Visual search attentional bias modification reduced social phobia in adolescents

AttentionCARE: replicability of a BCI for the clinical application of augmented reality-guided EEG-based attention modification for adolescents at high risk for depression

Affect-biased attention is the phenomenon of prioritizing attention to emotionally salient stimuli and away from goal-directed stimuli. It is thought that affect-biased attention to emotional stimuli is a driving factor in the development of depression. This effect has been well-studied in adults, but research shows that this is also true during adolescence, when the severity of depressive symptoms are correlated with the magnitude of affect-biased attention to negative emotional stimuli. Prior studies have shown that trainings to modify affect-biased attention may ameliorate depression in adults, but this research has also been stymied by concerns about reliability and replicability. This study describes a clinical application of augmented reality-guided EEG-based attention modification ("AttentionCARE") for adolescents who are at highest risk for future depressive disorders (i.e., daughters of depressed mothers). Our results (n = 10) indicated that the AttentionCARE protocol can reliably and accurately provide neurofeedback about adolescent attention to negative emotional distractors that detract from attention to a primary task. Through several within and cross-study replications, our work addresses concerns about the lack of reliability and reproducibility in brain-computer interface applications, offering insights for future interventions to modify affect-biased attention in high-risk adolescents.

Neural evidence of face processing in social anxiety disorder: A systematic review with meta-analysis

Numerous previous studies have used event-related potentials (ERPs) to examine facial processing deficits in individuals with social anxiety disorder (SAD). However, researchers still need to determine whether the deficits are general or specific and what the dominant factors are behind different cognitive stages. Meta-analysis was performed to quantitatively identify face processing deficits in individuals with SAD. Ninety-seven results in 27 publications involving 1032 subjects were calculated using Hedges' g. The results suggest that the face itself elicits enlarged P1 amplitudes, threat-related facial expressions induce larger P2 amplitudes, and negative facial expressions lead to enhanced P3/LPP amplitudes in SAD individuals compared with controls. That is, there is face perception attentional bias in the early phase (P1), threat attentional bias in the mid-term phase (P2), and negative emotion attentional bias in the late phase (P3/LPP), which can be summarized into a three-phase SAD face processing deficit model. These findings provide an essential theoretical basis for cognitive behavioral therapy and have significant application value for the initial screening, intervention, and treatment of social anxiety.

Patterns of attentional biases in children and emotional symptoms during the COVID-19 pandemic: a two-wave longitudinal study

BACKGROUND

It is unknown how the patterns of negative and positive attentional biases in children predict fear of COVID-19, anxiety symptoms, and depression symptoms during the COVID-19 pandemic. The study identified profiles of negative and positive attentional biases in children and examined their association with emotional symptoms during the COVID-19 pandemic.

METHOD

264 children (girls: 53.8% and boys: 46.2%) of 9-10 years born in Hong Kong or mainland China from a primary school in Shenzhen, People's Republic of China were involved in a two-wave longitudinal study. Children completed the COVID-19 Fear Scale, the Revised Child Anxiety and Depression Scale, and the Attention to Positive and Negative Information Scale to measure fear of COVID-19, anxiety and depression symptoms, and negative and positive attentional biases in classrooms. After six months, they completed the second assessment of fear of COVID-19, anxiety symptoms, and depression symptoms in classrooms. Latent profile analysis was conducted to reveal distinct profiles of attentional biases in children. A series of repeated MANOVA was performed to examine the association of profiles of attentional biases to fear of COVID-19, anxiety symptoms, and depression symptoms across 6 months.

RESULTS

Three profiles of negative and positive attentional biases were revealed in children. Children with a "moderate positive and high negative attentional biases" profile had significantly higher fear of the COVID-19 pandemic, anxiety symptoms, and depression symptoms than children with a "high positive and moderate negative attentional biases" profile. Children with a "low positive and negative attentional biases" profile were not significantly different in fear of COVID-19, anxiety symptoms, and depression symptoms than those with the other two profiles.

CONCLUSIONS

Patterns of negative and positive attentional biases were related to emotional symptoms during the COVID-19 pandemic. It might be important to consider children's overall patterns of negative and positive attentional biases to identify children at risk of higher emotional symptoms.

Attention bias modification for depression: A systematic review and meta-analysis

Background

Depression is a mental health disorder characterized by affective, somatic, and cognitive symptoms. Attention bias modification (ABM) has been widely used to treat depression. However, the results seem inconsistent. We conducted a systematic review and meta-analysis to investigate the efficacy of ABM for depression and to explore the optimal protocol of ABM.

Methods

Seven databases were systematically searched from their inceptions to 5 October 2022 to include randomized controlled trials (RCTs) of ABM for depression. Two independent reviewers selected the eligible articles, extracted data, and evaluated the risk of bias using version 2 of the Cochrane risk-of-bias tool (ROB 2.0) for randomized trials. The primary outcome was the evaluation of depressive symptoms using widely accepted and validated scales. The secondary outcomes included rumination and attentional control. Meta-analysis was conducted by using RevMan (version 5.4) and Stata (version 12.0). Subgroup analyses and meta-regressions were performed to identify the source of heterogeneity. The certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE).

Results

A total of 19 trials involving 20 datasets (1,262 participants) were included. The overall risk of bias in one study was rated as low risk of bias, three studies were considered as high, and the remaining studies were some concerns. Compared with attention control training (ACT), ABM had a greater effect in the improvement of depression (SMD = −0.48, 95% CI −0.80 to −0.17, I2 = 82%) and rumination (MD = −3.46, 95% CI −6.06 to −0.87, I2 = 0%). No significant differences were observed in the attentional control outcome between ABM and ACT (MD = 3.07, 95% CI −0.52 to 6.65, I2 = 0%). Subgroup analysis demonstrated that adults exhibited a greater decrease in depression scores than adolescents. ABM using the dot-probe task, training target stimulus presented by face, and training directions by left–right were associated with better antidepressant effects. ABM training delivered in the laboratory tended to yield a better effect than those conducted at home. Sensitivity analysis indicated that the results were robust. The certainty of the evidence for all outcomes was low or very low, and publication bias may exist.

Conclusion

Due to high heterogeneity and limited studies, not enough current evidence supported that ABM could be an effective intervention to relieve depressive symptoms. More rigorous RCTs are required to verify the benefits and to explore the optimal protocol of ABM training for depression.

Systematic Review Registration: [PROSPERO], identifier [No. CRD42021279163].

Can we challenge attention and interpretation threat biases in rescued child labourers with a history of physical abuse using a computerised cognitive training task? Data on feasibility, acceptability and target engagement

Child labourers are more likely to have experienced physical victimisation, which may increase risk for anxiety/depression, by shaping threat biases in information-processing. To target threat biases and vulnerability for anxiety/depression, we evaluated whether Cognitive Bias Modification (CBM) training could be feasibly and acceptably delivered to rescued youth labourers. Seventy-six physically abused rescued labourers aged 14-17 (40 from Nepal, 36 from India) in out-of-home care institutions received either multi-session computerised CBM or control training. Training targeted attention away from threat to positive cues and the endorsement of benign over threat interpretations. Feasibility and acceptability data were gathered along with pre and post intervention measures of attention and interpretation bias and emotional and behavioural symptoms. In terms of feasibility, uptake (proportion of those who completed the pre-intervention assessment from those who consented) and retention (proportion of those who completed the post-intervention assessment from those who completed the pre-intervention assessment) were above 75% in both countries. Average acceptability ratings were mostly 'moderate' on most indices for both countries, and none of the participants reported experiencing serious adverse events or reactions in response to or during the trial. Secondarily, CBM participants showed increased attention to positive and decreased attention to threatening stimuli, as well as increased endorsement of benign interpretation and decreased endorsement in negative interpretations of ambiguous social situations. Symptom changes were less clear. Delivering CBM to former child labourers in out-of-home care institutions has interventive potential. ClinicalTrials.gov Identifier: NCT03625206, Date of registration: August 10, 2018.

