Biases in attention and interpretation in adolescents with varying levels of anxiety and depression

Attentional bias for rejection and sad words in Chinese left-behind children with depression

BACKGROUND

This study aimed to examine attentional bias (AB) for sad and social rejection words in Chinese left-behind children (LBC) with depression.

METHOD

We investigated both stimulus specificity and components of AB in different groups using a cross-sectional design. Data were drawn from a school assessment of depression and anxiety, from which we selected LBC with depression (n = 40), LBC without depression (n = 33), a control group with depression (n = 31), and a control group without depression (n = 37). AB was measured with a dot-probe task covering two stimulus types (sad and rejection).

RESULTS

The analysis of AB scores revealed a significant three-way interaction (LBC × depression × word type), F(1, 137) = 4.00, p = 0.047, η2 = 0.028, with depressed non-LBC exhibiting a significant depression × word type interaction, F(1, 66) = 4.67, p = 0.034, η2 = 0.066, while the depression × word type interaction was not significant in LBC, F(1, 71) = 0.18, p = 0.675, η2 = 0.002. Depressed children living with their parents showed AB towards sad words but not rejection words, while depressed LBC showed greater AB towards both rejection and sad words.

CONCLUSIONS

The findings provide evidence that an AB towards sad information is critically involved in the depressed LBC. Compared with non-LBC depressed individuals, an AB for rejection may be involved as a risk factor in the LBC. It sheds light on the effective intervention programmes for LBC's depression and have important practical significance for reducing depression and improving the mental health of LBC.

Three-Stream Convolutional Neural Network for Depression Detection With Ocular Imaging

Depression is a prevalent and severe mental disorder that significantly affects both mind and body, leading to persistent feelings of sadness, despair, and impaired functionality. Diagnosis of depression primarily relies on clinical assessment and observation of symptoms. However, due to the lack of objective indicators, the experience and skills of doctor may lead to misdiagnosis. Current researches indicate that eye movement patterns and pupil dilation can serve as potential biomarkers for emotional and cognitive dysregulation in individuals with depression. However, most studies are based on manually extracted eye movement features, overlooking a significant portion of information available in ocular imaging. This paper proposes Three-Stream Convolutional Neural Network (TSCNN) for detecting depression, leveraging both spatio-temporal information of raw ocular imaging and paradigmatic semantic features. We suggest using optical flow with different sampling intervals to capture temporal features. In the third stream, we employ an encoder to learn semantic information from paradigm images and use it as prior knowledge. Finally, we utilize a fully connected network for classification, achieving an accuracy of 79.3% on our self-collected dataset. The proposed method may demonstrate significant clinical utility in the future.

Web-Based Cognitive Bias Modification Program for Young People With Social Anxiety and Hazardous Alcohol Use: Feasibility, Acceptability, and Preliminary Efficacy Study

BACKGROUND

Interpretation bias modification (IBM) and approach bias modification (ApBM) cognitive retraining interventions can be efficacious adjunctive treatments for improving social anxiety and alcohol use problems. However, previous trials have not examined the combination of these interventions in a young, comorbid sample.

OBJECTIVE

This study aims to describe the feasibility, acceptability, and preliminary efficacy of a web-based IBM+ApBM program for young adults with social anxiety and hazardous alcohol use ("Re-Train Your Brain") when delivered in conjunction with treatment as usual (TAU).

METHODS

The study involved a 3-arm randomized controlled pilot trial in which treatment-seeking young adults (aged 18-30 y) with co-occurring social anxiety and hazardous alcohol use were randomized to receive (1) the "integrated" Re-Train Your Brain program, where each session included both IBM and ApBM (50:50 ratio), plus TAU (35/100, 35%); (2) the "alternating" Re-Train Your Brain program, where each session focused on IBM or ApBM in an alternating pattern, plus TAU (32/100, 32%); or (3) TAU only (33/100, 33%). Primary outcomes included feasibility and acceptability, and secondary efficacy outcomes included changes in cognitive biases, social anxiety symptoms, and alcohol use. Assessments were conducted at baseline, after the intervention period (6 weeks after baseline), and 12 weeks after baseline.

RESULTS

Both Re-Train Your Brain program formats were feasible and acceptable for young adults. When coupled with TAU, both integrated and alternating programs resulted in greater self-reported improvements than TAU only in anxiety interpretation biases (at the 6-week follow-up; Cohen d=0.80 and Cohen d=0.89) and comorbid interpretation biases (at the 12-week follow-up; Cohen d=1.53 and Cohen d=1.67). In addition, the alternating group reported larger improvements over the control group in generalized social anxiety symptoms (at the 12-week follow-up; Cohen d=0.83) and alcohol cravings (at the 6-week follow-up; Cohen d=0.81). There were null effects on all other variables and no differences between the intervention groups in efficacy outcomes.

CONCLUSIONS

Should these findings be replicated in a larger randomized controlled trial, Re-Train Your Brain has the potential to be a scalable, low-cost, and non-labor-intensive adjunct intervention for targeting interpretation and comorbidity biases as well as generalized anxiety and alcohol-related outcomes in the real world.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry ACTRN12620001273976; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=364131.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/28667.

