

CONCLUSIONS

Pediatric anxiety is related to aberrant connectivity patterns among several networks, most of which include the cingulo-opercular network. These results help clarify the within- and between-network interactions associated with pediatric anxiety and its association with altered attention, suggesting that specific network connections could be targeted to improve specific altered processes associated with anxiety.

Interpreting ambiguous emotional information: Convergence among interpretation bias measures and unique relations with depression severity

This study aimed to examine the convergence among interpretation bias measures and their associations with depressive symptom severity. Research into interpretation biases employs measures of interpretation bias interchangeably, however, little is known about the relationship between these measures. Participants (N = 82 unselected undergraduate students; 59 female) completed four computer-based interpretation bias tasks in a cross-sectional design study. Indirect measures, based on participants' reaction times, were not correlated with each other and had poor split-half reliability. Direct measures were more strongly correlated with depressive symptoms than indirect measures, but only the Scrambled Sentences Task explained a reliable unique portion of the variance in depressive symptoms. Interpretation bias tasks may not measure the same cognitive process and may differ in the extent to which they are a cognitive marker of depression-linked interpretation bias. These findings help to improve the measurement of and theory underlying interpretation bias and depressive symptoms.

Cognitive Control, Cognitive Biases and Emotion Regulation in Depression: A New Proposal for an Integrative Interplay Model

Research traditions on cognition and depression focus on relatively unconnected aspects of cognitive functioning. On one hand, the neuropsychological perspective has concentrated on cognitive control difficulties as a prominent feature of this condition. On the other hand, the clinical psychology perspective has focused on cognitive biases and repetitive negative patterns of thinking (i.e., rumination) for emotional information. A review of the literature from both fields reveals that difficulties are more evident for mood-congruent materials, suggesting that cognitive control difficulties interact with cognitive biases to hinder cognitive switching, working memory updating, and inhibition of irrelevant information. Connecting research from these two traditions, we propose a novel integrative cognitive model of depression in which the interplay between mood-congruent cognitive control difficulties, cognitive biases, and rumination may ultimately lead to ineffective emotion-regulation strategies to downregulate negative mood and upregulate positive mood.

Attention Alterations in Pediatric Anxiety: Evidence From Behavior and Neuroimaging

BACKGROUND

Pediatric anxiety disorders involve greater capture of attention by threatening stimuli. However, it is not known if disturbances extend to nonthreatening stimuli, as part of a pervasive disturbance in attention-related brain systems. We hypothesized that pediatric anxiety involves greater capture of attention by salient, nonemotional stimuli, coupled with greater activity in the portion of the inferior frontal gyrus (IFG) specific to the ventral attention network (VAN).

METHODS

A sample of children (n = 129, 75 girls, mean 10.6 years of age), approximately half of whom met criteria for a current anxiety disorder, completed a task measuring involuntary capture of attention by nonemotional (square boxes) and emotional (angry and neutral faces) stimuli. A subset (n = 61) completed a task variant during functional magnetic resonance imaging. A priori analyses examined activity in functional brain areas within the right IFG, supplemented by a whole-brain, exploratory analysis.

RESULTS

Higher clinician-rated anxiety was associated with greater capture of attention by nonemotional, salient stimuli (F1,125 = 4.94, p = .028) and greater activity in the portion of the IFG specific to the VAN (F1,57 = 10.311, p = .002). Whole-brain analyses confirmed that the effect of anxiety during capture of attention was most pronounced in the VAN portion of the IFG, along with additional areas of the VAN and the default mode network.

CONCLUSIONS

The pathophysiology of pediatric anxiety appears to involve greater capture of attention to salient stimuli, as well as greater activity in attention-related brain networks. These results provide novel behavioral and brain-based targets for treatment of pediatric anxiety disorders.

