The threat sensitivity scale: A brief self-report measure of dispositional sensitivity toward perceiving threats to physical harm

The possibility of experiencing physical harm caused by an object, animal, or person is an omnipresent risk in almost any situation. People show variability in their in the propensity to perceive the possibility of harm from any ostensibly innocuous object or situation-a so-called threat bias. Despite the important psychological and societal consequences resulting from individual differences in physical threat bias, there does not currently exist an easily administered means to capture this disposition. We therefore endeavored to create a brief reliable self-report index of threat sensitivity for use by the many fields interested in the role of threat processing. We present here a physical threat sensitivity scale (TSS) that captures the dispositional tendency to perceive the possibility of physical harm in ostensibly innocuous situations or objects. We detail the development and validation of the TSS as a reliable index of individual threat bias (Studies 1a and 1b) and provide strong convergent evidence of the relationship between TS and both relevant individual differences (Study 2) and behavioral and perceptual indicates of threat bias (Study 3 and Study 4).

Improved implicit self-esteem is associated with extended antidepressant effects following a novel synergistic intervention

INTRODUCTION

In a previously published randomized controlled trial, automated self-association training (ASAT), a novel digital intervention, was found to extend the rapid antidepressant effect of a single infusion of ketamine for at least 30 days. In this secondary analysis, we aimed to understand the potential role of implicit self-esteem in the combined antidepressant effect of ketamine and ASAT training, by investigating the novel synergistic treatment's effects on implicit self-associations and their relation to symptom improvement.

METHODS

A total of 154 adults (ages 18-60) with treatment-resistant unipolar depression and lower-than-normative explicit self-esteem were randomized in a double-blind, parallel-arm design to receive one of three treatment allocations: an active/active treatment combination consisting of one infusion of ketamine (0.5 mg/kg) followed by four days of ASAT ( ~ 30-40 min/day), or one of two control arms that lacked either the active drug or the active behavioral component. The Implicit Association Test (IAT) was used to behaviorally assess the strength of association between self-related stimuli and negative concepts. Linear regression models were used to test the relationship between group assignment, IAT scores acquired immediately post-treatment, and both acute and extended clinical outcomes (% change in Montgomery-Asberg Depression Rating Scale scores, relative to pre-treatment baseline) in the trial.

RESULTS

The group assigned to ketamine + ASAT intervention, compared to the other groups, had a pattern of IAT scores indicating more positive self-associations immediately after treatment relative to the control arms (F(1, 131) = 3.979; p = 0.048). In regression models, IAT scores tracked with concurrent (acute post-treatment) % change in MADRS scores across all treatment arms (p = 0.001), and mediated more extended (Day 30) depression improvements specifically for the ketamine+ASAT arm (group * IAT interaction term: β = -0.201; p = 0.049).

DISCUSSION

Our findings suggest that changing implicit self-worth during a post-ketamine 'plasticity window' is one key mechanism whereby the novel ketamine+ASAT treatment combination exerts its antidepressant benefit, confirming the intended treatment target at the level of implicit cognition. Future studies should seek to further enhance the reliability of the biobehavioral intervention's impact on implicit cognition, as this mechanism appears linked to the intervention's enduring clinical benefits.

Multi-method assessment of suicidal thoughts and behaviors among patients in treatment for OCD and related disorders

Obsessive-compulsive and related disorders (OCRDs) are associated with increased risk of suicidal thoughts and behaviors (STBs), yet research characterizing suicidality in OCRDs remains limited. A major challenge in assessing STBs is the reliance on explicit self-report. This study utilized multi-method assessment to examine changes in both implicit and explicit STBs in 31 adults receiving partial/residential treatment for OCRDs. Assessments were administered at admission and weekly during treatment. Approximately three-quarters of participants reported lifetime suicidal thoughts, with 16 % reporting a prior suicide attempt. OCD severity was significantly correlated with lifetime suicidal thoughts, and was significantly higher for those with lifetime suicidal thoughts and prior attempts compared to those without. Implicit biases towards death were not associated with OCD severity, and did not predict explicitly endorsed STBs. This is the first study to measure both explicit and implicit STBs in adults with OCRDs. Limitations included small sample size and lack of racial/ethnic diversity. Given the majority had recent suicidal thoughts and one in six had a prior attempt, we emphasize the importance of STB assessment in OCD treatment settings.

