Attention bias modification augments cognitive-behavioral group therapy for social anxiety disorder: a randomized controlled trial

Cognitive behavioral group therapy for social anxiety disorder - A critical review of methodological designs

Social anxiety disorder (SAD) is highly prevalent with significant lifetime impacts, especially when left untreated. Cognitive behavioral therapy is the current gold standard treatment with successful patient outcomes. Cognitive behavioral group therapy (CBGT) is one form that provides unique benefits to participants including normalization of symptoms and social support, as well as providing increased access to treatment at a lower per-session cost. Research on this mode of treatment has been ongoing for over 20 years, but we still have much to learn about its overall efficacy. The goals of this critical review were to summarize and evaluate the most current research, including an analysis of the overall methodological design quality, and provide recommendations for the enhancement of future studies based on best practices. Recent studies included some best practice design elements used in measuring efficacy such as the use of comparison groups, masking procedures, fidelity assessments, and consideration of clinical significance in outcomes. However, many gaps exist such as a lack of consensus around measures and therapy manuals, as well as baseline competencies of facilitators. Future studies should consider incorporating additional best practice elements aligning with study goals to strengthen designs and provide the field with even more confidence in this mode of treatment.

Acute Augmentations to Psychological Therapies in Eating Disorders: A Systematic Review and Meta-Analysis

PURPOSE OF REVIEW

The purpose of this systematic review and meta-analysis was to examine the use and efficacy of acute augmentation therapies in eating disorders.

RECENT FINDINGS

A meta-analysis addressing this topic across psychological disorders found augmentation significantly improved therapy outcome with strongest findings for augmentations targeting biological mechanisms; however, only one study examined eating disorders. Our systematic review identified 29 studies examining people with eating disorders (N = 1831 participants, 93.7% female), of which 17 RCTs (n = 1162 participants) were included in the meta-analysis. Small subgroups of acute augmentations were identified. Adding acute augmentations to an intervention was effective in 72.4% of studies, with a significant effect on eating disorder outcomes (Hedges' g = 0.14, 95% CI: [0.02, 0.26]). Acute augmentation looks to be a promising approach regardless of weight status or whether it is added to treatment as usual or a single therapy approach.

Towards implementation of cognitive bias modification in mental health care: State of the science, best practices, and ways forward

Cognitive bias modification (CBM) has evolved from an experimental method testing cognitive mechanisms of psychopathology to a promising tool for accessible digital mental health care. While we are still discovering the conditions under which clinically relevant effects occur, the dire need for accessible, effective, and low-cost mental health tools underscores the need for implementation where such tools are available. Providing our expert opinion as Association for Cognitive Bias Modification members, we first discuss the readiness of different CBM approaches for clinical implementation, then discuss key considerations with regard to implementation. Evidence is robust for approach bias modification as an adjunctive intervention for alcohol use disorders and interpretation bias modification as a stand-alone intervention for anxiety disorders. Theoretical predictions regarding the mechanisms by which bias and symptom change occur await further testing. We propose that CBM interventions with demonstrated efficacy should be provided to the targeted populations. To facilitate this, we set a research agenda based on implementation frameworks, which includes feasibility and acceptability testing, co-creation with end-users, and collaboration with industry partners.

Reliability (or lack thereof) of smartphone ecological momentary assessment of visual dot probe attention bias toward threat indices

BACKGROUND AND OBJECTIVES

Cognitive bias theories posit that generalized anxiety disorder (GAD) and social anxiety disorder (SAD) are entwined with attention bias toward threats, commonly indexed by faster response time (RT) on threat-congruent (vs. threat-incongruent) trials on the visual dot probe. Moreover, although smartphone ecological momentary assessment (EMA) of the visual dot probe has been developed, their psychometric properties are understudied. This study thus aimed to assess the reliability of 8 smartphone-delivered visual dot probe attention bias and related indices in persons with and without GAD and SAD.

METHODS

Community-dwelling adults (n = 819; GAD: 64%; SAD: 49%; Mixed GAD and SAD: 37%; Non-GAD/SAD Controls: 24%) completed a five-trial smartphone-delivered visual dot probe for a median of 60 trials (12 sessions x 5 trials/session) and an average of 100 trials (20 sessions x 5 trials/session).

