Effects of appraisal training on responses to a distressing autobiographical event

Development and validation of the ambiguous scenario task for perfectionistic concerns for university students

BACKGROUND AND OBJECTIVES

Interpretation biases (IBs) are found in a range of psychological disorders, and the transdiagnostic role of IBs has gained increasing attention. Among the variants, IBs of perfectionism (e.g., interpreting a trivial error as equivalent to complete failure) are understood to be a central transdiagnostic phenotype. Perfectionism is a multidimensional construct and the dimension of perfectionistic concerns has been found to be most closely related to psychopathology. Therefore, capturing IBs that are specifically related to perfectionistic concerns (not perfectionism in general) is of particular importance in studying pathological IBs. Thus, we developed and validated the Ambiguous Scenario Task for Perfectionistic Concerns (AST-PC) to be used in university students.

METHODS

We created two versions of the AST-PC and administered each version to one of two independent student samples (i.e., Version A to n = 108 and Version B to n = 110). We then examined the factor structure and associations with established questionnaires of perfectionism, depression, and anxiety.

RESULTS

The AST-PC showed good factorial validity, confirming the hypothesized three-factor structure: perfectionistic concerns, adaptive, and maladaptive (but not perfectionistic) interpretations. The interpretations related to perfectionistic concerns showed good correlations with questionnaires of perfectionistic concerns, depressive symptoms, and trait anxiety.

LIMITATIONS

Additional validation studies are required to establish the temporal stability of the task scores and their sensitivity to experimental induction and clinical intervention. Additionally, IBs of perfectionism should be investigated within a broader transdiagnostic context.

CONCLUSIONS

The AST-PC demonstrated good psychometric properties. Future applications of the task are discussed.

The (un)learning of social functions and its significance for mental health

Social interactions are dynamic, context-dependent, and reciprocal events that influence prospective strategies and require constant practice and adaptation. This complexity of social interactions creates several research challenges. We propose a new framework encouraging future research to investigate not only individual differences in capacities relevant for social functioning and their underlying mechanisms, but also the flexibility to adapt or update one's social abilities. We suggest three key capacities relevant for social functioning: (1) social perception, (2) sharing emotions or empathizing, and (3) mentalizing. We elaborate on how adaptations in these capacities may be investigated on behavioral and neural levels. Research on these flexible adaptations of one's social behavior is needed to specify how humans actually "learn to be social". Learning to adapt implies plasticity of the relevant brain networks involved in the underlying social processes, indicating that social abilities are malleable for different contexts. To quantify such measures, researchers need to find ways to investigate learning through dynamic changes in adaptable social paradigms and examine several factors influencing social functioning within the three aformentioned social key capacities. This framework furthers insight concerning individual differences, provides a holistic approach to social functioning, and may improve interventions for ameliorating social abilities in patients.

Recognition memory, primacy vs. recency effects, and time perception in the online version of the fear of scream paradigm

Anxiety disorders are characterized by cognitive dysfunctions which contribute to the patient’s profound disabilities. The threat of shock paradigm represents a validated psychopathological model of anxiety to measure the impact of anxiety on cognitive processes. We have developed an online version of the threat of scream paradigm (ToSP) to investigate the impact of experimental anxiety on recognition memory. Two animated passive walkthrough videos (either under threat of scream or safety conditions) were shown to healthy participants. Recognition memory, primacy vs. recency effects, and subjective estimations of the length of encoding sessions were assessed. Subjective anxiety, stress, and emotional arousal ratings indicated that experimental anxiety could successfully be induced (Safe-Threat) or reversed (Threat-Safe) between the two passive walkthrough sessions. Participants exposed to distress screams showed impaired retrieval of complex information that has been presented in an animated environment. In the threat condition, participants failed to recognize details related to the persons encountered, their spatial locations, as well as information about the temporal order and sequence of encounters. Participant groups, which received a threat announcement prior to the first walkthrough session (Threat-Threat vs. Safety-Safety and Threat-Safety vs. Safety-Threat) showed poorer recognition memory as compared to the groups that received a safety announcement (P = 0.0468 and P = 0.0426, respectively; Mann–Whitney U test, Cohen’s d = 0.5071; effect size r = 0.2458). In conclusion, experimental anxiety induced by the online version of the ToSP leads to compromised recognition memory for complex multi-dimensional information. Our results indicate that cognitive functions of vulnerable populations (with limited mobility) can be evaluated online by means of the ToSP.

