Emotional working memory training as an online intervention for adolescent anxiety and depression: A randomised controlled trial

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.

An interactive online educational environment to reduce anxiety, improve emotional well-being, and critical thinking for college students

Interactive education can reduce anxiety among students by creating a supportive and supportive learning environment. This approach can also stimulate critical thinking, as it requires active student participation in debates, analysis, and discussions. The purpose of this study is to determine the impact of interactive learning on Zoom on the anxiety, emotional well-being, and critical thinking of college students. The experiment involved 80 college students between 18 and 21 years of age. The research was performed by scientists from the [Zhengzhou University of Technology] University. To analyze the impact of the proposed strategy on emotional and cognitive well-being, the study used a set of questionnaires, namely Taylor Manifest Anxiety Scale, WAM (Well-being Assessment Measure), and Subjective Questionnaire for assessing critical thinking. The obtained results confirm the effectiveness of the interactive learning methodology, which significantly reduced anxiety and increased the level of critical thinking among students. Anxiety decreased by 14 points, and critical thinking improved by 2.5 points, indicating positive dynamics of psychological and cognitive development. Despite the positive results, some contextual factors such as the level of the learning environment, cultural characteristics, and the personalities of students can influence the generalization of the findings. These findings can have practical application in the pedagogical practice of creating a favorable learning environment. Future research may focus on improving the methodology of interactive learning, studying its impact on other aspects of learning and development. It is also necessary to explore the use of interactive learning in various cultural and educational contexts.

The effect of working memory training on test anxiety symptoms and attentional control in adolescents

OBJECTIVE

The percentage of adolescents with test anxiety is increasing rapidly. Working memory (WM) training has been demonstrated to reduce anxiety levels and enhance attentional control in individuals. Therefore, we investigated whether adaptive dual n-back WM training could lower test anxiety level and improve attentional control in adolescents.

METHODS

Forty adolescents were allocated to either adaptive dual n-back WM training (n = 21) or non-adaptive dual 1-back WM training (n = 19) for 10 days. The Test Anxiety Scale was applied to measure individuals' test anxiety symptoms. The Attentional Control Scale (ACS), the flanker task, and the Go/Nogo task were used to measure attentional control.

RESULTS

Compared with the control group, the training group reported significantly relief of test anxiety symptoms; however, there were no significant differences between the two groups in pre-to-post changes in ACS scores or performance on the flanker task and Go/Nogo task.

CONCLUSION

In sum, adaptive dual n-back WM training effectively reduced adolescents' level of test anxiety but did not improve their attentional control.

Can Emotional Working Memory Training Improve Cognitive Behavioral Therapy Outcomes for Social Anxiety Disorder: A Pilot Study

Social anxiety disorder (SAD) models highlight maladaptive attention as a maintaining factor of SAD, potentially negatively impacting how individuals with SAD engage with cognitive behavioral therapy (CBT) content in a therapist's presence. Emotional working memory training (eWMT) has been shown to improve affective attentional control. This pilot study assessed the proposed methodology for a randomized controlled trial (RCT) to determine whether eWMT, by improving attentional control prior to internet-based CBT (iCBT), results in better CBT outcomes. The RCT would be considered feasible if the pilot study achieved rates ≥80% for eligible participants recruited, study measures completion, intervention completion, and participant retention. Results from 10 randomized participants showed rates ≥80% for recruitment of eligible participants and iCBT intervention completion. Completion of study measures, eWMT and Placebo training interventions, and participant retention were <80%. Results highlight the need to consider strategies to improve the methodology prior to the RCT.

The effects of working memory training on attention deficit, adaptive and non-adaptive cognitive emotion regulation of Chinese children with Attention Deficit/Hyperactivity Disorder (ADHD)

BACKGROUND

Attention Deficit/Hyperactivity Disorder (ADHD) poses cognitive and emotional challenges for Chinese children. This study addresses the potential benefits of Working Memory Training for ADHD-affected children. Understanding its impact on Attention, cognitive regulation, and emotional responses is crucial for tailored interventions in the Chinese context. The Trial Registration Number (TRN) for this study is [TRN-2023-123,456], and it was officially registered on July 15, 2023, by Changchun Normal University.

OBJECTIVES

This study investigated how Working Memory training influences Attention, adaptive cognitive regulation, and non-adaptive cognitive emotion regulation in Chinese children with ADHD. It also assessed changes in attentional focus, improvements in adaptive cognitive regulation, and alterations in non-adaptive cognitive emotion regulation strategies.

METHODOLOGY

This quasi-experimental study aimed to assess the impact of working memory training on Chinese children with ADHD. Using pretest-posttest measures, 120 female students underwent Cogmed software training, targeting attention deficits and cognitive emotion regulation. Three reliable instruments measured outcomes. The procedure involved informed consent, questionnaires, 25 training sessions, and a two-month follow-up. Statistical analyses, including repeated measures ANOVA, assessed training effects.