Dissociation of Implicit and Explicit Interpretation Bias: The Role of Depressive Symptoms and Negative Cognitive Schemata

A negative interpretation bias appears to depend on several depression-related state and trait characteristics, most notably depressive symptoms, negative mood, and negative cognitive schemas. While empirical findings for explicitly assessed interpretation bias are rather consistent, implicit measures have revealed heterogeneous results. In this context, we present two studies investigating the relationship between implicit and explicit interpretation bias and depression- and anxiety-related state and trait variables. In the first study, we conducted an implicit ambiguous cue-conditioning task (ACCT) with 113 young, healthy individuals. In the second study, we utilized an explicit ambiguous social situations task (DUCTUS) with 113 young, healthy individuals. Additionally, a subsample of 46 participants completed both the ACCT and DUCTUS tasks to directly relate the two bias scores obtained from the implicit and explicit assessment methods, respectively. In the first study, regression analysis revealed no significant predictors for the implicit interpretation bias. However, in the second study, the explicit negative interpretation bias was significantly predicted by female gender, depressive symptoms, and dysfunctional cognitive schemas. For the subsample that completed both tasks, we observed no significant correlation between the two bias scores obtained from the ACCT and DUCTUS. These results suggest that implicit and explicit interpretation biases are differently associated with depression-related trait and state characteristics, indicating that they represent different aspects of biased information processing.

Implicit and explicit COVID-19 associations and mental health in the United States: a large-scale examination and replication

BACKGROUND

Given the sensitive nature of COVID-19 beliefs, evaluating them explicitly and implicitly may provide a fuller picture of how these beliefs vary based on identities and how they relate to mental health.

OBJECTIVE

Three novel brief implicit association tests (BIATs) were created and evaluated: two that measured COVID-19-as-dangerous (vs. safe) and one that measured COVID-19 precautions-as-necessary (vs. unnecessary). Implicit and explicit COVID-19 associations were examined based on individuals' demographic characteristics. Implicit associations were hypothesized to uniquely contribute to individuals' self-reports of mental health.

METHODS

Participants (N = 13,413 US residents; April-November 2020) were volunteers for a COVID-19 study. Participants completed one BIAT and self-report measures. This was a preregistered study with a planned internal replication.

RESULTS

Results revealed older age was weakly associated with stronger implicit and explicit associations of COVID-as-dangerous and precautions-as-necessary. Black and Asian individuals reported greater necessity of taking precautions than White individuals (with small-to-medium effects); greater education was associated with greater explicit reports of COVID-19-as-dangerous and precautions-as-necessary with small effects. Replicated relationships between COVID-as-dangerous explicit associations and mental health had very small effects.

CONCLUSIONS

Implicit associations did not predict mental health but there was evidence that stronger COVID-19-as-dangerous explicit associations are weakly associated with worse mental health.

Do Psychedelics Facilitate Emergence of Unconscious Psychological Processes?

Psychedelic substances have a long history of use in traditional healing and religious ceremonies worldwide and are increasingly being investigated for their possible therapeutic usage. However, there is still a lack of consensus regarding how best to characterize the psychological effects of psychedelics and how they bring about the positive therapeutic outcomes observed in clinical studies. The aim of this article is to review available evidence from quantitative and qualitative studies on psychedelic-assisted therapy, as well as neurobiological studies, in relation to the hypothesis that psychedelics facilitate the emergence of emotionally charged unconscious material, originally proposed by pioneering psychedelics researcher Stanislav Grof. The reviewed process studies of therapeutic mechanisms in psychedelic-assisted therapy and qualitative studies of treatment participants clearly indicate that the psychedelic experience is associated with the subjective experience of having increased access to and awareness of emotions, memories, and perceptions that are normally avoided or outside of conscious awareness. Brain-imaging studies point to several different neurobiological effects of psychedelics that might be related to these subjective psychological experiences. Available evidence also indicates that this process might constitute an important therapeutic mechanism in psychedelic-assisted therapy, worthy of further investigation.

