Behavioral and neural stability of attention bias to threat in healthy adolescents

Eye-tracking measurement of attention bias to social threat among youth: A replication and extension study

Attentional bias to social threat cues has been linked to heightened anxiety and irritability in youth. Yet, inconsistent methodology has limited replication and led to mixed findings. The current study aims to 1) replicate and extend two previous pediatric studies demonstrating a relationship between negative affectivity and attentional bias to social threat and 2) examine the test-retest reliability of an eye-tracking paradigm among a subsample of youth. Attention allocation to negative versus non-negative emotional faces was measured using a free-viewing eye-tracking task among youth (N=185 total, 60% female, M age=13.10 years, SD age=2.77) with three face-pair conditions: happy-angry, neutral-disgust, sad-happy. Replicating procedures of two previous studies, linear mixed-effects models compared attention bias between children with anxiety disorders and healthy controls. Bifactor analysis was used to parse shared versus unique facets of general negative affectivity (i.e., anxiety, irritability), which were then examined in relation to attention bias. Test-retest reliability of the bias-index was estimated among a subsample of youth (N=36). No significant differences in attention allocation or bias emerged between anxiety and healthy control groups. While general negative affectivity across the sample was not associated with attention bias, there was a positive relationship for anxiety and irritability on duration of attention allocation toward negative faces. Test-retest reliability for attention bias was moderate (r=0.50, p<.01). While anxiety-related findings from the two previous studies were not replicated, the relationship between attention bias and facets of negative affect suggests a potential target for treatment. Evidence for test-retest reliability encourages future use of the eye-tracking task for researchers.

The effects of yohimbine and hydrocortisone on selective attention to fearful faces: An fMRI study

INTRODUCTION

Selective attention to salient emotional information can enable an advantage in the face of danger. The present study aims to investigate the influence of the stress neuromodulators, norepinephrine and cortisol, on selective attention processes to fearful faces and its neuronal activation.

METHODS AND MATERIALS

We used a randomized, double-blind, placebo-controlled design. 167 healthy men between 18 and 35 years (mean [SD] age: 25.23 [4.24] years) participated in the study. Participants received either: (A) yohimbine (n= 41), (B) hydrocortisone (n = 41), (C) yohimbine and hydrocortisone (n = 42) or (D) placebo only (n= 43) and participated in a dot-probe task with fearful and neutral faces in an fMRI scanner.

RESULTS

We found an attentional bias toward fearful faces across all groups and related neuronal activation in the left cuneus. We did not find any differences between experimental treatment groups in selective attention and its neuronal activation.

DISCUSSION

Our results provide evidence that fearful faces lead to an attentional bias with related neuronal activation in the left cuneus. We did not replicate formerly reported activation in the amygdala, intraparietal sulcus, dorsal anterior cingulate cortex, and thalamus. Suitability of the dot-probe task for fMRI studies and insignificant treatment effects are discussed.

Decoding visual fatigue in a visual search task selectively manipulated via myopia-correcting lenses

Introduction

Visual fatigue resulting from sustained, high-workload visual activities can significantly impact task performance and general wellbeing. So far, however, little is known about the underlying brain networks of visual fatigue. This study aimed to identify such potential networks using a unique paradigm involving myopia-correcting lenses known to directly modulate subjectively-perceived fatigue levels.

Methods

A sample of N = 31 myopia participants [right eye-SE: -3.77D (SD: 2.46); left eye-SE: -3.75D (SD: 2.45)] performed a demanding visual search task with varying difficulty levels, both with and without the lenses, while undergoing fMRI scanning. There were a total of 20 trials, after each of which participants rated the perceived difficulty and their subjective visual fatigue level. We used representational similarity analysis to decode brain regions associated with fatigue and difficulty, analyzing their individual and joint decoding pattern.

Results and discussion

Behavioral results showed correlations between fatigue and difficulty ratings and above all a significant reduction in fatigue levels when wearing the lenses. Imaging results implicated the cuneus, lingual gyrus, middle occipital gyrus (MOG), and declive for joint fatigue and difficulty decoding. Parts of the lingual gyrus were able to selectively decode perceived difficulty. Importantly, a broader network of visual and higher-level association areas showed exclusive decodability of fatigue (culmen, middle temporal gyrus (MTG), parahippocampal gyrus, precentral gyrus, and precuneus). Our findings enhance our understanding of processing within the context of visual search, attention, and mental workload and for the first time demonstrate that it is possible to decode subjectively-perceived visual fatigue during a challenging task from imaging data. Furthermore, the study underscores the potential of myopia-correcting lenses in investigating and modulating fatigue.

See no evil: Attentional bias toward threat is diminished in aged monkeys

Prior evidence demonstrates that relative to younger adults, older human adults exhibit attentional biases toward positive and/or away from negative socioaffective stimuli (i.e., the age-related positivity effect). Whether or not the effect is phylogenetically conserved is currently unknown and its biopsychosocial origins are debated. To address this gap, we evaluated how visual processing of socioaffective stimuli differs in aged, compared to middle-aged, rhesus monkeys (Macaca mulatta) using eye tracking in two experimental designs that are directly comparable to those historically used for evaluating attentional biases in humans. Results of our study demonstrate that while younger rhesus possesses robust attentional biases toward threatening pictures of conspecifics' faces, aged animals evidence no such bias. Critically, these biases emerged only when threatening faces were paired with neutral and not ostensibly "positive" faces, suggesting social context modifies the effect. Results of our study suggest that the evolutionarily shared mechanisms drive age-related decline in visual biases toward negative stimuli in aging across primate species. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Normalization of Fronto-Parietal Activation by Cognitive-Behavioral Therapy in Unmedicated Pediatric Patients With Anxiety Disorders

OBJECTIVE

Anxiety disorders are prevalent among youths and are often highly impairing. Cognitive-behavioral therapy (CBT) is an effective first-line treatment. The authors investigated the brain mechanisms associated with symptom change following CBT.

METHODS

Unmedicated youths diagnosed with an anxiety disorder underwent 12 weeks of CBT as part of two randomized clinical trials testing the efficacy of adjunctive computerized cognitive training. Across both trials, participants completed a threat-processing task during functional MRI before and after treatment. Age-matched healthy comparison youths completed two scans over the same time span. The mean age of the samples was 13.20 years (SD=2.68); 41% were male (youths with anxiety disorders, N=69; healthy comparison youths, N=62). An additional sample including youths at temperamental risk for anxiety (N=87; mean age, 10.51 years [SD=0.43]; 41% male) was utilized to test the stability of anxiety-related neural differences in the absence of treatment. Whole-brain regional activation changes (thresholded at p<0.001) were examined using task-based blood-oxygen-level-dependent response.