RESULTS

ANOVA revealed a significant impact of Working memory training on attention deficit. Repeated measures ANOVA for cognitive emotion regulation indicated positive changes in adaptive and non-adaptive strategies over time, with sustained improvements in self-blame, rumination, catastrophizing, and blaming others. Bonferroni follow-up tests showed significant differences between pre-test, post-test, and follow-up, favoring the post-test and follow-up tests.

CONCLUSIONS

In summary, this research sheds light on the positive impact of memory training on Attention and cognitive emotion regulation in children with ADHD. The study underscores the potential of working memory interventions, particularly software-focused approaches, in enhancing attention levels and improving cognitive emotion regulation. The findings align with existing literature emphasizing the role of working memory deficits in ADHD.

IMPLICATIONS

Practically, incorporating memory training interventions into educational settings emerges as a viable strategy to support children with ADHD. This includes integrating memory training programs into both classroom activities and home-based interventions. Additionally, sustained implementation and long-term follow-up assessments are crucial for maximizing the effectiveness of memory training interventions. Tailoring interventions to specific ADHD subtypes and seamlessly integrating memory training activities into daily routines offer practical and personalized solutions for managing ADHD symptoms in diverse settings.

Working memory training for reward processing in university students with subsyndromal depression: The influence of baseline severity of depression

Previous studies have tentatively suggested that working memory training (WMT) has the potential to improve reward processing, but it is not known how long this improvement lasts, whether there is a lag effect, or whether it is reflected in neurophysiological indicators. In this study, 40 university students with subsyndromal depression were randomly assigned to a training group or a control group and completed a 20-day working memory training task and a simple memory task, respectively. All participants completed the Temporal Experience of Pleasure Scale (TEPS) and a doors task with electroencephalogram (EEG) signals recorded simultaneously on a pre- and post-test and a 3-month follow-up. The reward-related positivity (RewP) amplitude, theta power, and their differences between conditions (i.e., ΔRewP and Δtheta power, respectively) in the doors task were the primary outcomes, and the score on TEPS was the secondary outcome. The results indicated no group-related effects were demonstrated in primary and secondary outcomes at post-test and 3-month follow-up. Furthermore, the differences in the pre- and post-test in Δtheta power were moderated by the baseline severity of depression. This was primarily driven by the fact that the change values in the control group increased with the severity of depression, while the change values in the training group had high homogeneity. Our findings did not provide support for the effect of WMT on reward processing across the whole sample, but without intervention, there would be high heterogeneity in the change in the cognitive control ability to loss feedback, which is detrimental to individuals with high depression severity.

Effects of emotional working memory training on problematic internet use, inhibition, attention, and working memory among young problematic internet users: A randomized control study

Problematic internet use (PIU) has been defined as an inability to control impulses to use the internet, and is associated with psychological, social, educational, and/or occupational problems. Considering the harmful effects of PIU, the present study evaluated a treatment intervention aimed at controlling PIU. A randomized control study investigated the effectiveness of emotional working memory training (eWMT) in improving inhibition, attention, and working memory among individuals with PIU in comparison with a placebo group. Young adults (N = 36) with PIU were either trained for 20 sessions in an n-back dual emotional task (eWMT; n = 18) or a feature matching task (placebo; n = 18). Results showed that 20 continuous sessions of eWMT significantly reduced the symptoms of PIU and improved participants' working memory, attention, and inhibition (compared to the placebo group). These preliminary findings suggest that eWMT can be considered a promising treatment to reduce PIU by improving individuals' cognitive and emotional functioning.

Anxiety-reducing effects of working memory training: A systematic review and meta-analysis

OBJECTIVE

To assess whether working memory training will relieve anxiety in participants.

METHODS

The PubMed, PsycINFO, Web of Science, and ProQuest databases were searched up to January 25, 2022. We included random controlled trials with low to moderate risk of bias in comparing working memory training with control condition as the only intervention in treating anxiety (PROSPERO ID: CRD42022300404). The language was restricted to English. Data extraction was independently carried out by two authors, following the PRISMA guideline for systematic reviews.

RESULTS

Of the 477 records identified, 19 studies (n = 1051) were included in the meta-analysis. The results showed that the post-training anxiety was reduced with a small but significant value (Hedge's g = -0.392, p = .009) by working memory training. Subgroup analyses confirmed that the moderating effect of anxiety type, anxiety measurement and training environment were significant.

LIMITATIONS

These results should be considered with caution for the heterogeneity of training paradigms, participant population and types of anxiety assessed between studies. Further research is required to support these results.

CONCLUSIONS

Working memory training is a promising intervention to relieve anxiety symptoms.

