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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: 1] [Impact Index Per Article: 1.0] [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: 8] [Impact Index Per Article: 4.0] [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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Zajenkowska A, Prusik M, Jasielska D, Szulawski M. Hostile attribution bias among offenders and non‐offenders: Making social information processing more adequate. JOURNAL OF COMMUNITY & APPLIED SOCIAL PSYCHOLOGY 2020. [DOI: 10.1002/casp.2493] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
| | | | - Dorota Jasielska
- Psychology Department Maria Grzegorzewska Academy of Special Education Poland
| | - Michał Szulawski
- Psychology Department Maria Grzegorzewska Academy of Special Education Poland
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Krebs G, Pile V, Grant S, Degli Esposti M, Montgomery P, Lau JYF. Research Review: Cognitive bias modification of interpretations in youth and its effect on anxiety: a meta-analysis. J Child Psychol Psychiatry 2018; 59:831-844. [PMID: 29052837 DOI: 10.1111/jcpp.12809] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/03/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Emerging evidence suggests that cognitive bias modification of interpretations (CBM-I) is effective in altering interpretation biases and reducing anxiety in adults. Less is known about the impact of CBM-I in young people, but some recent findings, including a meta-analysis of combined cognitive bias modification of interpretation and attention techniques, have cast doubt on its clinical utility. Given the current debate, this meta-analysis sought to establish the independent effects of CBM-I on interpretations biases and anxiety in youth. METHODS Studies were identified through a systematic literature search of PsycINFO, Ovid MEDLINE, PsycARTICLES, Web of Science and EMBASE between January 1992 and March 2017. Eligible studies aimed to target interpretation biases; did not combine CBM-I with another intervention; included a control condition; randomly allocated participants to conditions; assessed interpretation bias and/or anxiety as an outcome; included individuals up to age 18; and did not present previously reported data. Reference lists of included articles were checked for further eligible studies, and authors were contacted for unpublished data. RESULTS We identified 26 studies meeting eligibility criteria that included in the meta-analysis. CBM-I had moderate effects on negative and positive interpretations (g = -0.70 and g = -0.52, respectively) and a small but significant effect on anxiety assessed after training (g = -0.17) and after a stressor (g = -0.34). No significant moderators were identified. CONCLUSIONS In contrast to previous meta-analytic findings, our results indicate that CBM-I has potential but weak anxiolytic effects in youth. Our findings suggest that it may be premature to disregard the potential value of CBM-I research and further research in this field is warranted.
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Affiliation(s)
- Georgina Krebs
- OCD & Related Disorders Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK.,Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Victoria Pile
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Sean Grant
- Centre for Evidence-Based Intervention, University of Oxford, Oxford, UK.,RAND Corporation, Santa Monica, CA, USA
| | | | - Paul Montgomery
- Department of Social Policy and Social Work, University of Birmingham, Birmingham, UK
| | - Jennifer Y F Lau
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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Scott BG, Pina AA, Parker JH. Reluctance to express emotion explains relation between cognitive distortions and social competence in anxious children. BRITISH JOURNAL OF DEVELOPMENTAL PSYCHOLOGY 2017; 36:402-417. [PMID: 29235136 DOI: 10.1111/bjdp.12227] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Revised: 09/26/2017] [Indexed: 11/28/2022]
Abstract
Guided by social information processing and affective social competence models, the focal objective of this research was to examine the relations among anxious children's cognitive distortions, social skill competence, and reluctance to express emotion. In addition, we explored whether children's attention control played any meaningful role. Using a sample of 111 anxious children (Mage = 9.63, SD = 0.73; 75.7% girls; 56% Hispanic/Latino), we found that cognitive distortions were negatively related to social competence. In addition, tests of moderated mediation showed that the negative association between cognitive distortions and social skill competence was indirect via reluctance to express emotion, but this only was the case for anxious children with high attention control and for distortions in the academic domain. The findings of this study may set the stage for new ways to conceptualize the role of higher attention control among anxious youth. Statement of contribution What is already known on this subject? Cognitive errors are prevalent in anxious youth Anxious children show socio-emotion deficits What does this study add? Cognitive errors are related to socio-emotion deficits in anxious youth Relations depend on attention control.
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Affiliation(s)
- Brandon G Scott
- Department of Psychology, Montana State University, Bozeman, Montana, USA
| | - Armando A Pina
- Department of Psychology, Arizona State University, Tempe, Arizona, USA
| | - Julia H Parker
- Department of Psychology, Arizona State University, Tempe, Arizona, USA
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Rozenman M, Vreeland A, Piacentini J. Thinking anxious, feeling anxious, or both? Cognitive bias moderates the relationship between anxiety disorder status and sympathetic arousal in youth. J Anxiety Disord 2017; 45:34-42. [PMID: 27923164 PMCID: PMC5863750 DOI: 10.1016/j.janxdis.2016.11.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 11/01/2016] [Accepted: 11/15/2016] [Indexed: 01/10/2023]
Abstract
Cognitive bias and physiological arousal are two putative markers that may underlie youth anxiety. However, data on relationships between cognitive bias and arousal are limited, and typically do not include behavioral measurement of these constructs in order to tap real-time processes. We aimed to examine the relationship between performance-based cognitive bias and sympathetic arousal during stress in clinically anxious and typically-developing youth. The sample included children and adolescents ages 9 to 17 (Mean age=13.18, SD=2.60) who either met diagnostic criteria for primary generalized anxiety, social phobia, or separation anxiety (N=24) or healthy controls who had no history of psychopathology (N=22). Youth completed performance-based measures of attention and interpretation bias. Electrodermal activity was assessed while youth participated in the Trier Social Stress Test for Children (TSST-C; Buske-Kirschbaum, Jobst, & Wustmans, 1997). A mixed models analysis indicated significant linear and non-linear changes in skin conductance, with similar slopes for both groups. Interpretation bias, but not attention bias, moderated the relationship between group status and sympathetic arousal during the TSST-C. Arousal trajectories did not differ for anxious and healthy control youth who exhibited high levels of threat interpretation bias. However, for youth who exhibited moderate and low levels of interpretation bias, the anxious group demonstrated greater arousal slopes than healthy control youth. Results provide initial evidence that the relationship between anxiety status and physiological arousal during stress may be moderated by level of interpretation bias for threat. These findings may implicate interpretation bias as a marker of sympathetic reactivity in youth. Implications for future research and limitations are discussed.