RESULTS

As hypothesized, Global Attention Bias Index, Disengagement Effect, and Facilitation Bias had low-reliability estimates. However, retest-reliability and internal reliability were good for Trial-Level Bias Scores (TLBS) (Bias Toward Treat: intra-class correlation coefficients (ICCs) = 0.626-0.644; split-half r = 0.640-0.670; Attention Bias Variability: ICCs = 0.507-0.567; split-half r = 0.520-0.580) and (In)congruent RTs. Poor retest-reliability and internal reliability estimates were consistently observed for all traditional attention bias and related indices but not TLBS.

LIMITATIONS

Our visual dot probe EMA should have administered ≥320 trials to match best-practice guidelines based on similar laboratory studies.

CONCLUSIONS

Future research should strive to examine attention bias paradigms beyond the dot-probe task that evidenced meaningful test-retest reliability properties in laboratory and real-world naturalistic settings.

A transdiagnostic meta-analysis of acute augmentations to psychological therapy

At least half of all patients with mental health disorders do not respond adequately to psychological therapy. Acutely enhancing particular biological or psychological processes during psychological therapy may improve treatment outcomes. However, previous studies are confined to specific augmentation approaches, typically assessed within single diagnostic categories. Our objective was to assess to what degree acute augmentations of psychological therapy reduce psychiatric symptoms and estimate effect sizes of augmentation types (for example, brain stimulation or psychedelics). We searched Medline, PsycINFO and Embase for controlled studies published between database inception and 25 May 2022. We conducted a preregistered random-effects meta-analysis (PROSPERO CRD42021236403). We identified 108 studies (N = 5,889). Acute augmentation significantly reduced the severity of mental health problems (Hedges' g = -0.27, 95% CI: [-0.36, -0.18]; P < 0.0001), particularly for the transdiagnostic dimensions 'Fear' and 'Distress'. This result survived a trim-and-fill analysis to account for publication bias. Subgroup analyses revealed that pharmacological, psychological and somatic augmentations were effective, but to varying degrees. Acute augmentation approaches are a promising route to improve outcomes from psychological therapy.

Resting state connectivity predictors of symptom change during gaze-contingent music reward therapy of social anxiety disorder

BACKGROUND

Social anxiety disorder (SAD) is common, first-line treatments are often only partially effective, and reliable predictors of treatment response are lacking. Here, we assessed resting state functional connectivity (rsFC) at pre-treatment and during early treatment as a potential predictor of response to a novel attention bias modification procedure, gaze-contingent music reward therapy (GC-MRT).

METHODS

Thirty-two adults with SAD were treated with GC-MRT. rsFC was assessed with multi-voxel pattern analysis of fMRI at pre-treatment and after 2-3 weeks. For comparison, 20 healthy control (HC) participants without treatment were assessed twice for rsFC over the same time period. All SAD participants underwent clinical evaluation at pre-treatment, early-treatment (week 2-3), and post-treatment.

RESULTS

SAD and depressive symptoms improved significantly from pre-treatment to post-treatment. After 2-3 weeks of treatment, decreased connectivity between the executive control network (ECN) and salience network (SN), and increased connectivity within the ECN predicted improvement in SAD and depressive symptoms at week 8. Increased connectivity between the ECN and default mode network (DMN) predicted greater improvement in SAD but not depressive symptoms at week 8. Connectivity within the DMN decreased significantly after 2-3 weeks of treatment in the SAD group, while no changes were found in HC over the same time interval.

CONCLUSION

We identified early changes in rsFC during a course of GC-MRT for SAD that predicted symptom change. Connectivity changes within the ECN, ECN-DMN, and ECN-SN may be related to mechanisms underlying the clinical effects of GC-MRT and warrant further study in controlled trials.