Implicit assumptions and interpretation bias in youth with severe, chronic social phobia

Interpretation bias and dysfunctional social assumptions are proposed to play a pivotal role in the development and maintenance of social phobia (SP), especially in youth. In this study, we aimed to investigate disorder-specific implicit assumptions of rejection and implicit interpretation bias in youth with severe, chronic SP and healthy controls (CG). Twenty-seven youth with SP in inpatient/day-care treatment (M age = 15.6 years, 74% female) and 24 healthy controls (M age = 15.7 years, 54% female) were included. The Implicit Association Test (IAT) and the Affect Misattribution Procedure (AMP) were completed to assess implicit assumptions and interpretation bias related to the processing of social and affective stimuli. No group differences were observed for the IAT controlling for depressive symptoms in the analyses. However, group differences were found regarding interpretation bias (p = .017, η²_p = .137). Correlations between implicit scores and explicit questionnaire results were medium to large in the SP group (r =|.28| to |.54|, p_all ≤ .05), but lower in the control group (r =|.04| to |.46|, p_all ≤ .05). Our results confirm the finding of an interpretation bias in youth SP, especially regarding the implicit processing of faces, whereas implicit dysfunctional social assumptions of being rejected do not seem to be specific for SP. Future research should investigate the causal relationship of assumptions/interpretation bias and SP.

Maturing Out: Between- and Within-Persons Changes in Social-Network Drinking, Drinking Identity, and Hazardous Drinking Following College Graduation

Many college students reduce hazardous drinking (HD) following graduation without treatment. Identifying cognitive mechanisms facilitating this "natural" reduction in HD during this transition is crucial. We evaluated drinking identity as a potential mechanism and tested whether within-person changes in one's social network's drinking were linked to within-person changes in drinking identity and subsequent within-person changes in HD. A sample of 422 undergraduates reporting HD was followed from six months before until two years after graduation. Their drinking, drinking identity, and social networks were assessed online. Within-person changes in drinking identity did not mediate the relationship between within-person changes in social network drinking and personal HD, though significant positive between-person associations among all constructs were found. Instead, there was some evidence that within-person changes in drinking identity followed changes in HD, suggesting that drinking identity may function as a marker versus mechanism of "natural" HD reduction during transition out of college.

Using expectation violation models to improve the outcome of psychological treatments

Expectations are a central maintaining mechanism in mental disorders and most psychological treatments aim to directly or indirectly modify clinically relevant expectations. Therefore, it is crucial to examine why patients with mental disorders maintain dysfunctional expectations, even in light of disconfirming evidence, and how expectation-violating situations should be created in treatment settings to optimize treatment outcome and reduce the risk of treatment failures. The different psychological subdisciplines offer various approaches for understanding the underlying mechanisms of expectation development, persistence, and change. Here, we convey recommendations on how to improve psychological treatments by considering these different perspectives. Based on our expectation violation model, we argue that the outcome of expectation violation depends on several characteristics: features of the expectation-violating situation; the dynamics between the magnitude of expectation violation and cognitive immunization processes; dealing with uncertainties during and after expectation change; controlled and automatic attention processes; and the costs of expectation changes. Personality factors further add to predict outcomes and may offer a basis for personalized treatment planning. We conclude with a list of recommendations derived from basic psychology that could contribute to improved treatment outcome and to reduced risks of treatment failures.