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Affiliation(s)
- Michelle Rozenman
- Division of Child & Adolescent Psychiatry, UCLA Semel Institute for Neuroscience & Human Behavior, United States.
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Orchard F, Apetroaia A, Clarke K, Creswell C. Cognitive bias modification of interpretation in children with social anxiety disorder. J Anxiety Disord 2017; 45:1-8. [PMID: 27866085 PMCID: PMC5240849 DOI: 10.1016/j.janxdis.2016.10.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2015] [Revised: 08/17/2016] [Accepted: 10/28/2016] [Indexed: 11/25/2022]
Abstract
Negative (or a lack of positive) interpretation of ambiguous social situations has been hypothesised to maintain social anxiety disorder in children, yet there is currently limited evidence to support this. Cognitive Bias Modification of Interpretation (CBM-I) provides a means to explore the causal influence of interpretation bias on social anxiety disorder, and has been associated with a reduction in social anxiety symptoms in adults. Seven to twelve year old children with a diagnosis of social anxiety disorder completed CBM-I training, adapted from materials designed for socially anxious children in the community, or no training. Effects on interpretation bias and social anxiety were assessed. The adapted CBM-I training was not associated with significant changes in benign or negative interpretation. Unsurprisingly given the lack of successful interpretation training, there were no significant changes in child or parent reported social anxiety symptoms, clinician-rated severity or diagnoses and change in interpretation was not significantly associated with change in social anxiety. These findings contrast with some studies with community populations although it is possible that more intensive CBM-I training is required to fully test this hypothesis among clinical groups.
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Affiliation(s)
- Faith Orchard
- School of Psychology and Clinical Language Sciences, University of Reading, Whiteknights Road, Reading, RG6 6AL, United Kingdom.
| | - Adela Apetroaia
- Newham College University Centre, London, E15 4HT, United Kingdom
| | - Kiri Clarke
- Division of Psychology and Language Sciences, University College London, London, WC1E 6BT, United Kingdom
| | - Cathy Creswell
- School of Psychology and Clinical Language Sciences, University of Reading, Whiteknights Road, Reading, RG6 6AL, United Kingdom
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Fliek L, Dibbets P, Roelofs J, Muris P. Cognitive Bias as a Mediator in the Relation Between Fear-Enhancing Parental Behaviors and Anxiety Symptoms in Children: A Cross-Sectional Study. Child Psychiatry Hum Dev 2017; 48:82-93. [PMID: 27286719 PMCID: PMC5243885 DOI: 10.1007/s10578-016-0655-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The present cross-sectional study explored the relations between fear-enhancing parenting behaviors (modeling and threat information transmission) and children's cognitive biases and anxiety symptoms. Participants were 258 children aged 7-12 years (132 boys and 126 girls), and their mothers (n = 199) and/or fathers (n = 117). Children and parents completed the Parental Enhancement of Anxious Cognitions questionnaire, which measures parental modeling and threat information transmission, while children also filled in a scale for assessing anxiety symptoms. In addition, children conducted a number of computerized tasks for measuring confirmation and interpretation bias. The data indicated that both biases mediated the relationship between threat information transmission (of both parents) and children's anxiety symptoms. Only interpretation bias significantly mediated the relationship between modeling (of mothers) and anxiety symptoms. These findings give partial support for the hypothesis that cognitive biases play a mediating role in the relation between fear-enhancing parental behaviors and children's anxiety symptoms.
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Affiliation(s)
- Lorraine Fliek
- Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
| | - Pauline Dibbets
- Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Jeffrey Roelofs
- Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Peter Muris
- Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands ,Stellenbosch University, Stellenbosch, South Africa
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Wang X, Qian M, Yu H, Sun Y, Li S, Yang P, Lin M, Yao N, Zhang X. Social Anxiety and Interpretation Bias. Psychol Rep 2016; 119:539-56. [DOI: 10.1177/0033294116658605] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study examined how positive-scale assessment of ambiguous social stimuli affects interpretation bias in social anxiety. Participants with high and low social anxiety ( N = 60) performed a facial expression discrimination task to assess interpretation bias. Participants were then randomly assigned to assess the emotion of briefly presented faces either on a negative or on a positive scale. They subsequently repeated the facial expression discrimination task. Participants with high versus low social anxiety made more negative interpretations of ambiguous facial expressions. However, those in the positive-scale assessment condition subsequently showed reduced negative interpretations of ambiguous facial expressions. These results suggest that interpretation bias in social anxiety could be mediated by positive priming rather than an outright negative bias.