Joint trajectories of loneliness, depressive symptoms, and social anxiety from middle childhood to early adolescence: associations with suicidal ideation

This study examined the joint trajectories of loneliness, depressive symptoms, and social anxiety from middle childhood to early adolescence and their associations with suicidal ideation. A total of 643 Chinese elementary school students (55.2% male; Mage = 9.01; SD = 0.75; range = 7 to 11 years at T1) completed measures on six occasions at 6-month intervals. Parallel process latent class growth models revealed five distinct trajectories of loneliness, depressive symptoms, and social anxiety: "congruent-low" (45.1%), "moderately low with predominant loneliness and depressive symptoms" (15.7%), "moderate with predominant loneliness and depressive symptoms" (4.2%), "moderately low with predominant social anxiety" (24.9%), and "congruent-high" (10.1%). The highest suicidal ideation was observed among adolescents who persistently experienced two or three symptoms, followed by those who persistently experienced one predominant symptom, and finally, adolescents who persistently experienced low levels of all three symptoms. The findings highlight the importance of individual differences considerations in understanding the joint patterns of loneliness, depressive symptoms, and social anxiety among youth during the transition into adolescence and the need for more sophisticated intervention programs tailored to the unique characteristics of the relevant trajectories to reduce the risk of suicidal ideation.

Perceived parental depression, intrusive rumination, and internalizing problems: A three-wave longitudinal study in adolescents

Research suggests that perceiving parental depression elicits internalizing problems in adolescents, but certain studies have indicated that adolescents' internalizing problems also increase their perception of parental emotion. To further investigate the inconsistent findings about the nature of this relationship, the current study used longitudinal data to examine the causal association between adolescents' internalizing problems and the parental depression they perceived, as well as the role of intrusive rumination in the relationship. Method: In this longitudinal study, 392 adolescents who experienced the catastrophic Jiuzhaigou earthquake in 2017 were surveyed at three time points after the earthquake: 12 months (T1), 21 months (T2) and 27 months (T3). A cross-lagged panel model was used to carry out the data analysis. Results: Mutual cause-and-effect relationships were found between intrusive rumination and both perceived parental depression and internalizing problems, respectively; a unilateral causal relationship in which internalizing problems positively predicted perceived parental depression was also found. In addition, internalizing problems predicted perceived parental depression via the mediating role of intrusive rumination; similarly, intrusive rumination predicted perceived parental depression via internalizing problems. Conclusions: Internalizing problems were a risk factor for perceived parental depression, and intrusive rumination played an important role in the relationship between internalizing problems and perceived parental depression.

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

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

Social rejection sensitivity and its role in adolescent emotional disorder symptomatology

BACKGROUND

Most emotional disorders first emerge during adolescence, a time characterized by heightened sensitivity to social information, especially social rejection. Social rejection sensitivity (SRS), then, may be a promising intervention target.

METHODS

To explore this, 357 participants (M (SD) age = 19.40 (4.18), 63% female) completed self-report measures of SRS, its proposed antecedent, perceived parenting style, its proposed behavioral correlate, negative interpretation bias, and its proposed  clinical correlate, emotional disorder symptoms. Participants additionally completed a single session of a social interpretation bias modification task, the ambiguous social scenarios task (ASST).

RESULTS

SRS was associated with perceived parental rejection, while controlling for other types of maladaptive parenting. SRS partially accounted for variance in the relationship between perceived parental rejection and emotional disorder symptomatology, as well as the relationship between negative interpretation bias and emotional disorder symptoms. Learning rates (i.e., change in reaction time across the task) on the ASST differed as a function of age and SRS, such that younger participants with higher SRS showed the slowest rate of learning. Moreover, individual differences in SRS accounted for the magnitude of change in negative interpretation bias before and after the ASST. Individuals with greater SRS showed less change in interpretation bias.

CONCLUSIONS

SRS appears strongly associated with emotional disorder symptoms in adolescents. Importantly, SRS was associated with the malleability of negative interpretation bias, which may help account for the mixed findings on the effectiveness of interpretation-bias-modification-paradigms in adolescents.

Trait anger and negative interpretation bias in neutral face perception

Introduction

Anger is a basic emotion helping people to achieve goals by preparing the body for action and prompting others to change their behavior but is also associated with health issues and risks. Trait anger, the disposition to experience angry feelings, goes along with an attribution of hostile traits to others. Negative distortions in the interpretation of social information have also been observed in anxiety and depression. The present study examined the associations between components of anger and negative interpretation tendencies in the perception of ambiguous and neutral schematic faces controlling for anxiety, depressed mood, and other variables.

Methods

A sample of 150 young adults performed a computer-based perception of facial expressions task and completed the State-Trait Anger Expression Inventory (STAXI-2) along with other self-report measures and tests.