Implicit and explicit emotional memory recall in anxiety and depression: Role of basolateral amygdala and cortisol-norepinephrine interaction

Anxiety and depression are linked to both explicit and implicit memory biases, which are defined as the tendency to preferentially recall emotionally negative information at conscious and subconscious levels, respectively. Functional connectivity (FC) of the basolateral amygdala (BLA) and related stress hormones (i.e., cortisol and norepinephrine) are purportedly implicated in these biases. However, previous findings on memory biases in anxiety and depression have been inconsistent, likely due to their symptomatic complications. Therefore, the underlying neurobiological mechanism remains unclear. We thus investigated whether anxiety and depression as premorbid predispositions are related to the memory biases, and whether FC of BLA, cortisol, and 3-methoxy-4-hydroxyphenylglycol (MHPG: a major metabolite of norepinephrine) would affect the anxiety/depression-related biased memory recall in 100 participants without psychiatric symptomatology. Psycho-behavioral assessment, resting-state fMRI scans, and saliva collection at 10-points-in-time across two days were conducted. Correlations of memory biases with anxiety/depression and neurobiological markers were explored. As a result, neither anxiety nor depression were correlated with explicit memory bias to negative (vs. positive) information, although depression was associated with better recall of the negative stimuli only when they were perceived as self-relevant. In contrast, both anxiety and depression were correlated with implicit memory bias; however, the effects were solely explained by anxiety. Furthermore, FC of the BLA with subgenual anterior cingulate cortex (sgACC) and the synergetic effect of cortisol and MHPG uniquely affected the implicit memory bias. These findings suggest that anxiety facilitates an initial snapshot of negative information and can be accompanied by depression when the information creates negative semantic associations with the self. The BLA-sgACC neural connectivity and cortisol-norepinephrine interaction that are associated with the implicit memory bias might be one of the important neurobiological targets in the prevention and treatment for comorbid anxiety and depressive disorders.

Psychological risk factors and the course of depression and anxiety disorders: A review of 15 years NESDA research

BACKGROUND

The Netherlands Study of Depression and Anxiety (NESDA; N_baseline=2981) is an ongoing longitudinal, multi-site, naturalistic, cohort study examining the etiology, course, and consequences of depression and anxiety. In this article we synthesize and evaluate fifteen years of NESDA research on prominent psychological risk factors for the onset, persistence, recurrence, and comorbidity of affective disorders.

METHODS

A narrative review of 62 NESDA articles examining the specificity and predictive value of neuroticism, behavioral inhibition, repetitive negative thinking, experiential avoidance, cognitive reactivity, locus of control, (implicit) self-esteem, (implicit) disorder-specific self-associations, and attentional bias for the course of affective disorders.

RESULTS

All self-reported risk factors showed cross-sectional relationships with singular and comorbid affective disorders, and prospective relationships with the development and chronicity of depression and anxiety disorders. High neuroticism, low self-esteem, and negative repetitive thinking showed most prominent transdiagnostic relationships, whereas cognitive reactivity showed most pronounced depression-specific associations. Implicit self-esteem showed predictive validity for the persistence and recurrence of anxiety and depression over and above self-reported risk factors. Automatic approach-avoidance behavior and attentional bias for negative, positive, or threat words showed no relationship with affective disorders.

CONCLUSION

NESDA identified both (a) transdiagnostic factors (e.g., neuroticism, low implicit self-esteem, repetitive negative thinking) that may help explain the comorbidity between affective disorders and overlap in symptoms, and (b) indications for disorder-specific risk factors (e.g., cognitive responsivity) which support the relevance of distinct disorder categories and disorder-specific mechanisms. Thus, the results point to the relevance of both transdiagnostic and disorder-specific targets for therapeutic interventions.