Attention bias modification add-on to inpatient treatment for young women with anorexia nervosa-A randomized controlled trial

Patients with anorexia nervosa (AN) display elevated anxiety and attention biases (ABs) in threat processing. Attention bias modification treatment (ABMT) is considered promising for anxiety disorders, but its potential for AN is limited. In this study, 154 young women hospitalised because of AN were assigned to ED-related and anxiety-related threat stimuli, or to a non-ABMT intervention control condition in a randomized control trial. Hundred-and-ten patients completed the study. ABMT was an add-on to the regular inpatient treatment. Research participants completed two pretreatment training sessions and eight biweekly sessions of ABMT. AB, ED-related symptoms, depression, anxiety and stress were assessed before and after ABMT in the research groups, and, similarly, 5 weeks apart, in the controls. We found that despite the different patterns of change in AB between the three groups following ABMT, the reduction in AB, or the between-group differences in AB-reduction, were not significant. While the severity of ED-symptoms, depression, anxiety and stress was reduced following ABMT, or control condition, in all groups, there were no between-group differences in these changes. Changes in AB were not correlated with baseline and pre-post-treatment changes in ED-related and comorbid symptomatology. Methodological and inpatient treatment-related considerations may explain our negative ABMT-related results.

Associations between Optimism and Attentional Biases as Measured by Threat-Avoidance and Positive-Search Tasks

Evidence suggests that optimism has a positive impact on health status. Attentional bias modification (ABM) may be beneficial for enhancing optimism, but its effective application requires a detailed investigation of the association between attentional bias and optimism. This study aimed to determine the association between attentional bias and optimism based on different task types. Eighty-four participants completed the attentional bias measures using the dot-probe task (DPT), emotional visual search task (EVST) paradigms, and psychological assessments. Optimism was assessed using the Life Orientation Test-Revised with subscales for optimism and pessimism. Pearson's correlation coefficient and multivariate linear regression analysis were applied to investigate the association between optimism and attentional bias. Neither the attentional bias derived from DPT nor EVST was significantly correlated with optimism total score or subscales. Regression analysis also showed no association between attentional bias and optimism (DPT, β = 0.12; EVST, β = 0.09), optimism subscales (DPT, β = 0.09; EVST, β = 0.17), or pessimism subscales (DPT, β = -0.10; EVST, β = 0.02). Our findings showed no evidence that attentional biases derived from either the DPT or EVST measures are associated with optimism or pessimism. Further studies are needed to effectively adapt the ABM to enhance optimism.

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

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

Scary in the eye of the beholder: Attentional bias and attentional retraining for social anxiety

Consistent with cognitive models of social anxiety, socially anxious individuals show cognitive biases that magnify their perceived level of threat in the environment.

OBJECTIVES

The first objective was to determine whether attentional bias for socially threatening stimuli occurs after concomitant depression has been controlled. The second objective was to test the effectiveness of the Attention Control Training Program for Social Anxiety (ACTP-SA) for reducing social anxiety attentional bias and improving therapeutic indices in people with social anxiety.

METHOD

In the first study, socially anxious (N = 30) and non-anxious individuals (N = 30) completed the Beck Depression Inventory-II, Spielberger's State-Trait Anxiety Inventory, Conner's Social Phobia Inventory, a social-anxiety Stroop test, and a clinical interview. In the second study, individuals with social anxiety (N = 30) were randomly assigned to an experimental group that received 4 sessions of ACTP-SA, or to a sham-intervention control condition. At the post-test and a 3-month follow-up, both groups completed the same measures as in Study 1.

RESULTS

In Study 1, socially anxious individuals showed higher attentional bias for threatening stimuli than the controls, after depression had been controlled for. In Study 2, participants in the experimental group, compared with the controls, showed greater reductions in attentional bias, social anxiety, and trait anxiety at post-test and follow-up.

CONCLUSIONS

The results underscore the importance of information processing biases in social anxiety and the benefits of attentional bias training as a complementary intervention for modifying symptoms of social anxiety.

Threat biases associate with anxiety and depression in physically-abused young people with a history of child labour

BACKGROUND AND OBJECTIVES

Young people who have experienced early-life maltreatment preferentially attend to threat and draw more threatening interpretations. In turn, these threat biases may explain elevated risk for lifelong anxiety and/or depression. We investigated whether adolescent labourers with a history of physical abuse showed threat biases relative to non-abused labourers, and whether these threat biases associated with anxiety and depression.

METHODS

100 young people (aged 13-18 years, 64% female) from Nepal rescued from illegal child work were assessed for childhood maltreatment and anxiety and/or depression disorders. Participants completed an emotional visual search task (to measure attention engagement of positive versus negative faces) and an ambiguous scenarios questionnaire (to measure the endorsement of negative versus benign interpretations).

RESULTS

Seventy young people reported a history of physical (and emotional) abuse. They were more likely to meet symptom thresholds for depression, and marginally, for anxiety disorders than non-physically abused participants. Abused and non-abused participants did not differ on attention engagement/disengagement of threat or on interpretational style. Abused participants with anxiety were slower to disengage from negative faces to engage with a positive face than non-anxious abused participants. Abused participants with depression endorsed more negative interpretations of ambiguous situations than those without depression.

LIMITATIONS

The cross-sectional design limits our ability to infer whether threat biases reflect risk markers of psychopathology.

CONCLUSIONS

If threat biases are shown to confer risk for anxiety and depression in future studies, they could be targeted in mental health prevention programs for these vulnerable young people.

Reducing anxiety and attentional bias with reward association learning and attentional bias modification

The current study examined the effects of a reward associative learning procedure and the traditional threat-avoidance ABM paradigm on anxiety and attentional bias. In reward training, participants were given high rewards for correct responses to neutral target and low rewards for correct responses to negative target. In reward control training, participants received no cues of rewards after their responses. High trait anxious individuals (N = 76) first completed a session of reward training or reward control training, followed by four sessions of ABM training or ABM control training. Generalized anxiety disorder symptom (GAD-7) and attentional bias in a dot-probe task were assessed during pre-and post-training. Results indicated that the effect of ABM training on reducing anxiety was only obtained in the reward training condition. Participants who received reward training showed significantly less attentional bias compared with those receiving reward control training. There was no significant training effect of ABM on atttentiona bias. Results suggested that reward training reduced general anxiety and attentional bias. Traditional ABM training reduced anxiety only when combined with reward training. Attentional bias in anxiety are modifiable through reward training.

The role of attention control in complex real-world tasks

Working memory capacity is an important psychological construct, and many real-world phenomena are strongly associated with individual differences in working memory functioning. Although working memory and attention are intertwined, several studies have recently shown that individual differences in the general ability to control attention is more strongly predictive of human behavior than working memory capacity. In this review, we argue that researchers would therefore generally be better suited to studying the role of attention control rather than memory-based abilities in explaining real-world behavior and performance in humans. The review begins with a discussion of relevant literature on the nature and measurement of both working memory capacity and attention control, including recent developments in the study of individual differences of attention control. We then selectively review existing literature on the role of both working memory and attention in various applied settings and explain, in each case, why a switch in emphasis to attention control is warranted. Topics covered include psychological testing, cognitive training, education, sports, police decision-making, human factors, and disorders within clinical psychology. The review concludes with general recommendations and best practices for researchers interested in conducting studies of individual differences in attention control.

