Measuring automatic associations: validation of algorithms for the Implicit Association Test (IAT) in a laboratory setting

The role of explicit and implicit self-esteem in the relationship between childhood trauma and adult depression and anxiety

BACKGROUND

Self-esteem is an important psychological concept that can be measured explicitly (reflective processing) and implicitly (associative processing). The current study examined 1) the association between childhood trauma (CT) and both explicit and implicit self-esteem, and 2) whether self-esteem mediated the association between CT and depression/anxiety.

METHODS

In 1479 adult participants of the Netherlands Study of Depression and Anxiety, CT was assessed with a semi-structured interview, depression/anxiety symptoms with self-report questionnaires and explicit and implicit self-esteem with the Rosenberg Self-Esteem Scale and Implicit Association Test, respectively. ANOVAs and regression analyses determined the association between CT (no/mild/severe CT), its subtypes (abuse/neglect) and self-esteem. Finally, we examined whether self-esteem mediated the relationship between CT and depression/anxiety.

RESULTS

Participants with CT reported lower explicit (but not lower implicit) self-esteem compared to those without CT (p < .001, partial η2 = 0.06). All CT types were associated with lower explicit self-esteem (p = .05 for sexual abuse, p < .001 for other CT types), while only emotional neglect significantly associated with lower implicit self-esteem after adjusting for sociodemographic characteristics (p = .03). Explicit self-esteem mediated the relationship between CT and depression/anxiety symptoms (proportion mediated = 48-77 %).

LIMITATIONS

The cross-sectional design precludes from drawing firm conclusions about the direction of the proposed relationships.

CONCLUSIONS

Our results suggested that the relationship between CT and depression/anxiety symptoms can at least partly be explained by explicit self-esteem. This is of clinical relevance as it points to explicit self-esteem as a potential relevant treatment target for people with CT.

Understanding and predicting future relapse in depression from resting state functional connectivity and self-referential processing

BACKGROUND

The recurrent nature of Major Depressive Disorder (MDD) asks for a better understanding of mechanisms underlying relapse. Previously, self-referential processing abnormalities have been linked to vulnerability for relapse. We investigated whether abnormalities in self-referential cognitions and functioning of associated brain-networks persist upon remission and predict relapse.

METHODS

Remitted recurrent MDD patients (n = 48) and never-depressed controls (n = 23) underwent resting-state fMRI scanning at baseline and were additionally assessed for their implicit depressed self-associations and ruminative behaviour. A template-based dual regression approach was used to investigate between-group differences in default mode, cingulo-opercular and frontoparietal network resting-state functional connectivity (RSFC). Additional prediction of relapse status at 18-month follow-up was investigated within patients using both regression analyses and machine learning classifiers.

RESULTS

Remitted patients showed higher rumination, but no implicit depressed self-associations or RSFC abnormalities were observed between patients and controls. Nevertheless, relapse was related to i) baseline RSFC between the ventral default mode network and the precuneus, dorsomedial frontal gyrus, and inferior occipital lobe, ii) implicit self-associations, and iii) uncontrollability of ruminative thinking, when controlled for depressive symptomatology. Moreover, preliminary machine learning classifiers demonstrated that RSFC within the investigated networks predicted relapse on an individual basis.

CONCLUSIONS

Remitted MDD patients seem to be commonly characterized by abnormal rumination, but not by implicit self-associations or abnormalities in relevant brain networks. Nevertheless, relapse was predicted by self-related cognitions and default mode RSFC during remission, suggesting that variations in self-relevant processing play a role in the complex dynamics associated with the vulnerability to developing recurrent depressive episodes.

CLINICAL TRIAL REGISTRATION

Netherlands Trial Register, August 18, 2015, trial number NL53205.042.15.

Methods to split cognitive task data for estimating split-half reliability: A comprehensive review and systematic assessment

Estimating the reliability of cognitive task datasets is commonly done via split-half methods. We review four methods that differ in how the trials are split into parts: a first-second half split, an odd-even trial split, a permutated split, and a Monte Carlo-based split. Additionally, each splitting method could be combined with stratification by task design. These methods are reviewed in terms of the degree to which they are confounded with four effects that may occur in cognitive tasks: effects of time, task design, trial sampling, and non-linear scoring. Based on the theoretical review, we recommend Monte Carlo splitting (possibly in combination with stratification by task design) as being the most robust method with respect to the four confounds considered. Next, we estimated the reliabilities of the main outcome variables from four cognitive task datasets, each (typically) scored with a different non-linear algorithm, by systematically applying each splitting method. Differences between methods were interpreted in terms of confounding effects inflating or attenuating reliability estimates. For three task datasets, our findings were consistent with our model of confounding effects. Evidence for confounding effects was strong for time and task design and weak for non-linear scoring. When confounding effects occurred, they attenuated reliability estimates. For one task dataset, findings were inconsistent with our model but they may offer indicators for assessing whether a split-half reliability estimate is appropriate. Additionally, we make suggestions on further research of reliability estimation, supported by a compendium R package that implements each of the splitting methods reviewed here.

Implicit and Explicit Attitudes Toward Intimate Partner Violence Against Women: An Exploratory Study

There is consistent evidence that attitudes are important in understanding how people react and behave toward victims and perpetrators of intimate partner violence against women. Researchers have typically measured these attitudes through self-reports. However, explicit measures are prone to socially desirable responding. The overall objective of our research is to provide multimethod measures of public attitudes (explicit and implicit) toward intimate partner violence against women. An opportunity sample of 190 Psychology undergraduates (32 men and 158 women) took part in this study and completed two self-reports: the Inventory of Distorted Thoughts about Women and Violence, and the Inventory of Beliefs about Wife Beating. In addition, they completed a personalized Implicit Association Test, the Gender Violence Implicit Association Test. This study provides evidence of the best way to apply the Gender Violence Implicit Association Test (with feedback) and the best procedure for estimating the Implicit Association Test effect (built-in error penalty). The findings are also consistent with previous research and exhibit a significant disparity between explicit and implicit measures of attitudes toward intimate partner violence against women. These findings, although still preliminary, provide interesting information that affirms the need to incorporate implicit measures of attitudes toward intimate partner violence against women into research on this social problem.