Results

Trait anger and anger expression correlated with the perception of negative affects in neutral but not in ambiguous faces. More specifically, trait anger was linked to the attribution of anger, sadness, and anxiety to neutral faces. Trait anger predicted perceived negative affects in neutral faces when adjusting for anxiety, depression, and state anger.

Discussion

For neutral schematic faces, the present data support an association between trait anger and negatively biased interpretation of facial expression, which is independent of anxiety and depressed mood. The negative interpretation of neutral schematic faces in trait angry individuals seems not only to comprise the attribution of anger but also of negative emotions signaling weakness. Neutral schematic facial expressions might be useful stimuli in the future study of anger-related interpretation biases.

The Relations of Attention to and Clarity of Feelings With Facial Affect Perception

Attention to emotions and emotional clarity are core dimensions of individual differences in emotion awareness. Findings from prior research based on self-report indicate that attention to and recognition of one's own emotions are related to attention to and recognition of other people's emotions. In the present experimental study, we examined the relations of attention to and clarity of emotions with the efficiency of facial affect perception. Moreover, it was explored whether attention to and clarity of emotions are linked to negative interpretations of facial expressions. A perception of facial expressions (PFE) task based on schematic faces with neutral, ambiguous, or unambiguous emotional expressions and a gender decision task were administered to healthy individuals along with measures of emotion awareness, state and trait anxiety, depression, and verbal intelligence. Participants had to decide how much the faces express six basic affects. Evaluative ratings and decision latencies were analyzed. Attention to feelings was negatively correlated with evaluative decision latency, whereas clarity of feelings was not related to decision latency in the PFE task. Attention to feelings was positively correlated with the perception of negative affects in ambiguous faces. Attention to feelings and emotional clarity were not related to gender decision latency. According to our results, dispositional attention to feelings goes along with an enhanced efficiency of facial affect perception. Habitually paying attention to one's own emotions may facilitate processing of external emotional information. Preliminary evidence was obtained suggesting a relationship of dispositional attention to feelings with negative interpretations of facial expressions.

The combined cognitive bias hypothesis in anxiety: A systematic review and meta-analysis

Cognitive theories have postulated the relational nature of different cognitive biases in the development and maintenance of anxiety disorders. To test this combined cognitive bias hypothesis, this review addressed the following questions: (i) whether different cognitive biases are associated with each other and (ii) whether one bias influences another bias. We identified 36 articles that studied the relationship between cognitive biases (attention, interpretation and memory bias). Of these, 31 studies were entered into two meta-analyses. Sixteen studies were included in the first meta-analysis of the correlation between cognitive bias indices. A further 15 studies were included in another meta-analysis to examine the transfer effects of cognitive bias modification (CBM) to another bias. Both meta-analyses yielded small but significant overall pooled effect sizes after the removal of outliers (r = 0.11 and g = 0.19 respectively). Moderator analyses revealed that the relationship between interpretation and memory bias was significantly stronger than other types of cognitive bias correlations and CBM is more potent in modifying biases when it was delivered in the laboratory compared with online. Our review quantifies the strength of the relationships between biases and transfer effects following CBM, which serves as a basis to further understand the mechanisms underlying biased information processing.

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

Background

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

Methods

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

Results

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

Conclusions

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

A trans-diagnostic cognitive behavioural conceptualisation of the positive and negative roles of social media use in adolescents’ mental health and wellbeing

Whilst research into the association between social media and mental health is growing, clinical interest in the field has been dominated by a lack of theoretical integration and a focus on pathological patterns of use. Here we present a trans-diagnostic cognitive behavioural conceptualisation of the positive and negative roles of social media use in adolescence, with a focus on how it interacts with common mental health difficulties. Drawing on clinical experience and an integration of relevant theory/literature, the model proposes that particular patterns of social media use be judged as helpful/unhelpful to the extent that they help/hinder the adolescent from satisfying core needs, particularly those relating to acceptance and belonging. Furthermore, it introduces several key interacting processes, including purposeful/habitual modes of engagement, approach/avoidance behaviours, as well as the potential for social media to exacerbate/ameliorate cognitive biases. The purpose of the model is to act as an aide for therapists to collaboratively formulate the role of social media in young people’s lives, with a view to informing treatment, and ultimately, supporting the development of interventions to help young people use social media in the service of their needs and values.

Key learning aims

(1)

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

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

Media multitasking, depression, and anxiety of college students: Serial mediating effects of attention control and negative information attentional bias

BACKGROUND

The COVID-19 epidemic provides an environment for frequent media multitasking, which might associate with an increase in depression and anxiety. Since many studies have found that media multitasking negatively affects cognitive capacity, we propose a cognitive perspective to explore how media multitasking may associate with mental health. This study examined the potential mediating role of attention control and negative information attentional bias in the relationship between media multitasking and anxiety and depression.

METHODS

Participants (n = 567) were recruited from college students in China. They completed an online survey that included the Media Multitasking Inventory (MMI), Attention Control Scale (ACS), Attention to Positive and Negative Information Scale (APNI), Generalized Anxiety Disorder Scale (GAD-7), and Patient Health Questionnaire (PHQ-9). After exploring the correlations between the measures, serial mediation models were examined.