Effectiveness of Online Interventions for the Universal and Selective Prevention of Mental Health Problems Among Adolescents: a Systematic Review and Meta-Analysis

With the emergence of the coronavirus disease 2019 pandemic as a threat to mental health, the demand for online interventions that can replace face-to-face approaches for the prevention of mental health problems is increasing. Although several previous reviews on online interventions have targeted adolescents with symptoms of or those diagnosed with mental illness, there is still a lack of evidence on the effectiveness of online preventive interventions for general and at-risk adolescents. Therefore, this review aimed to evaluate the effectiveness of online interventions on the prevention of an increase in the scores of stress, anxiety, and depression in general and at-risk adolescents. A search was performed using PubMed, EMBASE, and Cochrane Library CENTRAL. Altogether, 19 studies were included, and 16 studies were used for the meta-analysis. Our results showed that cognitive behavioral therapy and family-based interventions were most commonly used. Twelve and seven studies conducted universal and selective preventive interventions, respectively. The meta-analysis showed that online interventions significantly prevent an increase in depression score but not in stress and anxiety scores. Evidence regarding the prevention of increases in stress and anxiety scores is limited, suggesting the need for further randomized controlled trials on online interventions for stress and anxiety in adolescents.

Emotional working memory training improves cognitive inhibitory abilities in individuals with borderline personality trait: A randomized parallel-group trial

BACKGROUND

Cognitive inhibition impairment is one of the causes of impulsive behaviors in individuals with borderline personality disorder (BPD). This study aimed to investigate the effect of emotional working memory training (EWMT) on cognitive inhibition in individuals with a clinically significant borderline personality trait.

METHODS

In a randomized, parallel-group trial, 40 individuals with borderline personality trait, were selected out of 1000 screened individuals and were randomly assigned to the experimental (N = 20) and waiting-list control (N = 20) groups based on the score on the Borderline Personality Scale and the follow-up Structured Clinical Interview for DSM-IV Personality Disorders. The experimental group underwent 10 sessions of EWMT and the control group did not receive any intervention (waiting list). Participants completed the Stroop Color and Word Test (SCWT) and Go/No-Go task Before and after the intervention.

RESULTS

EWMT significantly reduced reaction time of incongruent trials in the SCWT and commission errors in the Go/No-Go task after the intervention only in the experimental group. Furthermore, the interference score in SCWT and commission error rate at the post-intervention time were significantly lower for the experimental vs the waitlist group.

LIMITATIONS

The single-blind design and absence of follow-up measures.

CONCLUSIONS

EWMT can improve cognitive inhibition in individuals with borderline personality trait and could be used for therapeutic purposes of impulsivity behavior in BPD.

Affective Control Training (AffeCT) reduces negative affect in depressed individuals

Depression is the leading cause of disability worldwide, with prevalence rates rising. Despite the scale of the problem, available pharmacological and psychological interventions only have limited efficacy. The National Institute of Health's Science of Behaviour Change framework proposes to address this issue by capitalising on insights from basic science to identify mechanisms that can be targeted by novel interventions. The current study evaluated the potential of a computerized programme aimed at improving affective control, a mechanistic target involved in both risk and maintenance of depression. In a first phase the cognitive profiles of 48 depressed individuals (mean age: 39 years, 75 % female) were compared to cognitive functioning in 16 never-depressed individuals (mean age: 31 years, 56 % female). The sole index of functioning that differed between diagnostic groups was reaction time across negative and positively valanced trials on an affective Stroop task (d = 0.58). This index was then used to evaluate an affective control training (AffeCT) against a placebo training. Results showed no significant changes on tasks that showed no differences with never-depressed individuals in Phase I. However, compared to placebo training, AffeCT led to significantly greater improvement in the target index, affective Stroop performance (d = 1.17). Importantly, AffeCT led to greater reductions in negative affect as measured by the Positive Affect and Negative Affect Schedule compared to the placebo training (d = 0.98). This proof-of-concept study shows promising benefits of AffeCT on depressed individuals' affect, but not depressive symptoms. It further supports the utility of the Science of Behaviour Change framework, highlighting the need for determining meaningful assays of target mechanisms when evaluating novel interventions.

Correlation between suicidal ideation and emotional memory in adolescents with depressive disorder

This study explored the differences in emotional memory between adolescents with and without suicidal ideation. Fifty adolescents with depression and suicidal ideation, 36 with depression but no suicidal ideation, and 41 healthy controls rated the emotional valence of positive, neutral, and negative pictures. Then, the recognition of the images was evaluated 72 h later. Adolescents with suicidal ideation reported more negative emotional valence scores for positive and neutral pictures and were significantly less likely to recognize negative pictures than were those without suicidal ideation. The performance of adolescents with suicidal ideation on the negative picture recognition test was closely related to anxiety, depression severity, and intensity of suicidal ideation. The negative bias toward neutral stimuli and cognitive impairment may be important risk factors for adolescents with suicidal ideation. Improving emotional memory via targeted management approaches may help young people with suicidal ideation.

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

BACKGROUND

The effect of working memory training (WM-T) has been found to transfer to emotional wellbeing, despite some debate on whether an affective component in training is necessary to achieve specific emotion-related benefits. These novel cognitive trainings have not yet been tested in highly anxious individuals, who have deficits in implicit and explicit emotional regulation and should be the potential beneficiaries of these trainings.

