Cognitive biases in anxiety and depression: Introduction to the Special Issue

Suicidal Ideation During the COVID-19 Pandemic: Investigating Mental Health, COVID-19 Health Beliefs, and News Media Consumption in the United States Population in the Year 2020

This study examines the role of general news media consumption during COVID-19 in aggravating mental health and suicide risk in the US population. In a sample of U.S. adults (N = 5,010), we investigated how mental health, COVID-19 health beliefs, and general news consumption influenced the odds of suicidal ideation using hierarchical logistic regression models. Both worsening mental health overall and specifically in regard to COVID-19 increased suicidal ideation. Perceived susceptibility to COVID-19 infection did not increase suicidal ideation, yet higher levels of COVID-19 self-efficacy reduced suicidal ideation. Overall news consumption did not affect suicidal ideation, but media-specific post-hoc analyses revealed that TV news watching decreased suicidal ideation as much as high levels of COVID-19 self-efficacy decreased suicidal ideation. Furthermore, online news consumption increased suicidal ideation as much as worsening mental health overall increased suicidal ideation. Further implications are discussed.

A double-blind phase II randomized controlled trial of an online cognitive bias modification for interpretation program with and without psychoeducation for people with chronic pain

ABSTRACT

Cognitive bias modification for interpretation (CBM-I) is an effective intervention for anxiety, but there is only a single trial in people with chronic pain. The aim of this randomized controlled trial was to test CBM-I with and without psychoeducation for people with chronic pain. We randomized 288 participants to 4 groups comprising treatment (CBM-I vs placebo) with or without psychoeducation. One hundred and eighty-three participants (64%) completed 4, 15-minute training sessions over 2 weeks. The coprimary outcomes were pain interference and pain intensity. We also measured interpretation bias, fear of movement, catastrophizing, depression, anxiety, and stress. Participants with more psychopathology at baseline were more likely to dropout, as were those allocated to psychoeducation. Intention-to-treat analyses using linear mixed models regression were conducted. Training effects of CBM-I were found on interpretation bias, but not a near-transfer task. Cognitive bias modification of interpretation improved both primary outcomes compared with placebo. For pain interference, there was also a main effect favoring psychoeducation. The CBM-I group improved significantly more than placebo for fear of movement, but not catastrophizing, depression, or anxiety. Cognitive bias modification of interpretation reduced stress but only for those who also received psychoeducation. This trial shows that CBM-I has promise in the management of pain, but there was limited evidence that psychoeducation improved the efficacy of CBM-I. Cognitive bias modification of interpretation was administered entirely remotely and is highly scalable, but future research should focus on paradigms that lead to better engagement of people with chronic pain with CBM-I.

Barriers to the implementation of a computer-based rehabilitation programme in two public psychiatric settings

Background

Working memory (WM) deficits have a negative impact on treatment adherence and quality of life. Efficient and effective interventions are needed in order to improve the cognitive functioning of those affected, especially in low-resource communities. Computer-based rehabilitation programmes (CBRP) are low-cost therapeutic approaches for WM deficits. Perceptions and experiences of target users may influence whether CBRP constitute an effective therapeutic option for adults with cognitive impairment in under-resourced environments.

Aim

The goal of the study was to explore the experiences of a group of volunteers with WM deficits (associated with diagnoses of HIV and schizophrenia), in terms of the perceived barriers they encountered during their participation in a CBRP.

Methods

A qualitative, descriptive research design was implemented. Short interviews and field notes were used in order to investigate the experiences of nine participants in relation to the CBRP. The sample included four participants living with HIV and five with schizophrenia, all with WM deficits.

Results

Using a thematic analysis, eight barriers were identified: unawareness of the cognitive deficit, anticipation of negative results, stigma, difficulties accessing a computer and/or Internet connection, ill health, negative emotional experiences, daily routine challenges and non-conducive or sabotaging environments. A representational model of these barriers is proposed.

Conclusion

The implementation of a cognitive rehabilitation strategy should not only take into consideration issues of access to particular strategies and materials but should also be preceded by an exploration of how individual and contextual barriers are experienced by the potential users, as these contribute to the risk of dropout.

Are attentional bias and memory bias for negative words causally related?

BACKGROUND AND OBJECTIVES

In cognitive theories of depression, processing biases are assumed to be partly responsible for the onset and maintenance of mood disorders. Despite a wealth of studies examining the relation between depression and individual biases (at the level of attention, interpretation, and memory), little is known about relationships between different biases. The purpose of the present study was to assess if attentional bias is causally related to memory bias.

METHODS

71 participants were randomly assigned to a control (n = 37) or attentional training group (n = 34). The attentional manipulation was followed by an explicit, intentional memory task during which novel neutral, negative, and positive words were presented.

RESULTS

It was found that individuals with elevated depression score trained to orient away from negative words did not display a memory bias for negative words (adjectives) whereas similar individuals displayed this memory bias in the control condition.

LIMITATION

Generalization of the findings is limited because of the short study time frame and specific nature of the memory task.

CONCLUSIONS

These results indicate that altering attentional bias can influence elaborative processing of emotional material and that this bias could be one of the causes of mood congruent memory in depression.