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Affiliation(s)
- Xiaoling Wang
- Institute of Applied Psychology, Tianjin University, China; Department of Psychology and Beijing Key Laboratory of Behavior and Mental Health, Peking University, China
| | - Mingyi Qian
- Department of Psychology, Peking University, China
| | - Hongyu Yu
- Department of Psychology, Peking University, China
| | - Yang Sun
- Department of Psychology, Peking University, China
| | - Songwei Li
- Mental Health Development Center, Tsinghua University, China
| | - Peng Yang
- Guangdong Experimental High School, Guangzhou, China
| | - Muyu Lin
- Department of Psychology, Peking University, China
| | - Nishao Yao
- Department of Psychology, Peking University, China
| | - Xilin Zhang
- Laboratory of Brain and Cognition, National Institute of Mental Health, MD, USA
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Vassilopoulos SP, Moberly NJ, Lau JYF. Cognitive Bias Modification Training in Children Affects Anxiety During Anticipatory Processing of Social Evaluation. Int J Cogn Ther 2015. [DOI: 10.1521/ijct.2015.8.4.318] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Interpretation modification training reduces social anxiety in clinically anxious children. Behav Res Ther 2015; 75:78-84. [PMID: 26580081 DOI: 10.1016/j.brat.2015.10.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 10/15/2015] [Accepted: 10/20/2015] [Indexed: 11/20/2022]
Abstract
The present study was designed to examine the effects of training in positive interpretations in clinically anxious children. A total of 87 children between 7 and 12 years of age were randomly assigned to either a positive cognitive bias modification training for interpretation (CMB-I) or a neutral training. Training included 15 sessions in a two-week period. Children with an interpretation bias prior to training in the positive training group showed a significant reduction in interpretation bias on the social threat scenarios after training, but not children in the neutral training group. No effects on interpretation biases were found for the general threat scenarios or the non-threat scenarios. Furthermore, children in the positive training did not self-report lower anxiety than children in the neutral training group. However, mothers and fathers reported a significant reduction in social anxiety in their children after positive training, but not after neutral training. This study demonstrated that clinically anxious children with a prior interpretation bias can be trained away from negative social interpretation biases and there is some evidence that this corresponds to reductions in social anxiety. This study also highlights the importance of using specific training stimuli.
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Remmerswaal D, Muris P, Huijding J. Transmission of Cognitive Bias and Fear From Parents to Children: An Experimental Study. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2015; 45:642-654. [DOI: 10.1080/15374416.2014.987378] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Cognitive Bias Modification Training in Adolescents: Persistence of Training Effects. COGNITIVE THERAPY AND RESEARCH 2014. [DOI: 10.1007/s10608-014-9627-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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A Multi-Session Attribution Modification Program for Children with Aggressive Behaviour: Changes in Attributions, Emotional Reaction Estimates, and Self-Reported Aggression. Behav Cogn Psychother 2014; 43:538-48. [PMID: 24762404 DOI: 10.1017/s1352465814000149] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Research suggests that aggressive children are prone to over-attribute hostile intentions to peers. AIMS The current study investigated whether this attributional style can be altered using a Cognitive Bias Modification of Interpretations (CBM-I) procedure. METHOD A sample of 10-12-year-olds selected for displaying aggressive behaviours was trained over three sessions to endorse benign rather than hostile attributions in response to ambiguous social scenarios. RESULTS Compared to a test-retest control group (n = 18), children receiving CBM-I (n = 16) were less likely to endorse hostile attributions and more likely to endorse benign attributions in response to a new set of ambiguous social situations. Furthermore, aggressive behaviour scores reduced more in the trained group than in the untrained controls. Children who received attribution training also reported less perceived anger and showed a trend to report more self-control than those in the control group. CONCLUSIONS Implications of these findings are discussed.
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Remmerswaal D, Huijding J, Bouwmeester S, Brouwer M, Muris P. Cognitive bias in action: evidence for a reciprocal relation between confirmation bias and fear in children. J Behav Ther Exp Psychiatry 2014; 45:26-32. [PMID: 23933089 DOI: 10.1016/j.jbtep.2013.07.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Revised: 07/10/2013] [Accepted: 07/11/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVES Some cognitive models propose that information processing biases and fear are reciprocally related. This idea has never been formally tested. Therefore, this study investigated the existence of a vicious circle by which confirmation bias and fear exacerbate each other. METHODS One-hundred-and-seventy-one school children (8-13 years) were first provided with threatening, ambiguous, or positive information about an unknown animal. Then they completed a computerized information search task during which they could collect additional (negative, positive, or neutral) information about the novel animal. Because fear levels were repeatedly assessed during the task, it was possible to examine the reciprocal relationship between confirmation bias and fear. RESULTS A reciprocal relation of mutual reinforcement was found between confirmation bias and fear over the course of the experiment: increases in fear predicted subsequent increases in the search for negative information, and increases in the search for negative information further enhanced fear on a later point-in-time. In addition, the initial information given about the animals successfully induced diverging fear levels in the children, and determined their first inclination to search for additional information. LIMITATIONS As this study employed a community sample of primary school children, future research should test whether these results can be generalized to clinically anxious youth. CONCLUSIONS These findings provide first support for the notion that fearful individuals may become trapped in a vicious circle in which fear and a fear-related confirmation bias mutually strengthen each other, thereby maintaining the anxiety pathology.