Using machine learning-based analysis for behavioral differentiation between anxiety and depression

Anxiety and depression are distinct—albeit overlapping—psychiatric diseases, currently diagnosed by self-reported-symptoms. This research presents a new diagnostic methodology, which tests rigorously for differences in cognitive biases among subclinical anxious and depressed individuals. 125 participants were divided into four groups based on the levels of their anxiety and depression symptoms. A comprehensive behavioral test battery detected and quantified various cognitive–emotional biases. Advanced machine-learning tools, developed for this study, analyzed these results. These tools detect unique patterns that characterize anxiety versus depression to predict group membership. The prediction model for differentiating between symptomatic participants (i.e., high symptoms of depression, anxiety, or both) compared to the non-symptomatic control group revealed a 71.44% prediction accuracy for the former (sensitivity) and 70.78% for the latter (specificity). 68.07% and 74.18% prediction accuracy was obtained for a two-group model with high depression/anxiety, respectively. The analysis also disclosed which specific behavioral measures contributed to the prediction, pointing to key cognitive mechanisms in anxiety versus depression. These results lay the ground for improved diagnostic instruments and more effective and focused individually-based treatment.

"I Am a Total…Loser" - The Role of Interpretation Biases in Youth Depression

Negative interpretation biases have been found to characterize adults with depression and to be involved in the development and maintenance of the disorder. However, less is known about their role in youth depression. The present study investigated i) whether negative interpretation biases characterize children and adolescents with depression and ii) to what extent these biases are more pronounced in currently depressed youth compared to youth at risk for depression (as some negative interpretation biases have been found already in high-risk youth before disorder onset). After a negative mood induction interpretation biases were assessed with two experimental tasks: Ambiguous Scenarios Task (AST) and Scrambled Sentences Task (SST) in three groups of 9-14-year-olds: children and adolescents with a diagnosis of major depression (n = 32), children and adolescents with a high risk for depression (children of depressed parents; n = 48), as well as low-risk children and adolescents (n = 42). Depressed youth exhibited substantially more negative interpretation biases than both high-risk and low-risk groups (as assessed with both tasks), while the high-risk group showed more negative interpretation biases than the low-risk group only as assessed via the SST. The results indicate that the negative interpretation biases that are to some extent already present in high-risk populations before disorder onset are strongly amplified in currently depressed youth. The different findings for the two tasks suggest that more implicit interpretation biases (assessed with the SST) might represent cognitive vulnerabilities for depression whereas more explicit interpretation biases (assessed with the AST) may arise as a consequence of depressive symptomatology.

EXPLICIT-IMPLICIT DISCREPANCY IN MACRO-LEVEL MENTAL ILLNESS STIGMA IS LINKED TO PREVALENCE AND CARE

Introduction: This study explores the associations in the United States between each state's stereotypes about the dangerousness of people with mental illness and important outcomes for people with mental illness.

Methods: Implicit association test and questionnaire data from 17,312 online participants were aggregated within states and years. Each state's annual average implicit and explicit stereotypes were used to predict state differences in prevalence, and treatment, unemployment, and homelessness among people with mental illness.

Results: Implicit and explicit perceived dangerousness interact such that in states with low explicit perceived dangerousness, implicit perceived dangerousness is positively associated with all outcomes. In states with high explicit perceived dangerousness, implicit perceived dangerousness is negatively associated with homelessness.

Discussion: Explicit-implicit discrepancy in macro-level perceived dangerousness is generally associated with worse outcomes for people with mental illness, but the effects are small. Macro-level stereotypes might have larger effects in smaller regions, like counties, than in states.

Effect of Attachment Style on Selective Attention in Panic Disorder

Introduction: Given the heterogeneity of results in the attentional bias to threatening information in patients with panic disorder, we investigated the attentional bias toward threat and the moderating effect of attachment styles in a female-only sample of panic patients and a nonclinical control group.

Methods: Female panic patients (n = 47) were compared to a female control group (n = 47) using a modified Dot Probe Task with body-related and interpersonal threat as well as attachment positive words.

Results: An attentional bias toward threat words was not replicated. Furthermore, there was no moderation effect on attentional bias by attachment styles. However, high attachment avoidance was associated with faster reaction times (RT) in attachment positive compared to attachment threat trials in both groups. In the patient group, attachment anxiety was associated with faster RT in panic threat trials compared to attachment positive trials. Anxiously attached controls reacted faster to attachment positive vs. attachment threat trials.

Discussion: No attentional bias was found in the present study. However, the findings suggest that attachment avoidance and attachment anxiety differently influence attention responses to trials that include different emotional stimuli in clinical and nonclinical, female participants. Attachment insecurity may modify attention when processing trials including both, threat and positive stimuli.