RESULTS

The results indicated significant positive correlations between media multitasking and anxiety and depression. Media multitasking, anxiety, and depression were negatively correlated with attention focusing, while positively correlated with negative information attention bias. Media multitasking did not correlate with attention shifting. Mediation modeling demonstrated that attention focusing and negative information attention bias played a serial mediating role in the relationship between media multitasking and anxiety and depression. However, the results did not support the serial mediation model through attention shifting and negative information attention bias.

CONCLUSION

Media multitasking does not directly influence anxiety and depression, while attention focusing and negative information attention bias play serial mediating roles in their relationship. This study highlights the potential cognitive mechanisms between media multitasking and anxiety and depression, providing theoretical support for interventions in individual mental health during the epidemic.

Perceiving the Self and Emotions with an Anxious Mind: Evidence from an Implicit Perceptual Task

Anxiety disorders cause mental distress and low wellbeing in many people worldwide. Theories of anxiety describe negative worldviews and self-views as maintaining factors of the disorders. Recent research in social cognition has found a link between depression and altered perceptual biases to emotions, but the same research on anxiety is still missing. In this study, we measured perceptual biases to emotional and self-related stimuli in sub-clinically anxious participants and healthy controls using a self-emotional shape-label matching task. Results demonstrate that anxious participants had a diminished perceptual self-bias compared with healthy controls. Furthermore, the severity of anxiety was related to an emotional bias towards valanced other-related stimuli. The findings confirm the hypothesis that anxious individuals display an altered self-prioritisation effect in comparison with healthy individuals and that anxiety severity is linked to altered responses to emotionally valanced others. These findings have potential implications for early diagnosis and treatment of anxiety disorders.

The Association between Externalizing and Internalizing Problems with Bullying Engagement in Adolescents: The Mediating Role of Social Skills

Bullying has severe public health consequences, due to its high prevalence worldwide and devastating effects on physical and mental health. Therefore, it is relevant to further understand the factors that contribute to the emergence and maintenance of bullying. This study aimed to examine the differential mediating role of social skills in the relationship between (i) externalizing problems and engagement in aggressive bullying behaviors, and (ii) internalizing problems and the engagement in victimization bullying behaviors. Participants were 669 Portuguese adolescents aged between 12 and 19 years. The Social Skills Improvement System-Rating Scales and the Scale of Interpersonal Behavior at School were used to assess social skills and the engagement in bullying behaviors, respectively. Boys scored higher on aggressive behaviors and externalizing problems. Girls reported higher scores on internalizing problems, communication, cooperation and empathy. Social skills differently mediated the association between behavior problems and engagement in bullying. While empathy negatively mediated the association between externalizing problems and aggressive bullying behaviors, assertiveness negatively mediated the relationship between internalizing problems and victimization bullying behaviors. The risk factors for engaging in bullying are discussed, and so are the protective ones, which may help to prevent bullying behaviors and reduce their negative impact.

Examining Whether Social Anxiety Influences Satisfaction in Romantic Relationships

Research investigating social anxiety and the impacts on romantic relationships remains scarce. An online questionnaire examining romantic relationship status, social anxiety and depression symptomology, relationship satisfaction, and several relationship processes was completed by 444 adults. Individuals with higher social anxiety were less likely to be in romantic relationships. For the 188 adults in our sample in current relationships, relationship satisfaction was not influenced by social anxiety when controlling for depression. Although it was proposed that self-disclosure, social support, trust, and conflict initiation might influence romantic relationship satisfaction, none of these mechanisms interacted with social anxiety to explain additional variance in relationship satisfaction. These findings indicate that depression symptomology may be a treatment target for socially anxious individuals wishing to improve romantic relationship satisfaction.

Relations between anxiety sensitivity's cognitive concerns and anxiety severity: brooding and reflection as serial multiple mediators

The outbreak of COVID-19 has caused a major impact on productivity and life functioning, and also led to adverse emotional reactions. In the face of this public health event, increased anxiety is one of the most common emotional reactions. Previous studies have shown that anxiety sensitivity, rumination and anxiety are closely related. Various dimensions of anxiety sensitivity have different effects on anxiety. Also, rumination can be divided into brooding and reflection. To explore the relationships among anxiety sensitivity's cognitive concerns, anxiety and different types of rumination, we conducted an online survey during the outbreak of coronavirus (February 17-25, 2020), using the Anxiety Sensitivity Scale-3 (ASI-3), Ruminative Responses Scale (RSS), and Depression Anxiety Stress Scale-21 (DASS-21). The results showed significant positive correlations among anxiety sensitivity's cognitive concerns, anxiety, brooding and reflection. Furthermore, brooding and reflection had a chain mediation effect between cognitive concerns and anxiety, and the mediation effect of reflection was even stronger. Results suggest that anxiety sensitivity's cognitive concerns may not only affect anxiety directly, but also affect anxiety through rumination, especially reflection.