Cognitive Bias Modification bei Symptomen der Posttraumatischen Belastungsstörung

Kognitive Modelle der Posttraumatischen Belastungsstörung (PTBS) gehen davon aus, dass eine dysfunktionale Informationsverarbeitung in den Bereichen Aufmerksamkeit, Interpretation, Bewertung und Gedächtnis einen wichtigen Faktor für das Auftreten und die Aufrechterhaltung der PTBS darstellt. Parallel zeigen verschiedenste Entwicklungen in der klinisch-experimentellen Forschung, dass es möglich sein könnte, solche kognitiven Verzerrungen mithilfe von Cognitive Bias Modification (CBM)-Trainings zu modifizieren. In diesem Beitrag geben wir einen narrativen Überblick über die CBM-Forschung im Kontext von Trauma und PTBS, im experimentellen sowie klinisch-angewandten Bereich. Zudem werden Herausforderungen und neue Forschungslinien für die CBM-Forschung im Kontext der PTBS vorgestellt und diskutiert.

Changing Metacognitive Appraisal Bias in High-Worriers Through Reappraisal Training

Background and Objectives

Worry-related negative metacognitive beliefs about worrying maintain and predict pathological worry. For the current proof-of-principle study, we developed a computerized cognitive bias modification based—reappraisal training (RT), to modify the appraisal of negative metacognitive beliefs in a high-worrying sample. A functional and dysfunctional RT were pitted against each other to investigate whether appraisals of one’s thinking and coping changed following training. Moreover, training effects on the number of negative thoughts and interpretations of the worry content were examined.

Methods

Participants (N = 81) were trained to adopt a functional (disconfirmation of negative metacognitive beliefs) or dysfunctional (confirmation of negative metacognitive beliefs) appraisal style using a series of vignettes that had to be completed in line with the intended training direction. Changes in negative thoughts from pre- to post-RT were assessed with a behavioral state worry task, and transfer to interpretations with an open-ended stem sentence task.

Results

Findings support the use of the RT to alter a metacognitive appraisal bias, as participants receiving the functional RT reported fewer negative appraisals of one’s thinking and coping than participants in the dysfunctional RT group. Number of negative thoughts and interpretations were not directly affected by training.

Limitations

This study employed an analog sample and future research should replicate findings in a clinical sample for which negative metacognitions are more relevant.

Conclusions

These findings highlight the potential of metacognitive RT for future translational studies with (clinical) samples characterized by repetitive negative thinking and/or negative metacognitive beliefs.

How Expectations Shape the Formation of Intrusive Memories: An Experimental Study Using the Trauma Film Paradigm

Background

Although intrusions are the hallmark symptom of posttraumatic stress disorder, there is still limited knowledge about the processes that contribute to the development of intrusions. Here, we used the well-established trauma film paradigm (TFP) to investigate how expectations about the intensity and controllability of intrusions influence their occurrence.

Methods

90 healthy participants underwent the TFP before they were randomized to one of three conditions manipulating their expectations about intrusions: positive expectations group; negative expectations group; control group. The primary outcome was the frequency and severity of intrusive memories as assessed with an intrusion diary over seven days.

Results

The TFP was well implemented, as indicated by significant post-film anxiety and a substantial number of intrusions reported for the subsequent week. The three groups did not differ in their expectations about intrusions and, relatedly, in their experience of intrusions. A mediation analysis revealed that the influence of post-film anxiety on intrusive memories was fully mediated by expectations.

Conclusions

Despite the failure of the expectation manipulation, the results of the mediation analysis support the hypothesis that post-film expectations influence the formation of intrusive memories, suggesting that intrusions may result from maladaptive dynamics between emotional and cognitive processes following trauma(like) experiences.

Mental imagery in adolescent PTSD patients after child abuse: a comparison with matched healthy controls

BACKGROUND

Intrusive mental imagery (MI) plays a crucial role in the maintenance of posttraumatic stress disorder (PTSD) in adults. Evidence on the characteristics of MI in adolescents suffering from PTSD is sparse. The aim of this study was to thoroughly assess MI in an adolescent sample suffering from PTSD after the experience of childhood sexual abuse and/or childhood physical abuse (CA).

METHODS

Thirty-two adolescents with a primary diagnosis of PTSD after CA and 32 adolescents without any mental disorder and without a history of CA, matched for age and gender, completed questionnaires assessing the characteristics of negative and positive MI, as well as images of injury and death that lead to positive emotions (ID-images).

RESULTS

The PTSD group reported significantly more frequent, more vivid, more distressing and more strongly autobiographically linked negative MI compared to the control group. Although positive MI was highly present in both groups (PTSD: 65.6%; controls: 71.9%), no significant differences emerged between the two groups regarding the distinct characteristics of positive MI. The frequency of the ID-images did not significantly differ between the two groups (PTSD: 21.9%; controls: 9.4%), although the ID-images were more vivid in the PTSD group.