Effects of cognitive load during interpretation bias modification on interpretation bias and stress reactivity

BACKGROUND AND OBJECTIVES

Interpretation bias modification can affect stress reactivity, yet results have not been consistent. This inconsistency may be partly due to variability in the degree to which training procedures alter interpretation at a more automatic, rather than strategic, level of processing, and a mismatch in available resources between the training and the stress situation. We tested this possibility by investigating whether imposing a secondary cognitive load during interpretation bias modification would strengthen training-induced effects on both interpretation bias and emotional reactivity.

METHOD

We trained 71 participants in a single session to interpret ambiguity either positively or negatively. Half of our participants did so while performing a cognitively demanding secondary task. We assessed the effects of these different training regimes on interpretation bias and both self-reported and physiological indices of stress reactivity.

RESULTS

Positive and negative interpretation bias modification resulted in training-congruent changes in interpretation bias. There were no group differences in self-reported stress reactivity, but positive interpretation training did improve recovery from stress as indexed by the heart rate measurement. Countering our hypothesis, the addition of cognitive load during the training increased neither the induced interpretive change nor its emotional impact.

LIMITATIONS

Sample size was relatively small, though sufficient to detect medium sized effects.

CONCLUSIONS

Adding cognitive load to interpretation bias modification does not alter training-induced change in interpretation bias or emotional reactivity.

Cognitive Vulnerability in the Context of Panic: Assessment of Panic-Related Associations and Interpretations in Individuals with Varying Levels of Anxiety Sensitivity

Background

Cognitive models of panic disorder (PD) highlight the role of panic-related associations and interpretations. However, results are mixed and rely on specific measures. This study examined panic-related associations and interpretations using established and new paradigms in individuals varying on anxiety sensitivity (AS).

Methods

Associations were measured using a priming task and a novel Single Target Implicit Association Test (STIAT); interpretations were assessed using the Interpretation Bias Questionnaire (IBQ) and a novel Scrambled Sentences Task (SST). Symptoms were assessed via a provocation task (Straw Breathing Task, SBT).

Results

Panic-related interpretations correlated with AS and other PD-related measures. Of the association tasks, only the priming task correlated with one of the other PD-related measures. Panic-related interpretations assessed via the SST, but not priming, STIAT, and IBQ, predicted SBT reactivity. The relationship between AS and SBT reactivity was mediated by panic-related interpretations.

Conclusions

Our data provide support for panic-related interpretations as an important cognitive mechanism.

Activation of EphB2 in the basolateral amygdala promotes stress vulnerability of mice by increasing NMDA-dependent synaptic function

The occurrence of major depressive disorder (MDD) has been linked to an increased vulnerability to stress. The basolateral amygdala (BLA) is one of the critical brain areas that involved in the regulation of pathological reactivity to stress. Increasing evidence indicates that the EphB2 receptor (EphB2) plays a critical role in neuropsychiatric disorders, such as Alzheimer's disease, pain and anxiety. However, whether the EphB2 in the BLA is involved in stress vulnerability is unclear. Here, we identified EphB2 in the BLA as a key regulator contributed to the modulation of stress vulnerability in adult mice. We found that the expression of EphB2 in the BLA was significantly increased in the animal model induced by chronic social stress. Knockdown of EphB2 in the BLA produced antidepressant-like behavioral effects, whereas activation of EphB2 in the BLA increased the susceptibility to subthreshold social defeat stress. Furthermore, we demonstrated that the role of EphB2 in the stress vulnerability was mediated by modulating NMDA receptors, since the knockdown of EphB2 in the BLA prevented not only the increase in the amplitudes of both the miniature and the evoked NMDAR-mediated EPSC, but also the enhancement of surface expression of NMDARs in the defeated mice. Taken together, these results suggest that EphB2 in the BLA is a critical factor contributes to the vulnerability to stress, which may be a potential target for the treatment of depression.