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Lau JY. Cognitive bias modification of interpretations: A viable treatment for child and adolescent anxiety? Behav Res Ther 2013; 51:614-22. [DOI: 10.1016/j.brat.2013.07.001] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2013] [Revised: 06/25/2013] [Accepted: 07/01/2013] [Indexed: 11/29/2022]
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Platt B, Cohen Kadosh K, Lau JYF. The role of peer rejection in adolescent depression. Depress Anxiety 2013; 30:809-21. [PMID: 23596129 DOI: 10.1002/da.22120] [Citation(s) in RCA: 150] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Revised: 03/20/2013] [Accepted: 03/22/2013] [Indexed: 11/10/2022] Open
Abstract
Adolescence is a period of major risk for depression, which is associated with negative personal, social, and educational outcomes. Yet, in comparison to adult models of depression, very little is known about the specific psychosocial stressors that contribute to adolescent depression, and whether these can be targeted by interventions. In this review, we consider the role of peer rejection. First, we present a comprehensive review of studies using innovative experimental paradigms to understand the role of peer rejection in adolescent depression. We show how reciprocal relationships between peer rejection and depressive symptoms across adolescence powerfully shape and maintain maladaptive trajectories. Second, we consider how cognitive biases and their neurobiological substrates may explain why some adolescents are more vulnerable to the effects of, and perhaps exposure to, peer rejection compared to others. Finally, we draw attention to emerging cognitive and functional magnetic resonance imaging-based neurofeedback training, which by modifying aspects of information processing may promote more adaptive responses to peer rejection. A better understanding of the mechanisms underlying adolescent depression may not only alleviate symptoms during a period of substantial developmental challenges, but may also reduce the burden of the disorder across the lifespan.
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Affiliation(s)
- Belinda Platt
- Department of Experimental Psychology, University of Oxford, South Parks Road, Oxford, United Kingdom.
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Efficacy of Interpretation Bias Modification in Depressed Adolescents and Young Adults. COGNITIVE THERAPY AND RESEARCH 2013; 38:89-102. [PMID: 24729643 DOI: 10.1007/s10608-013-9578-4] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This study evaluated the efficacy of a four-session Cognitive Bias Modification-Interpretation program for 45 depressed adolescents and young adults (14-21 years old; 12 males, 33 females; Beck Depressive Inventory, Second Edition ≥ 14) randomized to an active intervention condition (repeated exposure to positive outcomes of depression-relevant ambiguous scenarios; n=23) or a control condition (n=22). Both conditions experienced reductions on a Test of Interpretation Bias at post-treatment, with no significant between-group differences. When limited to those with negative bias at baseline, the intervention group showed greater improvement in interpretation bias at mid- and post-treatment. In addition, the intervention group overall had greater improvements in self-reported negative cognitions than the control group at post-intervention and two-week follow-up. However, there were no differences between groups in depression or anxiety symptom change. Potential factors contributing to mixed findings are discussed.
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Change Processes During Cognitive Bias Modification for Obsessive Compulsive Beliefs. COGNITIVE THERAPY AND RESEARCH 2013. [DOI: 10.1007/s10608-013-9576-6] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Lau JY, Pettit E, Creswell C. Reducing children's social anxiety symptoms: Exploring a novel parent-administered cognitive bias modification training intervention. Behav Res Ther 2013; 51:333-7. [DOI: 10.1016/j.brat.2013.03.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2013] [Revised: 03/19/2013] [Accepted: 03/19/2013] [Indexed: 11/25/2022]
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Lau JYF, Belli SR, Chopra RB. Cognitive bias modification training in adolescents reduces anxiety to a psychological challenge. Clin Child Psychol Psychiatry 2013; 18:322-33. [PMID: 22923711 DOI: 10.1177/1359104512455183] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Many anxiety disorders begin in adolescence. Early interventions that target adolescent anxiety may prevent later disabling consequences. Previous studies show that cognitive bias modification training can generate positive interpretative styles of ambiguous information in adolescents but effects on anxious mood reduction are less clear. Adult studies suggest more consistent training effects on mood when assessed in response to a psychological challenge. Here, we assess whether positive training reduces adolescent anxious responses to a laboratory stressor. A total of 40 adolescents were randomly assigned to positive or negative computerised training. During training, ambiguous scenarios were resolved positively or negatively. After training, adolescents completed a test of interpretation bias and a difficult mental arithmetic task while believing that they were being videotaped for teaching purposes. First, positively-trained adolescents endorsed more positive and fewer negative interpretations of new ambiguous situations than negatively-trained adolescents. Second, positively-trained adolescents also showed attenuated anxiety levels after but not before the challenge. Induced positive interpretations via computerised cognitive training may modify anxious responsivity. Although there are some caveats to these data, in general they justify extensions of computerised training to adolescents with clinical anxiety, to reduce anxious responsivity.
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Affiliation(s)
- Jennifer Y F Lau
- Department of Experimental Psychology, University of Oxford, Oxford, UK.
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23
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The differential effects of written and spoken presentation for the modification of interpretation and judgmental bias in children. Behav Cogn Psychother 2013; 42:535-54. [PMID: 23663409 PMCID: PMC4162484 DOI: 10.1017/s1352465813000301] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Interpretation training programs, in which individuals are trained to interpret ambiguous scenarios in either a negative or benign way, have proven effective in altering anxiety-related cognitive biases in both children and adults. AIMS The current study investigated whether the effects of the interpretation training procedure in children are differentiated according to the mode of presentation of the training. METHOD Ninety-four primary school children (aged 10-12 years) scoring above the mean on a social anxiety scale were randomly allocated to four groups, in which they were trained using written or spoken presentation of training materials in either the negative or benign direction. RESULTS For the negative training, children who heard the training material spoken aloud (spoken presentation) made more negative interpretations of ambiguous social events, compared to children who read the training material (written presentation). However, for the benign training, there was less clear evidence for a differentiation of the effects between the two modes of presentation, although children in the spoken presentation group performed better in a stressful task and showed a trend to rate their mood as more positive after the task than children in the written presentation group. CONCLUSIONS These results not only forward our understanding of the mechanism of the genesis of cognitive bias in children, but also highlight the need for further investigation of how to optimize the effectiveness of interpretation training in children.