DISCUSSION

Negative MI appears to be crucial in adolescent PTSD, whilst positive MI are unexpectedly common in both the PTSD and the control group. The role of positive MI as well as that of ID-images remain unclear. Specific interventions for changing negative MI that are tailored to the developmental challenges in adolescents with PTSD should be developed.

TRIAL REGISTRATION

Some of the PTSD patients in this study were also part of a randomized controlled trial on Developmentally adapted Cognitive Processing Therapy (D-CPT). This trial was registered at the German Clinical Trial Registry (GCTR), DRKS00004787 , 18 March 2013.

The relationship between self-traumatized and self-vulnerable automatic associations and posttraumatic stress symptoms among adults who have experienced a distressing life event

Convergent evidence supports a crucial role for dysfunctional appraisals in the development and maintenance of post-traumatic stress disorder (PTSD). However, most research in this area has used self-report measures, assessing only explicit forms of such negative cognitions; the relevance of their more automatically-activated counterparts, as assumed by cognitive models, remains relatively unexplored. The current study aimed to further our understanding of the potential utility of measuring automatic dysfunctional associations in the context of posttraumatic stress. The relationship between scores on two different implicit association tests (IATs) and posttraumatic stress symptoms was investigated in a sample of adults (N = 279) who reported having experienced a potentially traumatic negative life event. Participants completed the two IATs (one assessing self-traumatized associations, the other self-vulnerable associations), a self-report measure of dysfunctional appraisals, and measures of posttraumatic stress symptoms and other aspects of psychopathology online. Scores indicating higher levels of dysfunctional associations on both IATs were associated with higher levels of posttraumatic stress symptoms. Only scores on the IAT measuring self-vulnerable associations, and not the IAT measuring self-traumatized associations, continued to show an association with posttraumatic stress symptoms after controlling for explicit dysfunctional appraisals. Overall, the results indicate the value of investigating PTSD-relevant automatic associations to further develop our understanding of cognitive processes implicated in posttraumatic stress.

Negative Cognitions and Emotional Distress Following Job Loss: Development and Validation of the Beliefs About Loss of Work (BLOW) Scale

Negative cognitions following job loss can contribute to emotional distress by motivating individuals to adopt coping styles that reduce stress in the short run while obstructing adjustment in the long run. It is unclear which specific cognitions are related to symptoms of complicated grief, depression, and anxiety following job loss. To fill this gap, this study introduces the Beliefs about Loss of Work (BLOW) scale and examines its psychometric properties. We recruited 222 Dutch workers who had lost their job, including 70 men and 152 women, with an average age of 52.5 years. Confirmatory factor analyses revealed that a second-order eight-factor model had the best fit to the data. The BLOW scale is a reliable instrument with a good convergent and divergent validity. This instrument may stimulate research on mechanisms involved in job loss-related distress and could inform the development of interventions to reduce this distress.

Using Three Indirect Measures to Assess the Role of Sexuality-Related Associations and Interpretations for Women's Sexual Desire: An Internet-Based Experimental Study

Theoretical models emphasize the role of both automatic appraisals (i.e., associations) and conscious appraisals (i.e., interpretations) for sexual desire. Studies on sexuality-related appraisals have not combined self-report measures and experimental paradigms in order to compare the relevance of associations or interpretations. The aim of this study was to assess the relative contribution of both associations and interpretations to the explanation of low sexual desire in women. Toward this goal, indirect measures assessing associations (via a Single Target Implicit Association Test [STIAT]) and interpretations (via a Scrambled Sentences Test [SST] and a scenario task) were administered in a sample of 263 women (M_age = 27.90, SD 8.27) with varying levels of sexual desire and different sexual orientations (exclusively heterosexual women: 54.6%). Negative sexuality-related interpretations as assessed with two variants of the SST as well as the scenario task added to the explanation of lower sexual desire in women. Negative associations as measured with the STIAT were predictive of lower sexual desire only in women who did not indicate an exclusively heterosexual orientation. In this study, sexuality-related interpretations were more relevant to women's sexual desire than automatic associations. Future studies should assess the causal mechanism underlying sexuality-related interpretations (e.g., by evaluating whether these can be changed via cognitive bias modification techniques or psychological treatments).

Using Cognitive Bias Modification-Appraisal Training to Manipulate Appraisals about the Self and the World in Analog Trauma

Background

Dysfunctional appraisals are a key mechanism in posttraumatic stress disorder (PTSD). Experimental manipulations of appraisals via Cognitive Bias Modification-Appraisal (CBM-App) training targeting cognitions related to the ‘self’ has shown to affect analog trauma symptoms. The present study aimed to conceptually replicate and extend previous findings by comparing a newly developed ‘world’ to the original ‘self’ training, and investigate the moderating role of locus of control (LOC) on intrusions.