Efficacy of attention bias modification via smartphones in a large population sample

Negative affective biases are a key feature of anxiety and depression that uphold and promote negative mood. Bias modification aims to reduce these biases using computerized training, but shows mixed success and has not been tested at scale. The aim was to determine whether bias modification delivered via smartphones can improve mood in a large sample. In total, 153 385 self-referring participants were randomly assigned to modification or sham bias training on a dot-probe or visual-search task. The primary outcome of interest was balance of mood, assessed on the Positive and Negative Affect Schedule. In total, 22 933 participants who provided at least two mood ratings were included in analyses. There was a large amount of participant attrition. In the remaining smaller sample, results supported the prediction that visual-search modification would result in improved mood (95%CI [0.10, 0.82]; p = 0.01, d = 0.05, N = 2588 after two ratings; 95%CI [1.75,6.54]; p = 0.001, d = 0.32, N = 118 after six ratings), which was not seen for the sham version (N = 4818 after two ratings; N = 138 after six ratings). Dot-probe modification was not associated with mood improvements (p = 0.52). Visual-search, but not dot-probe, bias modification slightly but significantly improved mood. Although this effect size is very small and subject to large participant drop-off, it might be worth considering an adjunct to current treatments.

Efficacy of attention bias modification via smartphones in a large population sample

Negative affective biases are a key feature of anxiety and depression that uphold and promote negative mood. Bias modification aims to reduce these biases using computerized training, but shows mixed success and has not been tested at scale. The aim was to determine whether bias modification delivered via smartphones can improve mood in a large sample. In total, 153 385 self-referring participants were randomly assigned to modification or sham bias training on a dot-probe or visual-search task. The primary outcome of interest was balance of mood, assessed on the Positive and Negative Affect Schedule. In total, 22 933 participants who provided at least two mood ratings were included in analyses. There was a large amount of participant attrition. In the remaining smaller sample, results supported the prediction that visual-search modification would result in improved mood (95%CI [0.10, 0.82]; p = 0.01, d = 0.05, N = 2588 after two ratings; 95%CI [1.75,6.54]; p = 0.001, d = 0.32, N = 118 after six ratings), which was not seen for the sham version (N = 4818 after two ratings; N = 138 after six ratings). Dot-probe modification was not associated with mood improvements (p = 0.52). Visual-search, but not dot-probe, bias modification slightly but significantly improved mood. Although this effect size is very small and subject to large participant drop-off, it might be worth considering an adjunct to current treatments.

The remediating effect of Attention Bias Modification on aggression in young offenders with antisocial tendency: A randomized controlled trial

BACKGROUND AND OBJECTIVES

An attention bias toward hostile stimuli is associated with an increased risk of aggressive behavior. Thus, reducing hostile attention bias may help to reduce aggression in young offenders. We evaluated the remediating effects of Attention Bias Modification (ABM) on hostile attention bias and aggressive behavior in Chinese male young offenders with antisocial tendencies.

METHODS

Institutionalized male young offenders (ages 16-18) were recruited and randomly assigned to ABM (n = 28), placebo (n = 28), or waiting list (n = 28). The ABM group received four weeks of training using visual search of emotional faces; the placebo group underwent similar training using visual search of neutral objects. Before and after treatment, aggressive behavior, attention bias toward positive stimuli and hostile stimuli were assessed.

RESULTS

Linear mixed models and hierarchical multiple regression analyses showed that the intervention effect of ABM was moderated by participants' initial attention bias. Young offenders with a high level of initial hostile attention bias, or with a low level of initial positive attention bias, benefitted most from ABM.

LIMITATIONS

The small sample size impedes investigation of the mechanism of the intervention's effects. Further research can determine whether the current results can be extrapolated to the population of female young offenders.

CONCLUSION

The results of the present study suggest that ABM is helpful for young offenders who show the greatest bias toward hostile stimuli and away from positive stimuli. These findings highlight the importance of matching the intervention and the participant.

TRIAL REGISTRATION

osf.io/vj5rk.

The Longitudinal Interplay Between Attention Bias and Interpretation Bias in Social Anxiety in Adolescents

Background

Cognitive biases are found to play a role in the onset and maintenance of social anxiety. However, particularly in adolescence, the link between different biases and their role in predicting social anxiety is far from clear. This study therefore investigated the interplay between attention bias and interpretation bias in relation to social anxiety in adolescence across three years.

Methods

816 adolescents in grade 7 to 9 participated at three yearly waves (52.8% boys, Mage grade7 = 12.60). Social anxiety was measured with a self-report questionnaire. Attention bias was measured with a visual search task with emotional faces. Textual vignettes assessed interpretation bias.

Results

Cross-lagged models showed that negative interpretation bias at grade 7 predicted an increase in social anxiety at grade 8. This effect was not found from grade 8 to 9. Attention bias did not predict social anxiety. Attention bias and interpretation bias were not longitudinally related to each other, nor did they interact with each other in predicting social anxiety.

Conclusions

Thus, no evidence was found for the Combined Cognitive Bias Hypothesis in social anxiety in adolescents. Instead, our results suggest that interpretation bias rather than attention bias contributes to the increase of social anxiety over time.

An Eye-Tracking Study of Attention Biases in Children at High Familial Risk for Depression and Their Parents with Depression

Attention biases (AB) are a core component of cognitive models of depression yet it is unclear what role they play in the transgenerational transmission of depression. 44 children (9-14 years) with a high familial risk of depression (HR) were compared on multiple measures of AB with 36 children with a low familial risk of depression (LR). Their parents: 44 adults with a history of depression (HD) and 36 adults with no history of psychiatric disorder (ND) were also compared. There was no evidence of group differences in AB; neither between the HR and LR children, nor between HD and ND parents. There was no evidence of a correlation between parent and child AB. The internal consistency of the tasks varied greatly. The Dot-Probe Task showed unacceptable reliability whereas the behavioral index of the Visual-Search Task and an eye-tracking index of the Passive-Viewing Task showed better reliability. There was little correlation between the AB tasks and the tasks showed minimal convergence with symptoms of depression or anxiety. The null-findings of the current study contradict our expectations and much of the previous literature. They may be due to the poor psychometric properties associated with some of the AB indices, the unreliability of AB in general, or the relatively modest sample size. The poor reliability of the tasks in our sample suggest caution should be taken when interpreting the positive findings of previous studies which have used similar methods and populations.

Promoting helpful attention and interpretation patterns to reduce anxiety and depression in young people: weaving scientific data with young peoples' lived experiences

BACKGROUND

Anxiety and depression are common, disabling and frequently start in youth, underscoring the need for effective, accessible early interventions. Empirical data and consultations with lived experience youth representatives suggest that maladaptive cognitive patterns contribute to and maintain anxiety and depression in daily life. Promoting adaptive cognitive patterns could therefore reflect "active ingredients" in the treatment and/or prevention of youth anxiety and depression. Here, we described and compared different therapeutic techniques that equipped young people with a more flexible capacity to use attention and/or promoted a tendency to positive/benign (over threatening/negative) interpretations of uncertain situations.

METHODS

We searched electronic databases (PubMed, PsycINFO, EMBASE, and PsycARTICLES) for studies containing words relating to: intervention; youth; anxiety and/or depression and attention and/or interpretation, and selected studies which sought to reduce self-reported anxiety/depression in youth by explicitly altering attention and/or interpretation patterns. Ten young people with lived experiences of anxiety and depression and from diverse backgrounds were consulted on the relevance of these strategies in managing emotions in their daily lives and also whether there were additional strategies that could be targeted to promote adaptive thinking styles.