A Pictorial Dot Probe Task to Assess Food-Related Attentional Bias in Youth With and Without Obesity: Overview of Indices and Evaluation of Their Reliability

Several versions of the dot probe detection task are frequently used to assess maladaptive attentional processes associated with a broad range of psychopathology and health behavior, including eating behavior and weight. However, there are serious concerns about the reliability of the indices derived from the paradigm as measurement of attentional bias toward or away from salient stimuli. The present paper gives an overview of different attentional bias indices used in psychopathology research and scrutinizes three types of indices (the traditional attentional bias score, the dynamic trial-level base scores, and the probability index) calculated from a pictorial version of the dot probe task to assess food-related attentional biases in children and youngsters with and without obesity. Correlational analyses reveal that dynamic scores (but not the traditional and probability indices) are dependent on general response speed. Reliability estimates are low for the traditional and probability indices. The higher reliability for the dynamic indices is at least partially explained by general response speed. No significant group differences between youth with and without obesity are found, and correlations with weight are also non-significant. Taken together, results cast doubt on the applicability of this specific task for both experimental and individual differences research on food-related attentional biases in youth. However, researchers are encouraged to make and test adaptations to the procedure or computational algorithm in an effort to increase psychometric quality of the task and to report psychometric characteristics of their version of the task for their specific sample.

The Gender Violence - Implicit Association Test to measure attitudes toward intimate partner violence against women

Attitudes play a central role in intimate partner violence against women and are related to its origin, to the responses of women who suffer violence, and to the settings where it occurs. In fact, these attitudes are recognized as one of the risk factors linked to violent perpetration and to public, professional, and victim responses to this type of violence. However, even though available research generally shows a broad rejection of this violence, it remains a serious social and health problem that has reached epidemic proportions. This suggests that the information available about these attitudes (obtained through explicit and direct measures, i.e., self-reports) may be distorted or influenced by factors such as social desirability. In this context, the overall objective of our research project is to provide multi-method measures (explicit and implicit) of attitudes toward intimate partner violence against women, and the main goal of this paper is to propose an instrument for the implicit measurement of these attitudes. In this regard, the Implicit Association Test (IAT) is the most common procedure used, providing a superior predictive validity compared to explicit measures for socially sensitive topics. We will present an exploratory study that describes its adaptation for our purposes, and the development of the Gender Violence - Implicit Association Test (GV-IAT) to use among Spanish-speaking populations, and discuss the strengths and limitations of this proposal.

Comparing Implicit and Explicit Attitudes Toward Intimate Partner Violence Against Women

Intimate partner violence against women (IPVAW) is an epidemic social and public health problem. Research has consistently found evidence for a complex etiology of IPVAW resulting from the interaction of many factors, among which gender-related norms and attitudes are among the main drivers of this violence. Public attitudes toward IPVAW are especially important because attitudes rejecting, condoning, or fostering such behavior are social factors that contribute to a climate of tolerance or refusal that can shape the social environment in which such violence takes place. Given the importance of these attitudes, the availability of reliable, valid, and concise measures is critical for both research and intervention purposes. The evidence shows a probable bias of direct or explicit assessment measures of IPVAW attitudes, and it has been suggested that they should be complemented by indirect or implicit measures. In this context, the main aim of this paper was to examine how implicit and explicit attitudes toward IPVAW differ among a Spanish population. An opportunity sample of 693 students took part in this study. Two direct or explicit measures (the Inventory of Distorted Thoughts about Women and Violence, IPDMV, and the Inventory of Beliefs about Intimate Partner Violence, IBIPV) and one indirect or implicit measure [the Gender Violence Implicit Association Test (GV-IAT), a personalized form of the Implicit Association Test (IAT)] were applied. The results obtained show that the psychometric characteristics of the implicit measure used (GV-IAT) are acceptable. Additionally, we obtained significant differences by gender, IPVAW knowledge, IPVAW involvement, and political opinion when we measured IPVAW attitudes by implicit measures. However, when we measured these attitudes by explicit measures, we only obtained significant differences by gender and political opinion. Finally, the results highlight the important differences between the levels of strong IPVAW rejection measured with explicit and implicit measures, confirming the traditional discrepancy between explicit and implicit measures of attitudes. In summary, the results obtained provide additional support for the idea that GV-IAT constitutes a promising assessment tool to complement explicit measures for attitudes toward IPVAW.

Neurocognitive working mechanisms of the prevention of relapse in remitted recurrent depression (NEWPRIDE): protocol of a randomized controlled neuroimaging trial of preventive cognitive therapy

BACKGROUND

Major Depressive Disorder (MDD) is a psychiatric disorder with a highly recurrent character, making prevention of relapse an important clinical goal. Preventive Cognitive Therapy (PCT) has been proven effective in preventing relapse, though not for every patient. A better understanding of relapse vulnerability and working mechanisms of preventive treatment may inform effective personalized intervention strategies. Neurocognitive models of MDD suggest that abnormalities in prefrontal control over limbic emotion-processing areas during emotional processing and regulation are important in understanding relapse vulnerability. Whether changes in these neurocognitive abnormalities are induced by PCT and thus play an important role in mediating the risk for recurrent depression, is currently unclear. In the Neurocognitive Working Mechanisms of the Prevention of Relapse In Depression (NEWPRIDE) study, we aim to 1) study neurocognitive factors underpinning the vulnerability for relapse, 2) understand the neurocognitive working mechanisms of PCT, 3) predict longitudinal treatment effects based on pre-treatment neurocognitive characteristics, and 4) validate the pupil dilation response as a marker for prefrontal activity, reflecting emotion regulation capacity and therapy success.