METHODS

We designed two types of mobile phone-based training applications: (1) WMT and (2) an emotional working memory training (EWM-T) that comprised negative face distraction. Ninety-eight participants (33, WM-T; 35, EWM-T; 30, Control group) with high trait anxiety completed the 21-day intervention or placebo program and conducted pre- and post-test procedures, including questionnaires, emotional regulation and emotional Stroop tasks alongside electroencephalogram recording. Late positive potential (LPP) in emotion regulation task and P3 in the emotional Stroop task were adopted as neutral indicators for the explicit and implicit affective regulation/control processing.

RESULTS

Those who had received training (WM-T and EWM-T) showed enhanced explicit regulation (indexed by reduced LPP during reappraisal) compared with the control. Besides, individuals in EWM-T showed reduced behavioral attention bias and a decline of P3 in response to negative faces in an emotional Stroop task. The altered neural indicators were correlated with corresponding behavior indexes that contributed to the anxiety alleviation.

CONCLUSIONS

The general WM-T was effective in enhancing explicit emotional regulation, while training with emotional add-in further improved implicit emotional control. (E)WM-T shows potential as a beneficial intervention for the anxiety population.

Cognitive control training for children with anxiety and depression: A systematic review

Cognitive control training has gained traction as an intervention for reducing anxiety and depression vulnerability in adults. There are, however, a limited number of studies investigating such training interventions for reducing symptomology of anxiety and depression in children and adolescents. Thus, we aimed to provide a robust review and qualitative synthesis of the available research in young people. Twelve articles met the inclusion criteria, and all were randomised control trials. Evidence of the efficacy of cognitive control training for relief of symptoms are reported separately for anxiety, depression, and other related psychological factors, and on the basis of type of cognitive control training paradigm. A lack of standardisation in relation to type of intervention, duration and context, outcome measures and population was observed. Results are discussed in terms of these variations and recommendations for future research are provided.

Do Metacognitions of Children and Adolescents with Anxiety Disorders Change after Intensified Exposure Therapy?

Metacognitive beliefs have repeatedly proven to play a role in anxiety disorders in children and adolescents, but few studies have investigated whether they change after cognitive behavioral therapy. This longitudinal intervention study explores whether positive and negative metacognitive beliefs in particular change after exposure-focused treatment, and if metacognitive changes predict reductions in anxiety symptoms. A sample of 27 children between 8 and 16 years of age with a primary diagnosis of specific phobia, separation-anxiety disorder or social phobia completed assessments of anxiety symptoms, metacognitive beliefs, worry and repetitive negative thoughts before and after 11 sessions of intensified exposure treatment. Metacognitive beliefs did not change significantly after intensified exposure, but post-hoc power analysis revealed a lack of power here. Change in negative metacognitive beliefs correlated with a change in anxiety symptoms, but did not independently contribute as a predictor variable. Differences between subsamples showed that patients with separation-anxiety disorder scored higher on negative metacognitive beliefs than those with specific or social phobia. Consideration of metacognition, and negative metacognitive beliefs in particular could help us further improve the understanding and treatment of anxiety disorders in children and adolescents and should therefore receive more attention in psychotherapy research.

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

The effectiveness of affective compared to neutral working memory training in university students with test anxiety

BACKGROUND

Test anxiety (TA), defined as the emotional, physiological, and behavioural responses surrounding situations involving formal evaluation of performance, is a relatively common occurrence, and, when present, can be a disruptive factor in students' academic careers. Research indicates that working memory, in particular, affective working memory, is impaired in individuals with TA. The current study therefore explored whether training the application of working memory in affective contexts could reduce TA and associated cognitive and affective impairments.

METHOD

60 Iranian university students (50% female; 19-22 years) with TA symptoms were randomized to receive 20 sessions of affective working memory training (aWMT), neutral working memory training (nWMT) or to a no-training control group. Prior and immediately after training, all participants completed measures of TA, working memory, cognitive control, and emotion regulation.

RESULTS

Compared to the control group, both the aWMT and the nWMT groups demonstrated improved cognitive and affective functioning from pre-to post-training. However, the reduction in TA symptoms and improvement in emotion regulation was greater in the aWMT group compared to the nWMT group.

CONCLUSION

aWMT may be an effective means of not only reducing TA, but also enhancing cognitive and affective functioning. These preliminary findings are promising given the potential for free and easy dissemination of aWMT in schools and online settings, including low- and middle-income countries.

Using Neuroscience to Augment Behavioral Interventions for Depression

Depression is both prevalent and costly, and many individuals do not adequately respond to existing psychopharmacological and behavioral interventions. The current article describes the use of neuroscience in augmenting behavioral interventions for depression in two primary areas: anhedonia and cognitive deficits/biases. Neuroscience research has increased our understanding of the neural bases of reward processing and regulation of positive affect, and anhedonia among depressed samples can be related to deficits in each of these domains. Treatments that specifically target reward processing and regulation of positive affect in order to reduce anhedonia represent a recent advance in the field. Depression is also associated with aberrant processes relating to working memory, autobiographical memory, attentional bias, and interpretive bias. Neuroscience findings have increasingly been leveraged to augment the efficacy of cognitive-training and bias-modification interventions in these domains. The use of neuroscience to inform the development and augmentation of behavioral interventions for depression is a promising avenue of continued research.