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24
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Blossom JB, Ginsburg GS, Birmaher B, Walkup JT, Kendall PC, Keeton CP, Langley AK, Piacentini JC, Sakolsky D, Albano AM. Parental and Family Factors as Predictors of Threat Bias in Anxious Youth. COGNITIVE THERAPY AND RESEARCH 2013; 37:812-819. [PMID: 25328258 DOI: 10.1007/s10608-012-9513-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The present study examined the relative predictive value of parental anxiety, parents' expectation of child threat bias, and family dysfunction on child's threat bias in a clinical sample of anxious youth. Participants (N = 488) were part of the Child/Adolescent Anxiety Multi-modal study (CAMS), ages 7-17 years (M = 10.69; SD = 2.80). Children met diagnostic criteria for generalized anxiety disorder, separation anxiety and/or social phobia. Children and caregivers completed questionnaires assessing child threat bias, child anxiety, parent anxiety and family functioning. Child age, child anxiety, parental anxiety, parents' expectation of child's threat bias and child-reported family dysfunction were significantly associated with child threat bias. Controlling for child's age and anxiety, regression analyses indicated that parents' expectation of child's threat bias and child-reported family dysfunction were significant positive predictors of child's self-reported threat bias. Findings build on previous literature by clarifying parent and family factors that appear to play a role in the development or maintenance of threat bias and may inform etiological models of child anxiety.
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Affiliation(s)
- Jennifer B Blossom
- Nemours Pediatrics, Thomas Jefferson University Hospital, 833 Chestnut Street, Ste 1210, Philadelphia, PA 19107, USA
| | - Golda S Ginsburg
- Division of Child and Adolescent Psychiatry, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Boris Birmaher
- Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - John T Walkup
- Division of Child and Adolescent Psychiatry, Weill Cornell Medical College, New York, NY, USA
| | - Philip C Kendall
- Department of Psychology, Temple University, Philadelphia, PA, USA
| | - Courtney P Keeton
- Division of Child and Adolescent Psychiatry, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Audra K Langley
- Semel Institute for Neuroscience and Human Behavior, University of California at Los Angeles, Los Angeles, CA, USA
| | - John C Piacentini
- Semel Institute for Neuroscience and Human Behavior, University of California at Los Angeles, Los Angeles, CA, USA
| | - Dara Sakolsky
- Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Anne Marie Albano
- New York State Psychiatric Institute, Columbia University Medical Center, New York, NY, USA
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25
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Abstract
Rates of depression double in the transition to adolescence. Symptoms of depression in adolescence also predict adult mood disorders. From a preventative perspective, research into the risk factors for adolescent depression is critical. Simultaneously, there is also growing interest in understanding why adolescence reflects a particularly critical period for the onset of early mood symptoms. Here, we review (a) the role of social, genetic, neural and cognitive factors in explaining individual differences in the propensity to develop symptoms in adolescence, and (b) whether changes in these factors may explain why adolescence is a particularly sensitive period for the onset of depressive symptoms. Finally, we speculate on whether novel social stressors interact with 'genetic innovation' to produce changes in brain circuitry structure and function and associated changes in emotion regulation abilities and social understanding-to increase emergence of symptoms in adolescence.
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Affiliation(s)
- Jennifer Y F Lau
- Department of Experimental Psychology, University of Oxford, UK.
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26
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Modifying adolescent interpretation biases through cognitive training: effects on negative affect and stress appraisals. Child Psychiatry Hum Dev 2013; 44:602-11. [PMID: 23722473 PMCID: PMC3764320 DOI: 10.1007/s10578-013-0386-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Adolescent anxiety is common, impairing and costly. Given the scale of adolescent anxiety and its impact, fresh innovations for therapy are in demand. Cognitive Bias Modification of Interpretations (CBM-I) studies of adults show that by training individuals to endorse benign interpretations of ambiguous situations can improve anxious mood-states particularly in response towards stress. While, these investigations have been partially extended to adolescents with success, inconsistent training effects on anxious mood-states have been found. The present study investigated whether positive versus negative CBM-I training influenced appraisals of stress, in forty-nine adolescents, aged 15-18. Data supported the plasticity of interpretational styles, with positively-trained adolescents selecting more benign resolutions of new ambiguous situations, than negatively-trained adolescents. Positively-trained adolescents also rated recent stressors as having less impact on their lives than negatively-trained adolescents. Thus, while negative styles may increase negative responses towards stress, positive styles may boost resilience.
