When expanding training from working memory to emotional working memory: not only improving explicit emotion regulation but also implicit negative control for anxious individuals

Does working memory training improve emotion regulation and reduce internalizing symptoms? A pair of three-level meta-analyses

BACKGROUND

Emotional dysfunction is a core feature of many mental disorders. Working memory training (WM-T) is promising to improve emotion regulation and reduce internalizing symptoms (anxiety and depressive symptoms), but the results are mixed. Therefore, we conducted meta-analyses to clarify these mixed results.

METHODS

We searched Web of Science, PubMed, ScienceDirect, and EBSCO to identify relevant studies and screened the references. The effect size was calculated using Hedges' g. Three-level, random-effects models were run using metafor in R.

RESULTS

The current study included 44 articles, of which 29 were involved with emotion regulation, and 30 were involved with internalizing symptoms. The results showed that WM-T could yield emotional benefits, but the benefits were confined to enhancing explicit emotional regulation capacity and reducing anxiety symptoms. For the meta-analysis regarding the effect of WM-T on emotion regulation, there was no significant moderator. For the meta-analysis regarding the effect of WM-T on internalizing symptoms, the emotional valence of the material and control group were statistically significant moderators.

CONCLUSION

WM-T could yield certain emotional effects, but only to improve explicit emotion regulation capacity and reduce anxiety symptoms. In addition, some measures could enhance the effect, such as targeting specific populations, increasing the number of training sessions (≥15) or duration (>450 minutes), using negative material, and using n-back training tasks.

Changes in affective control covary with changes in mental health difficulties following affective control training (AffeCT) in adolescents

BACKGROUND

Everyday affective fluctuations are more extreme and more frequent in adolescence compared to any other time in development. Successful regulation of these affective experiences is important for good mental health and has been proposed to depend on affective control. The present study examined whether improving affective control through a computerised affective control training app (AffeCT) would benefit adolescent mental health.

METHODS

One-hundred and ninety-nine participants (11-19 years) were assigned to complete 2 weeks of AffeCT or placebo training on an app. Affective control (i.e. affective inhibition, affective updating and affective shifting), mental health and emotion regulation were assessed at pre- and post-training. Mental health and emotion regulation were assessed again one month and one year later.

RESULTS

Compared with the placebo group, the AffeCT group showed significantly greater improvements in affective control on the trained measure. AffeCT did not, relative to placebo, lead to better performance on untrained measures of affective control. Pre- to post-training change in affective control covaried with pre- to post-training change in mental health problems in the AffeCT but not the placebo group. These mental health benefits of AffeCT were only observed immediately following training and did not extend to 1 month or year post-training.

CONCLUSION

In conclusion, the study provides preliminary evidence that AffeCT may confer short-term preventative benefits for adolescent mental health.

Associations Between Parenting Behavior and Neural Processing of Adolescent Faces in Mothers With and Without Depression

BACKGROUND

This study first examined how mothers with and without depression differ in neural activation in response to adolescents' affective faces. Second, it examined the extent to which these neural activation patterns are related to observed positive and aggressive parenting behavior.

METHODS

Mothers with and without depression (based on self-reported symptoms and treatment history; n = 77 and n = 64, respectively; meanage = 40 years) from low-income families completed an interaction task with their adolescents (meanage = 12.8 years), which was coded for parents' aggressive and positive affective behavior. During functional magnetic resonance imaging, mothers viewed blurry, happy, sad, and angry faces of unfamiliar adolescents, with an instruction to either label the emotion or determine the clarity of the image.

RESULTS

The depression group showed less activation in the posterior midcingulate than the control subject group while labeling happy faces. Higher activation in the insula and dorsomedial prefrontal cortex (PFC) was related to less positive parenting behavior. Ventrolateral PFC activation was most pronounced when labeling negative emotions, but stronger ventrolateral PFC response to happy faces was associated with more aggressive parenting behavior.

CONCLUSIONS

This demonstrates the association between parents' neural responses to adolescent faces and their behavior during interactions with their own adolescents, with relatively low insula and dorsomedial PFC activation supporting positive parenting and affect-dependent response in the ventrolateral PFC as being important to limit aggressive behavior.