Psychological training to improve psychosocial function in patients with major depressive disorder: A randomised clinical trial

Cognitive and emotional remediation training for depression (CERT-D): a randomised controlled trial to improve cognitive, emotional and functional outcomes in depression The aim of the current study was to evaluate an experimental treatment designed to improve psychosocial function in patients with Major Depressive Disorder (MDD) by reinforcing cognitive, emotional, and social-cognitive abilities. Participants (N = 112) with current or lifetime MDD were recruited to participate in a randomised, blinded, controlled trial. Exclusion criteria included diagnosis of a substance abuse disorder, bipolar disorder organic, eating disorders, or illness which affect cognitive function. The treatment involved repeated cognitive training designed to improve cognitive, emotional, and social-cognitive abilities. In training sessions, the principles of cognitive training were applied across cognitive, emotional, and social domains, with participants completing repeated mental exercises. Exercises included critically analysing interpretations of social interactions (e.g., body language), exploring emotional reactions to stimuli, and completing game-like cognitive training tasks. Training sessions placed great emphasis on the application of trained cognitive, emotional, and social cognitive skills to psychosocial outcomes. Outcomes demonstrated significant improvement in psychosocial function, symptom severity, self-reported cognition, and social-cognition. Our findings demonstrate the efficacy of multi-domain cognitive training to improve psychosocial functioning in individuals with MDD. We suggest that the present treatment could be deployed at a lower cost and with minimal training in comparison to established psychological therapies.

Psychological Treatments for Depression in Adolescents: More Than Three Decades Later

Depression is a common and impairing disorder which is a serious public health problem. For some individuals, depression has a chronic course and is recurrent, particularly when its onset is during adolescence. The purpose of the current paper was to review the clinical trials conducted between 1980 and 2020 in adolescents with a primary diagnosis of a depressive disorder, excluding indicated prevention trials for depressive symptomatology. Cognitive behavioral therapy (CBT) is the pre-eminent treatment and is well established from an evidence-based treatment perspective. The body of research on the remaining treatments is smaller and the status of these treatments is varied: interpersonal therapy (IPT) is well established; family therapy (FT) is possibly effective; and short-term psychoanalytic therapy (PT) is experimental treatment. Implementation of the two treatments that work well-CBT and IPT-has more support when provided individually as compared to in groups. Research on depression treatments has been expanding through using transdiagnostic and modular protocols, implementation through information and communication technologies, and indicated prevention programs. Despite significant progress, however, questions remain regarding the rate of non-response to treatment, the fading of specific treatment effects over time, and the contribution of parental involvement in therapy.

The Effects of Emotional Working Memory Training on Trait Anxiety

Background

Trait anxiety is a pervasive tendency to attend to and experience fears and worries to a disproportionate degree, across various situations. Decreased vulnerability to trait anxiety has been linked to having higher working memory capacity and better emotion regulation; however, the relationship between these factors has not been well-established.

Objective

This study sought to determine if participants who undergo emotional working memory training will have significantly lower trait anxiety post-training. The study also sought to determine if emotion regulation mediated the relationship between working memory training and trait anxiety.

Method

An experimental group comprising of 49 participants underwent 20 days of computerized emotional working memory training, which involved viewing a continuous stream of emotionally-charged content on a grid, and then remembering the location and color of items presented on the grid. The control group comprised of 51 participants.

Results

Participants of the experimental group had significantly lower trait anxiety compared to controls, post-training. Subsequent mediation analysis determined that working memory training capacity gains were significantly related to anxiety reduction as measured by form Y2 of the Spielberger State-Trait Anxiety Inventory (STAI-Y2). Emotion regulation, as measured by the Emotional Regulation Questionnaire (ERQ), was found not to mediate between working memory capacity gains and trait anxiety reduction.

Conclusion

Working memory capacity gains and reductions in levels of trait anxiety were observed following emotional working memory training. The study may therefore be useful in informing interventions targeted at improving working memory capacity, and reducing levels of trait anxiety. Moreover, it proposes for future research to further look into the mediating role of emotion regulation via the development or utilization of more comprehensive measures of emotion regulation.

