Annual Research Review: An expanded account of information-processing mechanisms in risk for child and adolescent anxiety and depression

Pupillary Responses to Dynamic Negative Versus Positive Facial Expressions of Emotion in Children and Parents: Links to Depression and Anxiety

Witnessing emotional expressions in others triggers physiological arousal in humans. The current study focused on pupil responses to emotional expressions in a community sample as a physiological index of arousal and attention. We explored the associations between parents' and offspring's responses to dynamic facial expressions of emotion, as well as the links between pupil responses and anxiety/depression. Children (N = 90, MAge = 10.13, range = 7.21-12.94, 47 girls) participated in this lab study with one of their parents (47 mothers). Pupil responses were assessed in a computer task with dynamic happy, angry, fearful, and sad expressions, while participants verbally labeled the emotion displayed on the screen as quickly as possible. Parents and children reported anxiety and depression symptoms in questionnaires. Both parents and children showed stronger pupillary responses to negative versus positive expressions, and children's responses were overall stronger than those of parents. We also found links between the pupil responses of parents and children to negative, especially to angry faces. Child pupil responses were related to their own and their parents' anxiety levels and to their parents' (but not their own) depression. We conclude that child pupils are sensitive to individual differences in parents' pupils and emotional dispositions in community samples.

The Impact of Mobile Social Media Use on Depressive Mood Among College Students: A Chain Mediating Effect of Upward Social Comparison and Cognitive Overload

Background

The 18-24 age group has a much higher rate of depression risk than other age groups, and this age group has the highest proportion among users of mobile social media. The relationship between the use of mobile social media and depressive mood is inconsistent and the mechanism of action is controversial.

Purpose

This study explored the relationship among the intensity of social media use, upward social comparison, cognitive overload and depressive mood.

Methods

In this research, we used the Brief Self-rating Depression Scale (PHQ-9), the Social Media Usage Intensity Questionnaire, the Social Comparison Scale on Social Networking Sites and the Social Networking Site Cognitive Overload Scale to investigate the depressive mood and mobile social media use of 568 college students.

Results

The intensity of mobile social media use, social networking site upward social comparison, and social networking site cognitive overload are all positively correlated with depressive mood. The intensity of mobile social media use has a positive predictive effect on depressive mood, with upward social comparison and cognitive overload acting as independent mediators in the relationship between mobile social media use intensity and depressive symptoms, as well as exhibiting a chained mediating effect of upward social comparison-cognitive overload.

Conclusion

The upward social comparison and cognitive load that occur during the use of mobile social media are important predictive factors for the occurrence of depressive mood. This study is a supplement to the mechanism of the relationship between mobile social media use and depression, providing more evidence-based evidence and intervention directions for university teachers, mobile social media developers, and psychologists.

Young Children of Mothers with a History of Depression Show Attention Bias to Sad Faces: An Eye-tracking Study

Maternal depression is a predictor of the emergence of depression in the offspring. Attention bias (AB) to negative emotional stimuli in children may serve as a risk factor for children of depressed parents. The present study aimed to examine the effect of maternal major depressive disorder (MDD) history on AB to emotional faces in children at age four, before the age of onset for full-blown psychiatric symptoms. The study also compared AB patterns between mothers and their offspring. Fifty-eight mothers and their four-year-old children participated in this study, of which 27 high-risk (HR) children had mothers with MDD during their children's lifetime. Attention to emotional faces was measured in both children and their mothers using an eye-tracking visual search task. HR children exhibited faster detection and longer dwell time toward the sad than happy target faces. The low-risk (LR) children also displayed a sad bias but to a lesser degree. Children across both groups showed AB towards angry target faces, likely reflecting a normative AB pattern. Our findings indicate that AB to sad faces may serve as an early marker of depression risk. However, we provided limited support for the mother-child association of AB. Future research is needed to examine the longitudinal intergenerational transmission of AB related to depression and possible mechanisms underlying the emergence of AB in offspring of depressed parents.

Seeing oneself as an unattractive loser: Similar interpretation and memory biases in adolescents with anorexia nervosa and adolescents with depression or anxiety

OBJECTIVE

Anorexia nervosa (AN) is characterised by dysfunctional cognitive biases but these have rarely been investigated in adolescents with AN. The present study systematically assessed cognitive biases in adolescents with AN and addressed the questions of content-specificity (i.e., do biases occur only for eating disorder-related information?) and disorder-specificity (i.e., are biases unique to individuals with AN?).

METHODS

Cognitive biases on three information processing levels (attention, interpretation, memory) and for two types of information content (eating disorder-related, non-eating disorder-related) were assessed within a single experimental paradigm based on the Scrambled Sentences Task. 12-18-year-old adolescents with AN (n = 40) were compared to a healthy (HC; n = 40) and a clinical (girls with depression and/or anxiety disorders; CC; n = 34) control group.

RESULTS

Both clinical groups (AN and CC) showed pronounced negative interpretation and memory biases compared to the HC group, for both disorder-related and non-disorder-related information. Attention biases could not be analysed.

CONCLUSION

The results support the hypothesis that adolescents with AN show negative cognitive biases but these were not limited to disorder-related information. Adolescents with depression and/or anxiety disorders showed similar biases, suggesting them to be transdiagnostic phenomena. Important implications for cognitive-behavioural theories of AN, subsequent cognitive bias modification studies in AN, as well as clinical practice are discussed.

The Relationship Between Harsh Parenting and Smartphone Addiction Among Adolescents: Serial Mediating Role of Depression and Social Pain

Purpose

With the increasing prevalence of smart phones, adolescent smartphone addiction has garnered significant attention from researchers. Previous studies have revealed that smartphone addiction is associated with various internalization and externalization problems. Therefore, this present study aims to investigate the risk factors contributing to adolescent smartphone addiction.

Methods

Study 1 recruited a sample of 540, 690, and 470 Chinese students aged between 10-17 years for exploratory factor analysis, confirmatory factor analysis, and predictive validity analysis of the social pain scale. Study 2 utilized data from a sample of 718 Chinese students aged between 10-17 years to examine the measurement model used revised social pain scale, smartphone addiction scale, harsh parenting scale, and depression sub-scale.

Results

The present study revealed that (1)The Social Pain Scale had good applicability in Chinese adolescents; (2) There were significant, positive correlations among harsh parenting, smartphone addiction, depression and social pain; (3) Social pain and depression played a partially serial mediating role in the relationship between harsh parenting and smartphone addiction, and similarly the relationship between paternal harsh parenting and smartphone addiction, while a completely serial mediating role in the relationship between maternal harsh parenting and smartphone addiction.

Conclusion

This study provides a direct path (improving parenting style) and an indirect path (reducing social pain to reduce depression) regarding interventions for adolescents with smartphone addiction, and establishes a basis for improving the situation of adolescent smartphone addiction.

Economic hardship and adolescent behavioral outcomes: Within- and between-family associations

Understanding how youth perceive household economic hardship and how it relates to their behavior is vital given associations between hardship and behavioral development. Yet, most studies ignore youth's own perceptions of economic hardship, instead relying solely on caregiver reports. Moreover, the literature has tended to treat economic hardship as a stable force over time, rather than a volatile one that varies month-to-month. This study addressed extant limitations by collecting monthly measures of economic hardship, specifically caregiver- and youth-reported material deprivation and youth-reported financial stress, and youth internalizing and externalizing problems from 104 youth-caregiver dyads (youth: 14-16 years, 55% female, 37% Black, 43% White) over nine months. We examined month-to-month variability of these constructs and how youth-reports of material deprivation and financial stress predicted their behavior problems, controlling for caregiver-reports of material deprivation. We found that hardship measures varied month-to-month (ICCs = 0.69-0.73), and youth-reported material deprivation positively predicted internalizing when examining both within- and between-individual variability (β = .19-.47). Youth-reported financial stress positively predicted within-individual variation in externalizing (β = .18), while youth reports of material deprivation predicted externalizing when looking between families (β = .41). Caregiver-reported material deprivation was unrelated to youth behavior when accounting for youth perceptions of economic hardship.