Breaking the Cybernetic Code: Understanding and Treating the Human Metacognitive Control System to Enhance Mental Health

The self-regulatory executive function (S-REF) model explains the role of strategic processes and metacognition in psychological disorder and was a major influence on the development of metacognitive therapy. The model identifies a universal style of perseverative negative processing termed the cognitive attentional syndrome (CAS), comprised of worry, rumination, and threat monitoring in the development of disorder. The CAS is linked to dysfunctional metacognitions that include beliefs and plans for regulating cognition. In this paper, I extend the theoretical foundations necessary to support further research on mechanisms linking metacognition to cognitive regulation and effective treatment. I propose a metacognitive control system (MCS) of the S-REF that can be usefully distinguished from cognition and is comprised of multiple structures, information, and processes. The MCS monitors and controls activity of the cognitive system and regulates the behavior of neural networks whose activities bias the way cognition is experienced. Metacognitive information involved in the regulation of on-line processing includes metacognitive beliefs, metacognitive procedural commands, and more transient cybernetic code. Separation of the cognitive and metacognitive systems and modeling their relationship presents major implications concerning what should be done in therapy and how it should be done. The paper concludes with an in-depth consideration of methods that strengthen the psychological basis of psychotherapy and aid in understanding and applying metacognitive therapy in particular. Finally, limitations of the model and implications for future research on self-awareness, self-regulation, and metacognition are discussed.

Examining the Interrelation Among Change Processes: Decentering and Anticipatory Processing Across Cognitive Behavioral Therapy for Social Anxiety Disorder

As evidence grows supporting certain mechanisms of change in psychological treatments and we improve statistical approaches to measuring them, it is important that we also explore how mechanisms and processes are related to each other, and how they together affect treatment outcomes. To answer these questions about interrelating processes and mechanisms, we need to take advantage of frequent assessment and modeling techniques that allow for an examination of the influence of one mechanism on another over time. Within cognitive behavioral therapy, studies have shown support for both decentering, the ability to observe thoughts and feelings as objective events in the mind, and anticipatory processing, the repetitive thinking about upcoming social situations, as potentially related mechanisms of change. Therefore, the current study examined weekly ratings of decentering and a single-item anticipatory processing question to examine the interrelation among these change mechanisms in 59 individuals who received a 12-weeks of Cognitive Behavioral Group Therapy for social anxiety disorder. Overall, these results found that both anticipatory processing and decentering changed over the course therapy for clients. Change in both anticipatory processing and decentering was related to outcome. The bivariate latent difference score analysis showed that anticipatory processing was a leading indicator of change in decentering, but not the reverse, indicating that change in anticipatory processing is leading to change in decentering. It may be that with the focus on cognitive reappraisal in this treatment, that reducing anticipatory processing is freeing up the cognitive resources for decentering to occur.

Expectations of Racism and Carotid Intima-Media Thickness in African American Women

OBJECTIVE

Several researchers have argued that racism-related stressors play an important role in adverse cardiovascular outcomes among African American women. However, studies have primarily focused on experiences of racism; thus, the role of expectations of racism is insufficiently understood. The current proof-of-concept study was designed to examine associations among expectations of racism, self-reported experiences of racism, and carotid intima-media thickness (IMT), a marker of cardiovascular risk, in African American women.

METHODS

Participants were 52 healthy African American women, aged 30 to 50 years (M (SD) = 40.8 (4.3)). Expectations of racism were assessed with a modified version of the Race-Based Rejection Sensitivity Questionnaire, experiences of racism were assessed with the Schedule of Racist Events, and carotid IMT was measured using B-mode ultrasound.

RESULTS

In linear regression analyses adjusted for age, expectations of racism were associated with higher levels of carotid IMT (b = .04, SE = .014, p = .013), after adjusting for experiences of racism. Findings remained significant after additional adjustments for cardiovascular risk factors (b = .03, SE = .014, p = .032). Associations were not confounded by additional stressors, hostility, or negative affect (depressive symptoms).

CONCLUSIONS

Independent of actual reports of racism, "expectations" of racism may be associated with increased cardiovascular risk in African American women. In addition, although experiences of discrimination were associated with depressive symptoms, expectations of racism were not, suggesting that other negative emotions likely play a role. Future studies are needed to replicate these results in larger samples and to explore the psychological and physiological pathways through which expectations of racism might affect cardiovascular disease risk across a range of populations.

A systematic review of the word sentence association paradigm (WSAP)

BACKGROUND AND OBJECTIVES

The Word Sentence Association Paradigm (WSAP) was originally designed to assess and modify interpretive biases (IB) in socially anxious individuals. Researchers have since modified the WSAP for use across various populations. Despite its widespread use, no studies have systematically reviewed the WSAP to determine its validity and reliability.