RESULTS

Before treatment, patients with an anxiety disorder exhibited altered activation in fronto-parietal attention networks and limbic regions relative to healthy comparison children across all task conditions. Fronto-parietal hyperactivation normalized over the course of treatment, whereas limbic responses remained elevated after treatment. In the at-risk sample, overlapping clusters emerged between regions showing stable associations with anxiety over time and regions showing treatment-related changes.

CONCLUSIONS

Activation in fronto-parietal networks may normalize after CBT in unmedicated pediatric anxiety patients. Limbic regions may be less amenable to acute CBT effects. Findings from the at-risk sample suggest that treatment-related changes may not be attributed solely to the passage of time.

Attentional bias to threat is modulated by stimulus content: an fNIRS study

People are evolutionarily predisposed to associate threat relevant stimuli with fear or aversiveness and show an attentional bias toward threat. Attentional bias modification (ABM) has been shown to reduce threat biases, while quantitative reviews assessing the effectiveness of bias modification yielded inconsistent results. The current study examined the relationship between the training effect of attentional bias to threat and the type of threatening stimuli. Twenty-two participants performed a modified dot-probe task while undergoing functional near-infrared spectroscopy (fNIRS) imaging. Results indicated that there was a strong pattern of attentional avoidance among individuals in an animal but not human threat condition. Furthermore, findings from fNIRS confirmed that the influence from type of threatening stimulus would be modulated by cortical activation patterns, especially in the ventrolateral prefrontal cortices (vlPFC) and angular gyrus. Overall, these results suggest that stimulus-specific may play a major role in personalization of specific psychological interventions.

Novel mechanism-based treatments for pediatric anxiety and depressive disorders

Pediatric anxiety and depressive disorders are common, can be highly impairing, and can persist despite the best available treatments. Here, we review research into novel treatments for childhood anxiety and depressive disorders designed to target underlying cognitive, emotional, and neural circuit mechanisms. We highlight three novel treatments lying along a continuum relating to clinical impact of the disorder and the intensity of clinical management required. We review cognitive training, which involves the lowest risk and may be applicable for problems with mild to moderate impact; psychotherapy, which includes a higher level of clinical involvement and may be sufficient for problems with moderate impact; and brain stimulation, which has the highest potential risks and is therefore most appropriate for problems with high impact. For each treatment, we review the specific underlying cognitive, emotional, and brain circuit mechanisms that are being targeted, whether treatments modify those underlying mechanisms, and efficacy in reducing symptoms. We conclude by highlighting future directions, including the importance of work that leverages developmental windows of high brain plasticity to time interventions to the specific epochs in childhood that have the largest and most enduring life-long impact.

Development of Neural Mechanisms Underlying Threat Processing: Associations With Childhood Social Reticence and Adolescent Anxiety

Background

Social reticence in early childhood is characterized by shy and anxiously avoidant behavior, and it confers risk for pediatric anxiety disorders later in development. Aberrant threat processing may play a critical role in this association between early reticent behavior and later psychopathology. The goal of this longitudinal study is to characterize developmental trajectories of neural mechanisms underlying threat processing and relate these trajectories to associations between early-childhood social reticence and adolescent anxiety.

Methods

In this 16-year longitudinal study, social reticence was assessed from 2 to 7 years of age; anxiety symptoms and neural mechanisms during the dot-probe task were assessed at 10, 13, and 16 years of age. The sample included 144 participants: 71 children provided data at age 10 (43 girls, meanage = 10.62), 85 at age 13 (46 girls, meanage = 13.25), and 74 at age 16 (36 girls, meanage = 16.27).

Results

A significant interaction manifested among social reticence, anxiety symptoms, and time, on functional connectivity between the left amygdala and the left dorsolateral prefrontal cortex, voxelwise p < .001, clusterwise familywise error p < .05. Children with high social reticence showed a negative association between amygdala-dorsolateral prefrontal cortex connectivity and anxiety symptoms with age, compared to children with low social reticence, suggesting distinct neurodevelopmental pathways to anxiety.

Conclusions

These findings were present across all conditions, suggesting task-general effects in potential threat processing. Additionally, the timing of these neurodevelopmental pathways differed for children with high versus low social reticence, which could affect the timing of effective preventive interventions.

Attentional biases in human anxiety

Across clinical and subclinical samples, anxiety has been associated with increased attentional capture by cues signaling danger. Various cognitive models attribute the onset and maintenance of anxiety symptoms to maladaptive selective information processing. In this brief review, we 1) describe the evidence for the relations between anxiety and attention bias toward threat, 2) discuss the neurobiology of anxiety-related differences in threat bias, 3) summarize work investigating the developmental origins of attention bias toward threat, and 4) examine efforts to translate threat bias research into clinical intervention. Future directions in each area are discussed, including the use of novel analytic approaches improving characterization of threat-processing-related brain networks, clarifying the role of cognitive control in the development of attention bias toward threat, and the need for larger, well-controlled randomized clinical trials examining moderators and mediators of treatment response. Ultimately, this work has important implications for understanding the etiology of and for intervening on anxiety difficulties among children and adults.

Attachment Security Priming Delayed Negative Information-Related Attentional Disengagement Among Anxiously Attached Individuals: Evidence From Behavioral and Functional MRI Experiments

Although attachment security has been found to attenuate people’s experience of unpleasant information, how it modulates the attentional process toward such information remains unknown. The present study examined this issue by employing the dot-probe task in functional MRI. After completing the Experiences in Close Relationships-Revised questionnaire (ECR-R), 39 participants were asked to complete the dot-probe task in two conditions: the attachment security priming condition and neutral priming condition. The behavioral results revealed that individuals with high level of attachment anxiety exhibited larger attention disengagement from negative traits in the security priming condition than in the control condition. Correspondingly, the brain regions involved in attention regulation and shifting, such as the posterior cingulate and bilateral parietal area, were less activated among high anxiously attached individuals in the security priming condition. These results suggest a role of attachment security priming in regulating the emotional response in anxiously attached individuals during the attentional stage.

Attentional bias to threat and gray matter volume morphology in high anxious individuals

In a sample of highly anxious individuals, the relationship between gray matter volume brain morphology and attentional bias to threat was assessed. Participants performed a dot-probe task of attentional bias to threat and gray matter volume was acquired from whole brain structural T1-weighted magnetic resonance imaging scans. The results replicate previous findings in unselected samples that elevated attentional bias to threat is linked to greater gray matter volume in the middle frontal gyrus and superior frontal gyrus. In addition, we provide novel evidence that elevated attentional bias to threat is associated with greater gray matter volume in the inferior frontal gyrus, insula, cerebellum, and other distributed regions. Lastly, exploratory analyses provide initial evidence that distinct subregions of the right posterior parietal cortex may contribute to attentional bias in a sex-specific manner. Our results illuminate how differences in gray matter volume morphology relate to attentional bias to threat in anxious individuals. This knowledge could inform neurocognitive models of anxiety-related attentional bias to threat.