Novel mechanism-based treatments for pediatric anxiety and depressive disorders

Pediatric anxiety and depressive disorders are common, can be highly impairing, and can persist despite the best available treatments. Here, we review research into novel treatments for childhood anxiety and depressive disorders designed to target underlying cognitive, emotional, and neural circuit mechanisms. We highlight three novel treatments lying along a continuum relating to clinical impact of the disorder and the intensity of clinical management required. We review cognitive training, which involves the lowest risk and may be applicable for problems with mild to moderate impact; psychotherapy, which includes a higher level of clinical involvement and may be sufficient for problems with moderate impact; and brain stimulation, which has the highest potential risks and is therefore most appropriate for problems with high impact. For each treatment, we review the specific underlying cognitive, emotional, and brain circuit mechanisms that are being targeted, whether treatments modify those underlying mechanisms, and efficacy in reducing symptoms. We conclude by highlighting future directions, including the importance of work that leverages developmental windows of high brain plasticity to time interventions to the specific epochs in childhood that have the largest and most enduring life-long impact.

Social interpretation inflexibility moderates emotional reactions to social situations in children and adolescents

Interpretation biases and inflexibility (i.e., difficulties revising interpretations) have been linked to increased internalizing symptoms. Although adolescence is a developmental period characterized by novel social situations and increased vulnerability to internalizing disorders, no studies have examined interpretation inflexibility in adolescents. Additionally, no studies (on adolescents or adults) have examined interpretation flexibility as a protective factor against adverse outcomes of interpersonal events. Using a novel task and a 28-day diary we examined relations among interpretation bias and inflexibility, internalizing symptoms, and negative interpersonal events in a sample of children and adolescents (N = 159, ages 9-18). At baseline, negative interpretation bias was positively correlated with social anxiety symptoms, and positive interpretation bias negatively correlated with social anxiety and depressive symptoms. Inflexible positive interpretations were correlated with higher social anxiety and depressive symptoms, while inflexible negative interpretations were correlated with higher social anxiety. Finally, interpretation inflexibility moderated daily associations between negative interpersonal events and depressive symptoms in daily life, such that higher inflexibility was associated with stronger associations between interpersonal events and subsequent depressive symptoms, potentially increasing depressive symptom instability. These results suggest that interpretation biases and inflexibility may act as both risk and protective factors for adolescent anxiety and depression.

Emotional and socio-cognitive processing in young children with symptoms of anxiety

Many children with anxiety disorders exhibit significant and persistent impairments in their social and interpersonal functioning. Two components essential for successful social interaction are empathy and theory of mind (ToM). Both constructs develop rapidly in childhood, but no study has simultaneously examined these skills in young children with emerging mental health problems, including those with symptoms of anxiety. This study investigated empathy and ToM in children with anxiety symptomatology and examined their relationship with anxiety severity. A cross-sectional study was carried out with 174 children aged 4-8 years with emerging mental health difficulties who were referred by school teachers for an assessment because of emotional, cognitive, or behavioural problems at school. Participants completed empathy and ToM tasks. Parents were interviewed and rated children's emotional and behavioural problems. Correlational analyses indicated that elevated anxiety was associated with better cognitive ToM and worse affective empathy; there were no associations between anxiety and either cognitive empathy or affective ToM. Subsequent regression analyses demonstrated that whilst enhanced cognitive ToM was explained by age and verbal IQ, anxiety symptoms uniquely predicted impaired affective empathy. These results indicate that children with symptoms of anxiety have difficulty in sharing in other people's emotions. As a result, they may find it difficult to behave in socially adequate ways in interactions with others that involve affective sharing. These findings encourage the use of early and targeted interventions that improve affective empathy development in children with anxiety symptoms.

Subgenual Anterior Cingulate Cortex Reactivity to Rejection Vs. Acceptance Predicts Depressive Symptoms among Adolescents with an Anxiety History

OBJECTIVE

The goal of this study was to examine whether neural sensitivity to negative peer evaluation conveys risk for depression among youth with a history of anxiety. We hypothesized that brain activation in regions that process affective salience in response to rejection, relative to acceptance, from virtual peers would predict depressive symptoms 1 year later and would be associated with ecological momentary assessment (EMA) reports of peer connectedness.

METHOD

Participants were 38 adolescents ages 11-16 (50% female) with a history of anxiety, recruited from a previous clinical trial. The study was a prospective naturalistic follow-up of depressive symptoms assessed 2 years (Wave 2) and 3 years (Wave 3) following treatment. At Wave 2, participants completed the Chatroom Interact Task during neuroimaging and 16 days of EMA.

RESULTS

Controlling for depressive and anxiety symptoms at Wave 2, subgenual anterior cingulate (sgACC; β = .39, p = .010) activation to peer rejection (vs. acceptance) predicted depressive symptoms at Wave 3. SgACC activation to rejection (vs. acceptance) was highly negatively correlated with EMA reports of connectedness with peers in daily life (r = - .71, p < .001).

CONCLUSION

Findings suggest that elevated sgACC activation to negative, relative to positive, peer evaluation may serve as a risk factor for depressive symptoms among youth with a history of anxiety, perhaps by promoting vigilance or reactivity to social evaluative threats. SgACC activation to simulated peer evaluation appears to have implications for understanding how adolescents experience their daily social environments in ways that could contribute to depressive symptoms.

Fearful temperament in middle childhood predicts adolescent attention bias and anxiety symptoms: The moderating role of frontal EEG asymmetry

The current study provided first analyses of the moderating effect of baseline-to-task frontal EEG asymmetry on the associations between 9-year fearful temperament and adolescent attention bias to threat as well as anxiety symptoms. Participants include a community sample of 122 children (60 boys, 62 girls; Mage = 14.66 years; Range = 11.82-18.13 years). Baseline-to-task frontal EEG asymmetry at age 9 moderated the relation between fearful temperament at age 9 and adolescent anxiety symptoms. Specifically, fearful temperament predicted adolescent anxiety symptoms when children showed greater right activation from baseline to an executive function task, but not greater left activation. Baseline-to-task frontal EEG asymmetry moderated the association between fearful temperament and sustained (i.e., stimulus onset asynchrony is 1250 ms) but not automatic attention bias (i.e., stimulus onset asynchrony is 500 ms). Children with greater left frontal activation from baseline to task more efficiently direct attention away from threat. Adolescent automatic attention bias to threat was related to concurrent anxiety symptoms. These findings illustrate the importance of considering frontal EEG asymmetry to shape how fearful children process threat and to influence their behavioral problems.

Effortful control and depression in school-age children: The chain mediating role of emotion regulation ability and cognitive reappraisal strategy

BACKGROUND

Depression is one of the main mental health problems facing primary school students. Temperamental effortful control (EC) has received much attention as a protective factor to depression. The present study aimed to verify the association of effortful control and children's depression and explore the mediating roles of emotion regulation ability (ERA) and strategies (ERSs) in the relationship.

METHODS

A total of 449 valid primary school students in grades 3 to 6 were included in the study. Self-report and parent-report questionnaires were used to collect data on key variables, including EC, depression, ERA and ERSs.

RESULTS

Gender and whether-native-or-not had significant effects on children's depression. EC was significantly and negatively correlated with children's depression; EC and depression were significantly correlated with Emotion Regulation dimension of ERA and cognitive reappraisal; but there was no correlation between EC and Lability/Negativity, as well as between expression suppression and depression. EmotionRegulation and cognitive reappraisal played mediating effects in the relationship between EC and depression parallelly and sequentially.

LIMITATIONS

The study used cross-sectional design and the sample was restricted to Chinese primary school students. Additionally, the types and research perspectives of ERSs can be further expanded.

CONCLUSIONS

EC can reduce the level of children's depression by improving the abilities of Emotion Regulation and the use of cognitive reappraisal strategy, as well as the chain mediating effects of the two.