METHODS

We review variations to the WSAP, populations in which the WSAP has been used, reliability data, and effect sizes across 41 studies published between 2008 and March 2018.

RESULTS

Results indicate that the WSAP has been utilized to target 18 disorders and symptoms in adults and children. Modifications include stimulus content, timing parameters, and presentation order of word and sentence pairs. Reported internal consistency and test-retest reliability suggest good to excellent reliability. Medium to large effect sizes were reported when comparing control samples to those with psychopathology and in pre-post comparisons of the modification version of the WSAP.

LIMITATIONS

Studies varied regarding which indices of the WSAP were presented and specific task parameters used, making it challenging to compare effects.

CONCLUSIONS

The WSAP is a reliable and valid instrument for assessing and modifying interpretive biases with unique characteristics compared with other IB assessment and modification tasks.

Automatic Antecedents of Discrimination

Abstract. In increasingly diverse societies, discrimination against social groups and their members continues to be a public and political concern. Research has addressed three basic cognitive processes that precede discrimination: categorization, stereotype/prejudice activation, and stereotype/prejudice application, suggesting that these processes occur in an automatic fashion. However, there are multiple components of automaticity, including unawareness, efficiency, unintentionality, and uncontrollability. Most of the previous research implies that these components of automaticity converge with respect to cognitive antecedents of discrimination. Here, we review evidence on the distinct components of automaticity in order to assess whether (a) categorization, (b) stereotype/prejudice activation, and (c) stereotype/prejudice application occur (1) without awareness, (2) efficiently, and (3) goal-independently. We highlight evidence indicating convergence or divergence of the automaticity components during each of the processing stages. This analysis provides readers with an up-to-date review that helps to evaluate whether a multi-component approach to automaticity is of additional benefit in aggregating knowledge about the cognitive antecedents of discrimination. We discuss open issues and avenues for future research.

Ventral attention-network effective connectivity predicts individual differences in adolescent depression

BACKGROUND

Stimulus-driven negative attention bias is a central deficit in depression and might play an important role in vulnerability to depression Adolescents are susceptible to depression. Thus, investigating the neural correlates of attention bias in adolescents is a critical step for identifying neural markers of early onset of depression. Previous studies have shown that the ventral attention network (VAN), which includes bilateral ventrolateral prefrontal cortex (VLPFC) and bilateral temporal-parietal junction (TPJ), is the key brain network for stimulus-driven attention. However, the relationship between depression and effective connectivity within the VAN in adolescents is poorly understood.

METHOD

We employed resting-state fMRI to assess the relationship between directional effective connectivity within the VAN and depression scores in 216 healthy adolescents.

RESULTS

Using stochastic dynamic modeling, we found that individuals who exhibited higher self-reported depression showed stronger effective connectivity between right VLPFC and left TPJ within the VAN.

LIMITATION

The level of depression in this study was assessed with self-reported questionnaire. This measure might be more influenced by current mood in adolescents than that in adults. Future studies should emplo more objective measures to index levels of depression.

CONCLUSIONS

Our findings indicate that effective connectivity between right VLPFC and left TPJ could at least partially serve as a biomarker for bottom-up processing of depression in adolescents.

Implicit Cognition and Psychopathology: Looking Back and Looking Forward

Implicit cognitive processing is theorized to have a central role in many forms of psychopathology. In the current review, we focus on implicit associations, by which we mean evaluative representations in memory that are difficult to control and do not require conscious reflection to influence affect, cognition, or behavior. We consider definitional and measurement challenges before examining recent empirical evidence for these associations in anxiety, obsessive–compulsive, posttraumatic stress, depressive, and alcohol use disorders. This examination is framed by a brief review of the ways that prominent models of psychopathology represent biased implicit processing of disorder-relevant information. We consider to what extent models reflect more traditional automatic/implicit versus strategic/explicit dual-process perspectives or reflect more recent dynamical systems perspectives in which mental representations are iteratively reprocessed, evolving continuously. Finally, we consider the future research needed to better understand the interactive and temporal dynamics of implicit cognition in psychopathology.

Comorbid interpretation and expectancy bias in social anxiety and alcohol use

BACKGROUND

In two studies, the present research examined whether being high in both social anxiety and alcohol use disorder symptoms is associated with a comorbid interpretation and expectancy bias that reflects their bidirectional relationship.