RESULTS

Two sets of techniques, each targeting different levels of responding with different strengths and weaknesses were identified. Cognitive bias modification training (CBM) tasks were largely able to alter attention and interpretation biases but the effects of training on clinical symptoms was more mixed. In contrast, guided instructions that teach young people to regulate their attention or to evaluate alternative explanations of personally-salient events, reduced symptoms but there was little experimental data establishing the intervention mechanism. Lived experience representatives suggested that strategies such as deliberately recalling positive past experiences or positive aspects of oneself to counteract negative thinking.

DISCUSSION

CBM techniques target clear hypothesised mechanisms but require further co-design with young people to make them more engaging and augment their clinical effects. Guided instructions benefit from being embedded in clinical interventions, but lack empirical data to support their intervention mechanism, underscoring the need for more experimental work. Feedback from young people suggest that combining complimentary techniques within multi-pronged "toolboxes" to develop resilient thinking patterns in youth is empowering.

Attention bias modification in depression: A randomized trial using a novel, reward-based, eye-tracking approach

BACKGROUND AND OBJECTIVES

Biased attention to negative information is a mechanism for risk and relapse in depression. Attentional bias modification (ABM) paradigms manipulate attention away from negative information to reduce this bias. ABM results have been mixed due to inconsistent methodologies and stimuli design. This randomized controlled trial used a novel approach to modifying attentional bias.

METHODS

An eye tracker manipulated stimuli in response to participants' fixations to preferentially reward attention to positive stimuli by obscuring or enhancing image quality of negative and positive stimuli, respectively. Participants with major depressive disorder completed three 35-min sessions of active (n = 20) or sham (n = 20) ABM training. Attentional bias, memory for emotional words, and mood were assessed pre- and post-training.

RESULTS

Training reduced negative attentional bias; relative to sham, active training participants focused significantly more on positive compared to negative stimuli in a free-viewing eye-tracker task (p = .038, η_p² = 0.109) and, at trend, disengaged from sad information more quickly in a computerized task (p = .052, η_p² = 0.096). Active training participants remembered more happy than sad words in an emotional word learning task, indicating a distal transfer of training to emotional memory (p = .036, η_p² = 0.11). Training did not significantly affect mood in the one-week trial.

LIMITATIONS

Future studies should build on this proof-of-principle study with larger sample sizes and more intensive treatment to explore which mechanisms of training may lead to improvements in mood.

CONCLUSIONS

Attention biases in depression are modifiable through reward-based, eye-tracking training. These data suggest generalizability of training to other cognitive faculties - recall for affective information.

Attentional Bias in Alcohol and Cannabis Use Disorder Outpatients as Indexed by an Odd-One-Out Visual Search Task: Evidence for Speeded Detection of Substance Cues but Not for Heightened Distraction

Current cognitive models of addiction imply that speeded detection and increased distraction from substance cues might both independently contribute to the persistence of addictive behavior. Speeded detection might lower the threshold for experiencing craving, whereas increased distraction might further increase the probability of entering a bias-craving-bias cycle, thereby lowering the threshold for repeated substance use. This study was designed to examine whether indeed both attentional processes are involved in substance use disorders. Both attentional processes were indexed by an Odd-One-Out visual search task in individuals diagnosed with alcohol use disorder (AUD; n = 63) and cannabis use disorder (CUD; n = 28). To test whether the detection and/or the distraction component are characteristic for AUD and CUD, their indices were compared with matched individuals without these diagnoses (respectively, n = 63 and n = 28). Individuals with CUD showed speeded detection of cannabis cues; the difference in detection between AUD and the comparison group remained inconclusive. Neither the AUD nor the CUD group showed more distraction than the comparison groups. The sample size of the CUD group was relatively small. In addition, participants made relatively many errors in the attentional bias (AB) task, which might have lowered its sensitivity to detect ABs. The current study provided no support for the proposed role of increased distraction in CUD and AUD. The findings did, however, provide support for the view that speeded detection might be involved in CUD. Although a similar trend was evident for AUD, the evidence was weak and remained therefore inconclusive.

Disgust face captures more attention in individuals with high social anxiety when cognitive resources are abundant: Evidence from N2pc

There is a debate about the relative contributions of top-down and bottom-up attention to the threat-related attentional bias. In this study we investigated the attentional bias in individuals with social anxiety under conditions of no, low and high visual working memory (WM) load. Event-related potential (ERP) and response time (RT) data were recorded while participants performed the dot-probe task and a concurrent change-detection task. The ERP results revealed that the maximum N2pc effect emerged in no visual WM load condition in individuals with social anxiety. The difference of N2pc effect between high socially anxious (HSA) and low socially anxious (LSA) groups was observed in no visual WM load condition, whereas this difference was eliminated under low and high load conditions. However, no significant main effects or interactions were observed in the behavioral index (reflected by Trial Level-Bias Score variability). Overall, the findings indicate the critical role of top-down attention on social anxiety-related attentional bias, which have important implication for attentional bias modification.

Psychometric properties of threat-related attentional bias in young children using eye-tracking

Anxiety is one of the most common forms of child psychopathology associated with persistent impairment across the lifespan. Therefore, investigating mechanisms that underlie anxiety in early childhood may improve prevention and intervention efforts. Researchers have linked selective attention toward threat (i.e., attentional bias to threat) with the development of anxiety. However, previous work on attentional bias has used less reliable, reaction time (RT)-based measures of attention. Additionally, few studies have used eye-tracking to measure attentional bias in young children. In the present study, we investigated the psychometric properties of an eye-tracking measure of attentional bias in a sample of young children between 6- and 9-years-old and explored if trait and clinical anxiety were related to attentional biases to threat. Results showed good psychometric properties for threat and neutral attentional biases, comparable to those found in adult eye-tracking studies. Temperamental and clinical anxiety did not significantly relate to threat/neutral dwell time and attentional biases. The significance of these null findings was discussed in relation to existing developmental theories of attentional biases. Future studies should explore if temperamental or clinical anxiety prospectively predict threat attentional bias and the onset of anxiety in older children using a longitudinal design.

A School-Based Comparison of Positive Search Training to Enhance Adaptive Attention Regulation with a Cognitive-Behavioural Intervention for Reducing Anxiety Symptoms in Children

Many children experience anxiety but have limited access to empirically-supported interventions. School-based interventions using brief, computer-assisted training provide a viable way of reaching children. Recent evidence suggests that computer-delivered 'positive search training' (PST) reduces anxiety in children. This multi-informant, randomised controlled trial compared classroom-based, computer-delivered PST (N = 116) to a classroom-based, therapist-delivered cognitive-behavioural intervention (CBI) (N = 127) and a curriculum-as-usual control condition (CAU) (N = 60) in 7-11 year old children. Primary outcomes were child and parent report of child anxiety symptoms. Secondary outcomes were child and parent report of child depressive symptoms and child attention biases. Outcomes were assessed before and after the interventions, and six- and 12-months post-intervention. Teacher report of children's social-emotional functioning was assessed at pre- and post-intervention. As expected, compared to CAU, children receiving PST and the CBI reported greater anxiety reductions by post-intervention and six-month follow-up but, unexpectedly, not at 12-month follow-up. Partially consistent with hypotheses, compared to CAU, parents reported greater anxiety reductions in children receiving PST, but not the CBI, at 12-month follow-up. Contrary to expectation, there was a pre- to post-intervention increase in threat attention bias in PST compared to the other conditions, with no significant differences at follow-up. In support of hypotheses, teachers reported higher post-intervention social-emotional functioning in Year 5 students receiving the CBI but, unexpectedly, lower post-intervention functioning in students receiving PST. There were no effects on depressive symptoms. Further research is needed on strategies to maintain long-term benefits and determine preventative versus early intervention effects.