Trained interpretive bias survives mood change

Evidence is accumulating that interpretations can be trained using Cognitive Bias Modification procedures (CBM). The effects are replicable, stable over time and there is some evidence of generalizability. As a next step in determining the boundaries of the CBM model, the present experiment was designed to test whether modified interpretive style endures fluctuations in mood. Participants were trained to interpret ambiguous scenarios in either a positive (n = 42) or negative (n = 40) way. Then, participants were exposed to either a positive (n = 41) or negative (n = 41) mood induction procedure to change their current mood state. Results showed that the modified interpretive bias did not change in reaction to a mood change. That is, differences in interpretation of new ambiguous information were related to the interpretive bias modification procedure and not to the current mood state.

Can we harness computerised cognitive bias modification to treat anxiety in schizophrenia? A first step highlighting the role of mental imagery

A new wave of computerised therapy is under development which, rather than simulating talking therapies, uses bias modification techniques to target the core psychological process underlying anxiety. Such interventions are aimed at anxiety disorders, and are yet to be adapted for co-morbid anxiety in psychosis. The cognitive bias modification (CBM) paradigm delivers repeated exposure to stimuli in order to train individuals to resolve ambiguous information in a positive, rather than anxiety provoking, manner. The current study is the first to report data from a modified form of CBM which targets co-morbid anxiety within individuals diagnosed with schizophrenia. Our version of CBM involved exposure to one hundred vignettes presented over headphones. Participants were instructed to actively simulate the described scenarios via visual imagery. Twenty-one participants completed both a single session of CBM and a single control condition session in counter-balanced order. Within the whole sample, there was no significant improvement on interpretation bias of CBM or state anxiety, relative to the control condition. However, in line with previous research, those participants who engage in higher levels of visual imagery exhibited larger changes in interpretation bias. We discuss the implications for harnessing computerised CBM therapy developments for co-morbid anxiety in schizophrenia.

Exploring Sex Differences in Worry with A Cognitive Vulnerability Model

A multivariate model was developed to examine the relative contributions of mastery, stress, interpretive bias, and coping to sex differences in worry. Rumination was incorporated as a second outcome variable to test the specificity of these associations. Participants included two samples of undergraduates totaling 302 men and 379 women. A path analysis of the full sample demonstrated good overall fit and revealed that low mastery, high stress, and high interpretive bias predicted increases in both worry and rumination. There proved to be no interactive effect of sex with the model. Comparisons of mean differences indicated that women reported significantly lower mastery and significantly higher stress, worry, and rumination than men. Results suggest similar processes confer risk for worry and rumination in men and women; however, lower levels of mastery and higher levels of stress in women may contribute to the female preponderance of anxiety and depression.

Rumination and attention in major depression

Up until recently, it had been assumed that attentional biases for negative information do not exist in depression. However studies using post-conscious exposure durations have produced contradictory results. The limitations of common attentional tasks, suitability of stimulus materials and differences in stimulus duration times may have contributed to these inconsistencies. We aimed to address many of these issues and examine attentional responses in major depression at two post-conscious exposure times. We also investigated possible roles for rumination and distraction in increasing and lessening attentional biases for negative information. We used a fully controlled experimental design to test the effects of both induced and trait rumination and distraction on attention in patients with major depression and healthy controls. Attention was assessed using the dot-probe task. The findings revealed an attentional bias for negative information in depressed patients only at the longer post-conscious exposure duration. Furthermore although this bias was not influenced by either induced or trait distraction, it was related to trait rumination. Overall, the results showed that depression is associated with a strategic attentional bias towards negative information and that this bias is stronger in individuals who habitually ruminate.

Positive interpretation training: effects of mental imagery versus verbal training on positive mood

Therapists often assume a special association between mental imagery and emotion, though empirical evidence has been lacking. Using an interpretation training paradigm, we previously found that imagery had a greater impact on anxiety than did verbal processing of the same material (Holmes & Mathews, 2005). Although the finding of a differential impact of imagery versus verbal processing of negative material was replicated, findings did not extend to benign material. Results therefore left open the question of whether there may be a special association between imagery and positive emotion. The current experiment examined positive interpretation training. Numerous scenarios were presented with initial ambiguity as to positive outcome or not, with final information then yielding consistently positive resolutions. Participants were asked to either imagine these positive events or to listen to the same descriptions while thinking about their verbal meaning. Those participants in the imagery condition reported greater increases in positive affect and rated new descriptions as being more positive than did those in the verbal condition. Results suggest that positive training can be enhanced through imagery as opposed to verbal processing. This study also provides the first test of a standardized intervention using an "interpretive bias training" paradigm to improve positive mood.

Further exploration memory bias in compulsive washers

The aim of the present study was to replicate Radomsky and Rachman's findings on memory bias in obsessive-compulsive disorder (OCD), using the same procedure but an increased sample size, more specific control groups, and a full analysis of contamination attribution data. Sixteen OCD-washers, 16 OCD-checkers, 16 social phobic patients and 16 non-anxious controls were presented with 50 'clean' or 'dirty' objects. After this incidental encoding phase, participants were asked to freely recall the objects, to rate their anxiety when almost touching each object, and, finally, to attribute each object to one of the two contamination conditions ('clean' or 'dirty'). Verbal episodic memory was also assessed with the California Verbal Learning Test. The results indicate that, contrary to Radomsky and Rachman's findings, OCD-washers did not differ from the other participants in their memory for 'clean' and 'dirty' objects. However, the OCD-washers recalled more accurately the 'dirty' source of contamination than the 'clean' source. This result was specific to the OCD-washers, and suggests a memory bias for contextually threatening information. The differences between our findings and those published by Radomsky and Rachman's are discussed.