The Moderation Effect of Cognitive Tendencies on the Relationship Between Fear of COVID-19 and Post-Traumatic Stress Symptoms in Chinese Children

COVID-19 pandemic is a public health emergency with potential traumatizing effects on children. However, not many studies have been devoted to investigating the association between fear of COVID-19 and post-traumatic stress symptoms (PTSS) in children during the pandemic. Also, if the association is modulated by cognitive tendencies to focus on negative and positive information in children is unknown. The study recruited 122 native Chinese children from a primary school in mainland China. Self-reported psychological inventories were used to assess the above variables. The prevalence rate of PTSS in Chinese children was approximately 15.1%. Girls had higher post-traumatic stress levels than boys. Fear of COVID-19 was associated with higher level of post-traumatic stress in children. Only cognitive tendency to focus on negative information was significantly associated with the level of post-traumatic stress in children. Moreover, cognitive tendency to focus on negative information was a significant moderator of the relationship between fear of COVID-19 and PTSS. Generalization of the results to adults should be cautious. It was concluded that stronger fear of COVID-19 was related to more PTSS in children. The association of fear of COVID-19 with PTSS was significant only for children with strong tendency to focus on negative information. Cognitive interventions for PTSS may need to be delivered to children who have both strong fear of COVID-19 and strong tendency to focus on negative information.

Cognitive behavioral therapy (CBT) plus attention bias modification (ABM) reduces anxiety sensitivity and depressive symptoms in panic disorder: A pilot randomized trial

BACKGROUND

Cognitive bias theories propose that reducing threat hypervigilance in mental disorders can augment cognitive behavioral therapy (CBT) outcomes. However, no studies have tested whether adding attention bias modification (ABM) can effectively enhance CBT's effects on anxiety sensitivity (AS), electromyography (EMG), and skin conductance (SC) for panic disorder (PD). This pilot randomized controlled trial (RCT) thus aimed to evaluate the efficacy of CBT + ABM (vs. CBT plus attention training placebo; PBO) on those outcomes.

METHOD

This study is a secondary analysis (Baker et al., 2020). Adults with PD were randomized to receive CBT + ABM (n = 11) or CBT + PBO (n = 12). Before each of the first five CBT sessions, CBT + ABM and CBT + PBO participants completed a 15-min ABM task or attention training PBO, respectively. AS and depression severity as well as SC and EMG during habituation to a loud-tone startle paradigm were assessed. Hierarchical Bayesian analyses were conducted.

RESULTS

During pre-post-treatment and pre-follow-up, CBM + ABM (vs. CBT + PBO) led to a notably greater reduction in ASI-Physical (between-group d = -1.26 to -1.25), ASI-Cognitive (d = -1.16 to -1.10), and depression severity (d = -1.23 to -0.99). However, no between-group difference was observed for ASI-Social, EMG, or SC indices.

DISCUSSION

Adding a brief computerized ABM intervention to CBT for PD protocols may enhance therapeutic change.

The effect of immersive virtual reality-based attentional bias modification on anxiety mitigation in healthy population

The present study compared an immersive virtual reality-based attentional bias modification (immersive VR-ABM) with the desktop version of the VR-ABM and an immersive virtual reality-based game (immersive VR-game) to examine the possible effect of the immersive presence on self-reported emotional reactions to a stressful task. One hundred and twenty participants were randomly assigned into three groups, and each group received a three-turn induction-intervention training. Anxiety symptoms were assessed at pre-induction, post-induction, and post-training. Results showed that virtual reality-based anxiety was induced and alleviated successfully in all three groups, but only the immersive VR-ABM group showed an accumulated effect on self-reported anxiety across sessions. The attentional bias based on probe latencies indicated no significant change in either the immersive or desktop VR-ABM groups. The present findings support the hypothesized VR-ABM's effect on self-reported anxiety at the immersive presence. The practical implications of using immersive VR-ABM are discussed for obtaining ecological validity.

Development and initial validation of the Visual Social Anxiety Scale (VSAS): Could a picture be worth a thousand words?