Effects of high-definition transcranial direct current stimulation on implicit emotion regulation of social pain in healthy individuals

BACKGROUND

Implicit emotion regulation (ER), a form of ER, is essential for protecting mental health in the process of social interaction. Both the ventrolateral prefrontal cortex (VLPFC) and the dorsolateral prefrontal cortex (DLPFC) have been shown to be involved in ER processes, including explicit ER of social pain, but whether they play a role in implicit ER is unclear.

METHODS

We investigated whether anodal high-definition transcranial direct current stimulation (HD-tDCS) of the right VLPFC (rVLPFC) or the right DLPFC (rDLPFC) influences implicit ER. In total, 63 healthy participants completed an emotion priming task, which measures the implicit ER of social pain, before and after receiving active or sham HD-tDCS (2 mA for 20 min, 10 consecutive days). Event-related potentials (ERPs) were recorded during task performance.

RESULTS

Combined with the results of the behavioral and electrophysiological indices indicated that stimulation of both the rVLPFC and the rDLPFC by anodic HD-tDCS could significantly reduce the affective responses caused by social exclusion. The further results also suggested that rDLPFC activation may contribute to promoting the involvement of early cognitive resources in the implicit ER process of social pain, thus helping to reduce the subjective negative experience of individuals.

LIMITATIONS

There were no dynamic interactive emotional stimuli to induce social pain, and only static images of social exclusion were used.

CONCLUSION

Our study provides cognitive and neurological evidence that expands our knowledge of the role of the rDLPFC and the rVLPFC in social ER. It can also serve as a reference for targeted intervention of implicit ER in social pain.

Adjunctive cognitive training with exposure enhances fear and neural outcomes in social anxiety

Exposure-based cognitive behavioral therapy (CBT) is the gold standard for treating social anxiety disorder (SAD), yet response is not universal. CBT is thought to operate via extinction-related learning during exposure, which in turn relies on cognitive processes such as working memory. The present proof-of-concept study investigates the potential for training working memory to improve anxiety related outcomes following exposure. Thirty-three adults with elevated social anxiety were randomized to complete a working memory training or sham training condition. Post-training, participants completed a working memory assessment, speech exposure session, and two fMRI tasks. Participants who received working memory training demonstrated lower distress ratings by the end of the speech exposures and better performance on the fMRI working memory task than those in sham. Working memory training completers had greater neural activation in frontoparietal regions during an in-scanner working memory task and exhibited less neural activation in the fusiform gyrus in response to an emotional face processing task than those in sham. Adding working memory training to exposure procedures could strengthen functioning of frontoparietal regions and alter emotional processing - key mechanisms implicated in extinction learning. Findings provide preliminary evidence that training working memory in conjunction with exposure may enhance exposure success.

Implicit, But Not Explicit, Emotion Regulation Relieves Unpleasant Neural Responses Evoked by High-Intensity Negative Images

Evidence suggests that explicit reappraisal has limited regulatory effects on high-intensity emotions, mainly due to the depletion of cognitive resources occupied by the high-intensity emotional stimulus itself. The implicit form of reappraisal has proved to be resource-saving and therefore might be an ideal strategy to achieve the desired regulatory effect in high-intensity situations. In this study, we explored the regulatory effect of explicit and implicit reappraisal when participants encountered low- and high-intensity negative images. The subjective emotional rating indicated that both explicit and implicit reappraisal down-regulated negative experiences, irrespective of intensity. However, the amplitude of the parietal late positive potential (LPP; a neural index of experienced emotional intensity) showed that only implicit reappraisal had significant regulatory effects in the high-intensity context, though both explicit and implicit reappraisal successfully reduced the emotional neural responses elicited by low-intensity negative images. Meanwhile, implicit reappraisal led to a smaller frontal LPP amplitude (an index of cognitive cost) compared to explicit reappraisal, indicating that the implementation of implicit reappraisal consumes limited cognitive control resources. Furthermore, we found a prolonged effect of implicit emotion regulation introduced by training procedures. Taken together, these findings not only reveal that implicit reappraisal is suitable to relieve high-intensity negative experiences as well as neural responses, but also highlight the potential benefit of trained implicit regulation in clinical populations whose frontal control resources are limited.