A Longitudinal Investigation of the Relationship Between Trauma-Related Cognitive Processes and Internalising and Externalising Psychopathology in Young People in Out-of-Home Care

Young people in out-of-home care are at increased risk of developing a range of posttrauma mental health difficulties, including PTSD, but more commonly anxiety, depression and externalising symptoms. Cognitive models of PTSD indicate that trauma-related maladaptive appraisals, coping strategies and trauma memory qualities are key processes in the development and maintenance of PTSD, yet there has been limited investigation of the potential role of these processes in broader posttrauma psychopathology, particularly in young people who have been exposed to complex, rather than acute, trauma. We recruited 120 10-18 years olds in out-of-home care, and their caregivers, who completed assessments at two time points: baseline and 12-month follow-up. Young people completed self-report measures of trauma-related maladaptive appraisals, coping strategies and trauma-memory qualities, as well as reporting on PTSD, anxiety, depression and externalising symptoms. Carers also reported on internalising and externalising symptoms. We found that all three cognitive processes were associated with baseline self-reported internalising symptoms, with maladaptive appraisals most robustly associated with both anxiety and depression. Changes in all three processes over 12-months predicted a change in self-reported internalising and externalising symptoms, with maladaptive appraisals and coping predicting anxiety symptoms, and coping uniquely predicting depression and externalising symptoms. Effects remained after controlling for co-occurring PTSD symptoms. Findings were not replicated when using carer-reported symptoms. These findings suggest that existing cognitive models of PTSD may also usefully explain broader posttrauma depression, anxiety and externalising symptoms in young people who have experienced maltreatment and live in out-of-home care. Clinical implications are discussed.

Attachment patterns and autobiographical episodic memory functioning: A systemic review of adult studies to advance clinical psychological science

Patterns of insecure attachment are associated with psychopathology but the mechanisms involved remain poorly understood. Cognitive science proposes that attachment patterns are influenced by the autobiographical memory system and in turn influence its ongoing functioning. Disturbances in autobiographical memory represent cognitive risks for later emotional difficulties. We systemically reviewed 33 studies (in 28 articles) examining the association between attachment patterns and autobiographical episodic memory (AEM) in individuals from the age of 16 (i.e., from young to older adulthood). Attachment patterns were associated with key areas of AEM phenomenology, including intensity and arousal; detail, specificity, and vividness; coherence and fragmentation; and accuracy and latency. These associations appeared to be moderated by contextual and individual factors; mediated by emotional regulation and schema-based processing; linked to mental health outcomes. Attachment patterns may also influence the impact of certain AEM-based manipulations. We conclude by providing a critical discussion and a research agenda for bringing together attachment, memory, and emotion, with a view to promote mechanism-driven treatment innovation in clinical psychology.

Frontal alpha asymmetry in anxious school-aged children during completion of a threat identification task

Asymmetry of EEG alpha power in the frontal lobe has been extensively studied over the past 30 years as a potential marker of emotion and motivational state. However, most studies rely on time consuming manipulations in which participants are placed in anxiety-provoking situations. Relatively fewer studies have examined alpha asymmetry in response to briefly presented emotionally evocative stimuli. If alpha asymmetry can be evoked in those situations, it would open up greater methodological possibilities for examining task-driven changes in neural activation. Seventy-seven children, aged 8-12 years old (36 of whom were high anxious), completed three different threat identification tasks (faces, images, and words) while EEG signal was recorded. Alpha power was segmented and compared across trials in which participants viewed threatening vs. neutral stimuli. Threatening images and faces, but not words, induced lower right vs. left alpha power (greater right asymmetry) that was not present when viewing neutral images or faces. Mixed results are reported for the effect of anxiety symptomatology on asymmetry. In a similar manner to studies of state- and trait-level withdrawal in adults, frontal neural asymmetry can be induced in school-aged children using presentation of brief emotional stimuli.

Attention Biases for Eating Disorder-Related Stimuli Versus Social Stimuli in Adolescents with Anorexia Nervosa - An Eye-Tracking Study

Anorexia nervosa (AN) is characterized by attention biases for eating disorder-related information as well as altered attentional processing of social information. However, little is known about the interplay between the altered attentional processing of these two types of information. The present study investigates attention biases for eating disorder-related information (pictures of bodies) versus social information (pictures of faces), in adolescents with AN. Attention biases were assessed via eye-tracking during a passive-viewing task in which female bodies and faces were presented simultaneously and thus competed directly for attention. Female adolescents (13-18 years) with AN (n = 28) were compared to a clinical comparison group (adolescents with major depression; n = 20) and a comparison group of adolescents with no mental illness (n = 24). All groups looked longer at bodies than at faces, i.e., showed attention biases for bodies in maintenance of attention. These biases were more pronounced in adolescents with AN than in both comparison groups, particularly for underweight bodies, at the expense of looking less at social stimuli. The results indicate "dual" attention biases in adolescents with AN (i.e., towards bodies and away from emotional faces) which could have a twofold negative impact on eating disorder psychopathology: increased attention to eating disorder-related information might directly influence eating disorder symptoms while less attention to social information might have an indirect influence through the amplification of interpersonal difficulties.

Early Life Maltreatment and Adolescent Interpretations of Ambiguous Social Situations: Investigating Interpersonal Cognitions and Emotional Symptoms

In the general population, negative interpretations of social situations have been associated with risk of developing emotional disorders such as anxiety and depression. Given that childhood maltreatment poses risk for later emotional disorders, this study examined whether interpersonal cognitive style differentiated maltreated adolescents from their non-maltreated peers and correlated with emotional symptoms across each group. Forty-seven maltreated and 28 non-maltreated adolescents were recruited from New South Wales, Australia to complete a battery of questionnaires that assessed interpersonal cognitions and levels of anxiety and depression. Comparable endorsement of threatening interpretations of social situations between maltreated adolescents and their non-maltreated peers across measures was found. Furthermore, an association between anxiety and depressive symptoms and interpretation bias was found within the non-maltreatment group but not the maltreated group. Unlike general population samples, negative cognitions do not associate with emotional symptoms in victims of early maltreatment. More research is needed to investigate the cognitive factors maintaining emotional symptoms in adolescent victims of maltreatment.

Can we challenge attention and interpretation threat biases in rescued child labourers with a history of physical abuse using a computerised cognitive training task? Data on feasibility, acceptability and target engagement

Child labourers are more likely to have experienced physical victimisation, which may increase risk for anxiety/depression, by shaping threat biases in information-processing. To target threat biases and vulnerability for anxiety/depression, we evaluated whether Cognitive Bias Modification (CBM) training could be feasibly and acceptably delivered to rescued youth labourers. Seventy-six physically abused rescued labourers aged 14-17 (40 from Nepal, 36 from India) in out-of-home care institutions received either multi-session computerised CBM or control training. Training targeted attention away from threat to positive cues and the endorsement of benign over threat interpretations. Feasibility and acceptability data were gathered along with pre and post intervention measures of attention and interpretation bias and emotional and behavioural symptoms. In terms of feasibility, uptake (proportion of those who completed the pre-intervention assessment from those who consented) and retention (proportion of those who completed the post-intervention assessment from those who completed the pre-intervention assessment) were above 75% in both countries. Average acceptability ratings were mostly 'moderate' on most indices for both countries, and none of the participants reported experiencing serious adverse events or reactions in response to or during the trial. Secondarily, CBM participants showed increased attention to positive and decreased attention to threatening stimuli, as well as increased endorsement of benign interpretation and decreased endorsement in negative interpretations of ambiguous social situations. Symptom changes were less clear. Delivering CBM to former child labourers in out-of-home care institutions has interventive potential. ClinicalTrials.gov Identifier: NCT03625206, Date of registration: August 10, 2018.

Excitatory brain stimulation over the left dorsolateral prefrontal cortex enhances voluntary distraction in depressed patients

BACKGROUND

While implicit distraction could ameliorate negative feelings in patients with major depressive disorders (MDD), it remains unclear whether patients could benefit from explicit, voluntary distraction. Meanwhile, though the dorsolateral prefrontal cortex (DLPFC) is established as a crucial brain region involved in attentional control, the causal relationship between the DLPFC and voluntary distraction is unexplored in patients.