Accurate assessment is crucial for determining appropriate therapeutic interventions for social anxiety and conducting sound clinical research. While self-report measures of social anxiety are widely used in both research and clinical settings, they have several drawbacks inherent to their textual nature. Here, we describe the development and initial validation of the Visual Social Anxiety Scale (VSAS), a novel picture-based self-report measure of social anxiety, based on the well-established widely-used Liebowitz Social Anxiety Scale (LSAS). Specifically, the 24 items of the LSAS were used as the basis for social situations to be included in the VSAS. First, pictures to serve as VSAS items were selected using a rigorous two-phase process (four pilot studies; n = 225). Next, reliability (internal consistency, test-retest) and validity (convergent, discriminant) were explored with new participants (n = 304) who completed the VSAS and a battery of additional self-report questionnaires, delivered in a random order. The VSAS was completed again a month later (n = 260/304). The VSAS showed high internal consistency and test-retest reliability, and good convergent and discriminant validities. VSAS correlations with convergent measures were significantly greater than its correlations with discriminant measures. Thus, the VSAS shows initial promise as a novel picture-based self-report measure of social anxiety.

Does attention bias modification reduce anxiety in socially anxious college students? An experimental study of potential moderators and considerations for implementation

According to cognitive models, preferential attention to social threat contributes to maintenance of social anxiety. Socially anxious individuals are known to show attention biases to threatening stimuli, although there is inconsistency in the literature with regards to the type of attentional biases they present. This study examines the effect of attention bias modification (ABM) for social anxiety in non-treatment-seeking college students meeting social anxiety disorder criteria, taking into consideration previous mixed results regarding its effectiveness. Attention bias levels and types (i.e. vigilance vs avoidance) at baseline were examined and considered as potential moderators of ABM effects. Sixty-eight socially anxious individuals were randomly allocated to ABM vs placebo groups. A structured interview and self-report assessment were completed at pre-treatment and post-treatment. Results showed half of the participants presented few attention biases at baseline, and the rest presented either vigilance or avoidance. Participants with low attention biases scored higher in social anxiety than those showing avoidance and there was no difference between those showing vigilance vs avoidance. No significant effects from pre to post treatment were observed in attention biases, self-report or structured interview of anxiety in the ABM group. Baseline attention biases did not moderate these effects. Results are discussed with regards to implications for future research towards the creation of more effective protocols, based on the needs of heterogeneous social anxiety sub-groups.

The effect of depression on treatment outcome in social anxiety disorder: an individual-level meta-analysis

Social anxiety disorder (SAD) is highly comorbid with depression. In the present meta-analysis, we conducted the first individual-level examination of the association between pre-treatment depression and improvement in social anxiety symptoms during treatment. We identified eligible studies on cognitive behavior therapy (CBT) and pharmacotherapy for SAD and contacted authors to obtain individual-level data. We obtained these data from 41 studies, including 46 treatment conditions (n = 4,381). Our results showed that individuals who had high levels of depression at pre-treatment experienced greater decreases in social anxiety symptoms from pre- to post-treatment, but not at follow-up. When analyzing treatment modalities (individual CBT, group CBT, internet-delivered CBT, and pharmacotherapy), we found that depressive symptoms were associated with better post-treatment outcomes for individual CBT and internet-delivered CBT, but not for pharmacotherapy or group CBT. Our findings suggest that depression does not negatively affect treatment outcome in SAD and may even lead to improved outcomes in some treatment formats. Clinical implications of these findings are discussed.

Increased attention allocation to socially threatening faces in social anxiety disorder: A replication study

BACKGROUND

Threat-related attention bias has been implicated in the etiology and maintenance of social anxiety disorder (SAD), with attentional research increasingly using eye-tracking methodology to overcome the poor psychometric properties of response-time-based tasks and measures. Yet, extant eye-tracking research in social anxiety has mostly failed to report on psychometrics and attempts to replicate past results are rare. Therefore, we attempted to replicate a previously published eye-tracking study of gaze patterns in socially anxious and nonanxious participants as they viewed social threatening and neutral faces, while also exploring the psychometric properties of the attentional measures used.

METHODS

Gaze was monitored as participants freely viewed 60 different matrices comprised of eight socially-threatening and eight neutral faces, presented for 6000 ms each. Gaze patterns directed at threat and neutral areas of interest (AOIs) were compared by group. Internal consistency and test-retest reliability were also evaluated.

RESULTS

Relative to healthy controls, socially anxious patients dwelled significantly longer on threat faces, replicating prior findings with the same task. Internal consistency of total dwell time on threat and neutral AOIs was high, and two-week test-retest reliability was acceptable.