Reliability of task-evoked neural activation during face-emotion paradigms: Effects of scanner and psychological processes

Assessing and improving test-retest reliability is critical to efforts to address concerns about replicability of task-based functional magnetic resonance imaging. The current study uses two statistical approaches to examine how scanner and task-related factors influence reliability of neural response to face-emotion viewing. Forty healthy adult participants completed two face-emotion paradigms at up to three scanning sessions across two scanners of the same build over approximately 2 months. We examined reliability across the main task contrasts using Bayesian linear mixed-effects models performed voxel-wise across the brain. We also used a novel Bayesian hierarchical model across a predefined whole-brain parcellation scheme and subcortical anatomical regions. Scanner differences accounted for minimal variance in temporal signal-to-noise ratio and task contrast maps. Regions activated during task at the group level showed higher reliability relative to regions not activated significantly at the group level. Greater reliability was found for contrasts involving conditions with clearly distinct visual stimuli and associated cognitive demands (e.g., face vs. nonface discrimination) compared to conditions with more similar demands (e.g., angry vs. happy face discrimination). Voxel-wise reliability estimates tended to be higher than those based on predefined anatomical regions. This work informs attempts to improve reliability in the context of task activation patterns and specific task contrasts. Our study provides a new method to estimate reliability across a large number of regions of interest and can inform researchers' selection of task conditions and analytic contrasts.

Leveraging big data to map neurodevelopmental trajectories in pediatric anxiety

Anxiety disorders are the most prevalent psychiatric condition among youth, with symptoms commonly emerging prior to or during adolescence. Delineating neurodevelopmental trajectories associated with anxiety disorders is important for understanding the pathophysiology of pediatric anxiety and for early risk identification. While a growing literature has yielded valuable insights into the nature of brain structure and function in pediatric anxiety, progress has been limited by inconsistent findings and challenges common to neuroimaging research. In this review, we first discuss these challenges and the promise of ‘big data’ to map neurodevelopmental trajectories in pediatric anxiety. Next, we review evidence of age-related differences in neural structure and function among anxious youth, with a focus on anxiety-relevant processes such as threat and safety learning. We then highlight large-scale cross-sectional and longitudinal studies that assess anxiety and are well positioned to inform our understanding of neurodevelopment in pediatric anxiety. Finally, we detail relevant challenges of ‘big data’ and propose future directions through which large publicly available datasets can advance knowledge of deviations from normative brain development in anxiety. Leveraging ‘big data’ will be essential for continued progress in understanding the neurobiology of pediatric anxiety, with implications for identifying markers of risk and novel treatment targets.

A preliminary study on functional activation and connectivity during frustration in youths with bipolar disorder

OBJECTIVES

Frustration is associated with impaired attention, heightened arousal, and greater unhappiness in youths with bipolar disorder (BD) vs healthy volunteers (HV). Little is known about functional activation and connectivity in the brain of BD youths in response to frustration. This exploratory study compared BD youths and HV on attentional abilities, self-reported affect, and functional activation and connectivity during a frustrating attention task.

METHODS

Twenty BD (Mage  = 15.86) and 20 HV (Mage  = 15.55) youths completed an fMRI paradigm that differentiated neural responses during processing of frustrating feedback from neural responses during attention orienting following frustrating feedback. We examined group differences in (a) functional connectivity using amygdala, inferior frontal gyrus (IFG), and striatum as seeds and (b) whole-brain and regions of interest (amygdala, IFG, striatum) activation. We explored task performance (accuracy, reaction time), self-reported frustration and unhappiness, and correlations between these variables and irritability, depressive, and manic symptoms.

RESULTS

Bipolar disorder youths, relative to HV, exhibited positive IFG-ventromedial prefrontal cortex (vmPFC) connectivity yet failed to show negative striatum-insula connectivity during feedback processing. Irritability symptoms were positively associated with striatum-insula connectivity during feedback processing. Moreover, BD vs HV youths showed positive IFG-parahippocampal gyrus (PHG)/periaqueductal gray (PAG) connectivity and negative amygdala-cerebellum connectivity during attention orienting following frustration. BD was not associated with atypical activation patterns.

CONCLUSIONS

Positive IFG-vmPFC connectivity and striatum-insula decoupling in BD during feedback processing may mediate heightened sensitivity to reward-relevant stimuli. Elevated IFG-PAG/PHG connectivity in BD following frustration may suggest greater recruitment of attention network to regulate arousal and maintain goal-directed behavior.

Enhanced contralateral theta oscillations and N170 amplitudes in occipitotemporal scalp regions underlie attentional bias to fearful faces

Attending toward fearful faces and other threatening stimuli increase the chance of survival. The dot-probe task is a commonly used measure of spatial attention. Event-related potentials (ERPs) have been found to be a reliable measure of attentional bias. The dot-probe literature suggests that posterior contralateral N170 amplitudes are more enhanced by fearful faces compared to ipsilateral amplitudes. However, ERP methods remove non-phase locked frequencies, which provides additional information about neural activity. Specifically, theta oscillations (5-7 Hz) have been linked to attentional processing. The purpose of this study was to examine the relationship between posterior contralateral theta oscillations and N170 amplitudes in the dot-probe task. A modified dot-probe task was used with fear and neutral facial expressions and EEG data was recorded from 33 electrodes. The ERP and time-frequency data were extracted from the P7 and P8 electrodes (left and right occipitotemporal regions). This study found enhanced N170 amplitude and theta oscillations in the electrodes posterior contralateral to the fearful face. Contralateral N170 amplitudes and theta oscillations were related such that greater N170 amplitudes were associated with greater theta oscillations. The results indicated that increased contralateral N170 and theta oscillations are related to each other and underlie attentional bias to fearful faces.

Across-subjects multiple baseline trial of exposure-based cognitive-behavioral therapy for severe irritability: a study protocol

INTRODUCTION

Irritability is defined as a tendency towards anger in response to frustration. Clinically, impairing irritability is a significant public health problem. There is a need for mechanism-based psychotherapies targeting severe irritability as it manifests in the context of disruptive mood dysregulation disorder (DMDD). This study protocol describes a randomised multiple baseline design testing the preliminary efficacy of a new treatment, exposure-based cognitive-behavioral therapy for severe irritability in youth, which also integrates components of parent management training. We will investigate associations of this intervention with primary clinical measures, as well as ecological momentary assessment measures.