Effects of a Smartphone-Based, Multisession Interpretation-Bias Modification for Anxiety: Positive Intervention Effects and Low Attrition

While interpretation-bias modification (IBM) is an effective intervention for treating anxiety, it is not broadly used in clinical or daily practice. To this end, this study developed and tested a smartphone-based IBM application. We adopted the ambiguous situation paradigm as an intervention task in conjunction with robust training materials that broadly covered situations encountered in daily life. We recruited participants with high-trait anxiety and divided them into three groups: (1) positive training; (2) 50% positive-50% negative training; and (3) no-training control. The first two groups completed 28 days of smartphone-based training (IBM in positive cases), and all groups completed six rounds of assessments. The smartphone-based IBM training changed positive and negative endorsements and more specific measures of interpretation bias, thus reducing anxiety. The results also showed that changes in the number of negative interpretations played a mediating role in anxiety reduction. It is notable that the attrition rate was extremely low across the experiment. Our follow-up showed that positive gains persisted throughout the intervening period. Smartphone-based IBM can help individuals with anxiety shift negative biases, broaden their thoughts, enhance their information processing, and effectively target the clinical features of anxiety.

Role of stimulus types and valence on the affective memory performance of adults with anxiety

Previous studies have found that the emotion of anxiety in adults is easily influence by negative stimuli However, few studies have explored the effect of stimulus types on working memory performance and cognitive processing of adults with anxiety. This study aimed to explore the effects of anxiety on affective working memory and the role of stimulus types and valences on affective working memory performance. Forty adults were recruited for the experiment and were divided into two groups according to their anxiety levels. The valence and type of stimulus were manipulated in a memory recognition experiment. The results indicated that individuals with anxiety performed poorer when subjected to positive stimuli than for neutral and negative stimuli, whereas healthy adults exhibited the opposite. Furthermore, participants outperformed on affective pictures than affective words, but the effect size of the words was larger than that of the pictures for the difference between the valence and anxiety groups. This study highlights the differences in affective working performance across stimulus types and valences between healthy adults and adults with anxiety. The findings clarified the effect of positive valence and affective words on the affective working memory processing mechanism in adults with anxiety.

Development of Proactive Control and Anxiety Among Behaviorally Inhibited Adolescents

OBJECTIVE

Behavioral inhibition (BI) is an infant temperament characterized by heightened reactivity and negative affect in response to novel people and situations. BI is among the earliest and strongest predictors of future anxiety problems. However, not all children with a history of BI will manifest anxiety problems. A growing body of evidence suggests that proactive control skills may help buffer youth with BI from future anxiety difficulties; yet, it remains unclear how temperament may interact with the development of cognitive control to influence anxiety risk. The present study tested whether enhancements in proactive control occurring during adolescence may reduce risk for anxiety among youth with a history of BI.

METHOD

Participants included 185 adolescents (56% female) whose temperament was assessed during toddlerhood. In adolescence, participants completed anxiety assessments and an AX Continuous Performance Test (AX-CPT) to assess cognitive control strategy. Both assessments were administered at age 13 years and again at 15 years.

RESULTS

Latent change score modeling revealed that, on average, participants increasingly used proactive control strategies and experienced worsening anxiety from age 13-15 years. Early BI was associated with a smaller anxiety increase from 13-15 years, but only among participants whose proactive control skills improved at mean or greater rates.

CONCLUSION

The present findings suggest that greater proactive control development during adolescence protects youth with high BI from age-related increases in anxiety. Results support a framework that highlights cognitive control as a key moderator of anxiety risk among children with a history of high BI.

Emotion control training enhances reappraisal success among individuals with reported ADHD symptoms

Previous research indicates that training individuals to recruit cognitive control before exposure to negative pictures can facilitate the propensity to use reappraisal and reappraisal success. Individuals with attention deficit hyperactivity disorder (ADHD) experience difficulties in cognitive control and emotion regulation, so they may especially benefit from such training. Individuals reporting high ADHD symptoms and controls were randomly assigned to one of two training conditions. In the high emotion control (H-EC) training condition, negative pictures were typically preceded by a stimulus that recruits cognitive control. In contrast, in the low emotion control (L-EC) training condition, negative pictures were typically preceded by a stimulus that does not recruit cognitive control. Participants were then asked to recall an adverse personal event and to reappraise the event. As predicted, instructed reappraisal was more effective in reducing negative mood in the H-EC training compared to the L-EC training. Furthermore, compared to controls, individuals with reported ADHD symptoms showed a greater propensity to use reappraisal after writing the event and a more considerable reduction in event significance and negativity following the instructed reappraisal assignment. We argue that employing cognitive control over emotional information has a causal role in reappraisal use and success among individuals with ADHD symptoms.