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Mayer B, Muris P, Kramer Freher N, Stout J, Polak M. Covariation bias for food-related control is associated with eating disorders symptoms in normal adolescents. J Behav Ther Exp Psychiatry 2012; 43:1008-13. [PMID: 22571969 DOI: 10.1016/j.jbtep.2012.03.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2011] [Revised: 02/29/2012] [Accepted: 03/31/2012] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND OBJECTIVES Covariation bias refers to the phenomenon of overestimating the contingency between certain stimuli and negative outcomes, which is considered as a heuristic playing a role in the maintenance of certain types of psychopathology. In the present study, covariation bias was investigated within the context of eating pathology. METHODS In a sample of 148 adolescents (101 girls, 47 boys; mean age 15.3 years), a priori and a posteriori contingencies were measured between words referring to control and loss of control over eating behavior, on the one hand, and fear, disgust, positive and neutral outcomes, on the other hand. RESULTS Results indicated that all adolescents displayed an a priori covariation bias reflecting an overestimation of the contingency of words referring to loss of control over eating behavior and fear- and disgust-relevant outcomes, while words referring to control over eating behavior were more often associated with positive and neutral outcomes. This bias was unrelated to level of eating disorder symptoms. In the case of a posteriori contingency estimates no overall bias could be observed, but some evidence was found indicating that girls with higher levels of eating disorder symptoms displayed a stronger covariation bias. CONCLUSION These findings provide further support for the notion that covariation bias is involved in eating pathology, and also demonstrate that this type of cognitive distortion is already present in adolescents.
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Affiliation(s)
- Birgit Mayer
- Institute of Psychology, Faculty of Social Sciences, Erasmus University Rotterdam, The Netherlands.
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28
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Cognitive Bias Modification in Pre-adolescent Children: Inducing an Interpretation Bias Affects Self-imagery. COGNITIVE THERAPY AND RESEARCH 2012. [DOI: 10.1007/s10608-012-9481-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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29
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Experimentally Modifying Interpretations for Positive and Negative Social Scenarios in Children: A Preliminary Investigation. Behav Cogn Psychother 2012; 41:103-16. [DOI: 10.1017/s1352465812000537] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Background: Past research suggests that socially anxious individuals display a tendency to interpret ambiguous and clearly valenced information in a threatening way. Interpretation training programs, in which individuals are trained to endorse benign rather than negative interpretations of ambiguous social scenarios, have proven effective for reducing anxiety-related cognitive biases. However, it is not clear whether the same paradigms are effective in modifying interpretation biases for clearly valenced social information. Method: In this experiment, a group of unselected children (aged 10–13 years) was trained to endorse the more positive of two possible interpretations of mildly negative and positive social events. Results: Data revealed that this group (n = 77) showed a decrease in catastrophic interpretations and an increase in neutral interpretations of mildly negative events compared to children in a no-training control group (n = 76). Furthermore, participants in the training condition showed an increase in positive interpretations and a trend for a decrease in discounting interpretations of positive events. However, training did not affect emotional ratings of mildly negative and positive events or trait social anxiety. Conclusions: Notwithstanding certain limitations of this pilot study, we believe that the results are promising with regard to modifying interpretative biases for clearly valenced vignettes, and that further study regarding the effects of training on mood is warranted.
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30
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Lau JY, Belli SD, Gregory AM, Napolitano M, Eley TC. The role of children’s negative attributions on depressive symptoms: an inherited characteristic or a product of the early environment? Dev Sci 2012; 15:569-78. [DOI: 10.1111/j.1467-7687.2012.01152.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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31
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Vassilopoulos SP, Blackwell SE, Moberly NJ, Karahaliou E. Comparing imagery and verbal instructions for the experimental modification of interpretation and judgmental bias in children. J Behav Ther Exp Psychiatry 2012; 43:594-601. [PMID: 21903044 DOI: 10.1016/j.jbtep.2011.08.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2011] [Revised: 08/03/2011] [Accepted: 08/11/2011] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND OBJECTIVES Using an interpretation training paradigm, previous research has demonstrated that it is possible to modify interpretation biases in socially anxious children and that trained interpretation bias affects important aspects of social anxiety (Vassilopoulos, Banerjee, & Prantzalou, 2009). The current experiment was designed to replicate and extend the results reported by Vassilopoulos et al. (2009). METHODS In a benign interpretation training paradigm, descriptions of ambiguous hypothetical events were presented in a form requiring participants to endorse the more benign of two interpretations. Ninety-four primary school children aged between 10 and 12 years were asked to either imagine these hypothetical events or to read the same descriptions while thinking about their verbal meaning. RESULTS Participants in the verbal instructions condition showed greater decreases in negative interpretations and negative emotional consequences of ambiguous events from pre-training to post-training than did those in the imagery instructions condition. Additionally, children in the verbal instructions condition reported a significant decrease in trait social anxiety as well as in their self-reported tendency to discount positive information compared with children in the imagery instructions condition. LIMITATIONS The results should be considered in the light of the exclusive use of self-report measures and the small effect sizes observed in some analyses. CONCLUSIONS These findings suggest that interpretation training in children can be effective with verbal instructions and highlight the need for further investigation of how to optimize the effectiveness of interpretation training in children.
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32
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Salemink E, Wiers RW. Adolescent threat-related interpretive bias and its modification: The moderating role of regulatory control. Behav Res Ther 2012; 50:40-6. [DOI: 10.1016/j.brat.2011.10.006] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2011] [Revised: 10/11/2011] [Accepted: 10/20/2011] [Indexed: 10/15/2022]
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Lau JYF, Molyneaux E, Telman MD, Belli S. The plasticity of adolescent cognitions: data from a novel cognitive bias modification training task. Child Psychiatry Hum Dev 2011; 42:679-93. [PMID: 21748287 DOI: 10.1007/s10578-011-0244-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Many adult anxiety problems emerge in adolescence. Investigating how adolescent anxiety arises and abates is critical for understanding and preventing adult psychiatric problems. Drawing threat interpretations from ambiguous material is linked to adolescent anxiety but little research has clarified the causal nature of this relationship. Work in adults using Cognitive Bias Modification of Interpretations (CBM-I) training show that manipulating negative interpretational style alters negative affect. Conversely, 'boosting' positive interpretations improves affect. Here, we extend CBM-I investigations to adolescents. Thirty-nine adolescents (13-18 years), varying in trait anxiety and self-efficacy, were randomly allocated to receive positive or negative training. Training-congruent differences emerged for subsequent interpretation style. Induced negative biases predicted a decline in positive affect in low self-efficacious adolescents only. Tentatively, our data suggest that cognitive biases predict adolescent affective symptoms in vulnerable individuals. The acquisition of positive cognitions through training has implications for prevention.