The relationship between self-traumatized and self-vulnerable automatic associations and posttraumatic stress symptoms among adults who have experienced a distressing life event

Convergent evidence supports a crucial role for dysfunctional appraisals in the development and maintenance of post-traumatic stress disorder (PTSD). However, most research in this area has used self-report measures, assessing only explicit forms of such negative cognitions; the relevance of their more automatically-activated counterparts, as assumed by cognitive models, remains relatively unexplored. The current study aimed to further our understanding of the potential utility of measuring automatic dysfunctional associations in the context of posttraumatic stress. The relationship between scores on two different implicit association tests (IATs) and posttraumatic stress symptoms was investigated in a sample of adults (N = 279) who reported having experienced a potentially traumatic negative life event. Participants completed the two IATs (one assessing self-traumatized associations, the other self-vulnerable associations), a self-report measure of dysfunctional appraisals, and measures of posttraumatic stress symptoms and other aspects of psychopathology online. Scores indicating higher levels of dysfunctional associations on both IATs were associated with higher levels of posttraumatic stress symptoms. Only scores on the IAT measuring self-vulnerable associations, and not the IAT measuring self-traumatized associations, continued to show an association with posttraumatic stress symptoms after controlling for explicit dysfunctional appraisals. Overall, the results indicate the value of investigating PTSD-relevant automatic associations to further develop our understanding of cognitive processes implicated in posttraumatic stress.

Do implicit measures improve suicide risk prediction? An 18-month prospective study using different tasks

BACKGROUND

There is accumulating evidence that implicit measures improve the prediction of suicidality within a 6-month follow-up period in psychiatric populations. Building upon these results, we set out to expand the follow-up period and to investigate various implicit methods.

METHODS

Seventy-nine inpatients completed the Beck Scale for Suicidal Ideation (BSS) and a range of implicit measures: three implicit association tests (IATs: Death; Self-harm-Me/Others; Self-Harm-Good/Bad) and a subliminal priming task (with separate scores for negative and positive adjectives, each indicating the association between the primes "dying" and "growing"). After 18 months, we reached n = 52 patients and reassessed suicidal ideation, plans, and attempts.

RESULTS

In a hierarchical regression, the five implicit task indices were entered after the patient's age, gender, and BSS score at baseline. The implicit scores improved prediction of BSS scores after 18 months compared to prediction based on age, gender, and BSS score at baseline alone. However, none of the implicit measures was associated with suicide plans or attempts during the follow-up period.

CONCLUSION

Results suggest that implicit measures can be a useful assessment tool for the prediction of suicidal ideation, even beyond the BSS. However, long-term prediction of suicide plans or attempts using implicit measures seems limited.

The implicit association of high-fat foods with shame and its link with eating disorder symptoms: The moderating role of race/ethnicity

BACKGROUND

An interesting debate in the literature is about the role of race/ethnicity not only as a risk factor for eating disorders (EDs), but also as a moderator of the relations between other risk factors and ED symptoms. The following research question was explored: Does race/ethnicity moderate the relations between the implicit belief that high-fat food is shameful and ED symptoms?

METHODS

About 15,000 (N = 14,964) volunteers (67.7% White, 7.7% Asian, 7.4% Hispanic, 6.9% Black) completed the Implicit Association Test (IAT) measuring the implicit associations between high-fat (vs. low-fat) food and shameful (vs. acceptable) on the Project Implicit mental-health website (https://implicit.harvard.edu) between 2011 and 2017. ED symptoms and demographics were measured via self-report.

RESULTS

Race/ethnicity moderated (beta = 0.087, p = .002) the relations between IAT and ED symptoms, adjusting for BMI, age, sex, education, such that the IAT was related to ED symptoms among Whites (r = 0.113, p < .001), Hispanics (r = 0.086, p = .004), and Asians (r = 0.097, p = .001), but not Blacks (r = 0.056, p = .071).

DISCUSSION

Although the effect size was small, findings imply that some ED risk factors may vary among racial/ethnic groups. Future studies should use prospective designs to examine whether implicit biases actually represent a risk factor for ED symptoms and whether this varies by race/ethnicity.