Development of a gamified cognitive training app “Social Brain Train” to enhance adolescent mental health: a participatory design study protocol

Background: Adolescence is a sensitive period for the onset of mental health disorders. Effective, easy-to-disseminate, scalable prevention and early interventions are urgently needed. Affective control has been proposed as a potential target mechanism. Training affective control has been shown to reduce mental health symptoms and improve emotion regulation. However, uptake and adherence to such training by adolescents has been low. Thus, the current study aims to receive end user (i.e., adolescents) feedback on a prototype of a novel app-based gamified affective control training program, the Social Brain Train. Methods: The proposed study aims to recruit participants aged 13-16 years old (N = 20) to provide user feedback on the Social Brain Train app. The first group of participants (n = 5) will complete an online questionnaire assessing demographics, symptoms of depression and anxiety, social rejection sensitivity and attitudes toward the malleability of cognition and mental health. They will complete two tasks assessing cognitive capacity and interpretation bias. Participants will be then be invited to an online group workshop, where they will be introduced to the app. They will train on the app for three days, and following app usage, participants will complete the aforementioned measures again, as well as provide ratings on app content, and complete a semi-structured interview to obtain in-depth user feedback, which will be used to inform modifications to the app. Following these modifications, a second group of participants (n = 15) will follow the same procedure, except they will train on the app for 14 days. Feedback from both groups of participants will be used to inform the final design. Conclusions: By including young people in the design of the Social Brain Train app, the proposed study will help us to develop a novel mental health intervention that young people find engaging, acceptable, and easy-to-use

Behavioral inhibition and dual mechanisms of anxiety risk: Disentangling neural correlates of proactive and reactive control

Background:

Behavioral inhibition (BI) is a temperament style characterized by heightened reactivity and negative affect in response to novel people and situations, and it predicts anxiety problems later in life. However, not all BI children develop anxiety problems, and mounting evidence suggests that how one manages their cognitive resources (cognitive control) influences anxiety risk. The present study tests whether more (proactive control) or less (reactive control) planful cognitive strategies moderate relations between early BI and later anxiety.

Methods:

Participants included 112 adolescents (55% female; M_age = 15.4 years) whose temperament was assessed during toddlerhood. In adolescence, participants completed an AX Continuous Performance Test while electroencephalography was recorded to disentangle neural activity related to proactive (cue-locked P3b) and reactive (probe-locked N2) control.

Results:

Greater BI was associated with greater total anxiety scores only among adolescents with smaller ΔP3bs and larger ΔN2s—a pattern consistent with decreased reliance on proactive strategies and increased reliance on reactive strategies. Additionally, a larger ΔP3b was associated with greater total anxiety scores; however, this effect was largely explained by the fact that females tended to have larger ΔP3bs and greater anxiety than males.

Conclusions:

Early BI relates to risk for later anxiety specifically among adolescents who rely less on proactive strategies and more on reactive control strategies. Thus, cognitive control strategy moderates the association between developmental context (i.e., temperament) and later anxiety. The present study is the first to characterize how proactive and reactive control uniquely relate to pathways toward anxiety risk.

Working memory training effects across the lifespan: Evidence from human and experimental animal studies

Working memory refers to a cognitive function that provides temporary storage and manipulation of the information necessary for complex cognitive tasks. Due to its central role in general cognition, several studies have investigated the possibility that training on working memory tasks could improve not only working memory function but also increase other cognitive abilities or modulate other behaviors. This possibility is still highly controversial, with prior studies providing contradictory findings. The lack of systematic approaches and methodological shortcomings complicates this debate even more. This review highlights the impact of working memory training at different ages on humans. Finally, it demonstrates several findings about the neural substrate of training in both humans and experimental animals, including non-human primates and rodents.