METHODS AND ANALYSIS

Forty youth will be enrolled. Participants, aged 8-17 years, must present at least one of two core symptoms of DMDD: abnormal mood or increased reactivity to negative emotional stimuli, with severe impairment in one domain (home, school, peers) and moderate in another, or moderate impairment in at least two domains. Each participant is randomised to a 2-week, 4-week or 6-week baseline observation period, followed by 12 active treatment sessions. Clinical ratings are conducted at baseline, biweekly (clinician), weekly (parent/child) throughout treatment, post-treatment, and 3-month and 6-month follow-up (clinician). Clinician ratings on the Affective Reactivity Index and Clinical Global Impressions-Improvement scale for DMDD are our primary outcome measures. Secondary outcome measures include parent and child reports of irritability. Post hoc additional symptom measures include clinician, parent and self-ratings of depression, anxiety and overall functional impairment. Prospective, digitally based event sampling of symptoms is acquired for a week pre-treatment, mid-treatment and post-treatment. Based on our pathophysiological model of irritability implicating frustrative non-reward, aberrant threat processing and instrumental learning, we probe these three brain-based targets using functional MRI paradigms to assess target engagement.

ETHICS AND DISSEMINATION

The research project and all related materials were submitted and approved by the appropriate Institutional Review Board (IRB) of the National Institute of Mental Health (NIMH).

TRIAL REGISTRATION NUMBERS

NCT02531893 and NCT00025935.

A systematic review of event-related potentials as outcome measures of attention bias modification

Attention bias modification (ABM) was initially developed with the goal of reducing attentional bias to threat-and subsequently anxious symptoms-in individuals with heightened anxiety. Although controversial, ABM appears to be generally effective in achieving this goal. Yet, the primary outcome measure of ABM (i.e., the reaction time-based differences score) has poor reliability and temporal resolution, which limits the inferences that can be drawn. In contrast, event-related potentials (ERPs) have superior reliability as well as temporal resolution and may therefore be better outcome measures of ABM. In this review, I systematically assess the research using ERPs as outcome measures in ABM protocols. I focus on the extent to which the ERPs modified by ABM represent earlier or later stages of information processing. In addition, I explore the extent to which ABM produces near and/or far transfer of learning effects on ERP measures. The reviewed literature suggests that ERPs are promising outcome measures of ABM. ABM modulates the effects of affective stimuli on posterior visually evoked ERPs (i.e., P1) as well as ERPs at anterior electrodes (i.e., P2, N2, and ERN). Based on the state of the field, several directions for future research are identified.

Attention shifting in the context of emotional faces: Disentangling neural mechanisms of irritability from anxiety

BACKGROUND

Irritability predicts concurrent and prospective psychiatric disorders across the lifespan. Anxiety commonly co-occurs with irritability, and such comorbidity complicates care. Understanding the mechanisms of comorbid traits is necessary to inform treatment decisions. This study aimed to disentangle neural mechanisms of irritability from anxiety in the context of attentional shifting toward and away from emotional faces in youths from treatment-seeking families.

METHODS

Youths (N = 45), mean age = 14.01 years (standard deviation = 1.89) completed a dot-probe task during functional magnetic resonance imaging acquisition. Whole-brain activation analyses evaluated the effect of irritability on neural reactivity in the context of varying attentional shifting toward and away from emotional faces, both depending on and above and beyond anxiety (i.e., with anxiety as [a] a moderator and [b] a covariate, respectively).

RESULTS

Higher irritability levels related to distinct task-related patterns of cuneus activation, depending on comorbid anxiety levels. Increased irritability also related to distinct task-related patterns of parietal, temporal, occipital, and cerebellar activation, controlling for anxiety. Overall, youths with higher levels of irritability evinced more pronounced fluctuations in neural reactivity across task conditions.

CONCLUSION

The present study contributes to a literature delineating the unique and shared neural mechanisms of overlapping symptom dimensions, which will be necessary to ultimately build a brain- and behavior-based nosology that forms the basis for more targeted and effective treatments.

The Heterogeneity of Anxious Phenotypes: Neural Responses to Errors in Treatment-Seeking Anxious and Behaviorally Inhibited Youths

OBJECTIVE

Although behaviorally inhibited (BI) temperament predicts risk for anxiety, anxiety in BI may involve distinct neural responses to errors. The current study examines the relations between anxiety and neural correlates of error processing both in youths identified as BI in early childhood and in youths seeking treatment for an anxiety disorder.

METHOD

All participants underwent functional magnetic resonance imaging using a flanker task to assess responses to errors. A study in healthy subjects assessed test-retest reliability to inform analyses in two other samples. For one sample, a cohort of BI youths (Low BI, n = 28; High BI, n = 27) was followed into adolescence. For the other, participants were recruited based on the presence or absence of an anxiety disorder. Using identical methods in medication-free subjects, analyses compared relations between anxiety and error processing across the two samples.

RESULTS

Error-processing exhibited acceptable reliability. Within a ventromedial-prefrontal-cortex (vmPFC) cluster, anxiety related to error processing only in youths whose early-life BI status was known. In the high BI group, anxiety related to reduced neural response to errors. No such associations manifested in treatment-seeking youths. Other analyses mapped relations between error-processing and anxiety in each sample on its own. However, only the vmPFC cluster statistically differentiated the neural correlates of anxiety in BI.

CONCLUSION

BI temperament may define a unique pathway into anxiety involving perturbed neural responding to errors. Although BI is a risk factor for later anxiety, the neural and associated features of anxiety in BI youths may differ from those in treatment-seeking youths.

The stability and reliability of attentional bias measures in the dot-probe task: Evidence from both traditional mean bias scores and trial-level bias scores

A new method of calculating attentional bias from the dot-probe task measures fluctuations in bias towards and away from emotional stimuli over time using trial level bias score metrics. We assessed the stability and reliability of traditional attentional bias scores and trial level bias score measures of attentional bias across time in two five-block dot-probe task experiments in non-clinical samples. In experiments 1 and 2, both traditional attentional bias scores and trial level bias score measures of attentional bias did not habituate/decrease across time. In general, trial level bias score metrics (i.e., attention bias variability as well as the mean biases toward and away from threat) were more reliable than the traditional attention bias measure. This pattern was observed across both experiments. The traditional bias score, however, did improve in reliability in the later blocks of the fearful face dot-probe task. Although trial level bias score measures did not habituate and were more reliable across blocks, these measures did not correlate with state or trait anxiety. On the other hand, trial level bias score measures were strongly correlated with general reaction time variability-and after controlling for this effect no longer superior in reliability in comparison to the traditional attention bias measure. We conclude that general response variability should be removed from trial level bias score measures to ensure that they truly reflect attention bias variability.

Age Differences in the Neural Correlates of Anxiety Disorders: An fMRI Study of Response to Learned Threat

OBJECTIVE

Although both pediatric and adult patients with anxiety disorders exhibit similar neural responding to threats, age-related differences have been found in some functional MRI (fMRI) studies. To reconcile disparate findings, the authors compared brain function in youths and adults with and without anxiety disorders while rating fear and memory of ambiguous threats.