METHODS

Combing explicit distraction and transcranial magnetic stimulation (TMS), this study investigated whether TMS-activated DLPFC facilitates voluntary distraction in MDD patients. Eighty patients diagnosed with current MDD underwent either active (n = 40) or sham (n = 40) TMS sessions, followed by receiving negative social feedback from other patients, during which they were requied to use distraction strategy to down-regulate their painful feelings. Electroencephalogram was recorded during the task.

RESULTS

Both the subjective emotional rating and the amplitude of late positive potential showed that depressed patients successfully down-regulate their negative emotions via voluntary distraction, and the TMS-activated left DLPFC produced a larger benefit of emotion regulation compared to the sham TMS group. Results also revealed that while emotion regulation effect was negatively associated with depressive symptoms in the sham TMS group, this correlation was largely diminished when patients' left DLPFC was activated by TMS during the voluntary distraction.

CONCLUSIONS

These findings demonstrated that distraction is valuable for emotion regulation in MDD patients and they could be beneficial in voluntary distraction by activating their left DLPFC using neural modulation techniques. This study has valuable implications for clinical treatement of emotional dysregulation in MDD patients.

Evidence for distinct genetic and environmental influences on fear acquisition and extinction

BACKGROUND

Anxiety disorders are highly prevalent with an early age of onset. Understanding the aetiology of disorder emergence and recovery is important for establishing preventative measures and optimising treatment. Experimental approaches can serve as a useful model for disorder and recovery relevant processes. One such model is fear conditioning. We conducted a remote fear conditioning paradigm in monozygotic and dizygotic twins to determine the degree and extent of overlap between genetic and environmental influences on fear acquisition and extinction.

METHODS

In total, 1937 twins aged 22-25 years, including 538 complete pairs from the Twins Early Development Study took part in a fear conditioning experiment delivered remotely via the Fear Learning and Anxiety Response (FLARe) smartphone app. In the fear acquisition phase, participants were exposed to two neutral shape stimuli, one of which was repeatedly paired with a loud aversive noise, while the other was never paired with anything aversive. In the extinction phase, the shapes were repeatedly presented again, this time without the aversive noise. Outcomes were participant ratings of how much they expected the aversive noise to occur when they saw either shape, throughout each phase.

RESULTS

Twin analyses indicated a significant contribution of genetic effects to the initial acquisition and consolidation of fear, and the extinction of fear (15, 30 and 15%, respectively) with the remainder of variance due to the non-shared environment. Multivariate analyses revealed that the development of fear and fear extinction show moderate genetic overlap (genetic correlations 0.4-0.5).

CONCLUSIONS

Fear acquisition and extinction are heritable, and share some, but not all of the same genetic influences.

An integrated review of social information processing as a mechanism in the association between maltreatment and depression among youth of color

BACKGROUND

Child maltreatment is a potent risk factor for depression across the life course, with maltreatment and depression demonstrated to disproportionately impact youth of color. Despite evidence for mechanisms (e.g., social information processing; SIP) accounting for the effects of maltreatment on youth broadly, pathways of risk for depression among maltreated youth of color specifically remain largely under-investigated.

OBJECTIVE

In an effort to address this gap in the literature, the present review synthesizes available research regarding SIP as a mechanism underlying the impact of maltreatment on the development of depression in general, and among youth of color specifically.

PARTICIPANTS & SETTING

A review of literature was conducted on English language articles published between 1989 and 2022 involving maltreatment, depression, social information processing, and/or youth of color.

METHODS

An electronic database search using terms "Maltreatment," "Depression," "Social Information Processing," "Social Cognition," and "Youth of Color" identified relevant literature.

RESULTS

Synthesis of literature supports SIP as a salient mechanism in the effect of maltreatment on depressive symptomatology for youth broadly, identifying the need for additional empirical work explicitly assessing this pathway among youth of color.

CONCLUSION

In addition to support for SIP as a risk pathway for youth broadly, this review highlights associated processes that can lend support to SIP as a meaningful mechanism of risk for youth of color. Additionally, this review addresses the deficit-based approach through which research and intervention tools evaluate youth of color experiencing maltreatment and depression, proposing alternative approaches towards prevention and intervention efforts with this marginalized population.

Lack of speeded disengagement from facial expressions of disgust in remitted major depressive disorder: Evidence from an eye-movement study

Acute major depression is characterized by specific abnormalities in the way emotional material is attended to. In late stages of stimulus processing, clinically depressed and dysphoric individuals show difficulties to disengage attention from emotionally negative material. It is unclear, however, whether aberrant disengagement is a transitory attentional phenomenon tied to depressive symptoms, or whether it constitutes a more stable disposition that outlast the symptomatic episode. To address this issue, the current study examined 39 currently euthymic individuals previously affected by major depression (RMD) and 40 healthy control participants reporting no lifetime psychopathology (ND). We used a gaze-contingent eye tracking paradigm designed to separately assess the attentional components of engagement and disengagement when viewing facial expressions of sadness, disgust and happiness. Never-depressed healthy participants, but not remitted euthymic individuals, showed speeded disengagement from facial expressions of disgust. We propose that the lack of this distinct acceleration in previously depressed but fully remitted individuals might reflect an attentional disposition that carries over to euthymic phases of the disease. On the other hand, a tendency to disengage quickly from areas in the visual field that convey social disdain could potentially act as a protective, possibly mood-stabilizing bias in resilient individuals.

Threat biases associate with anxiety and depression in physically-abused young people with a history of child labour

BACKGROUND AND OBJECTIVES

Young people who have experienced early-life maltreatment preferentially attend to threat and draw more threatening interpretations. In turn, these threat biases may explain elevated risk for lifelong anxiety and/or depression. We investigated whether adolescent labourers with a history of physical abuse showed threat biases relative to non-abused labourers, and whether these threat biases associated with anxiety and depression.

METHODS

100 young people (aged 13-18 years, 64% female) from Nepal rescued from illegal child work were assessed for childhood maltreatment and anxiety and/or depression disorders. Participants completed an emotional visual search task (to measure attention engagement of positive versus negative faces) and an ambiguous scenarios questionnaire (to measure the endorsement of negative versus benign interpretations).

RESULTS

Seventy young people reported a history of physical (and emotional) abuse. They were more likely to meet symptom thresholds for depression, and marginally, for anxiety disorders than non-physically abused participants. Abused and non-abused participants did not differ on attention engagement/disengagement of threat or on interpretational style. Abused participants with anxiety were slower to disengage from negative faces to engage with a positive face than non-anxious abused participants. Abused participants with depression endorsed more negative interpretations of ambiguous situations than those without depression.

LIMITATIONS

The cross-sectional design limits our ability to infer whether threat biases reflect risk markers of psychopathology.

CONCLUSIONS

If threat biases are shown to confer risk for anxiety and depression in future studies, they could be targeted in mental health prevention programs for these vulnerable young people.

Early exposure to flame retardants is prospectively associated with anxiety symptoms in adolescents: A prospective birth cohort study

BACKGROUND

Anxiety disorders emerge during childhood and adolescence and are frequently preceded by subsyndromal anxiety symptoms. Environmental toxicants, including gestational polybrominated diphenyl ether (PBDE) exposure, are associated with neuropsychiatric sequelae; however, the role of PBDEs as risk factors for anxiety in adolescence is unclear.

METHODS

Using data from the Health Outcomes and Measures of the Environment (HOME) Study, a prospective pregnancy and birth cohort enrolled from 2003 to 2006, we investigated the relationship between gestational serum PBDE concentrations and anxiety symptoms in adolescents (N = 236). We measured five PBDE congeners (PBDE-28, -47, -99, -100, and -153) at 16 ± 3 weeks of gestation and calculated their sum (∑PBDE). We assessed self-reported anxiety symptoms using the Screen for Child Anxiety Related Emotional Disorders (SCARED) and depressive symptoms using the Children's Depression Inventory (CDI-2) at age 12 years. We estimated the associations of maternal PBDE concentrations with child anxiety and depressive symptoms using multivariable linear regression and modified Poisson regression. Covariates included child sex, maternal race, maternal age at delivery, maternal marital status, maternal education, and household income at the 12-year study visit as well as maternal depressive and anxiety symptoms. Sensitivity analyses were performed to control for maternal lead and mercury at delivery.