LIMITATIONS

Test-retest reliability was only examined for the control group, which had a small sample size.

CONCLUSION

Increased dwell time on socially threatening stimuli is a reliable, stable, and generalizable measure of attentional bias in adults with social anxiety.

Can attention bias modification augment the effect of CBT for anxiety disorders? A systematic review and meta-analysis

Attention Bias Modification (ABM) is a novel computerized therapy for anxiety disorders and is thought to augment the effect of Cognitive Behavior Therapy (CBT) as it may target different mechanisms. Recently, a growing number of studies have examined the combined effects of ABM and CBT on clinically anxious patients, with mixed results. This review examined the combined efficacy of ABM and CBT. A literature search was conducted in four main databases: PsycINFO, Embase, Pubmed and the Cochrane library, resulting in 11 randomized studies. The combination of ABM and CBT had small but significant effects on clinician-rated anxiety symptoms and attention bias towards threat compared to the control group, while ESs for anxiety (all measures), self-reported or parent-reported anxiety measures and depression symptoms were non-significant. Studies in which ABM was conducted as an integral part of each CBT session yielded greater reduction in anxiety symptoms than those conducting ABM and CBT at separate time points. Older participants and patients with social anxiety disorder tended to benefit less from the combination of ABM and CBT based on bias scores. This study may provide preliminary evidence that ABM and CBT have the potential to complement each other, especially when they are conducted integrally.

Relationship Between Attention Bias and Psychological Index in Individuals With Chronic Low Back Pain: A Preliminary Event-Related Potential Study

Introduction: Attention bias towards pain-related information exists in patients with chronic pain, and recently, attention bias modification (ABM) training has been administered to patients with chronic pain. In this study, we conducted an attention bias modification task in conjunction with event-related potential measurements for individuals with chronic low back pain (LBP) and investigated the relationship between attention bias and psychological assessment.

Methods: Eleven women and two men with chronic LBP participated in the study.

Results: The Japanese version of the STarT Back Screening Tool (J-SBST) total score was significantly correlated with the N1 amplitude of Cz. The J-SBST psychological score was significantly correlated with the N1 amplitude of Cz and with reaction time (RT). The Japanese version of the Pain Catastrophizing Scale (PCS) and Japanese version of the Beck Depression Inventory-Second Edition (BDI-II) scores were significantly correlated with the P2 amplitude at Fz (only PCS), Cz, and Pz.

Conclusions: Our findings suggest that J-SBST, which provides a comprehensive evaluation of psychological factors, PCN with measuring of catastrophizing in the context of actual or anticipated pain, and BDI-II, can likely help identify chronic LBP patients with attention bias. For chronic LBP patients who are classified according to J-SBST or PCN pain-related outcome improvement with ABM training can be expected.

A pilot study augmenting cognitive behavioral therapy for panic disorder with attention bias modification: Clinical and psychophysiological outcomes

BACKGROUND AND OBJECTIVES

Studies show that attentional bias towards threat is a key maintenance factor for panic disorder (PD). Attentional bias may be an important mechanism of symptom reduction, and thus, a useful target for optimizing outcomes. The current study examined whether an attention bias modification (ABM) task enhanced CBT outcomes. Multiple methods for assessing PD were used, including physiological measurement and clinician-rated assessment.

METHODS

Adults with panic disorder (N = 24) received seven sessions of CBT with either ABM or sham attention tasks. Psychophysiological reaction to a loud tones startle paradigm was assessed before and after treatment.

RESULTS

Across both groups, panic symptom severity decreased with CBT. The ABM group showed greater reductions in PD symptoms compared to the placebo group. Notably, however, changes in attentional bias were not associated with symptom reductions across groups. No significant group differences on psychophysiological assessment were observed.

LIMITATIONS

This study is limited by the small sample size, which rendered our power to investigate mediators and moderators insufficient. More research is needed to validate the effect of attention bias modification on attentional bias to threat.

CONCLUSIONS

This pilot study suggests that future research should investigate attentional bias in conjunction with CBT. A larger sample would provide opportunity to further investigate the mechanisms through which ABM works, along with potential moderating factors and the use of psychophysiological measurements in panic disorder.