METHODS

In this randomized controlled trial, 75 remitted recurrent MDD (rrMDD) patients will be included. Detailed clinical and cognitive measurements, fMRI scanning and pupillometry will be performed at baseline and three-month follow-up. In the interval, 50 rrMDD patients will be randomized to eight sessions of PCT and 25 rrMDD patients to a waiting list. At baseline, 25 healthy control participants will be additionally included to objectify cross-sectional residual neurocognitive abnormalities in rrMDD. After 18 months, clinical assessments of relapse status are performed to investigate which therapy induced changes predict relapse in the 50 patients allocated to PCT.

DISCUSSION

The present trial is the first to study the neurocognitive vulnerability factors underlying relapse and mediating relapse prevention, their value for predicting PCT success and whether pupil dilation acts as a valuable marker in this regard. Ultimately, a deeper understanding of relapse prevention could contribute to the development of better targeted preventive interventions.

TRIAL REGISTRATION

Trial registration: Netherlands Trial Register, August 18, 2015, trial number NL5219.

Spatio-temporal associations with memory cues are linked to analogue traumatic intrusions

Trauma survivors with post-traumatic stress disorder (PTSD) frequently experience intrusive trauma memories associated with a feeling of "nowness". Information-processing models of PTSD ascribe these symptoms to an insufficient integration of memories with their spatio-temporal context in the past, turning them into powerful stressors. Here, we tested the idea that automatic associations of trauma reminders with the present or the past predict intrusive memories. We instructed 96 healthy participants to view two different traumatic films. Participants then underwent a computerized training that established implicit contingencies between film reminder pictures with the verbal responses "now" or "past" to increase and reduce intrusions, respectively. The training successfully altered implicit spatio-temporal associations for film reminder stimuli on a subsequent Implicit Association Test (IAT). There were no additional transfer effects for tense usage during a free recall task after one week and for the development of intrusion symptoms (one-week diary, retrospective questionnaire). However, participants who associated one film more strongly with the present and the other with the past consistently reported relatively more intrusive memories related to the former film. Thus, our results lend support to information processing models of PTSD and warrant further investigation of the causal role of implicit associations with spatio-temporal information.

Age Difference in Perceived Ease of Use, Curiosity, and Implicit Negative Attitude toward Robots

Understanding older adults’ attitudes toward robots has become increasingly important as robots have been introduced in various settings, such as retirement homes. We investigated whether there are age differences in both implicit and explicit attitudes toward robots after interacting with an assistive robot. Twenty-four younger and 24 older adults were recruited. Explicit attitudes were measured by self-reported questionnaires both before and after interacting with the robot. State curiosity toward robots was also measured as a momentary form of explicit attitude. Implicit attitude was measured via an implicit association test. Our results showed that (1) both older and younger adults had more positive explicit attitudes toward robots after interaction; (2) older adults had lower state curiosity than younger adults, however, their state curiosity would be up to the same level as younger adults when they perceived the robot with higher levels of personal association; and (3) the implicit association between robots and negative words was stronger for older adults than younger adults, suggesting that older adults had more implicit negative attitude toward robots. The results suggest that, despite older adults’ relatively more negative implicit attitude toward robots, personally relevant positive experiences could help improve their explicit attitudes toward robots.

Implicit evaluation of chocolate and motivational need states interact in predicting chocolate intake in everyday life

Snack food consumption has a high relevance for health and is partially controlled by implicit, motivational processes that make self-control difficult at certain times. Specifically, research suggests that individuals with a more positive implicit food evaluation consume more snack foods in the laboratory under conditions of high motivational needs (e.g., hunger and food craving). Yet, no study investigated if and under which circumstances implicit evaluation of food predicts snack food intake in real life. In the present study, 60 female undergraduate students (mean age: 22.3 ± 2.34 years) at the University of Salzburg, Austria, completed a chocolate-related Single Category Implicit Association Test in the laboratory and then reported snack food intake during seven days of signal-contingent Ecological Momentary Assessment. Results showed that a more positive implicit evaluation of chocolate was associated with a higher likelihood of consuming chocolate in states of high hunger and high momentary chocolate craving, whereas no such modulatory pattern was found in states of low hunger or low chocolate craving. Therefore, interventions targeting daily chocolate craving and consumption may be particularly beneficial in specific situations (i.e., in states of high hunger and craving) and also in vulnerable populations (e.g., those with a more positive implicit food evaluation).

An experimental examination of cognitive processes and response inhibition in patients seeking treatment for buying-shopping disorder

There is an ongoing debate about whether buying-shopping disorder (BSD) should be acknowledged as a behavioral addiction. The current study investigated if mechanisms that play a prominent role in disorders due to substance use or addictive behaviors are relevant in BSD, particularly cue reactivity, craving, cognitive bias and reduced inhibitory control regarding addiction-relevant cues. The study included 39 treatment-seeking patients with BSD and 39 healthy control (HC) participants (29 women and 10 men in each group). Subjective responses toward buying/shopping-relevant visual cues were compared in patients vs. control participants. Experimental paradigms with neutral and semi-individualized buying/shopping-related pictures were administered to assess attentional bias, implicit associations and response inhibition with respect to different visual cues: Dot-probe paradigm (DPP), Implicit Association Task (IAT), Go/nogo-task (GNG). The severity of BSD, craving for buying/shopping, and symptoms of comorbid mental disorders (anxiety, depressive and hoarding disorders) were measured using standardized questionnaires. The BSD-group showed more general craving for buying/shopping, stronger subjective craving reactions towards buying/shopping-related visual cues, and more symptoms of anxiety, depression and hoarding disorder than control participants. Task performance in the DPP, IAT and GNG paradigm did not differ between the two groups. The present findings confirm previous research concerning the crucial role of craving in BSD. The assumption that attentional bias, implicit associations and deficient inhibitory control with respect to buying/shopping-related cues are relevant in BSD could not be proven. Future research should address methodological shortcomings and investigate the impact of acute psychosocial stress and present mood on craving responses, cognitive processing, and response inhibition in patients with BSD.