RESULTS

After adjusting for predetermined covariates, each doubling in maternal PBDE concentrations was associated with increased SCARED scores (e.g., for ∑PBDE, SCARED total score, β = 1.6 95% confidence interval [CI]: 0.3-2.9, p = .019) and a nonsignificant increase in depressive symptoms (e.g., for CDI total score, β = .8, 95% CI: -0.2-1.8, p = .11).

CONCLUSIONS

Gestational serum PBDE concentrations just before mid-pregnancy and during a period of active cortical and limbic neurogenesis, synaptogenesis and myelogenesis may be a risk factor for developing anxiety symptoms in early adolescence.

Attentional biases in human anxiety

Across clinical and subclinical samples, anxiety has been associated with increased attentional capture by cues signaling danger. Various cognitive models attribute the onset and maintenance of anxiety symptoms to maladaptive selective information processing. In this brief review, we 1) describe the evidence for the relations between anxiety and attention bias toward threat, 2) discuss the neurobiology of anxiety-related differences in threat bias, 3) summarize work investigating the developmental origins of attention bias toward threat, and 4) examine efforts to translate threat bias research into clinical intervention. Future directions in each area are discussed, including the use of novel analytic approaches improving characterization of threat-processing-related brain networks, clarifying the role of cognitive control in the development of attention bias toward threat, and the need for larger, well-controlled randomized clinical trials examining moderators and mediators of treatment response. Ultimately, this work has important implications for understanding the etiology of and for intervening on anxiety difficulties among children and adults.

Sex and age differences in cognitive bias and neural activation in response to cognitive bias testing

Cognitive symptoms of depression, including negative cognitive bias, are more severe in women than in men. Current treatments to reduce negative cognitive bias are not effective and sex differences in the neural activity underlying cognitive bias may play a role. Here we examined sex and age differences in cognitive bias and functional connectivity in a novel paradigm. Male and female rats underwent an 18-day cognitive bias procedure, in which they learned to discriminate between two contexts (shock paired context A, no-shock paired context B), during either adolescence (postnatal day (PD 40)), young adulthood (PD 100), or middle-age (PD 210). Cognitive bias was measured as freezing behaviour in response to an ambiguous context (context C), with freezing levels akin to the shock paired context coded as negative bias. All animals learned to discriminate between the two contexts, regardless of sex or age. However, adults (young adults, middle-aged) displayed a greater negative cognitive bias compared to adolescents, and middle-aged males had a greater negative cognitive bias than middle-aged females. Females had greater neural activation of the nucleus accumbens, amygdala, and hippocampal regions to the ambiguous context compared to males, and young rats (adolescent, young adults) had greater neural activation in these regions compared to middle-aged rats. Functional connectivity between regions involved in cognitive bias differed by age and sex, and only adult males had negative correlations between the frontal regions and hippocampal regions. These findings highlight the importance of examining age and sex when investigating the underpinnings of negative cognitive bias and lay the groundwork for determining what age- and sex-specific regions to target in future cognitive bias studies.

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Middle-aged males had a greater negative cognitive bias than middle-aged females.

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Adult rats displayed a greater negative cognitive bias compared to adolescents.

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Greater neural activity in females than males in limbic and reward regions.

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Greater role of the frontal cortex activation in the cognitive bias of adults.

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Functional connectivity in response to cognitive bias differed by age and sex.

Cognitive mechanisms predicting resilient functioning in adolescence: Evidence from the CogBIAS longitudinal study

Resilience is a dynamic process depicted by better than expected levels of functioning in response to significant adversity. This can be assessed statistically, by taking the residuals from a model of psychological functioning regressed onto negative life events. We report the first study to investigate multiple cognitive factors in relation to this depiction of resilient functioning. Life events, internalizing symptoms, and a range of cognitive risk and protective factors were assessed in a large sample of adolescents (N = 504) across three waves spaced 12–18 months apart. Adolescents who displayed fewer symptoms than expected, relative to negative life events, were considered more resilient. Adolescents who displayed more symptoms than expected, relative to negative life events, were considered less resilient. All cognitive factors were associated with resilient functioning to differing degrees. These included memory bias, interpretation bias, worry, rumination, self-esteem, and self-reported trait resilience. Regression models showed that memory bias was a key factor explaining unique variance in prospective resilient functioning. In a subsequent cross-lagged panel model, memory bias and resilient functioning were reinforcing mechanisms across time points, supporting cognitive models of emotional resilience. This study adds to the literature, by highlighting key cognitive mechanisms as potential intervention targets

Disrupted Attention to Other's Eyes is Linked to Symptoms of ADHD in Childhood

Attention-deficit/hyperactivity disorder (ADHD) is associated with impaired social interaction. Other's eyes are important for understanding the social world. Here, we examined concurrent and longitudinal links between attention to other's eyes and symptoms of ADHD and comorbid externalizing and internalizing symptoms. Eighty-two 8 to 13-year-old children (40% with ADHD) participated. The latency to a first gaze shift to and away from the eye region of human faces, when primed to look at either the eyes or the mouth, was recorded with eye tracking. Parents rated ADHD, externalizing and internalizing symptoms at the time of testing and at 2-year follow-up. The results show that longer looking at the eyes before reorienting was specifically associated with concurrent and future symptoms of inattention, even when accounting for comorbid symptoms. We conclude that the temporal microstructure of attention to other's eyes is altered in children with symptoms of ADHD, which may contribute to social impairments.

Examining the Effects of Stuttering and Social Anxiety on Interpretations of Ambiguous Social Scenarios Among Adolescents

PURPOSE

The proclivity to construe ambiguous information in a negative way is known as interpretation bias, which has been implicated in the onset and/or maintenance of social anxiety. The purpose of this study was to examine group and individual differences in interpretation bias among young people who stutter and their typically fluent peers during the adolescent years when social fears and worries tend to escalate.

METHODS

A total of 99 adolescents (13 to 19 years old) participated, including 48 adolescents who stutter (67% male) and 51 typically fluent controls (68% male). They completed a computerized vignette-based interpretation bias task in which they first read 14 short ambiguous social scenarios (half including a verbal interaction, half including a non-verbal interaction). They were then presented with four possible interpretations of each scenario including two negative interpretations (one target, one foil) and two positive interpretations (one target, one foil). Participants used a 4-point Likert scale to rate how similar in meaning each interpretation was to the original scenario. Participants also completed self-report measures of social and general anxiety, and provided a speech sample for stuttering analysis.

RESULTS

There was no effect of stuttering on interpretations; the adolescents who stutter rated interpretations across both verbal and non-verbal scenarios comparably to the controls, and stuttering severity did not affect interpretation ratings. However, across groups, there was a significant effect of social anxiety such that higher social anxiety was associated with more negative interpretations, and lower social anxiety was associated with more positive interpretations.

DISCUSSION

This study provides preliminary evidence that social anxiety may affect how adolescents interpret ambiguous social cues in verbal and non-verbal scenarios more than stuttering, although more research into how people who stutter process social information is warranted.

Aetiology of shame and its association with adolescent depression and anxiety: results from a prospective twin and sibling study

BACKGROUND

Shame is considered a maladaptive self-conscious emotion that commonly co-occurs alongside depression and anxiety. Little is known, however, about the aetiology of shame and its associations with depression and anxiety. We estimated, for the first time, genetic and environmental influences on shame and on its associations with depression and anxiety in adolescence.

METHODS

The sample was twin and sibling pairs from the Genesis 1219 Study (Time 1, N = 2,685; males 42.8%, M_age  = 14.95, SD = 1.67, age range: 12-21; Time 2, N = 1618; males 39.7%, M_age  = 16.97, SD = 1.64, age range: 14-23). Participants completed validated questionnaires to measure shame (at Time 1), depression and anxiety (at Times 1 and 2).