METHODS

Two hundred medication-free individuals ages 8-50 were assessed, including 93 participants with an anxiety disorder. Participants underwent discriminative threat conditioning and extinction in the clinic. Approximately 3 weeks later, they completed an fMRI paradigm involving extinction recall, in which they rated their levels of fear evoked by, and their explicit memory for, morph stimuli with varying degrees of similarity to the extinguished threat cues.

RESULTS

Age moderated two sets of anxiety disorder findings. First, as age increased, healthy subjects compared with participants with anxiety disorders exhibited greater amygdala-ventromedial prefrontal cortex (vmPFC) connectivity when processing threat-related cues. Second, age moderated diagnostic differences in activation in ways that varied with attention and brain regions. When rating fear, activation in the vmPFC differed between the anxiety and healthy groups at relatively older ages. In contrast, when rating memory for task stimuli, activation in the inferior temporal cortex differed between the anxiety and healthy groups at relatively younger ages.

CONCLUSIONS

In contrast to previous studies that demonstrated age-related similarities in the biological correlates of anxiety disorders, this study identified age differences. These findings may reflect this study's focus on relatively late-maturing psychological processes, particularly the appraisal and explicit memory of ambiguous threat, and inform neurodevelopmental perspectives on anxiety.

Neural Correlates of Attentional Processing of Threat in Youth with and without Anxiety Disorders

Late-stage attentional processing of threatening stimuli, quantified through event-related potentials (ERPs), differentiates youth with and without anxiety disorders. It is unknown whether early-stage attentional processing of threatening stimuli differentiates these groups. Examining both early and late stage attentional processes in youth may advance knowledge and enhance efforts to identify biomarkers for translational prevention and treatment research. Twenty-one youth with primary DSM-IV-TR anxiety disorders (10 males, ages 8-15 years) and 21 typically developing Controls (15 males, ages 8-16 years) completed a dot probe task while electroencephalography (EEG) was recorded, and ERPs were examined. Youth with anxiety disorders showed significantly larger (more positive) P1 amplitudes for threatening stimuli than for neutral stimuli, and Controls showed the opposite pattern. Youth with anxiety showed larger (more negative) N170 amplitudes compared with Controls. Controls showed significantly larger (more positive) P2 and P3 amplitudes, regardless of stimuli valence, compared with youth with anxiety disorders. ERPs observed during the dot probe task indicate youth with anxiety disorders display distinct neural processing during early stage attentional orienting and processing of faces; this was not the case for Controls. Such results suggest these ERP components may have potential as biomarkers of anxiety disorders in youth.

Combining fMRI during resting state and an attention bias task in children

Neuroimaging studies typically focus on either resting state or task-based fMRI data. Prior research has shown that similarity in functional connectivity between rest and cognitive tasks, interpreted as reconfiguration efficiency, is related to task performance and IQ. Here, we extend this approach from adults to children, and from cognitive tasks to a threat-based attention task. The goal of the current study was to examine whether similarity in functional connectivity during rest and an attention bias task relates to threat bias, IQ, anxiety symptoms, and social reticence. fMRI was measured during resting state and during the dot-probe task in 41 children (M = 13.44, SD = 0.70). Functional connectivity during rest and dot-probe was positively correlated, suggesting that functional hierarchies in the brain are stable. Similarity in functional connectivity between rest and the dot-probe task only related to threat bias (puncorr < .03). This effect did not survive correction for multiple testing. Overall, children who allocate more attention towards threat also may possess greater reconfiguration efficiency in switching from intrinsic to threat-related attention states. Finally, functional connectivity correlated negatively across the two conditions of the dot-probe task. Opposing patterns of modulation of functional connectivity by threat-congruent and threat-incongruent trials may reflect task-specific network changes during two different attentional processes.

Levels of early-childhood behavioral inhibition predict distinct neurodevelopmental pathways to pediatric anxiety

BACKGROUND

Anxiety symptoms gradually emerge during childhood and adolescence. Individual differences in behavioral inhibition (BI), an early-childhood temperament, may shape developmental paths through which these symptoms arise. Cross-sectional research suggests that level of early-childhood BI moderates associations between later anxiety symptoms and threat-related amygdala-prefrontal cortex (PFC) circuitry function. However, no study has characterized these associations longitudinally. Here, we tested whether level of early-childhood BI predicts distinct evolving associations between amygdala-PFC function and anxiety symptoms across development.

METHODS

Eighty-seven children previously assessed for BI level in early childhood provided data at ages 10 and/or 13 years, consisting of assessments of anxiety and an fMRI-based dot-probe task (including threat, happy, and neutral stimuli). Using linear-mixed-effects models, we investigated longitudinal changes in associations between anxiety symptoms and threat-related amygdala-PFC connectivity, as a function of early-childhood BI.

RESULTS

In children with a history of high early-childhood BI, anxiety symptoms became, with age, more negatively associated with right amygdala-left dorsolateral-PFC connectivity when attention was to be maintained on threat. In contrast, with age, low-BI children showed an increasingly positive anxiety-connectivity association during the same task condition. Behaviorally, at age 10, anxiety symptoms did not relate to fluctuations in attention bias (attention bias variability, ABV) in either group; by age 13, low-BI children showed a negative anxiety-ABV association, whereas high-BI children showed a positive anxiety-ABV association.

CONCLUSIONS

Early-childhood BI levels predict distinct neurodevelopmental pathways to pediatric anxiety symptoms. These pathways involve distinct relations among brain function, behavior, and anxiety symptoms, which may inform diagnosis and treatment.

Change in gaze-based attention bias in adolescents with Social Anxiety Disorder

Although attention bias (AB) toward threat has been associated with Social Anxiety Disorder (SAD), concerns regarding the ability of current measures to detect change in AB following treatment exist. We sought to examine change in bias, as measured via eye-tracking, in adolescents with SAD receiving either attention-bias modification training (ABMT) or attention-control training (ACT). Gaze-based AB was associated (r = -0.361) with symptoms of social anxiety prior to treatment, whereas there was no association between bias as measured via dot probe and social anxiety. Moreover, gaze-based bias to same-age face stimuli showed change following treatment. Large effects are seen for condition (ABMT or ACT) and for time, independent of treatment condition, in gaze-based AB to same-age stimuli. Findings suggest that further research on gaze-based bias, to assess stability over time outside of treatment and sensitivity to change following intervention, is warranted.