Implicit Perceptions of Closeness From the Direct Eye Gaze

Eye gaze plays an important role during social interaction. Specifically, different eye gaze directions may send different functional messages to the observers, who have the capacity to automatically interpret these signals. In the present study, we used the implicit association test (IAT) to investigate whether direct eye gaze sends a functional, automatically perceived signal about non-target interpersonal closeness. Results suggest that the direct gaze strongly signals close relationship, and this association cannot be accounted for by positive valence. The findings suggest that the direct gaze may function to uniquely communicate a generalized closeness without orientation. Discussion focuses on the implications of these findings for social functions of direct gaze during interpersonal interaction and the automatic nature of such associations.

Evaluating Implicit Emotions of Chinese University Students With Different Levels of Social Adjustment: Implicit Measurement Based on the Go/No-go Association Task

In this study, 60 university students were selected as research participants based on the Chinese Student Adjustment Scale. Participants were divided into two groups: high level of social adjustment and low level of social adjustment. Then using the Go/No-go Association Task as the implicit association experimental paradigm, implicit emotions were evaluated by having participants respond to different facial expressions as quickly as possible. The group of participants with higher levels of social adjustment performed better when responding to self-concepts with positive facial expressions, compared to responding to non-self-concepts with either positive or negative facial expressions. Thus, they showed an implicit preference for processing information about self with positive emotions. The group of participants with lower levels of social adjustment did not show the same benefit when responding to self-concepts. Instead, they performed better when responding to other-related concepts with different facial expressions, irrespective of the emotional content. Thus, they manifested an implicit preference for processing information about others with different emotions, suggesting a deficiency in processing their own emotions. In addition, the results validated the objectivity of the Chinese Student Adjustment Scale as an assessment tool.

Could differences in implicit attitudes to sexual concurrency play a role in generalized HIV epidemics?

Background: Sexual partner concurrency has been implicated in the genesis of generalized HIV epidemic in South Africa. Most South Africans, however, disapprove of concurrency in surveys. These surveys test individuals' explicit attitudes which are susceptible to a number of important biases such as the social desirability bias. Assessment of implicit cognitions have been found to be better predictors of behaviour in socially sensitive domains. We hypothesized that South Africans may have implicit attitudes more tolerant of concurrency than lower concurrency prevalence populations. Methods: To test this hypothesis, we developed a concurrency-implicit association test (C-IAT) and compared the C-IATs of samples of South African and Belgian university students. Results: We found a large and statistically significant difference in the C-IAT between the South Africans (D600-score = -0.009, indicating absence of preference for concurrency or monogamy) and Belgians (D600-score = 0.783, indicating a strong preference for monogamy; t-test = 13.3; P < 0.0001). The effect size measure, Cohen's d, was found to be 0.88, which is considered a large effect size in this field. Conclusions: Our results are compatible with the thesis that differences in implicit attitudes to concurrency play a role in the genesis of generalised HIV epidemics.

Could differences in implicit attitudes to sexual concurrency play a role in generalized HIV epidemics?

Background: Sexual partner concurrency has been implicated in the genesis of generalized HIV epidemic in South Africa. Most South Africans, however, disapprove of concurrency in surveys. These surveys test individuals' explicit attitudes which are susceptible to a number of important biases such as the social desirability bias. Assessment of implicit cognitions have been found to be better predictors of behaviour in socially sensitive domains. We hypothesized that South Africans may have implicit attitudes more tolerant of concurrency than lower concurrency prevalence populations. Methods: To test this hypothesis, we developed a concurrency-implicit association test (C-IAT) and compared the C-IATs of samples of South African and Belgian university students. Results: We found a large and statistically significant difference in the C-IAT between the South Africans (D600-score = -0.009, indicating absence of preference for concurrency or monogamy) and Belgians (D600-score = 0.783, indicating a strong preference for monogamy; t-test = 13.3; P < 0.0001). The effect size measure, Cohen's d, was found to be 0.88, which is considered a large effect size in this field. Conclusions: Our results are compatible with the thesis that differences in implicit attitudes to concurrency play a role in the genesis of generalised HIV epidemics.

Implicit attitudes to sexual partner concurrency vary by sexual orientation but not by gender-A cross sectional study of Belgian students

High rates of sexual partner concurrency have been shown to facilitate the spread of various sexually transmitted infections. Assessments of explicit attitudes to concurrency have however found little difference between populations. Implicit attitudes to concurrency may vary between populations and play a role in generating differences in the prevalence of concurrency. We developed a concurrency implicit associations test (C-IAT) to assess if implicit attitudes towards concurrency may vary between individuals and populations and what the correlates of these variations are. A sample of 869 Belgian students (mean age 23, SD 5.1) completed an online version of the C-IAT together with a questionnaire concerning sexual behavior and explicit attitudes to concurrency. The study participants C-IATs demonstrated a strong preference for monogamy (-0.78, SD = 0.41). 93.2% of participants had a pro-monogamy C-IAT. There was no difference in this implicit preference for monogamy between heterosexual men and women. Men who have sex with men and women who have sex with women were more likely to exhibit implicit but not explicit preferences for concurrency compared to heterosexual men and women. Correlates of the C-IAT varied between men and women.