Characteristics of effective online interventions: implications for adolescents with personality disorder during a global pandemic

In recent years, the necessity of providing online interventions for adolescents, as an alternative to face-to-face interventions, has become apparent due to several barriers some adolescents face in accessing treatment. This need has become more critical with the coronavirus disease 2019 (COVID-19) global pandemic impacting the delivery of psychotherapy and limiting accessibility of face-to-face therapy. Whilst it has been established that face-to-face psychotherapy for adolescents with personality disorder can be effective in reducing the impact these complex mental illnesses have on functioning, online interventions for adolescents are rare, and to our knowledge there are no empirically validated online interventions for personality disorder. The development of novel online interventions are therefore necessary. To inform the development of online interventions for adolescents with personality disorder or symptoms of emerging personality disorder, a two-phase rapid review was conducted. Phase one consisted of a search and examination of existing online mental health programs for adolescents with symptoms of personality disorder, to understand how to best use online platforms. Phase two consisted of a rapid review of empirical literature examining online interventions for adolescents experiencing symptoms of personality disorder to identify characteristics that promote efficacy. There were no online programs specific to personality disorder in adolescence. However, 32 online mental health programs and 41 published empirical studies were included for analysis. Common intervention characteristics included timeframes of one to two months, regular confidential therapist contact, simple interactive online components and modules, and the inclusion of homework or workbook activities to practice new skills. There is an urgent need for online interventions targeting personality dysfunction in adolescence. Several characteristics of effective online interventions for adolescents were identified. These characteristics can help inform the development and implementation of novel online treatments to prevent and reduce the burden and impact of personality disorder, or symptoms of emerging personality disorder, in adolescents. This has implications for the COVID-19 pandemic when access to effective online interventions has become more urgent.

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.

Emotional working memory training reduces rumination and alters the EEG microstate in anxious individuals

Rumination is an important etiological factor of anxiety pathology, with its mechanism related to the deficit of working memory. The current study examined whether working memory training (WM-T) and emotional working memory training (EWM-T) could reduce rumination in anxious individuals. The participants with high trait anxiety underwent 21 days of mobile applications-based WM-T (n = 34), EWM-T (n = 36) or placebo control (n = 36), with questionnaires, cognitive tasks, and resting electroencephalogram (EEG) as the pre-post-test indicators. The results revealed that two training groups obtained comparable operation span increases (WM-T: d = 0.53; EWM-T: d = 0.65), updating improvement (WM-T: d = 0.43; EWM-T: d = 0.60) and shifting improvement (WM-T: d = 0.49; EWM-T: d = 0.72). Furthermore, compared to the control group, the EWM-T showed significant self-reported rumination reduction (d = 0.69), increased inhibition ability (d = 0.72), as well as modification of resting EEG microstate C parameters (Duration C: d = 0.42, Coverage C: d = 0.39), which were closely related to rumination level (r ~ 0.4). The WM-T group also showed the potential to reduced self-reported rumination (d = 0.45), but with the absence of the observable inhibition improvement and resting EEG changes. The correlation analysis suggested that the emotional benefits of WM-T depending more on improved updating and shifting, and that of EWM-T depending more on improved inhibition ability. The advantage to add emotional distractions into general working memory training for targeting rumination related anxiety has been discussed.

A randomised double-blind trial of cognitive training for the prevention of psychopathology in at-risk youth

BACKGROUND

The aim of this study was to evaluate the effectiveness of online cognitive training as a means of reducing psychopathology in at-risk youth.

METHODS

In a double-blind randomised controlled trial, 228 youths (mean age = 18.6, 74.6% female) were randomly allocated to either an intervention group (n = 114; online cognitive training focused on executive functioning) and a control group (n = 114; online cognitive training focused on other cognitive abilities). Participants were assessed online at baseline, post-training, 3-, 6- and 12-month follow-up. The primary outcome of the study was overall psychopathology as measured by the Strengths and Difficulties Questionnaire. Secondary outcomes were executive functioning ability (assessed using the n-back, trail-making and Stroop tasks), day-to-day functioning and risky drinking.

RESULTS

Mixed model intention-to-treat analyses indicated that psychopathology increased and day-to-day functioning decreased, regardless of intervention group. Those in the intervention group improved more than those in the control group in terms of the n-back task, but this was not statistically significant after adjusting for multiple comparisons. There were no statistically significant effects on risky drinking, or the trail-making and Stroop tasks.

CONCLUSION

This study failed to provide evidence for the efficacy of cognitive training as a stand-alone intervention for psychopathology.

Better cognitive efficiency is associated with increased experimental anxiety

There is increased interest in the development of cognitive training targeting working memory (WM) to alleviate anxiety symptoms, but the effectiveness of such an approach is unclear. Improved understanding of the effect of cognitive training on anxiety may facilitate the development of more effective cognitive training treatment for anxiety disorders. This study uses an experimental approach to examine the interplay of WM and anxiety following WM training. Previous studies show that increased demand on WM reduces concurrent anxiety evoked by threat of shock (induced anxiety). However, improving WM pharmacologically or via exercise prevents this anxiolytic effect. Conceivably, improving WM frees up cognitive resources to process threat information, thereby increasing anxiety. The present study tested the hypothesis that practicing a high load WM (i.e., increased demand) task would improve WM, and thus, free cognitive resources to process threat of shock, resulting in more anxiety (i.e., greater startle) during a subsequent WM task. Participants were randomly assigned to two training groups. The active-training group (N = 20) was trained on a 1- (low load) & 3-back (high load) WM task, whereas the control-training group (N = 20) performed a 0-back WM task. The experimental phase, similar in both groups, consisted of a 1- & 3-back WM task performed during both threat of shock and safety. As predicted, active training improved WM accuracy and increased anxiety during the experimental 3-back WM task. Therefore, improving WM efficiency can increase anxiety, possibly by freeing WM resources to process threat information.