Dual processes in fear and anxiety: no effects of cognitive load on the predictive value of implicit measures

Dual process models posit that combinations of impulsive and reflective processes drive behaviour, and that the capacity to engage in effortful cognitive processing moderates the relation between measures of impulsive or reflective processes and actual behaviour. When cognitive resources are low, impulsive processes are more likely to drive behaviour, while when cognitive resources are high, reflective processes will drive behaviour. In our current study, we directly addressed this hypothesis by comparing the capacity of implicit and explicit measures to predict fear and anxiety, either with or without additional cognitive load. In Experiment 1 (N = 83), only explicit measures of spider fear were predictive of spider avoidance, and manipulating cognitive load did not affect these relations. Experiment 2 (N = 70) confirmed these findings, as the capacity of explicit and implicit measures to predict self-reported and physiological responses to a social stressor was not moderated by cognitive load. In two experiments, we thus found no empirical support for the central dual process model assumption that cognitive control moderates the predictive value of implicit and explicit measures. While implicit measures and dual process accounts may still be valuable, we show that results in this field are not necessarily replicable and inconsistent.

Invalid Claims About the Validity of Implicit Association Tests by Prisoners of the Implicit Social-Cognition Paradigm

In a prior publication, I used structural equation modeling of multimethod data to examine the construct validity of Implicit Association Tests. The results showed no evidence that IATs measure implicit constructs (e.g., implicit self-esteem, implicit racial bias). This critique of IATs elicited several responses by implicit social-cognition researchers, who tried to defend the validity and usefulness of IATs. I carefully examine these arguments and show that they lack validity. IAT proponents consistently ignore or misrepresent facts that challenge the validity of IATs as measures of individual differences in implicit cognitions. One response suggests that IATs can be useful even if they merely measure the same constructs as self-report measures, but I find no support for the claim that IATs have practically significant incremental predictive validity. In conclusions, IATs are widely used without psychometric evidence of construct or predictive validity.

Explicit and Implicit Measures of Identity Diffusion in Adolescent Girls With Borderline Personality Disorder

The present study is the first to examine both the implicit and explicit self-concept of identity diffusion in a sample of adolescent patients with borderline personality disorder (BPD). A clinical sample of adolescent girls with diagnosed BPD (N = 30; M age = 15.9 years) and a sample of girls with a healthy personality development (N = 33; M age = 16.6 years) completed an implicit association test (IAT) that was adjusted to identity diffusion, the core of BPD. Common domains of child and adolescent psychopathology and core components of BPD were assessed using self-reports on the Strengths and Difficulties Questionnaire (SDQ), the Borderline Personality Features Scale for Children-11 (BPFSC-11) and the Assessment of Identity Development in Adolescence (AIDA). BPD patients scored significantly higher on explicit measures of borderline pathology than girls with a healthy personality development. A crucial finding for this study was that girls with BPD had a significantly lower implicit preference for stability than their counterparts in the control group. Moreover, explicit measures of borderline personality pathology were significantly correlated with an implicit measure of identity diffusion, the core of BPD. However, when looking at the predictive ability of implicit and explicit measures, only explicit identity diffusion was significantly associated with borderline features. Our data suggests that adolescent girls with BPD differ from healthy individuals not only in their conscious representation but also in their implicit representation of the self with regard to BPD related characteristics, which further advances the need for the identification of at-risk adolescents.