The validation of Implicit Association Test measures for smartphone and Internet addiction in at-risk children and adolescents

Background Potential concerns are increasing that smartphone and Internet addictions may have deleterious effects on the mental health. Despite the recognition of the important role that implicit associations may have over explicit processes in addiction, such implicit associations have not been comprehensively investigated with respect to Internet addiction. Therefore, we modified the Implicit Association Test (IAT) for smartphone and Internet addictions and investigated its validity in children and adolescents. Methods In this experimental study, 78 at-risk children and adolescents ranging in age from 7 to 17 years completed an IAT modified with pictures captured from the most popular Internet games among youth. Furthermore, measures of Internet and smartphone addictions, mental health and problem behaviors, impulsive tendencies, self-esteem, daily stress, and quality of life were assessed simultaneously. Results Significant correlations were found between IAT D2SD scores and standardized scales for Internet (r = .28, p < .05) and smartphone (r = .33, p < .01) addictions. There were no significant correlations between IAT parameters and other scales measuring the constructs that are less relevant to the features of addiction, such as daily stress levels, impulsivity, and quality of life. Multiple regression analysis revealed that the IAT D2SD was independently and positively associated with smartphone addiction (p = .03) after controlling for other clinical correlates. Conclusions This study demonstrated good convergent and discriminant validity of this IAT as a novel measurement relating to Internet and smartphone addictions. Further longitudinal and prospective studies are needed to evaluate its potential utility in clinical and community settings.

Cognitive bias modification and CBT as early interventions for adolescent social and test anxiety: Two-year follow-up of a randomized controlled trial

BACKGROUND AND OBJECTIVES

This two-year follow-up study evaluated the long-term outcomes of two early interventions that aimed at reducing social and test anxiety in young adolescents at risk for developing social anxiety disorder.

METHODS

In this RCT, moderately socially anxious adolescents (N=240, mean age 13.6 years) were randomly assigned to a 10-week internet-based multifaceted cognitive bias modification training (CBM), a 10-week school-based cognitive behavioral group training (CBT), or a no-intervention control condition. Using multiple imputation, this study examined the changes in primary and secondary outcome measures from pretest to follow-up in a repeated measures design.

RESULTS

Primary outcome: Self-reported social and test anxiety generally decreased from pre-test to two-year follow-up, regardless of treatment condition. The percentage of adolescents who developed a social anxiety disorder was very low (6%) and similar across conditions. Secondary outcome: There were beneficial changes in self-esteem, self-reported prosocial behaviors, and fear of negative evaluation, but none of these were related to treatment condition. Automatic social-threat associations did not significantly change. The CBM intervention was effective in changing interpretative bias as indexed by the Recognition Task but this long-term effect did not transfer to the Adolescent Interpretation and Belief Questionnaire.

LIMITATIONS

There was a substantial (50%) though seemingly non-selective attrition at follow-up.

CONCLUSIONS

This RCT does not support the longer-term efficacy of school-based CBT or CBM as an early intervention for social and test anxiety. Rather, it emphasizes the positive 'natural' course of highly socially anxious adolescents over two years.

Implicit and Explicit Self-Esteem in Current, Remitted, Recovered, and Comorbid Depression and Anxiety Disorders: The NESDA Study

Background

Dual processing models of psychopathology emphasize the relevance of differentiating between deliberative self-evaluative processes (explicit self-esteem; ESE) and automatically-elicited affective self-associations (implicit self-esteem; ISE). It has been proposed that both low ESE and ISE would be involved in major depressive disorder (MDD) and anxiety disorders (AD). Further, it has been hypothesized that MDD and AD may result in a low ISE “scar” that may contribute to recurrence after remission. However, the available evidence provides no straightforward support for the relevance of low ISE in MDD/AD, and studies testing the relevance of discrepant SE even showed that especially high ISE combined with low ESE is predictive of the development of internalizing symptoms. However, these earlier findings have been limited by small sample sizes, poorly defined groups in terms of comorbidity and phase of the disorders, and by using inadequate indices of discrepant SE. Therefore, this study tested further the proposed role of ISE and discrepant SE in a large-scale study allowing for stricter differentiation between groups and phase of disorder.

Method

In the context of the Netherlands Study of Depression and Anxiety (NESDA), we selected participants with current MDD (n = 60), AD (n = 111), and comorbid MDD/AD (n = 71), remitted MDD (n = 41), AD (n = 29), and comorbid MDD/AD (n = 14), recovered MDD (n = 136) and AD (n = 98), and never MDD or AD controls (n = 382). The Implicit Association Test was used to index ISE and the Rosenberg Self-Esteem Scale indexed ESE.

Results

Controls reported higher ESE than all other groups, and current comorbid MDD/AD had lower ESE than all other clinical groups. ISE was only lower than controls in current comorbid AD/MDD. Discrepant self-esteem (difference between ISE and ESE) was not associated with disorder status once controlling for ESE.

Limitations

Cross-sectional design limits causal inferences.

Conclusion

Findings suggest a prominent role for ESE in MDD and AD, while in comorbid MDD/AD negative self-evaluations are also present at the implicit level. There was no evidence to support the view that AD and MDD would result in a low ISE “scar”.

The manipulation of alcohol-related interpretation biases by means of Cognitive Bias Modification--Interpretation (CBM-I)

BACKGROUND AND OBJECTIVES

There is a large body of evidence demonstrating that alcohol abuse and misuse is characterized by alcohol-related interpretation biases (IBs). The present study tested whether alcohol-related IBs can be trained, and whether this has an effect on alcohol-related associations and drinking behavior. A newly developed alcohol Cognitive Bias Modification - Interpretation (CBM-I) training was employed. The potential moderating effect of executive control on CBM-I training effects was tested.