Methods

Healthy participants (N = 173) were exposed to distressing films as an analog trauma induction. Next, participants received positive or negative CBM-App, targeting either self- or world-relevant appraisals. Dysfunctional appraisals and LOC were assessed pre- and post-training. During the week after the laboratory session, participants recorded their intrusions and associated distress in a diary. One week later, trauma-relevant symptomatology was assessed.

Results

Positive compared to negative CBM-App induced training-congruent appraisals, independent of the trained cognition (self vs. world). However, there was no effect on analog trauma symptoms and LOC did not moderate the training’s effect.

Conclusions

Our results underline the validity of CBM-App as a method to experimentally manipulate appraisals. However, since we did not fully replicate previous findings further research on mechanisms associated with transfer effects is warranted.

The Effects of Modifying Dysfunctional Appraisals in Posttraumatic Stress Disorder Using a Form of Cognitive Bias Modification: Results of a Randomized Controlled Trial in an Inpatient Setting

INTRODUCTION

Dysfunctional appraisals about traumatic events and their sequelae are a key mechanism in posttraumatic stress disorder (PTSD). Experimental studies have shown that a computerized cognitive training, cognitive bias modification for appraisals (CBM-APP), can modify dysfunctional appraisals and reduce analogue trauma symptoms amongst healthy and subclinical volunteers.

OBJECTIVE

We aimed to test whether CBM-APP could reduce dysfunctional appraisals related to trauma reactions in PTSD patients, and whether this would lead to improvements in PTSD symptoms.

METHODS

We compared CBM-APP to sham training in a parallel-arm proof-of-principle double-blind randomized controlled trial amongst 80 PTSD patients admitted to an inpatient clinic. Both arms comprised a training schedule of 8 sessions over a 2-week period and were completed as an adjunct to the standard treatment programme.

RESULTS

In intention-to-treat analyses, participants receiving CBM-APP showed a greater reduction in dysfunctional appraisals on a scenario task from pre- to posttraining (primary outcome) assessments, compared to those receiving sham training (d = 1.30, 95% CI 0.82-1.80), with between-group differences also found on the Posttraumatic Cognitions Inventory (PTCI; d = 0.85, 95% CI 0.39-1.32) and the PTSD Checklist for DSM-5 (PCL-5; d = 0.68, 95% CI 0.23-1.14), but not for long-term cortisol concentrations (d = 0.25, 95% CI -0.28 to 0.78). Reductions in dysfunctional appraisals assessed via the scenario task correlated with reductions on the PTCI, PCL-5, and hair cortisol concentrations from pre- to posttraining time points.

CONCLUSIONS

Results support dysfunctional appraisals as a modifiable cognitive mechanism, and that their proximal modification transfers to downstream PTSD symptoms. These findings could open new avenues for improving present therapeutic approaches.

Appraisal-based cognitive bias modification in patients with posttraumatic stress disorder: a randomised clinical trial

Background: Negative appraisals of the trauma and its sequelae play a crucial role in the development and maintenance of Posttraumatic Stress Disorder (PTSD). Experimental studies have shown promise in reducing negative appraisal through Cognitive Bias Modification (CBM) training. Objective: To determine whether an online CBM training designed to modify dysfunctional appraisals is successful in reducing appraisal bias in PTSD patients. Method: In this double-blinded 2-arm randomised clinical trial, 107 patients with PTSD were randomly allocated to active (n = 49) or control online CBM training (n = 57). Training comprised the completion of four sessions of online CBM training within one week. Change in bias, as measured by a scenario task and questionnaire (i.e. PostTraumatic Cognition Inventory), was the primary outcome. Secondary outcome included change in PTSD symptoms. Assessments took place prior to training, during training sessions, post-training and at 1- and 6-month follow-up. Results: Intent-to-treat analysis indicated that there was no interaction effect of condition by time. Regardless of training condition, participants showed a small to moderate decline in appraisal bias and PTSD symptoms from pre- to post-training. In both conditions, bias change during training sessions was related to decline in PTSD symptomatology following training. No moderators of outcome were found. Conclusions: There was no evidence that active training was more effective than control training in reducing dysfunctional appraisals. In both conditions, participants showed a decline in dysfunctional appraisals and PTSD symptoms following training. Importantly, bias reduction during training was related to PTSD symptom decline following training. Explanations and future research directions are discussed.