RESULTS

Shame was moderately to strongly associated with concurrent depression and anxiety. Prospectively, shame was significantly associated with an increase in depression, but not anxiety. Genetic analyses revealed that shame was moderately heritable with substantial nonshared environmental influence. The associations between shame and concurrent depression and anxiety were primarily accounted for by overlapping genetic influences. Prospectively, the association between shame and later depression was primarily accounted for by genetic and nonshared environmental influences shared with earlier depression. The unique association between shame and later depression was mostly explained by common nonshared environmental influences.

CONCLUSIONS

The findings offer novel evidence regarding aetiology of shame-although moderately heritable, shame in adolescents may also result from nonshared environmental factors. Genetic and nonshared environmental influences contribute to the co-occurrence of shame with depression and anxiety.

The transdiagnostic origins of anxiety and depression during the pediatric period: Linking NIMH research domain criteria (RDoC) constructs to ecological systems

In the last decade, an abundance of research has utilized the National Institute of Mental Health (NIMH) research domain criteria (RDoC) framework to examine mechanisms underlying anxiety and depression in youth. However, relatively little work has examined how these mechanistic intrapersonal processes intersect with context during childhood and adolescence. The current paper covers reviews and meta-analyses that have linked RDoC-relevant constructs to ecological systems in internalizing problems in youth. Specifically, cognitive, biological, and affective factors within the RDoC framework were examined. Based on these reviews and some of the original empirical research they cover, we highlight the integral role of ecological factors to the RDoC framework in predicting onset and maintenance of internalizing problems in youth. Specific recommendations are provided for researchers using the RDoC framework to inform future research integrating ecological systems and development. We advocate for future research and research funding to focus on better integration of the environment and development into the RDoC framework.

Interpersonal Cognitive Biases in Children and Young People with Neurodevelopmental Disorders: A Systematic Review

Purpose of Review

Interpersonal cognitive biases have been linked to externalising and internalising problems. This systematic review investigates their role in children and young people with neurodevelopmental disorders (NDD), who have a high risk of experiencing such problems.

Recent Findings

With 16 identified studies, this is a widely under-recognised research area. The three studies conducted within the last 5 years focused on threat interpretation and its association with anxiety. No difference between children and young people with and without NDD was found in the eleven studies investigating hostile attribution of intent, of which the most recent is nearly a decade old. No studies addressed attention or memory bias towards ambiguous interpersonal information.

Summary

The scarcity and heterogeneity of research highlighted in this paper demonstrate the urgency to use standardised and accessible research methods to develop a strong evidence base regarding the potential content-specific interpretation bias in individuals with NDD.

The KOALA-study: study protocol for a comprehensive study of cognitive biases in adolescent anorexia nervosa patients compared to healthy and clinical controls

BACKGROUND

Anorexia nervosa (AN) is characterized by dysfunctional cognitions including cognitive biases at various levels of information processing. However, less is known about the specificity of these biases, i.e., if they occur for eating-disorder-related information alone or also for non-eating-disorder-related emotional information in AN patients (content-specificity) and if they are unique to individuals with AN or are also shown by individuals with other mental disorders (disorder-specificity).

METHODS

The present study systematically assesses cognitive biases in 12-18-year-old female adolescents with AN on three levels of information processing (attention, interpretation, and memory) and with regard to two types of information content (eating-disorder-related, i.e., stimuli related to body weight and shape, and non-eating-disorder-related). To address not only content- but also disorder-specificity, adolescents with AN will be compared not only to a healthy control group but also to a clinical control group (adolescents with major depression or particular anxiety disorders). Cognitive biases are assessed within a single experimental paradigm based on the Scrambled Sentences Task. During the task eye movements are recorded in order to assess attention biases while interpretation biases are derived from the behavioural outcome. An incidental free recall test afterwards assesses memory biases. We expect adolescents with AN to show more pronounced negative cognitive biases on all three levels of information processing and for both types of content compared to healthy adolescents. In addition, we expect the specificity of biases to translate into differential results for the two types of content: AN patients are expected to show stronger biases for disorder-related stimuli but similar or less pronounced biases for non-disorder-related stimuli compared to the clinical control group.

DISCUSSION

This is the first study to comprehensively assess cognitive biases in adolescents with AN. It will have essential implications not only for cognitive-behavioural models of AN but also for subsequent studies aiming to modify cognitive biases in this population, thereby addressing important maintaining factors already at an early stage of the disorder.

Promoting helpful attention and interpretation patterns to reduce anxiety and depression in young people: weaving scientific data with young peoples' lived experiences

BACKGROUND

Anxiety and depression are common, disabling and frequently start in youth, underscoring the need for effective, accessible early interventions. Empirical data and consultations with lived experience youth representatives suggest that maladaptive cognitive patterns contribute to and maintain anxiety and depression in daily life. Promoting adaptive cognitive patterns could therefore reflect "active ingredients" in the treatment and/or prevention of youth anxiety and depression. Here, we described and compared different therapeutic techniques that equipped young people with a more flexible capacity to use attention and/or promoted a tendency to positive/benign (over threatening/negative) interpretations of uncertain situations.

METHODS

We searched electronic databases (PubMed, PsycINFO, EMBASE, and PsycARTICLES) for studies containing words relating to: intervention; youth; anxiety and/or depression and attention and/or interpretation, and selected studies which sought to reduce self-reported anxiety/depression in youth by explicitly altering attention and/or interpretation patterns. Ten young people with lived experiences of anxiety and depression and from diverse backgrounds were consulted on the relevance of these strategies in managing emotions in their daily lives and also whether there were additional strategies that could be targeted to promote adaptive thinking styles.

RESULTS

Two sets of techniques, each targeting different levels of responding with different strengths and weaknesses were identified. Cognitive bias modification training (CBM) tasks were largely able to alter attention and interpretation biases but the effects of training on clinical symptoms was more mixed. In contrast, guided instructions that teach young people to regulate their attention or to evaluate alternative explanations of personally-salient events, reduced symptoms but there was little experimental data establishing the intervention mechanism. Lived experience representatives suggested that strategies such as deliberately recalling positive past experiences or positive aspects of oneself to counteract negative thinking.

DISCUSSION

CBM techniques target clear hypothesised mechanisms but require further co-design with young people to make them more engaging and augment their clinical effects. Guided instructions benefit from being embedded in clinical interventions, but lack empirical data to support their intervention mechanism, underscoring the need for more experimental work. Feedback from young people suggest that combining complimentary techniques within multi-pronged "toolboxes" to develop resilient thinking patterns in youth is empowering.

Adolescent anxiety disorders and the developing brain: comparing neuroimaging findings in adolescents and adults

Adolescence is the peak period for the incidence of anxiety disorders. Recent findings have revealed the immaturity of neural networks underlying emotional regulation in this population. Brain vulnerability to anxiety in adolescence is related to the unsynchronised development of anxiety-relevant brain functional systems. However, our current knowledge on brain deficits in adolescent anxiety is mainly borrowed from studies on adults. Understanding adolescent-specific brain deficits is essential for developing biomarkers and brain-based therapies targeting adolescent anxiety. This article reviews and compares recent neuroimaging literature on anxiety-related brain structural and functional deficits between adolescent and adult populations, and proposes a model highlighting the differences between adolescence and adulthood in anxiety-related brain networks. This model emphasises that in adolescence the emotional control system tends to be hypoactivated, the fear conditioning system is immature, and the reward and stress response systems are hypersensitive. Furthermore, the striatum’s functional links to the amygdala and the prefrontal cortex are strengthened, while the link between the prefrontal cortex and the amygdala is weakened in adolescence. This model helps to explain why adolescents are vulnerable to anxiety disorders and provides insights into potential brain-based approaches to intervene in adolescent anxiety disorders.

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.