Cross-species convergence in pupillary response: understanding human anxiety via non-human primate amygdala lesion

Few studies have used matched affective paradigms to compare humans and non-human primates. In monkeys with amygdala lesions and youth with anxiety disorders, we examined cross-species pupillary responses during a saccade-based, affective attentional capture task. Given evidence of enhanced amygdala function in anxiety, we hypothesized that opposite patterns would emerge in lesioned monkeys and anxious participants. A total of 53 unmedicated youths (27 anxious, 26 healthy) and 8 adult male rhesus monkeys (Macaca mulatta) completed matched behavioral paradigms. Four monkeys received bilateral excitotoxic amygdala lesions and four served as unoperated controls. Compared to healthy youth, anxious youth exhibited increased pupillary constriction in response to emotional and non-emotional distractors (F(1,48) = 6.28, P = 0.02, η2p = 0.12). Pupillary response was associated significantly with anxiety symptoms severity (F(1,48) = 5.59, P = 0.02, η2p = 0.10). As hypothesized, lesioned monkeys exhibited the opposite pattern i.e. decreased pupillary constriction in response to distractors, compared to unoperated control monkeys (F(1,32) = 24.22, P < 0.001, η2 = 0.33). Amygdala lesioned monkeys and youth with anxiety disorders show opposite patterns of pupil constriction in the context of an affective distractor task. Such findings suggest the presence of altered amygdala circuitry functioning in anxiety. Future lesion and human neuroimaging work might examine the way in which specific amygdala sub-nuclei and downstream circuits mediate these effects.

Efficacy and mechanisms underlying a gamified attention bias modification training in anxious youth: protocol for a randomized controlled trial

BACKGROUND

Attention bias modification training (ABMT) and cognitive behavioral therapy (CBT) likely target different aspects of aberrant threat responses in anxiety disorders and may be combined to maximize therapeutic benefit. However, studies investigating the effect of ABMT in the context of CBT have yielded mixed results. Here, we propose an enhanced ABMT to target the attentional bias towards threat, in addition to classic CBT for anxiety disorders in youth. This enhanced ABMT integrates the modified dot-probe task used in previous studies, where a target is always presented at the previous location of the neutral and not the simultaneously presented threatening stimulus, with a visual search, where the targets are always presented distally of threatening distractors. These two training elements (modified dot-probe and visual search) are embedded in an engaging game to foster motivation and adherence. Our goal is to determine the efficacy of the enhanced ABMT in the context of CBT. Further, we aim to replicate two previous findings: (a) aberrant amygdala connectivity being the neurobiological correlate of the attentional bias towards threat at baseline; and (b) amygdala connectivity being a mediator of the ABMT effect. We will also explore moderators of treatment response (age, sex, depressive symptoms and irritability) on a behavioral and neuronal level.

METHODS

One hundred and twenty youth (8-17 years old) with a primary anxiety disorder diagnosis all receive CBT and are randomized to nine weeks of either active or control ABMT and symptom improvement will be compared between the two study arms. We will also recruit 60 healthy comparison youth, who along with eligible anxious youth, will be assessed with the dot-probe task during fMRI (anxious youth: before and after training; healthy volunteers: second measurement twelve weeks after initial assessment).

DISCUSSION

The present study will contribute to the literature by (1) potentially replicating that aberrant amygdala connectivity mediates the attentional bias towards threat in anxious youth; (2) determining the efficacy of enhanced ABMT; and (3) advancing our understanding of the mechanisms underlying ABMT.

TRIAL REGISTRATION

Clinicaltrials.gov: NCT03283930 Trial registration date: September 14th 2017. The trial registration took place retrospectively. Data acquisition started February 1st 2017.

Brain structure changes induced by attention bias modification training

Attention bias modification (ABM) therapy aims to reduce anxiety by changing threat-related attention patterns using computerized training tasks. We examined changes in brain microstructure following ABM training. Thirty-two participants were randomly assigned to one of two training conditions: active ABM training shifting attention away from threat or attention control training involving no attention modification. Participants completed six lab visits, including five training sessions and three diffusion tensor imaging scans: immediately before and after the first training session, and at the end of the training series. Indices of local and global changes in microstructure and connectivity were measured. Significant longitudinal differences in fractional anisotropy (FA) between the active and control training regimens occurred in inferior temporal cortex. Changes in FA occurred across groups within ventromedial prefrontal cortex and middle occipital gyrus. These results indicate specific effects of active ABM on brain structure. Such changes could relate to clinical effects of ABM.

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

BACKGROUND

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

METHOD

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

RESULTS

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

LIMITATION

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

CONCLUSIONS

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

State and trait neural correlates of the balance between work and nonwork roles

Difficulty managing the demands of work and nonwork roles (often referred to in terms of managing balance) can be detrimental to psychological wellbeing and contribute to occupational burnout. The current study investigated the neural correlates of perceived satisfaction with this balance using both trait and state EEG alpha measures. EEG was recorded from 14 participants in full time employment (12 females, aged 35.1 ± 10.1 years) during a resting state and performance of an auditory oddball task; e-mail and messaging alert sounds were used as target stimuli. It was predicted that dissatisfaction with the balance between work and nonwork roles would be associated with increased resting alpha power, consistent with studies of burnout, and diminished alpha response to oddball distractors, consistent with difficulty suppressing automatic responses to work-related stimuli. Significant correlations between self-reported measures of work/nonwork balance and both resting, and task-related alpha responses, supported our predictions. Furthermore, an exploratory partial correlation between work and nonwork balance and resting EEG, controlling for task-related alpha response, suggested that the three variables were interrelated. We propose that dissatisfaction with work/nonwork balance is associated with a state hypervigilance to work-related cues, and a trait neural marker of fatigue, both symptomatic of lowered cognitive capacity.

Attentional bias toward emotional stimuli in type 2 diabetic Chinese patients with different self-management levels

Extensive evidence has been obtained that supports an association between an attentional bias (AB) toward negative stimuli and vulnerability to mental and behavioral problems; however, diabetes self-management (DSM) behavior in type 2 diabetic patients has not specifically been assessed. The current study investigated whether type 2 diabetic Chinese patients who had different levels of self-management behaviors showed different patterns of AB toward either positive or negative stimuli. A sample of 195 patients completed questionnaires measuring DSM and a modified dot-probe task measuring AB. Patients with low levels of DSM had an avoidance bias for positive stimuli, the regression showed that negative orienting index significantly predicted lower DSM; patients with medium levels of DSM had difficulty in disengaging attention from negative stimuli, the regression showed that negative disengaging index significantly predicted lower DSM; while patients with high levels of DSM had an avoidance bias for negative stimuli and difficulty in disengaging from positive stimuli. An implication of this finding is that the understanding of information processing bias affects DSM and therefore suggests a novel target for prevention and treatment interventions.

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.

A neuromarker of clinical outcome in attention bias modification therapy for social anxiety disorder

BACKGROUND

Attention bias modification (ABM) therapy aims to modify threat-related attention patterns via computerized tasks. Despite showing medium clinical effect sizes for anxiety disorders, underlying neural-cognitive mechanisms of change remain unclear. We used visual mismatch negativity (vMMN), an event-related potential sensitive to violations of learned statistical contingencies, to assess therapy-related contingency extraction processes in healthy participants and in patients with social anxiety disorder (SAD). We then assessed whether vMMN amplitude predicts ABM treatment outcome.