The effect of emotional working memory training on emotional and cognitive outcomes in individuals with elevated social anxiety

BACKGROUND

Although cognitive-behavioural therapy is the gold standard psychological treatment for individuals with social anxiety disorder (SAD), it does not benefit everyone. Emotional working memory training (eWMT) is a promising alternative intervention. This study examined the effects of eWMT versus control training (CT) on emotional and cognitive outcomes in individuals with elevated social anxiety.

METHODS

Forty participants with elevated social anxiety were randomly allocated to eWMT (n = 21) or CT (n = 19), each consisting of six training sessions. At pre- and post-training, participants completed: a working memory task, an impromptu speech, and self-reported measures of emotional and cognitive outcomes (anticipatory processing, peak anxiety and attentional focus during the speech, post-event processing).

RESULTS

Participants in both training conditions exhibited performance improvements on their respective training tasks. As expected, there was a Time x Condition interaction for peak anxiety, reflecting a decrease in peak anxiety for the eWMT condition but not the CT condition. Exploratory analyses also indicated a Time x Condition interaction for an aspect of post-event processing, reflecting a decrease in thinking about the past for the eWMT condition but not the CT condition.

LIMITATIONS

Although the level of social anxiety of the current sample is comparable to that of samples of individuals diagnosed with SAD in the literature, participant diagnoses were not assessed in this study.

CONCLUSIONS

The findings suggest that eWMT has potential as an alternative intervention for individuals with elevated social anxiety.

What Works and What Doesn't Work? A Systematic Review of Digital Mental Health Interventions for Depression and Anxiety in Young People

Background: A major challenge in providing mental health interventions for young people is making such interventions accessible and appealing to those most in need. Online and app-based forms of therapy for mental health are burgeoning. It is therefore crucial to identify features that are most effective and engaging for young users. Objectives: This study reports a systematic review and meta-analysis of digital mental health interventions and their effectiveness in addressing anxiety and depression in young people to determine factors that relate to outcomes, adherence, and engagement with such interventions. Methods: A mixed methods approach was taken, including a meta-analysis of 9 randomized controlled trials that compared use of a digital intervention for depression in young people to a no-intervention control group, and 6 comparing the intervention to an active control condition. A thematic analysis and narrative synthesis of 41 studies was also performed. Results: The pooled effect size of digital mental health interventions on depression in comparison to a no-intervention control was small (Cohen's d = 0.33, 95% CI 0.11 to 0.55), while the pooled effect size of studies comparing an intervention group to an active control showed no significant differences (Cohen's d = 0.14, 95% CI -.04 to 0.31). Pooled effect sizes were higher when supervision was involved (studies with no-intervention controls: Cohen's d = 0.52, 95% CI 0.23 to 0.80; studies with active control: Cohen's d = 0.49, 95% CI -0.11, 1.01). Engagement and adherence rates were low. Qualitative analysis revealed that users liked interventions with a game-like feel and relatable, interactive content. Educational materials were perceived as boring, and users were put off by non-appealing interfaces and technical glitches. Conclusions: Digital interventions work better than no intervention to improve depression in young people when results of different studies are pooled together. However, these interventions may only be of clinical significance when use is highly supervised. Digital interventions do not work better than active alternatives regardless of the level of support. Future interventions need to move beyond the use of digital educational materials, considering other ways to attract and engage young people and to ensure relevance and appeal.

From Surviving to Thriving in the Face of Threats: The Emerging Science of Emotion Regulation Training

A key survival skill is the ability to regulate your emotions so as to respond adaptively to life's challenges. As such, it is essential to understand how we can improve this ability through training. While this is still a new area of research, to date, behavioral and brain studies have taken one of two approaches: either training individuals to implement strategies that directly impact current emotional responses, or training a cognitive control ability (like working memory, selective attention, response inhibition) to strengthen or tune control processes that can support regulation to subsequently encountered events. Behavioral data highlight the importance of tailoring training to an individual and their emotional situation. Brain data suggest that training impacts domain general cognitive control systems and their interaction with subcortical regions (mainly the amygdala). Future progress will depend on systematic examination of the mechanisms involved in training effectiveness and the populations that may benefit from training.

Training Working Memory in Adolescents Using Serious Game Elements: Pilot Randomized Controlled Trial

BACKGROUND

Working memory capacity has been found to be impaired in adolescents with various psychological problems, such as addictive behaviors. Training of working memory capacity can lead to significant behavioral improvements, but it is usually long and tedious, taxing participants' motivation to train.