Do depressive symptoms affect the outcome of treatments for SAD? A meta analysis of randomized controlled trials

Individuals with social anxiety disorder (SAD) typically have elevated depressive symptoms. In the present meta-analysis, we reviewed the treatment outcome literature in SAD and examined whether depressive symptoms predict treatment outcome. We focused on randomized controlled trials of cognitive behavior therapy (individual face-to-face, group format, and internet-delivered format) and randomized controlled trials of pharmacotherapy. After implementing exclusion criteria, 108 studies with 133 treatment conditions (n = 12,913 participants) were included in the meta-analysis. Our findings indicated that treatments for SAD were efficacious and significantly reduced social anxiety symptoms across all treatment modalities. Exclusion of individuals with MDD or high levels of depression did not affect outcome at post-treatment or at follow-up. However, we found that elevated depressive symptoms were associated with greater reductions in social anxiety symptoms from pre-treatment to post-treatment. Importantly, this effect was above and beyond pre-treatment levels of social anxiety. Finally, analyzing treatment modalities separately, we found that depressive symptoms were associated with better post-treatment outcomes in individual face-to-face CBT but not in other modalities. Clinical and research implications of these findings are discussed.

A systematic review of treatments targeting cognitive biases in socially anxious adolescents: Special Section on "Translational and Neuroscience Studies in Affective Disorders" Section Editor, Maria Nobile MD, PhD

BACKGROUND

Adolescence is a period of brain plasticity that is affected by social and affective stimuli. Adaptive neurodevelopmental changes in the context of complex social situations may precipitate or exacerbate cognitive biases (i.e., attention and/or interpretation biases) and predispose at-risk individuals to symptoms of social anxiety.

METHODS

This systematic review followed the PRISMA guidelines. Nine adolescent studies were examined including 3 studies using Cognitive Bias Modification Training (CBMT) to target attention biases (CBMT-A), 3 studies using CBMT to target interpretation biases (CBMT-I), and 3 aimed at reducing both attention and interpretation biases.

RESULTS

The studies of CBMT-A alone did not find significant effects on cognitive and clinical outcomes. However, studies of CBMT-I alone showed some improvement in interpretation bias. The combination of CBMT-A and CBMT-I appeared promising in reducing both attentionl and interpretation biases.

LIMITATIONS

The paucity of studies and the heterogeneity across studies (e.g., format of CBMT, assessment measures) limit the calculation of overall effect sizes and the examination of predictors, moderators, and mediators of outcome.

CONCLUSIONS

Technology-driven interventions such as CBMT have the potential to extend treatments outside the clinic setting and to augment current therapies for social anxiety. Further research is needed to develop CBMT procedures that optimize learning in group and real-world settings and to identify predictors of treatment response. Understanding the neural correlates of response to CBMT may help identify future targets for intervention.

Bias-contingent attention bias modification and attention control training in treatment of PTSD: a randomized control trial

BACKGROUND

Randomized control trials (RCTs) comparing attention control training (ACT) and attention bias modification (ABM) in posttraumatic stress disorder (PTSD) have shown mixed results. The current RCT extends the extant literature by comparing the efficacy of ACT and a novel bias-contingent-ABM (BC-ABM), in which direction of training is contingent upon the direction of pre-treatment attention bias (AB), in a sample of civilian patients with PTSD.

METHODS

Fifty treatment-seeking civilian patients with PTSD were randomly assigned to either ACT or BC-ABM. Clinician and self-report measures of PTSD and depression, as well as AB and attention bias variability (ABV), were acquired pre- and post-treatment.

RESULTS

ACT yielded greater reductions in PTSD and depressive symptoms on both clinician-rated and self-reported measures compared with BC-ABM. The BC-ABM condition successfully shifted ABs in the intended training direction. In the ACT group, there was no significant change in ABV or AB from pre- to post-treatment.

CONCLUSIONS

The current RCT extends previous results in being the first to apply ABM that is contingent upon AB at pre-treatment. This personalized BC-ABM approach is associated with significant reductions in symptoms. However, ACT produces even greater reductions, thereby emerging as a promising treatment for PTSD.