METHOD

Participants were hazardously male drinking students. A classical Stroop was used to assess levels of executive control. Half of the sample was trained to interpret ambiguous alcohol-related scenarios in an alcohol-related manner (alcohol training group), whereas the other half was trained to interpret ambiguous alcohol-related scenarios in a neutral manner (neutral training group). A Single Target Implicit Association Test (STIAT) was used to test whether the training would generalize to implicit alcohol-related associations (target words: alcohol, attributes: positive vs. neutral). To test the training's effect on drinking behavior, a bogus taste test and a one week follow-up measure assessing participant's real life drinking behavior were used.

RESULTS

The CBM-I training was partly successful: When presented with novel ambiguous alcohol-related scenarios, participants of the alcohol training group interpreted these scenarios as more alcohol-related after the training. However, there was no reduction in alcohol-related IBs in the neutral training group. Results of the STIAT demonstrated that both training groups showed stronger positive than neutral alcohol-related associations. However, there were no between-group differences in alcohol-related associations. Moreover, the CBM-I training's effect was not moderated by levels of executive control. Finally, no group differences were found on levels of alcohol consumption (bogus taste test and at one week follow-up).

LIMITATIONS

The neutral training might have been operationalized sub-optimally. A multi-session training might have resulted in stronger effects.

CONCLUSIONS

These findings are the first to show that alcohol-related IBs can be trained. However, the training effect only partly generalized so more research is needed to advance our understanding of alcohol CBM-I effects.

Implicit associations in cybersex addiction: Adaption of an Implicit Association Test with pornographic pictures

Recent studies show similarities between cybersex addiction and substance dependencies and argue to classify cybersex addiction as a behavioral addiction. In substance dependency, implicit associations are known to play a crucial role, and such implicit associations have not been studied in cybersex addiction, so far. In this experimental study, 128 heterosexual male participants completed an Implicit Association Test (IAT; Greenwald, McGhee, & Schwartz, 1998) modified with pornographic pictures. Further, problematic sexual behavior, sensitivity towards sexual excitation, tendencies towards cybersex addiction, and subjective craving due to watching pornographic pictures were assessed. Results show positive relationships between implicit associations of pornographic pictures with positive emotions and tendencies towards cybersex addiction, problematic sexual behavior, sensitivity towards sexual excitation as well as subjective craving. Moreover, a moderated regression analysis revealed that individuals who reported high subjective craving and showed positive implicit associations of pornographic pictures with positive emotions, particularly tended towards cybersex addiction. The findings suggest a potential role of positive implicit associations with pornographic pictures in the development and maintenance of cybersex addiction. Moreover, the results of the current study are comparable to findings from substance dependency research and emphasize analogies between cybersex addiction and substance dependencies or other behavioral addictions.

Cognitive reactivity, self-depressed associations, and the recurrence of depression

BACKGROUND

Mixed evidence exists regarding the role of cognitive reactivity (CR; cognitive responsivity to a negative mood) as a risk factor for recurrences of depression. One explanation for the mixed evidence may lie in the number of previous depressive episodes. Heightened CR may be especially relevant as a risk factor for the development of multiple depressive episodes and less so for a single depressive episode. In addition, it is theoretically plausible but not yet tested that the relationship between CR and number of episodes is moderated by the strength of automatic depression-related self-associations.

AIM

To investigate (i) the strength of CR in remitted depressed individuals with a history of a single vs. multiple episodes, and (ii) the potentially moderating role of automatic negative self-associations in the relationship between the number of episodes and CR.

METHOD

Cross-sectional analysis of data obtained in a cohort study (Study 1) and during baseline assessments in two clinical trials (Study 2). Study 1 used data from the Netherlands Study of Depression and Anxiety (NESDA) and compared never-depressed participants (n=901) with remitted participants with either a single (n=336) or at least 2 previous episodes (n=273). Study 2 included only remitted participants with at least two previous episodes (n=273). The Leiden Index of Depression Sensitivity Revised (LEIDS-R) was used to index CR and an Implicit Association Test (IAT) to measure implicit self-associations.

RESULTS

In Study 1, remitted depressed participants with multiple episodes had significantly higher CR than those with a single or no previous episode. The remitted individuals with multiple episodes of Study 2 had even higher CR scores than those of Study 1. Within the group of individuals with multiple episodes, CR was not heightened as a function of the number of episodes, even if individual differences in automatic negative self-associations were taken into account.

LIMITATIONS

The study employed a cross-sectional design, which precludes a firm conclusion with regard to the direction of this relationship.

CONCLUSIONS

The findings are consistent with the view that high CR puts people at risk for recurrent depression and is less relevant for the development of an incidental depressive episode. This suggests that CR is an important target for interventions that aim to prevent the recurrence of depression.

Should We Stop Looking for a Better Scoring Algorithm for Handling Implicit Association Test Data? Test of the Role of Errors, Extreme Latencies Treatment, Scoring Formula, and Practice Trials on Reliability and Validity

Since the development of D scores for the Implicit Association Test, few studies have examined whether there is a better scoring method. In this contribution, we tested the effect of four relevant parameters for IAT data that are the treatment of extreme latencies, the error treatment, the method for computing the IAT difference, and the distinction between practice and test critical trials. For some options of these different parameters, we included robust statistic methods that can provide viable alternative metrics to existing scoring algorithms, especially given the specificity of reaction time data. We thus elaborated 420 algorithms that result from the combination of all the different options and test the main effect of the four parameters with robust statistical analyses as well as their interaction with the type of IAT (i.e., with or without built-in penalty included in the IAT procedure). From the results, we can elaborate some recommendations. A treatment of extreme latencies is preferable but only if it consists in replacing rather than eliminating them. Errors contain important information and should not be discarded. The D score seems to be still a good way to compute the difference although the G score could be a good alternative, and finally it seems better to not compute the IAT difference separately for practice and test critical trials. From this recommendation, we propose to improve the traditional D scores with small yet effective modifications.