Like parent, like child: Is parent interpretation bias associated with their child's interpretation bias and anxiety? A systematic review and meta-analysis

BACKGROUND

Anxiety disorders are the most prevalent psychiatric problem across the lifespan, with typical onset during the pediatric period. Prior literature has examined cognitive mechanisms associated with youth anxiety and identified interpretation bias, the threatening appraisal of ambiguity, as a ubiquitous correlate and likely mechanism. A small set of studies have examined interpretation bias and anxiety in parent-child dyads, although results about this potential relationship are conflicted. This systematic review and meta-analysis investigates the association between parent interpretation bias with child interpretation bias and child anxiety.

METHODS

Eight studies met the rigorous inclusion criteria, which required direct assessment of interpretation bias in both youth and parent.

RESULTS

Meta-analysis with a random effects model indicated a small and significant correlation between parent and child interpretation biases (r = 0.14, p < .01), as well as a small and significant correlation between parent interpretation bias and child anxiety (r =  = 0.20, p = .01).

LIMITATIONS

As only eight studies were included in this meta-analysis, reflecting the state of the extant literature, it is possible that, as data accumulate and this work continues in the future, results may or may not be replicated.

CONCLUSIONS

Despite variability in findings across the included empirical studies, the current meta-analysis suggests that a correlational relationship between parent interpretation bias and child bias/anxiety exists. This work has implications for conceptualizing parent interpretation bias as a possible explanatory mechanism underlying youth interpretation bias and anxiety.

Fearful Temperament and the Risk for Child and Adolescent Anxiety: The Role of Attention Biases and Effortful Control

Fearful temperament represents one of the most robust predictors of child and adolescent anxiety; however, not all children with fearful temperament unvaryingly develop anxiety. Diverse processes resulting from the interplay between automatic processing (i.e., attention bias) and controlled processing (i.e., effortful control) drive the trajectories toward more adaptive or maladaptive directions. In this review, we examine the associations between fearful temperament, attention bias, and anxiety, as well as the moderating effect of effortful control. Based on the reviewed literature, we propose a two-mechanism developmental model of attention bias that underlies the association between fearful temperament and anxiety. We propose that the sub-components of effortful control (i.e., attentional control and inhibitory control) play different roles depending on individuals' temperaments, initial automatic biases, and goal priorities. Our model may help resolve some of the mixed findings and conflicts in the current literature. It may also advance our knowledge regarding the cognitive mechanisms linking fearful temperament and anxiety, as well as facilitate the continuing efforts in identifying and intervening with children who are at risk. Finally, we conclude the review with a discussion on the existing limitations and then propose questions for future research.

Developmental Variation in the Associations of Attention Bias to Emotion with Internalizing and Externalizing Psychopathology

Attention biases to emotion are associated with symptoms of internalizing and externalizing psychopathology in children and adolescents. It is unknown whether attention biases to emotion and their associations with different symptoms of psychopathology vary across development from early childhood through young adulthood. We examine this age-related variation in the current study. Participants (N = 190; ages: 4-25) completed survey-based psychopathology symptom measures and a dot-probe task to assess attention bias to happy, sad, and angry relative to neutral faces. We tested whether linear or non-linear (e.g., spline-based models) associations best characterized age-related variation in attention to emotion. We additionally examined whether attention biases were associated with depression, anxiety, and externalizing symptoms and whether these associations varied by age. No age-related differences in attention biases were found for any of the emotional faces. Attention biases were associated with psychopathology symptoms, but only when examining moderation by age. Biased attention to angry faces was associated with greater symptoms of anxiety and depression in adolescents and young adults, but not children. Similarly, biased attention to happy faces was associated with externalizing symptoms in adolescents and young adults, but not in children. In contrast, biased attention to happy faces was associated with greater anxiety symptoms in children, but not in adolescents or young adults. Biased attention toward social threat and reward becomes more strongly coupled with internalizing and externalizing symptoms, respectively, during the transition to adolescence. These findings could inform when interventions such as attention bias modification training may be most effective.

Effects of two different emotion-inducing methods on the emotional memory of non-clinically depressed individuals

In the study of emotional memory bias in depressed individuals, most previous studies have used emotional materials, but there were significant differences in the effects of different emotion-inducing methods on face memory. In the present study, two experiments were conducted to explore the effects of different emotion-inducing methods on memory between healthy participants and non-clinically depressed participants. The results from experiment 1 showed that when feedback was used as induction, the memory performance of the non-clinical depression group was significantly higher than that of the healthy group under the condition of negative feedback. Under positive and neutral feedback, there were no significant differences between the two groups. In experiment 2, when emotional materials were used as a mode of induction, no significantly difference in each emotional condition between the healthy and depressed groups was found. The results of the present study show that different methods of emotional induction have different effects on depressed participants. Compared with the emotion induced by the emotional material, the non-clinical depressed participants had a better memory effect induced by negative emotional events.

Theory of Mind as a Mechanism That Accounts for the Continuity or Discontinuity of Behavioral Inhibition: A Developmentally Informed Model of Risk for Social Anxiety

Research has established that children with high levels of early behavioral inhibition (BI) - a subdued, timid, fearful response to novel or mildly challenging stimuli or events - are at an elevated risk for social anxiety in later childhood and adolescence. Yet, substantial heterogeneity has been documented in those developmental trajectories; consequently, understanding factors that moderate children's paths from early BI to social anxiety is an important goal. We proposed that the association between children's BI at toddler age and social anxiety at early school age is (a) mediated by their BI at preschool age, and (b) moderated by the level of social understanding, or Theory of Mind (ToM). In 102 typically developing community children, we observed BI in the laboratory at age 2 and 4.5 in "Risk Room" paradigms and assessed ToM at age 4.5 and 5.5 using false belief tasks. Mothers and fathers rated children's social anxiety symptoms at age 6.5. We supported the proposed moderated mediation model, with the path from BI at age 2 to BI at age 4.5 to social anxiety at age 6.5 unfolding only for children whose ToM abilities were relatively low, but not for those whose ToM abilities were relatively high. Results also supported a curvilinear relation between ToM and social anxiety, which highlights the risk of elevated social anxiety for children with extremely low ToM abilities. Taken together, proficiency in mindreading may help inhibited children navigate social environments and thus reduce risks for social anxiety.

Brain and Behavior Correlates of Risk Taking in Pediatric Anxiety Disorders

Avoidant behavior is a defining feature of pediatric anxiety disorders. Although prior research has examined it from the perspective of early information processing events, there has been relatively less consideration of the processes by which anxious youth make avoidant decisions and how these choices are reinforced over time. Studies of risk taking are valuable in this regard because they consider how individuals identify the pros and cons of their choices, how they weigh potential gains and losses and estimate their respective probabilities, and how they tolerate the uncertainty intrinsic to any decision. In this review, we place risk taking within existing models of information processing in pediatric anxiety disorders and highlight the particular value of this construct for informing models of developmental psychopathology and individual differences in outcome over time. We review existing behavioral and neurobiological studies of risk taking in anxious youth and conclude by identifying directions for future research.

Relationships between hope and mental health among women in prison

BACKGROUND

Previous research with non-offenders has linked a higher dispositional cognition of hope to lower levels of psychological symptoms and demonstrated mediating effects of attentional biases on the relationship between hope and psychological symptoms, but this has not been explored among offenders.

AIMS

Our aim was to investigate associations between a dispositional cognition of hope and habitual attentional processing styles and distress among women in prison. We hypothesised that higher levels of hope would be associated with more attention to positive information and less to negative information in the surroundings and, in turn, lower levels of depression, anxiety and stress symptoms in women in prison.

METHOD

In a cross-sectional study, we recruited consenting women serving a prison sentence who had been referred to psychological services. Participants completed a set of self-rating inventories individually, which scaled their levels of hope, attention to positive and negative information and symptoms of anxiety, stress and depression.

RESULTS

Two hundred and three women participated. Their average age was 35.68 years (range 21-67 years). Over half were recidivists (170, 58%). Overall, the higher the level of hope they had, the lower were the ratings of their psychological symptoms. Positive attentional bias was associated with higher hope and lower psychological distress. In contrast, negative attentional bias was related to lower hope and higher psychological distress ratings. In statistical models, both attentional biases appeared to be partial mediators of the relationship between hope and psychological distress.