Neurobiological Markers of Resilience to Depression Following Childhood Maltreatment: The Role of Neural Circuits Supporting the Cognitive Control of Emotion

BACKGROUND

Childhood adversity is strongly linked to negative mental health outcomes, including depression and anxiety. Leveraging cognitive neuroscience to identify mechanisms that contribute to resilience in children with a history of maltreatment may provide viable intervention targets for the treatment or prevention of psychopathology. We present a conceptual model of a potential neurobiological mechanism of resilience to depression and anxiety following childhood adversity. Specifically, we argue that neural circuits underlying the cognitive control of emotion may promote resilience, wherein a child's ability to recruit the frontoparietal control network to modulate amygdala reactivity to negative emotional cues-such as during cognitive reappraisal-buffers risk for internalizing symptoms following exposure to adversity.

METHODS

We provide preliminary support for this model of resilience in a longitudinal sample of 151 participants 8 to 17 years of age with (n = 79) and without (n = 72) a history of childhood maltreatment who completed a cognitive reappraisal task while undergoing functional magnetic resonance imaging.

RESULTS

Among maltreated youths, those who were better able to recruit prefrontal control regions and modulate amygdala reactivity during reappraisal exhibited lower risk for depression over time. By contrast, no association was observed between neural functioning during reappraisal and depression among youths without a history of maltreatment.

CONCLUSIONS

These preliminary findings support the hypothesis that children who are better able to regulate emotion through recruitment of the frontoparietal network exhibit greater resilience to depression following childhood maltreatment. Interventions targeting cognitive reappraisal and other cognitive emotion regulation strategies may have potential for reducing vulnerability to depression among children exposed to adversity.

Acceptance and Commitment Therapy Preceded by Attention Bias Modification on Residual Symptoms in Depression: A 12-Month Follow-Up

Depression is a highly recurrent disorder with limited treatment alternatives for reducing risk of subsequent episodes. Acceptance and commitment therapy (ACT) and attention bias modification (ABM) separately have shown some promise in reducing depressive symptoms. This study investigates (a) if group-based ACT had a greater impact in reducing residual symptoms of depression over a 12-month follow-up than a control condition, and (b) if preceding ACT with ABM produced added benefits. This multisite study consisted of two phases. In phase 1, participants with a history of depression, currently in remission (N = 244), were randomized to either receive 14 days of ABM or a control condition. In phase 2, a quasi- experimental design was adopted, and only phase-1 participants from the Sørlandet site (N = 124) next received an 8-week group-based ACT intervention. Self-reported and clinician-rated depression symptoms were assessed at baseline, immediately after phase 1 and at 1, 2, 6, and 12 months after the conclusion of phase 1. At 12-month follow-up, participants who received ACT exhibited fewer self-reported and clinician-rated depressive symptoms. There were no significant differences between ACT groups preceded by ABM or a control condition. There were no significant differences between ACT groups preceded by ABM or a control condition. Group-based ACT successfully decreased residual symptoms in depression over 12 months, suggesting some promise in preventing relapse.

Insula activation is modulated by attention shifting in social anxiety disorder

Social anxiety disorder (SAD) is characterized by exaggerated reactivity to social threat, often documented by biased attention to threatening information, and increased activation in brain regions involved in salience/threat processing. Attention training has been developed to ameliorate the attention bias documented in individuals with SAD, with mixed results. We investigated patterns of brain activation underlying acute attention modulation in 41 participants (29 with SAD and 12 health controls). We then investigated how brain activation changed over time in both groups in response to a 4-session attention training protocol (toward threat, away from threat, no-training control). Results revealed diminished pre-training deactivation in the insula in SAD participants during attention modulation. SAD participants also demonstrated an increase in insula deactivation over time, suggestive of an improvement in attention modulation of emotion, and this was associated with a decrease in symptom severity. Attention training did not, itself, lead to clinical improvement, though there was a trend level effect of training toward threat on increased insula deactivation over time. While deficits in attentional control and emotion modulation are documented in individuals with SAD, current attention training protocols are not robustly effective in ameliorating aberrant functioning. Pursuit of training protocols that have more robust impacts on the relevant neural circuitry may have some value.