Emotional information-processing correlates of positive mental health in adolescence: a network analysis approach

The combined cognitive bias hypothesis proposes that emotional information-processing biases may conjointly influence mental health. Yet, little is known about the interrelationships amongst cognitive biases, particularly in adolescence. We used data from the CogBIAS longitudinal study (Booth et al., 2017), including 450 adolescents who completed measures of interpretation bias, memory bias, and a validated measure of general mental health in a typically developing population. We used a moderated network modelling approach to examine positive mental health-related moderation of the cognitive bias network. We found that mental health was directly associated with positive and negative memory biases, and positive interpretation biases, but not negative interpretation biases. Further, we observed some mental health-related moderation of the network structure. Network connectivity decreased with higher positive mental health scores. Network approaches allow us to model complex relationships amongst cognitive biases and develop novel hypotheses for future research.

A Web-Based Cognitive Bias Modification Intervention (Re-train Your Brain) for Emerging Adults With Co-occurring Social Anxiety and Hazardous Alcohol Use: Protocol for a Multiarm Randomized Controlled Pilot Trial

BACKGROUND

Alcohol use and anxiety disorders commonly co-occur, resulting in a more severe clinical presentation and poorer response to treatment. Research has shown that approach bias modification (ApBM) and interpretation bias modification (IBM) cognitive retraining interventions can be efficacious adjunctive treatments that improve outcomes for alcohol use and social anxiety, respectively. However, the acceptability, feasibility, and clinical utility of combining ApBM and IBM programs to optimize treatments among comorbid samples are unknown. It is also unclear whether integrating ApBM and IBM within each training session or alternating them between each session is more acceptable and efficacious.

OBJECTIVE

This paper describes the protocol for a randomized controlled pilot trial investigating the feasibility, acceptability, and preliminary efficacy of the Re-train Your Brain intervention-an adjunct web-based ApBM+IBM program-among a clinical sample of emerging adults with hazardous alcohol use and social anxiety.

METHODS

The study involves a three-arm randomized controlled pilot trial in which treatment-seeking emerging adults (18-30 years) with co-occurring hazardous alcohol use and social anxiety will be individually randomized to receive the Re-train Your Brain integrated program, delivered with 10 biweekly sessions focusing on both social anxiety and alcohol each week, plus treatment as usual (TAU; ie, the model of care provided in accordance with standard practice at their service; n=30); the Re-train Your Brain alternating program, delivered with 10 biweekly sessions focusing on social anxiety one week and alcohol the next week, plus TAU (n=30); or TAU only (n=30). Primary outcomes include feasibility (uptake, follow-up rates, treatment adherence, attrition, and adverse events) and acceptability (system usability, client satisfaction, user experience, and training format preference). Secondary efficacy outcomes include changes in alcohol approach and interpretation biases, social anxiety, and alcohol use (eg, drinks per day, binge drinking, drinking motives, severity of dependence, and cravings). The primary end point will be posttreatment (6 weeks postbaseline), with a secondary end point at 3 months postbaseline. Descriptive statistics will be conducted for primary outcomes, whereas intention-to-treat, multilevel mixed effects analysis for repeated measures will be performed for secondary outcomes.

RESULTS

This study is funded from 2019 to 2023 by Australian Rotary Health. Recruitment is expected to be completed by mid-2022 to late 2022, with follow-ups completed by early 2023.

CONCLUSIONS

This study will be the first to evaluate whether an ApBM+IBM program is acceptable to treatment-seeking, emerging adults and whether it can be feasibly delivered via the web, in settings where it will ultimately be used (eg, at home). The findings will broaden our understanding of the types of programs that emerging adults will engage with and whether the program may be an efficacious treatment option for this comorbidity.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry ACTRN12620001273976; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=364131.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/28667.

"That's Not What I Heard!": Adolescent Internalizing, Negative Perceptions of Maternal Communication, and Felt Shame and Guilt

Adolescents with internalizing problems are more prone to feelings of guilt and shame, experience more guilt-induction, and report more negative parenting, but little is known about the way these processes are associated nor the extent to which they occur within real-time parent-adolescent interactions. The current study sought to clarify these links by investigating whether negatively biased perceptions of maternal communication mediate links between adolescent internalizing symptoms and their feelings of guilt, shame, and guilt-induction during real-time mother-adolescent discussions. One hundred twenty-three mother-adolescent dyads participated in the study. These dyads were moderately diverse in both race/ethnicity (53% White, 29% Black, 12% Hispanic) and family income (26% earned less than $30,000/year, 22% earned more than $100,000/year) and included adolescents who ranged in age from 12 to 17 (Mage = 13.99) and were approximately half female (54%). Mothers and adolescents engaged in lab discussions about issues of conflict and guilt and rated mothers' positive and negative communication during the tasks; observers rated these same behaviors. Adolescents also reported on their general internalizing symptoms prior to the discussions and feelings of guilt, shame, and experienced guilt induction following each discussion task. Structural equation models, parceling out shared and unique perceptions of maternal communication behaviors, showed that adolescents with more internalizing symptoms reported greater feelings of shame and perceived maternal guilt-induction following the discussion, and that these associations were mediated by adolescents' unique perceptions of more maternal negativity. These findings highlight the potential role of cognitive biases in perpetuating established associations among adolescent internalizing symptoms, shame, and parental guilt-induction.