Investigating stereotypes of social anxiety

BACKGROUND AND OBJECTIVES

This paper consists of two studies that test for the presence and content of stereotypes of highly socially anxious individuals.

DESIGN

The current studies examined traits that comprise social anxiety stereotypes, and then tested whether undergraduate students held part of this stereotype via an implicit-association test (IAT).

METHODS

In Study 1, a sample of undergraduate students (n = 635) was asked to generate descriptors of people who are highly socially anxious. These descriptors were utilized to create the Social Anxiety Stereotype Measure (SASM) and the underlying factor structure of the SASM was analyzed. In Study 2, a different sample of undergraduate students (n = 87) was given an IAT to further test for the presence of one of the factors obtained in Study 1.

RESULTS

Factor analyses indicated the presence of two social anxiety stereotypes: social inhibition and oddity (comparative fit index = .97, Tucker-Lewis Index = .95, root mean square error of approximation = .07, standardized root mean square residual = .06). Oddity as a stereotype of social anxiety was further supported via an IAT: Participants reacted more quickly when oddity (vs. normality) words were paired with social anxiety (vs. social confidence) words (D = -1.15, SD = .26; t(85) = -41.50, p < .001).

CONCLUSIONS

Factor analyses revealed two social anxiety stereotypes: social inhibition and oddity. Further testing of the oddity stereotype was supported via an IAT.

Predicting dyscontrolled drinking with implicit and explicit measures of alcohol attitude

BACKGROUND

A defining feature of alcohol addiction is dyscontrol - drinking despite intentions to restrain use. Given that dyscontrolled drinking involves an automatic (nonvolitional) element and that implicit measures are designed to assess automatic processes, it follows that implicit measures may be particularly useful for predicting dyscontrolled alcohol use. Although there is accumulating evidence for the benefit of using implicit measures to predict nonvolitional behaviors, relatively little research has examined such predictive validity for alcohol dyscontrol. The current study was designed to examine whether an implicit measure of alcohol attitude would predict variance of dyscontrol above that explained by typical drinking behavior and an explicit measure of alcohol attitude.

METHODS

A sample of 62 undergraduate students completed implicit and explicit measures of alcohol-positive (relative to alcohol-negative) valence associations and retrospective self-report measures of typical drinking behavior and difficulty in controlling alcohol consumption.

RESULTS

Both the implicit and explicit measures predicted alcohol dyscontrol. The implicit measure continued to predict dyscontrol when controlling for the explicit measure and typical drinking behavior.

CONCLUSIONS

These findings indicate that assessing the automaticity of alcohol-positive associations may be beneficial for predicting clinically relevant behaviors such as post-treatment outcome.

Implicit and explicit self-esteem and their reciprocal relationship with symptoms of depression and social anxiety: a longitudinal study in adolescents

BACKGROUND AND OBJECTIVES

A negative self-view is a prominent factor in most cognitive vulnerability models of depression and anxiety. Recently, there has been increased attention to differentiate between the implicit (automatic) and the explicit (reflective) processing of self-related evaluations. This longitudinal study aimed to test the association between implicit and explicit self-esteem and symptoms of adolescent depression and social anxiety disorder. Two complementary models were tested: the vulnerability model and the scarring effect model.

METHOD

Participants were 1641 first and second year pupils of secondary schools in the Netherlands. The Rosenberg Self-Esteem Scale, self-esteem Implicit Association Test and Revised Child Anxiety and Depression Scale were completed to measure explicit self-esteem, implicit self-esteem and symptoms of social anxiety disorder (SAD) and major depressive disorder (MDD), respectively, at baseline and two-year follow-up.

RESULTS

Explicit self-esteem at baseline was associated with symptoms of MDD and SAD at follow-up. Symptomatology at baseline was not associated with explicit self-esteem at follow-up. Implicit self-esteem was not associated with symptoms of MDD or SAD in either direction.

LIMITATIONS

We relied on self-report measures of MDD and SAD symptomatology. Also, findings are based on a non-clinical sample.

CONCLUSIONS

Our findings support the vulnerability model, and not the scarring effect model. The implications of these findings suggest support of an explicit self-esteem intervention to prevent increases in MDD and SAD symptomatology in non-clinical adolescents.

Overweight people have low levels of implicit weight bias, but overweight nations have high levels of implicit weight bias

Although a greater degree of personal obesity is associated with weaker negativity toward overweight people on both explicit (i.e., self-report) and implicit (i.e., indirect behavioral) measures, overweight people still prefer thin people on average. We investigated whether the national and cultural context – particularly the national prevalence of obesity – predicts attitudes toward overweight people independent of personal identity and weight status. Data were collected from a total sample of 338,121 citizens from 71 nations in 22 different languages on the Project Implicit website (https://implicit.harvard.edu/) between May 2006 and October 2010. We investigated the relationship of the explicit and implicit weight bias with the obesity both at the individual (i.e., across individuals) and national (i.e., across nations) level. Explicit weight bias was assessed with self-reported preference between overweight and thin people; implicit weight bias was measured with the Implicit Association Test (IAT). The national estimates of explicit and implicit weight bias were obtained by averaging the individual scores for each nation. Obesity at the individual level was defined as Body Mass Index (BMI) scores, whereas obesity at the national level was defined as three national weight indicators (national BMI, national percentage of overweight and underweight people) obtained from publicly available databases. Across individuals, greater degree of obesity was associated with weaker implicit negativity toward overweight people compared to thin people. Across nations, in contrast, a greater degree of national obesity was associated with stronger implicit negativity toward overweight people compared to thin people. This result indicates a different relationship between obesity and implicit weight bias at the individual and national levels.