Health anxiety and attentional bias toward virus-related stimuli during the COVID-19 pandemic

After the COVID-19 worldwide spread, evidence suggested a vast diffusion of negative consequences on people's mental health. Together with depression and sleep difficulties, anxiety symptoms seem to be the most diffused clinical outcome. The current contribution aimed to examine attentional bias for virus-related stimuli in people varying in their degree of health anxiety (HA). Consistent with previous literature, it was hypothesized that higher HA would predict attentional bias, tested using a visual dot-probe task, to virus-related stimuli. Participants were 132 Italian individuals that participated in the study during the lockdown phase in Italy. Results indicated that the HA level predicts attentional bias toward virus-related objects. This relationship is double mediated by the belief of contagion and by the consequences of contagion as assessed through a recent questionnaire developed to measure the fear for COVID-19. These findings are discussed in the context of cognitive-behavioral conceptualizations of anxiety suggesting a risk for a loop effect. Future research directions are outlined.

Context matters: The role of subjective arousal during Attentional Bias Modification targeting socially anxious students

BACKGROUND AND OBJECTIVES

Attentional Bias Modification (ABM) paradigms targeting anxiety aim to reduce attentional biases for threatening stimuli and thereby reduce anxiety. Based on cognitive theories of performance and learning, elevated levels of arousal during ABM might enhance its effectiveness by making training more engaging and activating fear schemas. This study investigated whether elevated levels of arousal during ABM would increase its effectiveness in reducing attentional bias, stress reactivity, and post-event processing.

METHOD

We randomly assigned 79 high socially anxious students to a session of ABM or control training preceded by either a social stress or control induction to manipulate arousal. Training outcomes were attentional bias, stress reactivity, and post-event processing. Subjective arousal was assessed before, during, and after training.

RESULTS

Results indicated that ABM was not successful in reducing attentional bias, stress reactivity or post-event processing, and that the effects of ABM were not moderated by subjective arousal. There was a trend towards ABM being more effective than control training in reducing attentional bias directly after training when participants were more aroused. However, this effect was not maintained one day after the training.

LIMITATIONS

The arousal manipulation did not result in significant between-group differences in subjective arousal.

CONCLUSIONS

This study did not provide support for the moderating role of arousal in ABM training effects. Replications with more effective mood induction procedures and more power are needed as a trend finding was observed suggesting that higher levels of arousal improved the direct ABM effects on attentional bias.

Age Moderates Link Between Training Effects and Treatment Response to Attention Bias Modification Treatment for Social Anxiety Disorder

Attention bias modification treatment (ABMT) aims to reduce anxiety symptoms via practice on computerized attention training tasks. Despite evidence of efficacy, clinical effects appear heterogeneous. More research on ABMT mechanisms and moderators of treatment response is needed. Age is one potentially important moderator, as developmental differences in training effects may impact response. We examined developmental links between ABMT training effects and response in social anxiety disorder (SAD). We pooled data from two randomized controlled trials in treatment-seeking youths and adults with SAD (N = 99) that used identical ABMT methods. We first characterized learning effects associated with the eight-session ABMT training protocol. We then tested whether learning magnitude predicted the clinical (change in SAD symptoms) and cognitive (change in attention bias) responses to treatment. Finally, we tested whether age moderated the association between ABMT learning and treatment response. Results indicate that ABMT was associated with an incremental learning curve during the protocol, and that learning improved with age. Age further moderated the association between learning gains during the ABMT protocol and subsequent reduction in self-reported SAD symptoms, such that this association was stronger with age. These effects were not evident in bias scores or clinician ratings. Finally, pre-treatment SAD symptoms and bias scores predicted ABMT learning gains. This study highlights the links among age, learning processes, and clinical response to ABMT. These insights may inform attempts to increase the clinical efficacy of ABMT for anxiety.

Seeking neutral: A VR-based person-identity-matching task for attentional bias modification - A randomised controlled experiment

BACKGROUND

Attentional bias modification (ABM) aims to reduce anxiety by attenuating bias towards threatening information. The current study incorporated virtual reality (VR) technology and 3-dimensional stimuli with a person-identity-matching (PIM) task to evaluate the effects of a VR-based ABM training on attentional bias and anxiety symptoms.

METHODS

One hundred participants with elevated social anxiety were randomised to four training groups. Attentional bias was assessed at pre- and post-training, and anxiety symptoms were assessed at pre-training, post-training, 1-week follow-up, and 3-month follow-up.

RESULTS

Change in anxiety did not correlate with change in bias (r = -0.08). A repeated-measures ANOVA showed no significant difference in bias from pre- to post-ABM, or between groups. For anxiety symptoms, a linear mixed-effects model analysis revealed a significant effect of time. Participants showed reduction in anxiety score at each successive assessment (p < .001, Nagelkerke's pseudo r ² = 0.65). However, no other significant main effect or interactions were found. A clinically significant change analysis revealed that 4% of participants were classified as 'recovered' at 3-month follow-up.

CONCLUSIONS

A single session of VR-based PIM task did not change attentional bias. The significant reduction in anxiety was not specific to active training, and the majority of participants remained clinically unchanged.

The altered early components and the decisive later process underlying attention bias modification in social anxiety: evidence from event-related potentials

Attention bias modification (ABM) is a potential intervention in relieving social anxiety symptoms, while its underlying neural mechanisms are not yet understood. The current study included 63 college students with social anxiety. Participants were assigned to the attention modification program (AMP, n = 20), the attention control condition (ACC, n = 20) and the passive waiting group (PW, n = 23). Questionnaires and the emotional Stroop task with EEG recordings were used to assess whether and how the 4-week ABM period affected emotional symptoms and specific emotional processing. Results showed that the two training groups (AMP and ACC) produced comparable emotional improvements and both showed a decrease in negative bias compared with the PW group. The ERP results indicated that despite no significant ERP changes in the PW group, the ACC group exhibited a greater N1, whereas the AMP group exhibited a reduced VPP at the post-test stage compared to the pre-test stage. Besides, both training groups showed a similar late positive potential (LPP) reduction. Notably, the reduction in LPP was positively correlated with behavioral and symptom improvement. Thus, manipulations unique to ABM (face-target contingency) primarily modulate the early attention distribution of material-related stimuli. However, the clinical benefits of attention training may be due to later cognitive-affective mechanisms.

Varying Cognitive Scars - Differential Associations Between Types of Childhood Maltreatment and Facial Emotion Processing

Background

Distorted cognitive processing has been found among survivors of child maltreatment. However, different types of abuse and neglect may bring about differences in emotion and attention processing. The present study aimed to detect differential associations between various types of childhood maltreatment and attentional biases in facial emotion processing.

Methods

A non-clinical sample was recruited on University campus and consisted of 67 individuals with varying degrees of maltreatment. In an evaluative conditioning task, images of faces with neutral emotional expressions were either associated with short videos of intense negative statements, or associated with neutral videos. Subsequently, these faces were used as stimuli in a face in the crowd recognition task in which the familiar faces had to be recognized within a crowd of unfamiliar neutral faces.

Results

In multiple linear regression analyses controlling for the intercorrelatedness of types of maltreatment, differential relationships between types of maltreatment and attentional bias were found. While emotional abuse was associated with faster detection of negatively associated faces, emotional neglect was associated with an impaired recognition of familiar stimuli regardless of the emotional content.

Conclusion

Results indicated that interindividual differences in cognitive biases may be due to the activation of diverse cognitive schemas based on differential experiences of maltreatment.

Attentional bias for alcohol cues in visual search-Increased engagement, difficulty to disengage or both?