Left superior temporal sulcus morphometry mediates the impact of anxiety and depressive symptoms on sleep quality in healthy adults

Anxiety and depressive symptoms may predispose individuals to sleep disturbance. Understanding how these emotional symptoms affect sleep quality, especially the underlying neural basis, could support the development of effective treatment. The aims of the present study were therefore to investigate potential changes in brain morphometry associated with poor sleep quality and whether this structure played a mediating role between the emotional symptoms and sleep quality. One hundred and forty-one healthy adults (69 women, mean age = 26.06 years, SD = 6.36 years) were recruited. A structural magnetic resonance imaging investigation was performed, and self-reported measures of anxiety, depressive symptoms and sleep quality were obtained for each participant. Whole-brain regression analysis revealed that worse sleep quality was associated with thinner cortex in left superior temporal sulcus (STS). Furthermore, the thickness of left STS mediated the association between the emotional symptoms and sleep quality. A subsequent commonality analysis showed that physiological component of the depressive symptoms had the greatest influence on sleep quality. In conclusion, thinner cortex in left STS may represent a neural substrate for the association between anxiety and depressive symptoms and poor sleep quality and may thus serve as a potential target for neuromodulatory treatment of sleep problems.

Somatization Symptoms Regulate Emotional Memory Bias in Adolescents With Major Depressive Disorder

Objective: Somatization symptoms are commonly comorbid with depression. Furthermore, people with depression and somatization have a negative memory bias. We investigated the differences in emotional memory among adolescent patients with depressive disorders, with and without functional somatization symptoms (FSS). Methods: We recruited 30 adolescents with depression and FSS, 38 adolescents with depression but without FSS, and 38 healthy participants. Emotional memory tasks were conducted to evaluate the emotional memory of the participants in the three groups. The clinical symptoms were evaluated using the Hamilton Depression Rating Scale (HDRS) and the Children's Somatization Inventory (CSI). Results: The valence ratings and recognition accuracy rates for positive and neutral images of adolescent patients were significantly lower than those of the control group (F = 12.208, P < 0.001; F = 6.801, P < 0.05; F = 14.536, P < 0.001; F = 6.306, P < 0.05, respectively); however, the recognition accuracy rate for negative images of adolescent patients of depression without FSS was significantly lower than that of patients with FSS and control group participants (F = 10.316, P < 0.001). These differences persisted after controlling for HDRS scores. The within-group analysis revealed that patients of depression with FSS showed significantly higher recognition accuracy rates for negative images than the other types (F = 5.446, P < 0.05). The recognition accuracy rate for negative images was positively correlated with CSI scores (r = 0.352, P < 0.05). Conclusion: Therefore, emotional memory impairment exists in adolescent patients of depression and FSS are associated with negative emotional memory retention.

Attentional bias in individuals with depression and adverse childhood experiences: influence of the noradrenergic system?

RATIONALE

Major depressive disorder (MDD) is a severe mental disorder with affective, cognitive, and somatic symptoms. Mood congruent cognitive biases, including a negative attentional bias, are important for development, maintenance, and recurrence of depressive symptoms. MDD is associated with maladaptive changes in the biological stress systems such as dysregulations of central noradrenergic alpha2-receptors in the locus coeruleus-noradrenergic system, which can affect cognitive processes including attention. Patients with adverse childhood experiences (ACE), representing severe stress experiences in early life, might be particularly affected.

OBJECTIVES

With an experimental design, we aimed to gain further knowledge about the role of noradrenergic activity for attentional bias in MDD patients with and without ACE.

METHODS

We tested the effect of increased noradrenergic activity induced by the alpha2-receptor blocker yohimbine on attentional bias in a placebo-controlled repeated measures design. Four groups were included as follows: MDD patients with and without ACE, and healthy participants with and without ACE (total N = 128, all without antidepressant medication).

RESULTS

A significant effect of MDD on attentional bias scores of sad face pictures (p = .037) indicated a facilitated attentional processing of sad face pictures in MDD patients (compared to non-MDD individuals). However, we found no such effect of ACE. For attentional bias of happy face pictures, we found no significant effects of MDD and ACE. Even though a higher increase of blood pressure and salivary alpha-amylase following yohimbine compared to placebo indicated successful noradrenergic stimulation, we found no significant effects of yohimbine on attentional bias of happy or sad face pictures.

CONCLUSIONS

Our results are consistent with the hypothesis of a negative attentional bias in MDD patients. However, as we found no effect of ACE or yohimbine, further research is needed to understand the mechanisms by which ACE increases the risk of MDD and to understand the biological basis of the MDD-related negative attentional bias.