DESIGN

Cross-sectional, quantitative surveys.

METHODS

Measures of social anxiety and alcohol use disorder symptoms, as well as an interpretation and expectancy bias task assessing biases for social anxiety, drinking, and comorbid social anxiety and drinking.

RESULTS

In Study 1 (N = 447), individuals high (vs. low) in social anxiety had stronger social threat bias and individuals high (vs. low) in alcohol use disorder symptoms had stronger drinking bias. Those high in both social anxiety and alcohol use disorder symptoms endorsed interpretations and expectancies linking social interaction with alcohol use. Comorbid bias predicted membership into the high social anxiety/drinking group, even after taking into account single-disorder biases. In Study 2 (N = 325), alcohol use disorder symptoms predicted drinking bias and social anxiety symptoms predicted social anxiety bias. Alcohol use disorder symptoms, social anxiety symptoms, and their interaction predicted comorbid interpretation and expectancy bias.

CONCLUSION

Results indicate unique cognitive vulnerability markers for persons with comorbid social anxiety and alcohol use disorder symptoms, which may improve detection and treatment of this serious comorbidity.

A failure to show the efficacy of a dot-probe attentional training in dysphoria: Evidence from an eye-tracking study

OBJECTIVE

This study examines whether a 4-day dot-probe attentional training to orient attention toward positive words could lead participants with dysphoria to change selective attention to emotional faces. It was also explored whether this positive attentional bias training could lead to a decrease in depressive symptoms.

METHODS

Participants were randomly assigned to Positive Training Group (PTG) and No Training Group (NTG). PTG was composed of 16 subjects, whereas NTG was composed of 15 subjects. All participants were women with a mean age of 22.87 (SD = 3.21).

RESULTS

Results showed that dysphoric participants in the PTG did not show changes in attentional patterns to emotional faces. Furthermore, depressive symptoms did not significantly change after the 4-session training.

CONCLUSIONS

These results suggest that cognitive training procedures based on dot-probe paradigms are probably not adequate to modify attentional patterns in individuals with depressive symptoms. The theoretical and practical implications are discussed.

Masking exposure to phobic stimuli reduces fear without inducing electrodermal activity

A series of experiments has shown that limiting awareness of exposure to feared stimuli through visual masking-or very brief exposure (VBE)-reduces avoidance of a live tarantula by spider-phobic participants. We investigated this process of fear reduction by directly relating the effects of VBE on electrodermal activity to its ensuing effects on phobic behavior. Sixty spider-phobic participants, identified by approaching a live tarantula and a questionnaire, were administered either VBE to masked spiders or control exposure to masked flowers. Skin conductance levels (SCLs) were continuously recorded during exposure. The participants approached the tarantula again immediately thereafter. VBE reduced avoidance of the tarantula and did not increase SCLs or cause subjective distress relative to control exposure. SCL increases during VBE were strongly negatively correlated with the reduction of self-reported fear of the tarantula: the less that SCLs increased during VBE, the more it reduced fear. VBE only increased SCLs in participants whose fear was not reduced; it did not increase SCLs in participants whose fear of the tarantula was reduced. Awareness of the stimuli did not mediate these effects. Control exposure did not yield any of these effects. In a second experiment, clearly visible exposure to spider images increased SCLs and subjective distress more than both VBE and control exposure, whereas VBE did not increase SCLs or subjective distress relative to control exposure within the same spider-phobic participants. These findings suggest that exposure to phobic images can reduce fear even when it bypasses the induction of electrodermal activity.

On the context dependency of implicit self-esteem in social anxiety disorder

BACKGROUND AND OBJECTIVES

Cognitive models assume that negative self-evaluations are automatically activated in individuals with Social Anxiety Disorder (SAD) during social situations, increasing their individual level of anxiety. This study examined automatic self-evaluations (i.e., implicit self-esteem) and state anxiety in a group of individuals with SAD (n = 45) and a non-clinical comparison group (NC; n = 46).

METHODS

Participants were randomly assigned to either a speech condition with social threat induction (giving an impromptu speech) or to a no-speech condition without social threat induction. We measured implicit self-esteem with an Implicit Association Test (IAT).