Cognitive models emphasise the importance of attentional bias in addiction. However, many attentional bias tasks have been criticised for questionable psychometric properties and inability to differentiate between engagement and disengagement processes. This study therefore examined the suitability of two alternative tasks for assessing attentional bias within the context of alcohol use. Participants were undergraduate students (N = 169) who completed the Visual Search Task and Odd-One-Out Task, the latter of which is designed to differentiate between engagement and disengagement processes of attention, at baseline and one week later. Participants also completed baseline measures of alcohol consumption, craving, and alcohol use problems. Internal consistency was adequate for the Visual Search Task index, and weak for the Odd-One-Out Task indices. Test-retest reliability was weak for both tasks. The Visual Search Task index and the disengagement (but not the engagement) index of the Odd-One-Out Task showed a positive association with alcohol consumption. This study was restricted to a non-clinical student sample. The relatively high error rate of the Odd-One-Out Task might have reduced its sensitivity as an index of attentional bias. Both tasks showed some merit as attentional bias measures, and results suggested that attentional disengagement might be particularly related to alcohol use. However, the reliability of the current measures was inadequate. One potential explanation for the low reliability is that non-clinical samples may have weak and unstable attentional biases to alcohol. Future efforts should be made to improve the psychometric qualities of both tasks and to administer them in a clinical sample.

Systematic Review and Meta-Analysis: Eye-Tracking of Attention to Threat in Child and Adolescent Anxiety

OBJECTIVE

Attention biases for threat may reflect an early risk marker for anxiety disorders. Yet questions remain regarding the direction and time-course of anxiety-linked biased attention patterns in youth. A meta-analysis of eye-tracking studies of biased attention for threat was used to compare the presence of an initial vigilance toward threat and a subsequent avoidance in anxious and nonanxious youths.

METHOD

PubMed, PsycARTICLES, Medline, PsychINFO, and Embase were searched using anxiety, children and adolescent, and eye-tracking-related key terms. Study inclusion criteria were as follows: studies including participants ≤18 years of age; reported anxiety using standardized measures; measured attention bias using eye tracking with a free-viewing task; comparison of attention toward threatening and neutral stimuli; and available data to allow effect size computation for at least one relevant measure. A random effects model estimated between- and within-group effects of first fixations toward threat and overall dwell time on threat.

RESULTS

Thirteen eligible studies involving 798 participants showed that neither youths with or without anxiety showed significant bias in first fixation to threat versus neutral stimuli. However anxious youths showed significantly less overall dwell time on threat versus neutral stimuli than nonanxious controls (g = -0.26).

CONCLUSION

Contrasting with adult eye-tracking data and child and adolescent data from reaction time indices of attention biases to threat, there was no vigilance bias toward threat in anxious youths. Instead, anxious youths were more avoidant of threat across the time course of stimulus viewing. Developmental differences in brain circuits contributing to attention deployment to emotional stimuli and their relationship with anxiety are discussed.

Attentional Bias Modification in Virtual Reality - A VR-Based Dot-Probe Task With 2D and 3D Stimuli

Background

Attentional bias modification (ABM) aims to reduce anxiety by attenuating bias toward threatening information. The current study incorporated virtual reality (VR) technology and three-dimensional stimuli with a dot-probe task to evaluate the effects of a VR-based ABM training on attentional bias and anxiety symptoms.

Methods

A total of 100 participants were randomized to four training groups. Attentional bias was assessed at pre- and post-training, and anxiety symptoms were assessed at pre-training, post-training, 1-week follow-up, and 3-months follow-up.

Results

Change in anxiety did not correlate with change in bias (p = 0.24). A repeated-measures ANOVA showed no significant difference in bias from pre- to post-ABM (p = 0.144), or between groups (p = 0.976). For anxiety symptoms, a linear mixed-effects model analysis revealed a significant effect of time. Participants showed reduction in anxiety score at each successive assessment (p < 0.001). However, no other significant main effect or interactions were found. A clinically significant change analysis revealed that 9% of participants were classified as ‘recovered’ at 3-months follow-up.

Conclusion

A single session of VR-based ABM did not change attentional bias. The significant reduction in anxiety was not specific to active training, and the majority of participants remained clinically unchanged.

Transdiagnostic school-based intervention for adolescents with early persistent psychiatric symptoms: An initial single-group effect study

AIM

Mental health intervention programs for adolescents generally focus on specific symptoms, such as anxiety or depression. Psychiatric symptoms in adolescence are often heterogeneous, transient and shift over time. These characteristics require a transdiagnostic approach with emphasis on positive psychological development. This study aimed to examine the feasibility and effectiveness of Mastermind, a novel transdiagnostic intervention targeting general underlying mechanisms of psychiatric symptoms in adolescents.

METHODS

Adolescents were screened for psychiatric symptoms with the Strengths and Difficulties Scale in a school-based program in two consecutive years. Adolescents were eligible for the intervention when they had psychiatric symptoms at both screening assessments. Participants received an 8 weeks program containing elements of empowerment and attention bias modification. Psychiatric symptoms were assessed before the start of the intervention, immediately after the intervention and at 6-month follow-up.

RESULTS

A total of 241 adolescents were eligible for the intervention, of whom 80 participated (mean age 12.5 years). Generalized Estimating Equations, adjusted for gender and educational level, showed a decrease of negative attention bias, psychotic, anxiety, depression and behavioural symptoms immediately after intervention. The effects remained at follow-up. Overall risk for psychiatric disorders, distress and low self-esteem had decreased at follow-up.

CONCLUSIONS

A simple two-step school-based screening can identify adolescents with persistent psychiatric symptoms. The Mastermind transdiagnostic group intervention may be effective to reduce psychiatric symptoms, enhance self-esteem and lower the risk for developing psychiatric disorders.

The Cognitive Neuropsychology of Depression in Adolescents

Purpose of Review

Adolescent depression is a major public health concern associated with severe outcomes. A lack of efficacious interventions has triggered an increase in cognitive neuropsychology research to identify relevant treatment targets for new interventions. This review summarises key neurocognitive findings in adolescent depression and explores the potential of neurocognitive markers as treatment targets in new interventions.

Recent Findings

Studies support difficulties in the voluntary deployment of attention towards and away from emotional stimuli, negative interpretation biases and overgeneralised autobiographical memories in adolescent depression; however, little evidence is given to a general decline in executive function. There is consistent evidence for abnormalities in several distributed neural networks in adolescent depression, including dysfunction in and between the amygdala, medial prefrontal cortex and ventral striatum.

Summary

The relationships between different cognitive biases and abnormalities in specific neural networks remain unclear. Several new experimental interventions targeting these neurocognitive markers await evaluation.

Learning to Look at the Bright Side of Life: Attention Bias Modification Training Enhances Optimism Bias

Identifying neurocognitive mechanisms underlying optimism bias is essential to understand its benefits for well-being and mental health. The combined cognitive biases hypothesis suggests that biases (e.g., in expectancies and attention) interact and mutually enforce each other. Whereas, in line with this hypothesis, optimistic expectancies have been shown to guide attention to positive information, reverse causal effects have not been investigated yet. Revealing such bidirectional optimism-attention interactions both on a behavioral and neural level could explain how cognitive biases contribute to a self-sustaining upward spiral of positivity. In this behavioral study, we hypothesized that extensive training to direct attention to positive information enhances optimism bias. To test this hypothesis, for 2 weeks, 149 participants underwent either daily online 80-trial attention bias modification training (ABMT) toward accepting faces and away from rejecting faces or neutral control training. Participants in the ABMT group were instructed to click as quickly as possible on the accepting face among 15 rejecting faces randomly displayed on a 4-by-4 matrix; participants in the control group were instructed to click on the five-petaled flower depicted among 15 seven-petaled flowers. Comparative optimism bias and state optimism were measured via questionnaires before training, after one training week, and after two training weeks. ABMT enhanced comparative optimism bias, whereas control training did not. Our findings reveal that ABMT toward positive social information causally influences comparative optimism bias and may, thereby trigger the biases' benefits for well-being and mental health. These results can (a) stimulate future neurophysiological research in the area of positive psychology; and (b) reveal an innovative low-cost and easy-to-access intervention that may support psychotherapy in times of rising numbers of patients with psychological disorders.