Repeated measurement of implicit self-associations in clinical depression: Psychometric, neural, and computational properties

Implicit self-associations are theorized to be rigidly and excessively negative in affective disorders like depression. Such information processing patterns may be useful as an approach to parsing heterogeneous etiologies, substrates, and treatment outcomes within the broad syndrome of depression. However, there is a lack of sufficient data on the psychometric, neural, and computational substrates of Implicit Association Test (IAT) performance in patient populations. In a treatment-seeking, clinically depressed sample (n = 122), we administered five variants of the IAT-a dominant paradigm used in hundreds of studies of implicit cognition to date-at two repeated sessions (outside and inside a functional MRI scanner). We examined reliability, clinical correlates, and neural and computational substrates of IAT performance. IAT scores showed adequate (.67-.81) split-half reliability and convergent validity with one another and with relevant explicit symptom measures. Test-retest correlations (in vs. outside the functional MRI scanner) were present but modest (.15-.55). In depressed patients, on average, negative implicit self-representations appeared to be weaker or less efficiently processed relative to positive self-representations; elicited greater recruitment of frontoparietal task network regions; and, according to computational modeling of trial-by-trial data, were driven primarily by differential efficiency of information accumulation for negative and positive attributes. Greater degree of discrepancy between implicit and explicit self-worth predicted depression severity. Overall, these IATs show potential utility in understanding heterogeneous substrates of depression but leave substantial room for improvement. The observed clinical, neural, and computational correlates of implicit self-associations offer novel insights into a simple computer-administered task in a clinical population and point toward heterogeneous depression mechanisms and treatment targets. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Discrepant negative self-associations as a risk factor for depressive deterioration after outpatient psychotherapy

BACKGROUND AND OBJECTIVES

This paper examines the discrepancy between implicit and explicit negative self-associations (NSA) after cognitive psychotherapy for depression as a predictor of long-term outcome.

METHODS

One hundred and twenty patients completed an Implicit-Association Test relating the self with depressive attributes and a self-report questionnaire with identical item content, at the end of time-limited outpatient depression psychotherapy. At post-treatment and at 3-, 6-, and 12-month follow-up, patients completed the BDI-II. We used different strategies to operationalized implicit and explicit NSA discrepancies and three-level Hierarchical linear models to analyze the effects.

RESULTS

We found significant interactive effects of discrepancy between implicit and explicit NSA and the direction of the discrepancy on long-term outcome. In patients with a greater explicit than implicit NSA (a damaged self-esteem pattern) a greater absolute discrepancy was associated with worse long-term outcome in terms of BDI scores at the end of follow-up and rate of change during follow-up. Consistently, with an alternative method, we found that damaged self-esteem discrepancies were associated with worse estimated BDI-II scores at the end of follow-up.

LIMITATIONS

The inclusion in the sample of only treatment completers limits the generalizability of the results. Furthermore, the follow-up period captured only the first 12 months after treatment.

CONCLUSIONS

Our results support the notion that a discrepancy between implicit and explicit negative self-associations may pose a risk factor for deterioration after psychotherapy for depression.

Propositional Accounts of Implicit Evaluation: Taking Stock and Looking Ahead

Associative accounts suggest that implicit (indirectly measured) evaluations are sensitive primarily to co-occurrence information (e.g., pairings of gorges with positive experiences) and are represented associatively (e.g., Gorge–Nice). By contrast, recent propositional accounts have argued that implicit evaluations are also responsive to relational information (e.g., gorges causing vs. preventing ennui) and are represented propositionally (e.g., “I find gorges fascinating”). In a review of 30 empirical papers involving exposure to contradictory co-occurrence information and relational information, we found overwhelming evidence for the latter dominating the updating of implicit evaluations, supporting the propositional perspective. However, unlike explicit evaluations, implicit evaluations seem recalcitrant in the face of relational information that requires retrospective revaluation of already encoded co-occurrence information. These findings may be jointly explained by a “common currency” hypothesis under which implicit evaluations emerge from compressed summary representations, which are sensitive to relational information but are not fully propositional.