The implicit health-related self-concept in somatoform disorders

BACKGROUND AND OBJECTIVE

Dual-process theories stress the importance of explicit as well as implicit cognitive processes for the development of somatoform disorders (SFDs).(1) In particular, the self-concept has been demonstrated to be a key factor in SFD. Yet, the self-concept in SFDs has been studied only on an explicit but not on an implicit level.

METHODS

The present study empirically examined the implicit health-related self-concept in SFDs by using the Implicit Association Test (IAT). Twenty-two patients with SFDs (according to DSM-IV) and 27 healthy control participants (CG) completed an IAT to assess associations of the self with illness- versus health-related words.

RESULTS

(a) Patients with an SFD associated themselves more with illness-related words than patients in the CG, (b) this implicit self-concept was connected to self-reported bodily weakness in the SFD group, and (c) both the explicit and implicit health-related self-concepts were significantly related to the number and severity of bodily symptoms. However, the implicit measure had no incremental predictive value for symptom reports over the explicit self-concept measure.

LIMITATIONS

Due to the small sample size and the failure to match the SFD group and CG on education, further confirming evidence including other clinical control groups is needed.

CONCLUSION

These findings are consistent with existing dual-process models of SFDs and could be of clinical relevance as they bring into focus implicit cognitive processes that may be targeted more directly for an effective treatment of SFDs.

Cognitive reactivity, implicit associations, and the incidence of depression: a two-year prospective study

BACKGROUND

Cognitive reactivity to sad mood is a vulnerability marker of depression. Implicit self-depressed associations are related to depression status and reduced remission probability. It is unknown whether these cognitive vulnerabilities precede the first onset of depression.

AIM

To test the predictive value of cognitive reactivity and implicit self-depressed associations for the incidence of depressive disorders.

METHODS

Prospective cohort study of 834 never-depressed individuals, followed over a two-year period. The predictive value of cognitive reactivity and implicit self-depressed associations for the onset of depressive disorders was assessed using binomial logistic regression. The multivariate model corrected for baseline levels of subclinical depressive symptoms, neuroticism, for the presence of a history of anxiety disorders, for family history of depressive or anxiety disorders, and for the incidence of negative life events.

RESULTS

As single predictors, both cognitive reactivity and implicit self-depressed associations were significantly associated with depression incidence. In the multivariate model, cognitive reactivity was significantly associated with depression incidence, together with baseline depressive symptoms and the number of negative life events, whereas implicit self-depressed associations were not.

CONCLUSION

Cognitive reactivity to sad mood is associated with the incidence of depressive disorders, also when various other depression-related variables are controlled for. Implicit self-depressed associations predicted depression incidence in a bivariate test, but not when controlling for other predictors.

Low implicit self-esteem and dysfunctional automatic associations in social anxiety disorder

BACKGROUND AND OBJECTIVES

Negative automatic associations towards the self and social cues are assumed to play an important role in social anxiety disorder. We tested whether social anxiety disorder patients (n = 45) showed stronger dysfunctional automatic associations than non-clinical controls (n = 45) and panic disorder patients (n = 24) and whether there existed gender differences in this respect.

METHODS

We used a single-target Implicit Association Test and an Implicit Association Test to measure dysfunctional automatic associations with social cues and implicit self-esteem, respectively.

RESULTS

Results showed that automatic associations with social cues were more dysfunctional in socially anxious patients than in both control groups, suggesting this might be a specific characteristic of social anxiety disorder. Socially anxious patients showed relatively low implicit self-esteem compared to non-clinical controls, whereas panic disorder patients scored in between both groups. Unexpectedly, we found that lower implicit self-esteem was related to higher severity of social anxiety symptoms in men, whereas no such relationship was found in women.

CONCLUSIONS

These findings support the view that automatic negative associations with social cues and lowered implicit self-esteem may both help to enhance our understanding of the cognitive processes that underlie social anxiety disorder.

Cognitive bias modification versus CBT in reducing adolescent social anxiety: a randomized controlled trial

Social anxiety is a common mental disorder among adolescents and is associated with detrimental long term outcomes. Therefore, this study investigated the efficacy of two possible early interventions for adolescent social anxiety and test anxiety. An internet-based cognitive bias modification (CBM; n = 86) was compared to a school-based cognitive behavioral group training (CBT; n = 84) and a control group (n = 70) in reducing symptoms of social and test anxiety in high socially and/or test anxious adolescents aged 13–15 years. Participants (n = 240) were randomized at school level over the three conditions. CBM consisted of a 20-session at home internet-delivered training; CBT was a 10-session at school group training with homework assignments; the control group received no training. Participants were assessed before and after the intervention and at 6 and 12 month follow-up. At 6 month follow-up CBT resulted in lower social anxiety than the control condition, while for CBM, this effect was only trend-significant. At 12 month follow-up this initial benefit was no longer present. Test anxiety decreased more in the CBT condition relative to the control condition in both short and long term. Interestingly, in the long term, participants in the CBM condition improved more with regard to automatic threat-related associations than both other conditions. The results indicate that the interventions resulted in a faster decline of social anxiety symptoms, whereas the eventual end point of social anxiety was not affected. Test anxiety was influenced in the long term by the CBT intervention, and CBM lead to increased positive automatic threat-related associations.

Trial Registration

TrialRegister.nl NTR965