"I Am a Total…Loser" - The Role of Interpretation Biases in Youth Depression

Negative interpretation biases have been found to characterize adults with depression and to be involved in the development and maintenance of the disorder. However, less is known about their role in youth depression. The present study investigated i) whether negative interpretation biases characterize children and adolescents with depression and ii) to what extent these biases are more pronounced in currently depressed youth compared to youth at risk for depression (as some negative interpretation biases have been found already in high-risk youth before disorder onset). After a negative mood induction interpretation biases were assessed with two experimental tasks: Ambiguous Scenarios Task (AST) and Scrambled Sentences Task (SST) in three groups of 9-14-year-olds: children and adolescents with a diagnosis of major depression (n = 32), children and adolescents with a high risk for depression (children of depressed parents; n = 48), as well as low-risk children and adolescents (n = 42). Depressed youth exhibited substantially more negative interpretation biases than both high-risk and low-risk groups (as assessed with both tasks), while the high-risk group showed more negative interpretation biases than the low-risk group only as assessed via the SST. The results indicate that the negative interpretation biases that are to some extent already present in high-risk populations before disorder onset are strongly amplified in currently depressed youth. The different findings for the two tasks suggest that more implicit interpretation biases (assessed with the SST) might represent cognitive vulnerabilities for depression whereas more explicit interpretation biases (assessed with the AST) may arise as a consequence of depressive symptomatology.

Loneliness, Social Anxiety Symptoms, and Depressive Symptoms in Adolescence: Longitudinal Distinctiveness and Correlated Change

Loneliness, social anxiety symptoms, and depressive symptoms are internalizing problems that are highly intertwined and often co-occur during adolescence. This overlap and co-occurrence raises the question whether three different labels are used for the same underlying phenomenon. The present study adopts a comprehensive approach to this issue by investigating the development of the three phenomena simultaneously. Specifically, this study aimed to investigate (1) the developmental trend for all three internalizing problems separately, (2) whether they are best described by a single developmental trend, (3) how they co-develop across adolescence, and (4) gender differences in this co-development. The analyses were run in three three-wave longitudinal samples of adolescents with one-year intervals in order to verify the robustness of the findings. Sample 1 (roughly ages 15, 16, and 17) comprised 549 adolescents (63% girls), and Samples 2 and 3 (roughly ages 13, 14, and 15) comprised 811 adolescents (46% girls) and 1101 adolescents (52% girls), respectively. Latent growth curve modeling for the three phenomena separately showed either small increases or stable patterns. A comparison of a Multiple Indicator Latent Growth Model (MILGM) with a Parallel Process Latent Growth Curve Modeling (PPLGCM) showed that the three internalizing problems followed unique, but related, developmental trends across adolescence. The intercepts of the three phenomena were positively correlated with one another in all samples and increases in loneliness were associated consistently with increases in social anxiety symptoms. Only in Sample 3 evidence was found for a similar association between loneliness and depressive symptoms and between social anxiety symptoms and depressive symptoms. Except for differences in initial levels, gender differences in the development of the three problems were limited. Overall, the results of the present study clearly indicate that the three internalizing problems are longitudinally distinct from one another, but co-develop across adolescence.

Relationships between depressive symptoms and brain responses during emotional movie viewing emerge in adolescence

Affective disorders such as major depression are common but serious illnesses characterized by altered processing of emotional information. Although the frequency and severity of depressive symptoms increase dramatically over the course of childhood and adolescence, much of our understanding of their neurobiological bases comes from work characterizing adults' responses to static emotional information. As a consequence, relationships between depressive brain phenotypes and naturalistic emotional processing, as well as the manner in which these associations emerge over the lifespan, remain poorly understood. Here, we apply static and dynamic inter-subject correlation analyses to examine how brain function is associated with clinical and non-clinical depressive symptom severity in 112 children and adolescents (7-21 years old) who viewed an emotionally evocative clip from the film Despicable Me during functional MRI. Our results reveal that adolescents with greater depressive symptom severity exhibit atypical fMRI responses during movie viewing, and that this effect is stronger during less emotional moments of the movie. Furthermore, adolescents with more similar item-level depressive symptom profiles showed more similar brain responses during movie viewing. In contrast, children's depressive symptom severity and profiles were unrelated to their brain response typicality or similarity. Together, these results indicate a developmental change in the relationships between brain function and depressive symptoms from childhood through adolescence. Our findings suggest that depressive symptoms may shape how the brain responds to complex emotional information in a dynamic manner sensitive to both developmental stage and affective context.

The combined influence of cognitions in adolescent depression: Biases of interpretation, self-evaluation, and memory

OBJECTIVES

Depression is characterized by a range of systematic negative biases in thinking and information processing. These biases are believed to play a causal role in the aetiology and maintenance of depression, and it has been proposed that the combined effect of cognitive biases may have greater impact on depression than individual biases alone. Yet little is known about how these biases interact during adolescence when onset is most common.