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Affiliation(s)
- Jennifer Y F Lau
- Department of Experimental Psychology, University of Oxford, Oxford, OX1 4AU, UK.
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34
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Lester KJ, Field AP, Muris P. Experimental Modification of Interpretation Bias about Animal Fear in Young Children: Effects on Cognition, Avoidance Behavior, Anxiety Vulnerability, and Physiological Responding. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2011; 40:864-77. [DOI: 10.1080/15374416.2011.618449] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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35
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Abstract
Clinical anxiety disorders and elevated levels of anxiety vulnerability are characterized by cognitive biases, and this processing selectivity has been implicated in theoretical accounts of these conditions. We review research that has sought to evaluate the causal contributions such biases make to anxiety dysfunction and to therapeutically alleviate anxiety using cognitive-bias modification (CBM) procedures. After considering the purpose and nature of CBM methodologies, we show that variants designed to modify selective attention (CBM-A) or interpretation (CBM-I) have proven capable of reducing anxiety vulnerability and ameliorating dysfunctional anxiety. In addition to supporting the causal role of cognitive bias in anxiety vulnerability and dysfunction and illuminating the mechanisms that underpin such bias, the findings suggest that CBM procedures may have therapeutic promise within clinical settings. We discuss key issues within this burgeoning field of research and suggest future directions CBM research should take to maximize its theoretical and applied value.
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Affiliation(s)
- Colin MacLeod
- School of Psychology, The University of Western Australia, Crawley WA 6009 Australia.
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36
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Abstract
Socially anxious feelings sharply increase during adolescence and such feelings have been associated with interpretive biases. Studies in adults have shown that interpretive biases can be modified using Cognitive Bias Modification procedures (CBM-I) and subsequent effects on anxiety have been observed. The current study was designed to examine whether the CBM-I procedure has similar effects in adolescents. Unselected adolescents were randomly allocated to either a positive interpretation training (n = 88) or a placebo-control condition (n = 82). Results revealed that the training was successful in modifying interpretations and effects generalized to a new task. The interpretive bias effects were most pronounced in individuals with a threat-related interpretive bias at pre-test. No effects on state anxiety were observed. The current findings are promising with regard to applying bias modification procedures to adolescents, while further research is warranted regarding emotional effects.
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Affiliation(s)
- Elske Salemink
- Department of Developmental Psychology, University of Amsterdam, Roetersstraat 15, 1018 WB, Amsterdam, The Netherlands.
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37
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Beard C. Cognitive bias modification for anxiety: current evidence and future directions. Expert Rev Neurother 2011; 11:299-311. [PMID: 21306216 DOI: 10.1586/ern.10.194] [Citation(s) in RCA: 140] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Cognitive bias modification (CBM) is an innovative approach to modifying cognitive biases that confer vulnerability to anxiety. CBM interventions are designed to directly modify attention and interpretation biases via repeated practice on cognitive tasks. Analogue studies have demonstrated that CBM affects cognitive biases and anxiety in a number of anxiety conditions. Multisession CBM treatments have shown preliminary efficacy for generalized social phobia and generalized anxiety disorder, with effect sizes comparable to existing treatments. However, with any newly developing field, there are a number of important limitations of the existing data that need to be addressed before making firm conclusions regarding CBM's efficacy for anxiety disorders. This article focuses on the theoretical rationale for CBM and the current evidence from analogue and clinical samples.
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Affiliation(s)
- Courtney Beard
- Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, Box G-BH, Providence, RI 02912, USA.
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38
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Lester KJ, Field AP, Muris P. Experimental modification of interpretation bias regarding social and animal fear in children. J Anxiety Disord 2011; 25:697-705. [PMID: 21489749 DOI: 10.1016/j.janxdis.2011.03.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2010] [Revised: 03/10/2011] [Accepted: 03/10/2011] [Indexed: 10/18/2022]
Abstract
Using an experimental bias modification task, an interpretation bias towards or away from threat was induced about animal or social situations in a sample of 103 children split into a young (7-10 years) and old age group (11-15 years). Children rapidly learned to select outcomes of ambiguous situations which were congruent with their assigned modification condition. Following positive modification, children's threat interpretation biases significantly decreased, while threat biases increased (non-significantly) after negative modification. Bias modification effects also varied as a function of age with children appearing particularly vulnerable to acquiring biases about stimuli that were congruent with the normative fears for their age group. Weak age-related modification-congruent effects on younger but not older children's anxiety vulnerability in response to a behavioral task were also observed. However, no consistent effects of bias modification on avoidance behavior were found.
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Affiliation(s)
- K J Lester
- School of Psychology, University of Sussex, Brighton BN1 9QH, UK.