RESULTS

Implicit self-esteem differed significantly between SAD and NC groups under the speech condition but not under the no-speech condition. The SAD group showed lower implicit self-esteem than the NC group under the speech-condition. State anxiety was significantly higher under the speech condition than under the no-speech condition in the SAD group but not in the NC group. Mediation analyses supported the idea that for the SAD group, the effect of experimental condition on state anxiety was mediated by implicit self-esteem.

LIMITATIONS

The causal relation between implicit self-esteem and state anxiety could not be determined.

CONCLUSION

The findings corroborate hypotheses derived from cognitive models of SAD: Automatic self-evaluations were negatively biased in individuals with SAD facing social threat and showed an inverse relationship to levels of state anxiety. However, automatic self-evaluations in individuals with SAD can be unbiased (similar to NC) in situations without social threat.

Smaller amygdala volume and increased neuroticism predict anxiety symptoms in healthy subjects: A volumetric approach using manual tracing

Volume reductions in the amygdala (AMY) have been found in patients with anxiety disorders, but findings are mixed in subclinical participants with high trait anxiety scores, in whom both reductions and increases in AMY volume have been identified. One potential reason for such discrepancies could be the employment of different methods to determine the AMY volume (i.e., manual tracing in psychiatric research vs. automated methods), in non-patient research. In addition to trait anxiety, smaller AMY volume has also been linked to neuroticism, a personality trait consistently linked to increased vulnerability to anxiety. However, it is not clear how AMY volume and neuroticism together may contribute to anxiety symptoms in healthy functioning. These issues were investigated in a sample of 46 healthy participants who underwent anatomical MRI scanning and completed questionnaires measuring trait anxiety and neuroticism. AMY volume was assessed using manual tracing, based on anatomical landmarks identified in each participant's anatomical image. First, smaller left AMY volume was linked to higher levels of neuroticism (p = .013) and trait anxiety (p = .024), which in turn were positively correlated with each other. Moreover, AMY volume had a significant indirect effect on trait anxiety through neuroticism (ab = - .009, 95% CI [- .019, - .002]). This effect was not bidirectional, as trait anxiety did not predict AMY volume through neuroticism. Collectively, these findings provide support for a brain-personality-symptom framework of understanding affective dysregulation, which may help inform the development of prevention and intervention paradigms targeting preservation of AMY volume and reduction of neuroticism, to protect against anxiety symptoms.

Negativity bias and instability in spontaneous and deliberate evaluations of others: The role of borderline personality features

This study tested the hypotheses that borderline personality (BP) features are characterized by a negativity bias and instability in spontaneous and deliberate evaluations of others. Undergraduate women (N = 204) watched two movie clips depicting either positive or negative conjugal interactions. Spontaneous and deliberate evaluations of the male character were assessed after each clip with an Evaluative Priming Task and a self-report measure, respectively. Participants with high BP features showed unstable spontaneous evaluations. Results revealed a non-significant trend toward more negative spontaneous evaluations after the negative clip and less positive and more negative deliberate evaluations after watching the positive clip first relative to participants with low BP features. These results provide preliminary evidence that impression formation in borderline personality may be characterized by negative and unstable evaluations that are shaped at least in part at earlier processing stages.

Using Advances From Cognitive Behavioral Models of Anxiety to Guide Treatment for Social Anxiety Disorder

This case features an adult male with moderate social anxiety disorder and mild depressive symptoms who showed an initial positive response to an earlier experience of cognitive behavior therapy, but then relapsed when he started avoiding social situations again because of continuing beliefs that experiencing anxiety was unacceptable. His treatment at our clinic focused on shifting unhelpful thinking about the likelihood and consequences of becoming anxious and reengaging in avoided social situations so he could learn to tolerate negative affect and uncertainty. The treatment approach draws from cognitive behavioral models of social anxiety and highlights advances in clinical science, especially recent work on the causal role of interpretation biases (the tendency to assign negative or threatening meaning to ambiguous situations) in the maintenance and reduction of anxiety.

Face processing in adolescents with positive and negative threat bias

BACKGROUND

Individuals with anxiety disorders exhibit a 'vigilance-avoidance' pattern of attention to threatening stimuli when threatening and neutral stimuli are presented simultaneously, a phenomenon referred to as 'threat bias'. Modifying threat bias through cognitive retraining during adolescence reduces symptoms of anxiety, and so elucidating neural mechanisms of threat bias during adolescence is of high importance. We explored neural mechanisms by testing whether threat bias in adolescents is associated with generalized or threat-specific differences in the neural processing of faces.