METHODS

A modified version of the dot-probe task was used to elicit vMMN, in which 80% of trials were standard and 20% were deviant. In study 1, 30 healthy adults were randomly assigned to one of two ABM conditions: one in which threat-congruent targets were deviant trials and threat-incongruent targets were standard trials, and another in which the contingency was reversed. Electroencephalography (EEG) was continuously measured and vMMN analyzed. In study 2, 38 patients with SAD underwent six sessions of ABM therapy. We tested whether rule extraction in the ABM task, indicated by vMMN amplitude, predicts treatment outcome.

RESULTS

vMMN clearly emerged over prespecified scalp locations indicating contingency extraction during ABM (study 1). vMMN amplitude predicted clinical improvement after ABM therapy, uniquely accounting for 7% and 14.4% of the variance in clinician-rated and self-reported posttreatment SAD symptoms, respectively.

CONCLUSIONS

vMMN emerges as a neural marker for contingency learning in ABM, suggesting a significant role for contingency extraction processes in the clinical efficacy of this therapy.

Exploring the fMRI based neural correlates of the dot probe task and its modulation by sex and body odor

The dot probe task implicitly cues attention via emotional information, an effect which is especially pronounced for threat-related cues. However, several questions remain unexplored. The first one is whether chemosignals like the androgen-derivative androstadienone can influence such attentional biases. Second, few studies have addressed sex differences regarding attentional biases. Finally, the neural correlates of these potential behavioral effects based on functional magnetic resonance imaging (fMRI) are not known. In two experiments we aimed to answer these questions. A total of 159 healthy individuals (58 oral-contraceptive-users, 42 luteal women, 59 men) were tested. In experiment 1 (behavioral study) we examined attentional biases behaviorally, while in experiment 2 (fMRI study) the dot probe task was complemented by fMRI. Our results provide robust evidence that in healthy participants fearful but not angry or happy faces lead to a strong general attentional bias. Elucidating the neural basis of this effects points to an early processing advantage in bilateral thalamus for valid compared to invalid cued fear. However, this finding was limited to those participants with the strongest attentional biases and was not linked to behavioral measures. Furthermore, no consistent sex or group differences existed neither did the putative human chemosignal androstadienone reliably modulate attentional biases or change neural processing.

Integrating high-density ERP and fMRI measures of face-elicited brain activity in 9-12-year-old children: An ERP source localization study

Social information processing is a critical mechanism underlying children's socio-emotional development. Central to this process are patterns of activation associated with one of our most salient socioemotional cues, the face. In this study, we obtained fMRI activation and high-density ERP source data evoked by parallel face dot-probe tasks from 9-to-12-year-old children. We then integrated the two modalities of data to explore the neural spatial-temporal dynamics of children's face processing. Our results showed that the tomography of the ERP sources broadly corresponded with the fMRI activation evoked by the same facial stimuli. Further, we combined complementary information from fMRI and ERP by defining fMRI activation as functional ROIs and applying them to the ERP source data. Indices of ERP source activity were extracted from these ROIs at three a priori ERP peak latencies critical for face processing. We found distinct temporal patterns among the three time points across ROIs. The observed spatial-temporal profiles converge with a dual-system neural network model for face processing: a core system (including the occipito-temporal and parietal ROIs) supports the early visual analysis of facial features, and an extended system (including the paracentral, limbic, and prefrontal ROIs) processes the socio-emotional meaning gleaned and relayed by the core system. Our results for the first time illustrate the spatial validity of high-density source localization of ERP dot-probe data in children. By directly combining the two modalities of data, our findings provide a novel approach to understanding the spatial-temporal dynamics of face processing. This approach can be applied in future research to investigate different research questions in various study populations.

Ketamine normalizes brain activity during emotionally valenced attentional processing in depression

Background

An urgent need exists for faster-acting pharmacological treatments in major depressive disorder (MDD). The glutamatergic modulator ketamine has been shown to have rapid antidepressant effects, but much remains unknown about its mechanism of action. Functional MRI (fMRI) can be used to investigate how ketamine impacts brain activity during cognitive and emotional processing.

Methods

This double-blind, placebo-controlled, crossover study of 33 unmedicated participants with MDD and 26 healthy controls (HCs) examined how ketamine affected fMRI activation during an attentional bias dot probe task with emotional face stimuli across multiple time points. A whole brain analysis was conducted to find regions with differential activation associated with group, drug session, or dot probe task-specific factors (emotional valence and congruency of stimuli).

Results

A drug session by group interaction was observed in several brain regions, such that ketamine had opposite effects on brain activation in MDD versus HC participants. Additionally, there was a similar finding related to emotional valence (a drug session by group by emotion interaction) in a large cluster in the anterior cingulate and medial frontal cortex.

Conclusions

The findings show a pattern of brain activity in MDD participants following ketamine infusion that is similar to activity observed in HCs after placebo. This suggests that ketamine may act as an antidepressant by normalizing brain function during emotionally valenced attentional processing.

Clinical trial

NCT#00088699: https://www.clinicaltrials.gov/ct2/show/NCT00088699

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The effects of ketamine versus placebo on brain activation were studied using fMRI.

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MDD and healthy participants were tested on an fMRI emotion-based attentional task.

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Ketamine had opposite effects on brain activity in MDD versus healthy participants.

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In MDD, brain activity post-ketamine was similar to healthy controls post-placebo.

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These findings suggest that ketamine may act by normalizing brain function.

A Latent Variable Approach to Differentiating Neural Mechanisms of Irritability and Anxiety in Youth

IMPORTANCE

Comorbidity is ubiquitous in psychiatry, but it is unclear how to differentiate neural mechanisms of co-occurring symptoms. Pediatric irritability and anxiety symptoms are prevalent and frequently co-occur. Threat orienting is pertinent to both phenotypes and is an ideal context in which to examine their unique and common neural mechanisms.

OBJECTIVES

To decompose the unique and shared variances of pediatric irritability and anxiety symptoms and to determine neural correlates of these differentiated phenotypes during threat orienting.

DESIGN, SETTING, AND PARTICIPANTS

This investigation was a cross-sectional functional magnetic resonance imaging study. The setting was a research clinic at the National Institute of Mental Health. Participants were youth aged 8 to 18 years spanning multiple diagnostic categories (141 youth with disruptive mood dysregulation disorder, anxiety disorder, and/or attention-deficit/hyperactivity disorder and 56 healthy youth). This combination provided wide variation in levels of irritability and anxiety symptoms. Data were acquired between June 30, 2012, and June 28, 2016.

MAIN OUTCOMES AND MEASURES

Participants and parents rated youth's irritability on the Affective Reactivity Index and anxiety on the Screen for Child Anxiety Related Emotional Disorders. Bifactor analysis decomposed the unique and shared variances. A functional magnetic resonance imaging dot-probe task assessed attention orienting to angry (ie, threat) vs neutral faces. Whole-brain analyses examined associations between the bifactor-derived phenotypes and both neural activity and amygdala functional connectivity.