Threat-related Attention Bias in Socioemotional Development: A Critical Review and Methodological Considerations

Cross-sectional evidence suggests that attention bias to threat is linked to anxiety disorders and anxiety vulnerability in both children and adults. However, there is a lack of developmental evidence regarding the causal mechanisms through which attention bias to threat might convey risks for socioemotional problems, such as anxiety. Gaining insights into this question demands longitudinal research to track the complex interplay between threat-related attention and socioemotional functioning. Developing and implementing reliable and valid assessments tools is essential to this line of work. This review presents theoretical accounts and empirical evidence from behavioral, eye-tracking, and neural assessments of attention to discuss our current understanding of the development of normative threat-related attention in infancy, as well as maladaptive threat-related attention patterns that may be associated with the development of anxiety. This review highlights the importance of measuring threat-related attention using multiple attention paradigms at multiple levels of analysis. In order to understand if and how threat-related attention bias in real-life, social interactive contexts can predict socioemotional development outcomes, this review proposes that future research cannot solely rely on screen-based paradigms but needs to extend the assessment of threat-related attention to naturalistic settings. Mobile eye-tracking technology provides an effective tool for capturing threat-related attention processes in vivo as children navigate fear-eliciting environments and may help us uncover more proximal bio-psycho-behavioral markers of anxiety.

Emotion-in-Motion, a Novel Approach for the Modification of Attentional Bias: An Experimental Proof-of-Concept Study

Background

Individuals with heightened anxiety vulnerability tend to preferentially attend to emotionally negative information, with evidence suggesting that this attentional bias makes a causal contribution to anxiety vulnerability. Recent years have seen an increase in the use of attentional bias modification (ABM) procedures to modify patterns of attentional bias; however, often this change in bias is not successfully achieved.

Objective

This study presents a novel ABM procedure, Emotion-in-Motion, requiring individuals to engage in patterns of attentional scanning and tracking within a gamified, complex, and dynamic environment. We aimed to examine the capacity of this novel procedure, as compared with the traditional probe-based ABM procedure, to produce a change in attentional bias and result in a change in anxiety vulnerability.

Methods

We administered either an attend-positive or attend-negative version of our novel ABM task or the conventional probe-based ABM task to undergraduate students (N=110). Subsequently, participants underwent an anagram stressor task, with state anxiety assessed before and following this stressor.

Results

Although the conventional ABM task failed to induce differential patterns of attentional bias or affect anxiety vulnerability, the Emotion-in-Motion training did induce a greater attentional bias to negative faces in the attend-negative training condition than in the attend-positive training condition (P=.003, Cohen d=0.87) and led to a greater increase in stressor-induced state anxiety faces in the attend-negative training condition than in the attend-positive training condition (P=.03, Cohen d=0.60).

Conclusions

Our novel, gamified Emotion-in-Motion ABM task appears more effective in modifying patterns of attentional bias and anxiety vulnerability. Candidate mechanisms contributing to these findings are discussed, including the increased stimulus complexity, dynamic nature of the stimulus presentation, and enriched performance feedback.

Group Cognitive Behavioral Therapy and Attention Bias Modification for Childhood Anxiety Disorders: A Factorial Randomized Trial of Efficacy

BACKGROUND

The objective of this study is to assess group differences in symptom reduction between individuals receiving group cognitive behavioral therapy (G-CBT) and attention bias modification (ABM) compared to their respective control interventions, control therapy (CT), and attention control training (ACT), in a 2 × 2 factorial design.

METHODS

A total of 310 treatment-naive children (7-11 years of age) were assessed for eligibility and 79 children with generalized, separation or social anxiety disorder were randomized and received G-CBT (n = 42) or CT (n = 37). Within each psychotherapy group, participants were again randomized to ABM (n = 38) or ACT (n = 41) in a 2 × 2 factorial design resulting in four groups: G-CBT + ABM (n = 21), G-CBT + ACT (n = 21), CT + ABM (n = 17), and CT + ACT (n = 20). Primary outcomes were responder designation as defined by Clinical Global Impression-Improvement (CGI-I) scale (≤2) and change on the Pediatric Anxiety Rating Scale (PARS).

RESULTS

There were significant improvements of symptoms in all groups. No differences in response rates or mean differences in PARS scores were found among groups: G-CBT + ABM group (23.8% response; 3.9 points, 95% confidence interval [CI] -0.3 to 8.1), G-CBT + ACT (42.9% response; 5.6 points, 95% CI 2.2-9.0), CT + ABM (47.1% response; 4.8 points 95% CI 1.08-8.57), and CT + ACT (30% response; 0.8 points, 95% CI -3.0 to 4.7). No evidence or synergic or antagonistic effects were found, but the combination of G-CBT and ABM was found to increase dropout rate.

CONCLUSIONS

We found no effect of G-CBT or ABM beyond the effects of comparison groups. Results reveal no benefit from combining G-CBT and ABM for anxiety disorders in children and suggest potential deleterious effects of the combination on treatment acceptability.

Affect-Driven Attention Biases as Animal Welfare Indicators: Review and Methods

Attention bias describes the differential allocation of attention towards one stimulus compared to others. In humans, this bias can be mediated by the observer's affective state and is implicated in the onset and maintenance of affective disorders such as anxiety. Affect-driven attention biases (ADABs) have also been identified in a few other species. Here, we review the literature on ADABs in animals and discuss their utility as welfare indicators. Despite a limited research effort, several studies have found that negative affective states modulate attention to negative (i.e., threatening) cues. ADABs influenced by positive-valence states have also been documented in animals. We discuss methods for measuring ADAB and conclude that looking time, dot-probe, and emotional spatial cueing paradigms are particularly promising. Research is needed to test them with a wider range of species, investigate attentional scope as an indicator of affect, and explore the possible causative role of attention biases in determining animal wellbeing. Finally, we argue that ADABs might not be best-utilized as indicators of general valence, but instead to reveal specific emotions, motivations, aversions, and preferences. Paying attention to the human literature could facilitate these advances.

Affective science and avoidant end-of-life communication: Can the science of emotion help physicians talk with their patients about the end of life?

Despite believing end-of-life (EOL) discussions with patients are important, doctors often do not have them. Multiple factors contribute to this shortfall, which interventions including reimbursement changes and communication skills training have not significantly improved to date. One commonly cited but under-researched reason for physician avoidance of EOL discussion is emotional difficulty. High occupational demand for frequent difficult discussions may overload physicians' normal emotional functioning, leading to avoidance or failure. We propose that cognitive, behavioral, and neuroscience evidence from affective science may offer helpful insights into this problem. Data from other populations show that strong emotion impairs cognitive performance and multiple demands can overload cognitive resources. We discuss several affective processes that may apply to physicians attempting EOL discussions. We then discuss selected interventions that have been shown to modify some of these processes and associated behavioral outcomes. Evidence for change in behavioral outcomes of interest includes performance and mood enhancement in healthy populations. We suggest that such mechanistically-targeted interventions may be hypothesized to help decrease physician avoidance of EOL discussion. Physicians may be motivated to adopt such interventions in order to enhance normal emotional functioning to meet supra-normal occupational demand. We propose this as a promising area of future study.