METHOD

Subjects were categorized into those with (n = 25) and without (n = 27) threat avoidance based on a dot-probe task at average age 12.9 years. Threat avoidance in this cohort has previously been shown to index threat bias. Brain response to individually presented angry and neutral faces was assessed in a separate session using functional magnetic resonance imaging.

RESULTS

Adolescents with threat avoidance exhibited lower activity for both angry and neutral faces relative to controls in several regions in the occipital, parietal, and temporal lobes involved in early visual and facial processing. Results generalized to happy, sad, and fearful faces. Adolescents with a prior history of depression and/or an anxiety disorder had lower activity for all faces in these same regions. A subset of results replicated in an independent dataset.

CONCLUSIONS

Threat bias is associated with generalized, rather than threat-specific, differences in the neural processing of faces in adolescents. Findings may aid in the development of novel treatments for anxiety disorders that use attention training to modify threat bias.

Combined behavioural markers of cognitive biases are associated with anhedonia

Biases towards negative information, as well as away from positive information, are associated with psychopathology. Examining biases in multiple processes has been theorised to be more predictive than examining bias in any process alone. Anhedonia is a core symptom of psychopathology and predictive of future psychopathological symptoms. Finding that combined biases are associated with anhedonia would advance knowledge of the nature of emotional processing biases and the value of objective performance-based measures for identifying early risk markers. Participants (N = 139) completed tasks that assess latency bias (dot probe) and biased recognition (two-alternative forced-choice) of emotional information, as well as an anhedonia measure. An index was computed for each task's performance reflecting biased processing of positive and negative words. Only combined biases on both tasks were associated with anhedonia. Attentional bias was positively associated with anhedonia, but only when recognition bias for emotional words was high. Thus, assessing biases in multiple domains increased sensitivity to uncover relationships between emotional processing biases and anhedonic symptoms.

When the "Golden Years" Turn Blue: Using the Healthy Aging Literature to Elucidate Anxious and Depressive Disorders in Older Adulthood

Current treatments for disorders of emotion, like pathological anxiety, are often less effective in older adults than in younger adults and have poorly understood mechanisms, pointing to the need for psychopathology models that better account for age-related changes in normative emotional functioning and the expression of disordered emotion. This article describes ways in which the healthy aging and emotion literature can enhance understanding and treatment of symptoms of anxiety and depression in later life. We offer recommendations for how to integrate the healthy aging literatures' theories and findings with psychopathology research and clinical practice, and highlight opportunities for future research.

Less is more: Neural activity during very brief and clearly visible exposure to phobic stimuli

Research on automatic processes in fear has emphasized the provocation of fear responses rather than their attenuation. We have previously shown that the repeated presentation of feared images without conscious awareness via backward masking reduces avoidance of a live tarantula in spider-phobic participants. Herein we investigated the neural basis for these adaptive effects of masked exposure. 21 spider-phobic and 21 control participants, identified by a psychiatric interview, fear questionnaire, and approaching a live tarantula, viewed stimuli in each of three conditions: (1) very brief exposure (VBE) to masked images of spiders, severely limited awareness; (2) clearly visible exposure (CVE) to spiders, full awareness; and (3) masked images of flowers (control), severely limited awareness. Only VBE to masked spiders generated neural activity more strongly in phobic than in control participants, within subcortical fear, attention, higher-order language, and vision systems. Moreover, VBE activated regions that support fear processing in phobic participants without causing them to experience fear consciously. Counter-intuitively, CVE to the same spiders generated stronger neural activity in control rather than phobic participants within these and other systems. CVE deactivated regions supporting fear regulation and caused phobic participants to experience fear. CVE-induced activations also correlated with measures of explicit fear ratings, whereas VBE-induced activations correlated with measures of implicit fear (color-naming interference of spider words). These multiple dissociations between the effects of VBE and CVE to spiders suggest that limiting awareness of exposure to phobic stimuli through visual masking paradoxically facilitates their processing, while simultaneously minimizing the experience of fear. Hum Brain Mapp 38:2466-2481, 2017. © 2017 Wiley Periodicals, Inc.