OBJECTIVE

This study aimed to evaluate whether adding game elements to the training could help improve adolescents' motivation to train while improving cognition.

METHODS

A total of 84 high school students were allocated to a working memory capacity training, a gamified working memory capacity training, or a placebo condition. Working memory capacity, motivation to train, and drinking habits were assessed before and after training.

RESULTS

Self-reported evaluations did not show a self-reported preference for the game, but participants in the gamified working memory capacity training condition did train significantly longer. The game successfully increased motivation to train, but this effect faded over time. Working memory capacity increased equally in all conditions but did not lead to significantly lower drinking, which may be due to low drinking levels at baseline.

CONCLUSIONS

We recommend that future studies attempt to prolong this motivational effect, as it appeared to fade over time.

Age-varying associations between coping and depressive symptoms throughout adolescence and emerging adulthood

The objective of the current study was to apply the novel technique of time-varying effect modeling to examine age-varying associations between specific coping strategies and depressive symptoms across adolescence and emerging adulthood (ages 14–24). The participants were drawn from a community sample and followed across 4 years of high school and once 5 years postgraduation (N = 1,251, 53% female, 58% non-Hispanic White). Coping and depressive symptom questionnaires were administered across all data collection time points. Time-varying effect modeling used all available data (N = 5,651 measurement occasions) and adjusted for gender. Venting emotions and denial were associated with more depressive symptoms at a similar magnitude across adolescence and emerging adulthood. A positive association between problem solving oriented strategies (planning, active coping) and depressive symptoms was not observed until age 17.5, after which the magnitude of the association strengthened. More frequent instrumental and emotional support seeking were linked to fewer depressive symptoms between ages 18.8 and 23.6. More frequent use of humor was associated with greater depressive symptoms from ages 14.0 to 14.6, but with fewer depressive symptoms from ages 16.8 to 18.8. The findings illuminate when and how associations between specific coping strategies and depressive symptoms may emerge and change across developmental age, generating both theoretical and clinical implications.

A randomized controlled trial of multi-session online interpretation bias modification training: Short- and long-term effects on anxiety and depression in unselected adolescents

Introduction

Negatively biased interpretations play an important role in anxiety and depression, which are highly prevalent in adolescence, and changing such biases might thus reduce or prevent emotional disorders. We investigated the short- and long-term effects of an online interpretation bias modification training in unselected adolescents to explore its potential in preventing anxiety and depression.

Methods

Participants (N = 173) were randomly allocated to eight online sessions of interpretation or placebo training. Interpretation bias was assessed pre- and post-training. Primary outcomes of anxiety and depression, and secondary measures of emotional resilience were assessed pre- and post-training and at three, six, and twelve months follow-up.

Results

Compared to placebo, interpretation training marginally increased positive interpretations. Irrespective of training condition, symptoms of anxiety and depression showed a decline post-training and at follow-up, and indices of resilience showed an increase. Change in interpretation bias, baseline interpretation bias, stressful life events, or number of training sessions completed did not moderate the effects on anxiety or depression.

Conclusions

Results suggest that interpretation training as implemented in this study has no added value in reducing symptoms or enhancing resilience in unselected adolescents.

Performance-based ability emotional intelligence benefits working memory capacity during performance on hot tasks

Emotional intelligence (EI) is the ability to perceive, use, understand, and regulate emotions. Higher scores on this ability measured through performance tests (but no through self-reports) appears to be related to better performance on “hot” (emotionally laden) cognitive tasks. However, there are relatively few studies concerning how EI may benefit the working memory capacity (WMC). Thus, the objective of this study is to analyse the relationship between EI (as measured through a performance-based ability test, a self-report mixed test, and a self-report ability test) and the WMC during the performance of hot and “cool” (i.e., non-emotionally laden) “2-back” tasks. 203 participants completed three EI tests as well as two 2-back tasks. The results provide evidence for better performance of higher EI participants (specifically in the managing branch) measured through the performance-based ability test, but only on the hot task. For the self-report mixed model, incongruent results were found, and no correlations were obtained using the self-report ability model. The implications of these findings are discussed in terms of the validity of the various EI models.

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

This is the first study to investigate multiple cognitive biases in adolescence simultaneously, to examine whether anxiety and depression are associated with biases in attention and interpretation, and whether these biases are able to predict unique variance in self-reported levels of anxiety and depression. A total of 681 adolescents performed a Dot Probe Task (DPT), an Emotional Visual Search Task (EVST), and an Interpretation Recognition Task. Attention and interpretation biases were significantly correlated with anxiety. Mixed results were reported with regard to depression: evidence was found for an interpretation bias, and for an attention bias as measured with the EVST but not with the DPT. Furthermore, interpretation and attention biases predicted unique variance in anxiety and depression scores. These results indicate that attention and interpretation biases are unique processes in anxiety and depression. They also suggest that anxiety and depression are partly based on similar underlying cognitive mechanisms.