Association between attention bias to threat and anxiety symptoms in children and adolescents

BACKGROUND

Considerable research links threat-related attention biases to anxiety symptoms in adults, whereas extant findings on threat biases in youth are limited and mixed. Inconsistent findings may arise due to substantial methodological variability and limited sample sizes, emphasizing the need for systematic research on large samples. The aim of this report is to examine the association between threat bias and pediatric anxiety symptoms using standardized measures in a large, international, multi-site youth sample.

METHODS

A total of 1,291 children and adolescents from seven research sites worldwide completed standardized attention bias assessment task (dot-probe task) and child anxiety symptoms measure (Screen for Child Anxiety Related Emotional Disorders). Using a dimensional approach to symptomatology, we conducted regression analyses predicting overall, and disorder-specific, anxiety symptoms severity, based on threat bias scores.

RESULTS

Threat bias correlated positively with overall anxiety symptoms severity (ß = 0.078, P = .004). Furthermore, threat bias was positively associated specifically with social anxiety (ß = 0.072, P = .008) and school phobia (ß = 0.076, P = .006) symptoms severity, but not with panic, generalized anxiety, or separation anxiety symptoms. These associations were not moderated by age or gender.

CONCLUSIONS

These findings indicate associations between threat bias and pediatric anxiety symptoms, and suggest that vigilance to external threats manifests more prominently in symptoms of social anxiety and school phobia, regardless of age and gender. These findings point to the role of attention bias to threat in anxiety, with implications for translational clinical research. The significance of applying standardized methods in multi-site collaborations for overcoming challenges inherent to clinical research is discussed.

Specificity and overlap of attention and memory biases in depression

BACKGROUND

Attentional and memory biases are viewed as crucial cognitive processes underlying symptoms of depression. However, it is still unclear whether these two biases are uniquely related to depression or whether they show substantial overlap.

METHODS

We investigated the degree of specificity and overlap of attentional and memory biases for depressotypic stimuli in relation to depression and anxiety by means of meta-analytic commonality analysis. By including four published studies, we considered a pool of 463 healthy and subclinically depressed individuals, different experimental paradigms, and different psychological measures.

RESULTS

Memory bias is reliably and strongly related to depression and, specifically, to symptoms of negative mood, worthlessness, feelings of failure, and pessimism. Memory bias for negative information was minimally related to anxiety. Moreover, neither attentional bias nor the overlap between attentional and memory biases were significantly related to depression.

LIMITATIONS

Limitations include cross-sectional nature of the study.

CONCLUSIONS

Our study showed that, across different paradigms and psychological measures, memory bias (and not attentional bias) represents a primary mechanism in depression.

The Revised Child Anxiety and Depression Scale: A systematic review and reliability generalization meta-analysis

BACKGROUND

Anxiety and depression are among the most common mental disorders during childhood and adolescence. Among the instruments for the brief screening assessment of symptoms of anxiety and depression, the Revised Child Anxiety and Depression Scale (RCADS) is one of the more widely used. Previous studies have demonstrated the reliability of the RCADS for different assessment settings and different versions. The aims of this study were to examine the mean reliability of the RCADS and the influence of the moderators on the RCADS reliability.

METHODS

We searched in EBSCO, PsycINFO, Google Scholar, Web of Science, and NCBI databases and other articles manually from lists of references of extracted articles.

RESULTS

A total of 146 studies were included in our meta-analysis. The RCADS showed robust internal consistency reliability in different assessment settings, countries, and languages. We only found that reliability of the RCADS was significantly moderated by the version of RCADS. However, these differences in reliability between different versions of the RCADS were slight and can be due to the number of items.

LIMITATIONS

We did not examine factor structure, factorial invariance across gender, age, or country, and test-retest reliability of the RCADS.

CONCLUSIONS

The RCADS is a reliable instrument for cross-cultural use, with the advantage of providing more information with a low number of items in the assessment of both anxiety and depression symptoms in children and adolescents.

Attention Bias Modification (ABM): Review of Effects of Multisession ABM Training on Anxiety and Threat-Related Attention in High-Anxious Individuals

Attention bias modification (ABM) aims to reduce anxiety by reducing attention bias (AB) to threat; however, effects on anxiety and AB are variable. This review examines 34 studies assessing effects of multisession-ABM on both anxiety and AB in high-anxious individuals. Methods include ABM-threat-avoidance (promoting attention-orienting away from threat), ABM-positive-search (promoting explicit, goal-directed attention-search for positive/nonthreat targets among negative/threat distractors), and comparison conditions (e.g., control-attention training combining threat-cue exposure and attention-task practice without AB-modification). Findings indicate anxiety reduction often occurs during both ABM-threat-avoidance and control-attention training; anxiety reduction is not consistently accompanied by AB reduction; anxious individuals often show no pretraining AB in orienting toward threat; and ABM-positive-search training appears promising in reducing anxiety. Methodological and theoretical issues are discussed concerning ABM paradigms, comparison conditions, and AB assessment. ABM methods combining explicit goal-directed attention-search for nonthreat/positive information and effortful threat-distractor inhibition (promoting top-down cognitive control during threat-cue exposure) warrant further evaluation.

Gender Differences in the Difficulty in Disengaging from Threat among Children and Adolescents With Social Anxiety

There is some research showing that social anxiety is related with attentional bias to threat. However, others fail to find this relationship and propose that gender differences may play a role. The aim of this study was to investigate the gender differences in the subcomponents of attentional bias to threat (hypervigilance and difficulty in disengaging) among children and adolescents with social anxiety. Overall, 181 youngsters aged between 10 and 14 participated in the current study. Images of disgusted faces were used as threat stimuli in an Exogenous Cueing Task was used to measure the subcomponents of attentional bias. Additionally, the Social Anxiety Scale for Children was used to measure social anxiety. The repeated measures ANOVA showed that male participants with high social anxiety showed difficulty in disengaging from threat, but this was not the case for female participants. Our results indicated that social anxiety is more related with attentional bias to threat among male children and adolescents than females. These findings suggested that developing gender-specific treatments for social anxiety may improve treatment effects.

Effects of cognitive bias modification on social anxiety: A meta-analysis

Background

Cognitive bias modification (CBM), a set of techniques for modifying bias in information processing—is considered a novel intervention for social anxiety disorder (SAD), which has drawn considerable interest from researchers. However, the effects of CBM on SAD are not consistent. Some studies have demonstrated significant positive effects compared to control groups, while others have found no such effects.

Aims

We conducted a meta-analysis aimed at quantitatively assessing the effects of CBM on SAD at post-test.

Method

Through a systematic literature search by two independent raters, 34 articles (36 randomized studies) including 2,550 participants were identified. A multilevel modeling approach was employed to assess the effects of CBM on SAD, and to explore the potentially crucial procedures and sample characteristics that enhance the effectiveness of benign training.

Results

In general, there were small but significant effects of CBM on the primary symptoms of SAD (g = 0.17), cognitive bias (CB) toward threat (g = 0.32), and reactivity in stressful situations (g = 0.25), but non-significant effects on secondary symptoms. However, the interpretation modification program was more effective than was attentional bias modification in reducing SAD primary symptoms and negative CB. Laboratory training procedures produced larger primary symptom reductions compared to Internet-based training, whereas the percentage of contingency and feedback about training performance boosted cognitive effects only. Finally, the following groups were more likely to benefit from CBM: younger participants (primary symptoms and cognitive effects), women (primary symptom effects), and samples with stronger CB (stressor effects). The quality of the randomized controlled trials was less than desirable, as there was some indication of publication bias in our study.

Conclusions

Current findings broadly supported cognitive theories of SAD that consider a bidirectional or mutually reinforcing relationship between symptoms and CBs. However, the small therapeutic effect observed here indicates that it is necessary to develop more reliable and efficient CBM interventions that are specific to SAD.