RESULTS

Among 197 participants included in the final analysis, the mean (SD) age was 13.1 (2.7) years, and 91 (46.2%) were female. The best-fit bifactor model (Comparative Fit Index, 0.959; Root Mean Square Error of Approximation, 0.066) included unique factors of parent-reported irritability, youth-reported irritability, and anxiety, as well as a common factor of negative affectivity. When the task required attention away from threat, higher parent-reported irritability was associated with increased activity in the insula, caudate, dorsolateral and ventrolateral prefrontal cortex, and inferior parietal lobule (t189≥4.15 for all, P < .001 for all). In contrast, higher anxiety was associated with decreased amygdala connectivity to the cingulate, thalamus, and precentral gyrus (t189≤-4.19 for all, P < .001 for all). These distinctive neural correlates did not emerge using a diagnostic approach.

CONCLUSIONS AND RELEVANCE

A latent variable approach to parsing co-occurring symptom dimensions revealed a novel double dissociation. During orientation away from threat, only irritability was associated with neural activity, whereas only anxiety was associated with amygdala connectivity. Despite the challenges of symptom co-occurrence for clinical neuroscience, data-driven phenotyping may facilitate a path forward.

Multisession Cognitive Bias Modification Targeting Multiple Biases in Adolescents with Elevated Social Anxiety

Research studies applying cognitive bias modification of attention (CBM-A) and interpretations (CBM-I) training to reduce adolescent anxiety by targeting associated cognitive biases have found mixed results. This study presents a new multi-session, combined bias CBM package, which uses a mix of training techniques and stimuli to enhance user-engagement. We present preliminary data on its viability, acceptability and effectiveness on reducing symptoms and biases using an A–B case series design. 19 adolescents with elevated social anxiety reported on their social anxiety, real-life social behaviours, general anxiety, depression, and cognitive biases at pre/post time-points during a 2-week baseline phase and a 2-week intervention phase. Retention rate was high. Adolescents also reported finding the CBM training helpful, particularly CBM-I. Greater reductions in social anxiety, negative social behaviour, and general anxiety and depression, characterised the intervention but not baseline phase. There was a significant correlation between interpretation bias change and social anxiety symptom change. Our enhanced multi-session CBM programme delivered in a school-setting appeared viable and acceptable. Training-associated improvements in social anxiety will require further verification in a study with an active control condition/group.

Reliability of neural activation and connectivity during implicit face emotion processing in youth

Face emotion imaging paradigms are widely used in both healthy and psychiatric populations. Here, in children and adolescents, we evaluate the test-retest reliability of blood oxygenation-level dependent (BOLD) activation and task-based functional connectivity on a widely used implicit face emotion processing task (i.e., gender labeling). Twenty-five healthy youth (M age = 13.97 year s; 60% female) completed two functional magnetic resonance imaging (fMRI) scan sessions approximately two months apart. Participants identified the gender of faces displaying angry, fearful, happy, and neutral emotions. A Bayesian adaptation of the intraclass correlation (ICC) assessed reliability of evoked BOLD activation and amygdala seed-based functional connectivity on task events vs. baseline as well as contrasts between face emotions. For each face emotion vs. baseline, good reliability of activation was demonstrated across key emotion processing regions including middle, medial, and inferior frontal gyri. However, contrasts between face emotions yielded variable results. Contrasts of angry to neutral or happy faces exhibited good reliability of amygdala connectivity to prefrontal regions. Contrasts of fearful to happy faces exhibited good reliability of activation in the anterior cingulate. Findings inform the reproducibility literature and emphasize the need for continued evaluation of task reliability.

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.

Intraclass correlation: Improved modeling approaches and applications for neuroimaging

Intraclass correlation (ICC) is a reliability metric that gauges similarity when, for example, entities are measured under similar, or even the same, well-controlled conditions, which in MRI applications include runs/sessions, twins, parent/child, scanners, sites, and so on. The popular definitions and interpretations of ICC are usually framed statistically under the conventional ANOVA platform. Here, we provide a comprehensive overview of ICC analysis in its prior usage in neuroimaging, and we show that the standard ANOVA framework is often limited, rigid, and inflexible in modeling capabilities. These intrinsic limitations motivate several improvements. Specifically, we start with the conventional ICC model under the ANOVA platform, and extend it along two dimensions: first, fixing the failure in ICC estimation when negative values occur under degenerative circumstance, and second, incorporating precision information of effect estimates into the ICC model. These endeavors lead to four modeling strategies: linear mixed-effects (LME), regularized mixed-effects (RME), multilevel mixed-effects (MME), and regularized multilevel mixed-effects (RMME). Compared to ANOVA, each of these four models directly provides estimates for fixed effects and their statistical significances, in addition to the ICC estimate. These new modeling approaches can also accommodate missing data and fixed effects for confounding variables. More importantly, we show that the MME and RMME approaches offer more accurate characterization and decomposition among the variance components, leading to more robust ICC computation. Based on these theoretical considerations and model performance comparisons with a real experimental dataset, we offer the following general-purpose recommendations. First, ICC estimation through MME or RMME is preferable when precision information (i.e., weights that more accurately allocate the variances in the data) is available for the effect estimate; when precision information is unavailable, ICC estimation through LME or the RME is the preferred option. Second, even though the absolute agreement version, ICC(2,1), is presently more popular in the field, the consistency version, ICC(3,1), is a practical and informative choice for whole-brain ICC analysis that achieves a well-balanced compromise when all potential fixed effects are accounted for. Third, approaches for clear, meaningful, and useful result reporting in ICC analysis are discussed. All models, ICC formulations, and related statistical testing methods have been implemented in an open source program 3dICC, which is publicly available as part of the AFNI suite. Even though our work here focuses on the whole-brain level, the modeling strategy and recommendations can be equivalently applied to other situations such as voxel, region, and network levels.

Event-related potentials of attentional bias toward faces in the dot-probe task: A systematic review

The dot-probe task is a common task to assess attentional bias toward different stimuli and how groups differ (e.g., attentional bias in anxiety disorders). However, measuring reaction time has been suggested to be unreliable. Neuroimaging methods such as fMRI were shown to be more reliable in assessing attentional bias, but fMRI has poor temporal resolution and therefore cannot assess timing of attention. ERPs have been used to examine the time course of attentional bias. Although ERP research may be more reliable than reaction time, there have been inconsistencies in the literature. This review systematically searched for articles that used the dot-probe task with facial expressions and measured neural correlates with ERP. We found that some of the inconsistencies might be the cause of methodological differences (e.g., timing of stimuli), differences in emotional expression, and/or sample differences (e.g., sex, age, etc.). Suggestions on how future research could address the issues presented in this review were discussed.