METHODS

In this study, adolescents were recruited from the community (n = 212) and from a Child And Adolescent Mental Health Service (n = 84). Participants completed measures of depressive symptoms, interpretation bias, self-evaluation, and recall memory. These included the Mood and Feelings Questionnaire, Ambiguous Scenarios Test for Depression in Adolescents, Self-Description Questionnaire, and an immediate recall task. The clinically referred sample also took part in a formal diagnostic interview.

RESULTS

Individual cognitive biases were significantly intercorrelated and associated with depression severity. The combination of cognitive biases was a stronger predictor of depression severity than individual biases alone, predicting 60% of the variance in depression severity across all participants. There were two significant predictors, interpretation bias and negative self-evaluation; however, almost all of the variance was explained by negative self-evaluation.

CONCLUSIONS

The findings support the interrelationship and additive effect of biases in explaining depression and suggest that understanding the way in which cognitive biases interact could be important in advancing methods of identification, early intervention, and treatment.

PRACTITIONER POINTS

A combination of biases was a better predictor of depression symptom severity than individual biases. Interpretation and self-evaluation were better predictors of depression symptom severity than recall. Negative self-evaluation was the strongest individual predictor of depression symptom severity. Negative self-evaluation was able to classify depressed from non-depressed adolescents. The cross-sectional design of the study precludes any conclusions about the potential causal role of these variables. Different tasks were used to assess different types of cognitive bias meaning that the possible linear operation along an information processing 'pathway' could not be examined.

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.

Translational Shifts in Preclinical Models of Depression: Implications for Biomarkers for Improved Treatments

Understanding the neurobiology of major depressive disorder (MDD) remains one of the major challenges in neuroscience. The disease is heterogeneous in nature, and patients present with a varied symptom profile. Studies seeking to identify biomarkers for MDD diagnosis and treatment have not yet found any one candidate which achieves sufficient sensitivity and specificity. In this article, we consider whether neuropsychological impairments, specifically affective biases, could provide a behavioural biomarker. Affective biases are observed when emotional states influence cognitive function. These biases have been shown to influence a number of different cognitive domains with some specific deficits observed in MDD. It has also been possible to use these neuropsychological tests to inform the development of translational tasks for non-human species. The results from studies in rodents suggest that quantification of affective biases is feasible and may provide a reliable method to predict antidepressant efficacy as well as pro-depressant risk. Animal studies suggest that affective state-induced biases in learning and memory operate over a different time course to biases influencing decision-making. The implications for these differences in terms of task validity and future ideas relating to affective biases and MDD are discussed. We also describe our most recent studies which have shown that depression-like phenotypes share a common deficit in reward-related learning and memory which we refer to as a reward-induced positive bias. This deficit is dissociable from more typical measures of hedonic behaviour and motivation for reward and may represent an important and distinct form of reward deficit linked to MDD.

Abnormal emotional processing in maltreated children diagnosed of Complex Posttraumatic Stress Disorder

Maltreated children usually show a specific pattern of emotional and behavioral symptoms that exceed those relating to posttraumatic stress disorder (PTSD). These symptoms have been defined as Complex PTSD (CPTSD). The underlying attentional mechanisms of abnormal emotional processing and their relation to the clinical presentation of CPTSD are not well understood. A visual dot-probe paradigm involving pre-attentive (i.e., 500ms) and attentive (i.e., 1500ms) presentation rates of neutral versus emotional (i.e., angry, happy or sad) facial expressions was applied. Twenty-one maltreated CPTSD children were compared with twenty-six controls. The results are as follows: an attention bias away from threatening faces and an attentional bias towards sad faces were observed in maltreated CPTSD children during pre-attentive and attentive processing. Whereas the attentional bias away from angry faces was associated with social problems, the attentional bias towards sad faces was associated with depressive and withdrawn symptoms. Therefore, CPTSD children develop maladaptive negative cognitive styles, which may underlie not only social problems (by a cognitive avoidance of threatening stimuli) but also depressive symptoms (by a cognitive approach to sad stimuli). Attention processing abnormalities should be considered as therapeutic targets for new treatment approaches in this population.

Anxiety and depression: toward overlapping and distinctive features

This Special Issue of Cognition and Emotion addresses one of the cardinal concerns of affective science, which is overlapping and distinctive features of anxiety and depression. A central finding in the study of anxiety and depression is that they are moderately highly correlated with each other. This leads us to the question: What is behind this co-occurrence? Possible explanations relate to poor discriminant validity of measures; both emotional states are associated with negative affect; stressful life events; impaired cognitive processes; they share a common biological/genetic diathesis. However, despite a set of common (nonspecific) features, anxiety and depression are clearly not identical emotional states. Differences between them might be best viewed, for example, through their heterogeneous and multi-layered nature, adaptive functions and relations with regulatory processes, positive affect, and motivation or complex cognitive processes. In this introduction we consider several approaches (e.g. functional approach; tripartite model and content-specificity hypothesis) to which most research in this Special Issue is relevant. In addition, we have asked contributors to this Special Issue to indicate how their own studies on comparisons between anxiety and depression and models on anxiety and depression move this area of research to more mature science with applicability.