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39
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Is there room for 'development' in developmental models of information processing biases to threat in children and adolescents? Clin Child Fam Psychol Rev 2011; 13:315-32. [PMID: 20811944 DOI: 10.1007/s10567-010-0078-8] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Clinical and experimental theories assume that processing biases in attention and interpretation are a causal mechanism through which anxiety develops. Despite growing evidence that these processing biases are present in children and, therefore, develop long before adulthood, these theories ignore the potential role of child development. This review attempts to place information processing biases within a theoretical developmental framework. We consider whether child development has no impact on information processing biases to threat (integral bias model), or whether child development influences information processing biases and if so whether it does so by moderating the expression of an existing bias (moderation model) or by affecting the acquisition of a bias (acquisition model). We examine the extent to which these models fit with existing theory and research evidence and outline some methodological issues that need to be considered when drawing conclusions about the potential role of child development in the information processing of threat stimuli. Finally, we speculate about the developmental processes that might be important to consider in future research.
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40
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Lothmann C, Holmes EA, Chan SWY, Lau JYF. Cognitive bias modification training in adolescents: effects on interpretation biases and mood. J Child Psychol Psychiatry 2011; 52:24-32. [PMID: 20629805 DOI: 10.1111/j.1469-7610.2010.02286.x] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Negative biases in the interpretation of ambiguous material have been linked to anxiety and mood problems. Accumulating data from adults show that positive and negative interpretation styles can be induced through cognitive bias modification (CBM) paradigms with accompanying changes in mood. Despite the therapeutic potential of positive training effects, training paradigms have not yet been explored in adolescents. METHODS Eighty-two healthy adolescents (aged 13-17 years) were randomly allocated to either positive or negative CBM training. To assess training effects on interpretation bias, participants read ambiguous situations followed by test sentences with positive or negative interpretations of the situation. Participants rated the similarity of these sentences to the previously viewed ambiguous situations. Training effects on negative and positive affect were assessed using visual analogue scales before and after training. RESULTS After training, adolescents in the negative condition drew more negative and fewer positive interpretations of new ambiguous situations than adolescents in the positive condition. Within the positive condition, adolescents endorsed more positive than negative interpretations. In terms of mood changes, positive training resulted in a significant decrease in negative affect across participants, while the negative condition led to a significant decrease in positive affect among male participants only. CONCLUSION This is the first study to demonstrate the plasticity of interpretation bias in adolescents. The immediate training effects on mood suggest that it may be possible to train a more positive interpretation style in youth, potentially helping to protect against anxiety and depressive symptoms.
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Affiliation(s)
- Claudia Lothmann
- Department of Experimental Psychology, Oxford University, Oxford, UK
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41
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Field AP, Lester KJ. Is there room for 'development' in developmental models of information processing biases to threat in children and adolescents? Clin Child Fam Psychol Rev 2010. [PMID: 20811944 DOI: 10.1007/s10567‐010‐0078‐8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Clinical and experimental theories assume that processing biases in attention and interpretation are a causal mechanism through which anxiety develops. Despite growing evidence that these processing biases are present in children and, therefore, develop long before adulthood, these theories ignore the potential role of child development. This review attempts to place information processing biases within a theoretical developmental framework. We consider whether child development has no impact on information processing biases to threat (integral bias model), or whether child development influences information processing biases and if so whether it does so by moderating the expression of an existing bias (moderation model) or by affecting the acquisition of a bias (acquisition model). We examine the extent to which these models fit with existing theory and research evidence and outline some methodological issues that need to be considered when drawing conclusions about the potential role of child development in the information processing of threat stimuli. Finally, we speculate about the developmental processes that might be important to consider in future research.
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Affiliation(s)
- Andy P Field
- School of Psychology, University of Sussex, Brighton, UK.
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42
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Are children's own interpretations of ambiguous situations based on how they perceive their mothers have interpreted ambiguous situations for them in the past? J Anxiety Disord 2010; 24:102-8. [PMID: 19815372 DOI: 10.1016/j.janxdis.2009.09.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2009] [Revised: 09/07/2009] [Accepted: 09/14/2009] [Indexed: 11/20/2022]
Abstract
The intergenerational transmission of anxious cognitions and behaviors may be a possible mechanism underlying concordance between maternal and child anxieties. By disambiguating ambiguous situations for their child in a threatening manner, anxious mothers may 'train' their children towards a general tendency to also interpret ambiguity in a threatening way. Ninety-two children and their mothers completed trait anxiety measures. Children completed two ambiguous scenario questionnaires, to measure their own interpretations of ambiguous situations (ASQ-C) and to measure their expectations of their mother's interpretation and behavior in response to ambiguous situations involving them (ASQ-EM). Maternal and child anxiety were significantly correlated. Children who made threat interpretations also anticipated that their mother would disambiguate situations for them in a threatening way. The relationship between maternal anxiety and child threat cognitions was mediated by children's expectations of how their mother would disambiguate situations for them when taken together with children's trait anxiety. The present findings provide preliminary support for the suggestion that children of anxious mothers may learn to interpret and respond to ambiguous situations based on how their mothers have interpreted ambiguous situations for them in the past.
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43
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Vassilopoulos SP, Banerjee R, Prantzalou C. Experimental modification of interpretation bias in socially anxious children: Changes in interpretation, anticipated interpersonal anxiety, and social anxiety symptoms. Behav Res Ther 2009; 47:1085-9. [DOI: 10.1016/j.brat.2009.07.018] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2009] [Revised: 07/02/2009] [Accepted: 07/29/2009] [Indexed: 10/20/2022]
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