CONCLUSIONS

Our findings among women in prison were consistent with those in non-forensic populations and not previously studied among prisoners. They suggest that it would be worth evaluating interventions to modify attentional styles as they may have value in increasing hope and reducing psychological symptoms and perhaps also harmful behaviours in this vulnerable population.

Research Review: Pediatric anxiety disorders - what have we learnt in the last 10 years?

BACKGROUND

Anxiety disorders first emerge during the critical developmental periods of childhood and adolescence. This review synthesizes recent findings on the prevalence, risk factors, and course of the anxiety disorders; and their neurobiology and treatment.

METHODS

For this review, searches were conducted using PubMed, PsycINFO, and clinicaltrials.gov. Findings related to the epidemiology, neurobiology, risk factors, and treatment of pediatric anxiety disorders were then summarized.

FINDINGS

Anxiety disorders are high prevalence, and early-onset conditions associated with multiple risk factors including early inhibited temperament, environment stress, and structural and functional abnormalities in the prefrontal-amygdala circuitry as well as the default mode and salience networks. The anxiety disorders are effectively treated with cognitive behavioral therapy (CBT), selective serotonin reuptake inhibitors (SSRIs), and serotonin-norepinephrine reuptake inhibitors (SNRIs).

CONCLUSIONS

Anxiety disorders are high prevalence, early-onset conditions associated with a distinct neurobiological fingerprint, and are consistently responsive to treatment. Questions remain regarding who is at risk of developing anxiety disorders as well as the way in which neurobiology predicts treatment response.

Delayed gaze shifts away from others' eyes in children and adolescents with social anxiety disorder

BACKGROUND

Social anxiety disorder (SAD) is linked to atypical attention to other's eyes. Empirical literature about this phenomenon in childhood and adolescence is scarce. Previous studies in adults have suggested that SAD may be characterized by either rapid avoidance of eye contact, or by impaired shifting of attention away from eyes once eye contact has been established. SAD has also been linked to quick orienting towards eyes, indicating vigilant monitoring of perceived threat.

METHODS

In the largest eye-tracking study of youth with SAD to date, 10 to 17 year-olds with SAD (n = 88) and healthy controls (n = 62) were primed to look at either the eyes or the mouth of human faces. The latency and likelihood of a first gaze shift from, or to the eyes, was measured.

RESULTS

Individuals with SAD were slower to shift their gaze away from the eye region of faces than controls, but did not differ in orienting toward eyes.

LIMITATIONS

Participants were assessed once after the onset of SAD symptoms, meaning that the longitudinal predictive value of delayed gaze shifts from others' eyes could not be examined.

CONCLUSIONS

Youth with SAD may be impaired in shifting attention from other's eyes. This could contribute to the experience of eye contact as aversive, and may be a maintaining factor of childhood SAD.

Developmental consequences of emotional abuse and neglect in vulnerable adolescents: A multi-informant, multi-wave study

BACKGROUND

Extant research and theory posit that emotional abuse and emotional neglect-exposure is uniquely harmful during adolescence. Yet, these findings are mostly based on mono-informant, retrospective studies with unselected adults that examine emotional maltreatment in the aggregate. This prevents inferences concerning the unique, prospective risk emotional abuse and neglect, as reported by multiple informants, may confer within at-risk, adolescent samples.

OBJECTIVE

In response, the present study examined how emotional abuse and emotional neglect-exposure in adolescence uniquely related to psychological symptoms and social impairment.

PARTICIPANTS AND SETTING

Our aims were tested in a child welfare system (CWS)-involved sample of adolescents (N = 657; Age_M = 12.49 at baseline) who were participating in a longitudinal study.

METHODS

A multi-informant approach was used to assess emotional abuse/neglect and mental health. Physical abuse and lifetime CWS contact represented covariates in growth curve models.

RESULTS

Emotional abuse predicted symptoms within informant, such that youth-reported emotional abuse predicted youth-reported internalizing, β = 0.21, p = .001, and externalizing, β=0.35, p = .001, symptoms while parent-reported emotional abuse predicted parent-reported externalizing, β=0.30, p <  .001, and internalizing β=0.29, p <  .001, symptoms. Meanwhile, youth-reported emotional neglect predicted heightened self-reported internalizing symptoms, β=0.29, p <  .001, parent-reported externalizing symptoms, β=0.15, p = .002 and social impairment across youth, β=-0.17, p = .01 and parent, β=-0.24, p <  .001, report.

CONCLUSIONS

This study shows the importance of distinguishing between these maltreatment subtypes in adolescence and provides measurement recommendations for future maltreatment research. The manuscript concludes by discussing adolescent emotional abuse and neglect-exposure as a maintenance, as opposed to causal risk, factors.

Pain and Interoceptive Awareness Outcomes of Chronic Pain Patients With Spinal Cord Stimulation

OBJECTIVES

Meditation has been shown to improve outcomes for chronic pain by increasing patients' awareness of their own bodies. Some patients have an innate ability to leverage their mind-body connection, and this interoceptive awareness may aid them in garnering pain relief. We explored whether spinal cord stimulation (SCS) patients with greater innate awareness had better outcomes.

MATERIALS AND METHODS

We contacted 30 thoracic SCS patients with baseline and postoperative pain, psychological, and disability outcomes to complete the Multidimensional Assessment of Interoceptive Awareness (MAIA) survey. MAIA distinguishes between beneficial and maladaptive aspects of the perception of body sensations via six positive subscales (noticing, attention regulation, emotional awareness, self-regulation, body listening, and trusting) and two negative subscales (not distracting, not worrying). MAIA subscales and positive/negative groups were correlated with percentage change in Numerical Rating Scale (NRS), Oswestry Disability Index (ODI), Beck's Depression Inventory (BDI), Pain Catastrophizing Scale (PCS), and McGill Pain Questionnaire (MPQ).

RESULTS

Patients included 14 males/16 females with a mean age of 58. At a mean follow-up of 14.13 months (range 6-26), NRS, ODI, BDI, PCS, and MPQ showed improvements. Positive traits correlated with improvements in pain (MAIA-self regulation with NRS-worst [p = 0.018], NRS-least [p = 0.042], NRS-average [p = 0.006], NRS-current [p = 0.001]; MAIA-body listening with MPQ-total [p = 0.016] and MPQ-sensory [p = 0.026]). Improvement in PCS-total was associated with higher scores in noticing (p = 0.002), attention regulation (p = 0.017), emotional awareness (p = 0.039), and trusting (p = 0.047). PCS-rumination correlated with MAIA-positive total (p = 0.012). In contrast, better attention regulation signified less improvement in ODI (p = 0.043) and MPQ affective (p = 0.026).

CONCLUSIONS

Higher interoceptive awareness in SCS patients correlated with greater improvement following the procedure, particularly with regards to pain relief and pain catastrophizing. These findings suggest that patients with better mind-body connections may achieve greater pain relief following SCS in this patient population, thereby aiding providers in determining who may benefit from this intervention.

Reduced left visual field bias for faces in adolescents with social anxiety disorder

Introduction: Individuals tend to explore the left side of a face first and for a longer time in comparison to the right side. This left visual field (LVF) bias is suggested to reflect right hemispheric dominance for face processing. Social anxiety disorder (SAD) is associated with maladaptive interpretations of facial expressions, but it is not known whether this is linked to an atypical LVF bias. Previous studies have reported a reduced LVF bias in autism, a condition overlapping with SAD. This pre-registered study examined the LVF bias in adolescents with SAD. Methods: Eye-tracking was used to investigate the ratio of first fixations to the left on upright and inverted face stimuli in 26 adolescents (13-17 years) with SAD and 23 healthy controls primed to look either between the eyes or at the mouth. Results: The SAD group showed a smaller LVF bias and an atypical face inversion effect when primed to look at the eyes. Autistic traits predicted a smaller LVF bias, independently of social anxiety level. Conclusions: Results suggest that SAD is associated with impaired processing of faces at an early stage of visual scanning. The findings contribute to a better understanding of SAD and its overlap with autism.