Moving Beyond the Relative Assessment of Implicit Biases: Navigating the Complexities of Absolute Measurement

A relative assessment of implicit biases is limited because it produces a combined summary evaluation of two attitudinal beliefs while concealing the biases driving this evaluation. Similar limitations occur for relative explicit measures. Here, we will discuss the benefits and weaknesses of using relative versus absolute (individual/separate) assessments of implicit and explicit attitudes. The Implicit Association Test (IAT) will be the focal implicit measure discussed, and we will present a new perspective challenging the evidence that the IAT can only be utilized to measure relative, not absolute, implicit attitudes. Modeling techniques (i.e., Quad models) that can determine the separate biases behind the relative summary evaluation will also be considered. Accurately utilizing absolute implicit bias scores will enable academia and industry to answer more complex research questions. For implicit social cognition to maintain and expand its usefulness, we encourage researchers to further test and refine the measurement of absolute implicit biases.

EXPLICIT-IMPLICIT DISCREPANCY IN MACRO-LEVEL MENTAL ILLNESS STIGMA IS LINKED TO PREVALENCE AND CARE

Introduction: This study explores the associations in the United States between each state's stereotypes about the dangerousness of people with mental illness and important outcomes for people with mental illness.

Methods: Implicit association test and questionnaire data from 17,312 online participants were aggregated within states and years. Each state's annual average implicit and explicit stereotypes were used to predict state differences in prevalence, and treatment, unemployment, and homelessness among people with mental illness.

Results: Implicit and explicit perceived dangerousness interact such that in states with low explicit perceived dangerousness, implicit perceived dangerousness is positively associated with all outcomes. In states with high explicit perceived dangerousness, implicit perceived dangerousness is negatively associated with homelessness.

Discussion: Explicit-implicit discrepancy in macro-level perceived dangerousness is generally associated with worse outcomes for people with mental illness, but the effects are small. Macro-level stereotypes might have larger effects in smaller regions, like counties, than in states.

Medically unexplained symptoms in children and adolescents: Illness-related self-concept and parental symptom evaluations

BACKGROUND AND OBJECTIVES

According to cognitive-behavioral models, illness-related symptom evaluations and self-concepts play a pivotal role in the development and maintenance of medically unexplained somatic symptoms (MUS). However, illness-related cognitions related to MUS have rarely been studied in children/adolescents and their parents.

METHODS

Seventy-eight children and adolescents (M = 14.2 years; 59% female) performed two versions of the Implicit Association Test (IAT) to measure the implicit illness-related and the implicit anxiety-related self-concept. Illness-related evaluations of unspecific symptoms were assessed via the Health Norms Sorting Task (HNST), and MUS as well as characteristics of somatic symptom disorder (SSD) via questionnaires.

RESULTS

MUS were significantly positively associated with the explicit (r = 0.30, p < .01) and implicit illness-related self-concept (r = 0.24, p = .04), but not with the anxiety-related self-concept (r = 0.15, p = .18). The implicit illness-related self-concept explained incremental variance in MUS (ΔR² = 0.05, p = .04) beyond the explicit illness-related self-concept. Regarding health anxiety, parental illness-related symptom evaluations moderated the relationship between child-reported severity of MUS and health anxiety (B = 0.12, p < .01).

LIMITATIONS

Some measures have been adapted for childhood and adolescence, but validations on larger samples are still pending.

CONCLUSIONS

A disorder-specific self-concept of being ill, as well as parental symptom evaluations, seem to play an essential role in MUS and health anxiety in childhood and adolescence. Due to the importance of the top-down processes found here, the findings are in line with current predictive coding models of somatic symptom perception.

A reformulated contextual model of psychotherapy for treating anxiety and depression

This paper describes a reformulated contextual model that uses cognitive theory (dual process theory), motivation theory (personality) and behavioral adaptation (self-correcting control systems) to show how anxiety and depression are caused, treated and prevented by an interaction between people and contexts. Depression and anxiety are the result of implicit beliefs (not cognitions) that all experience is unrewarding and threatening, these being components of the implicit belief that life is bad. Implicit beliefs are formed automatically from contextual cues and in healthy individuals are consistent with rational appraisal. They become more negative than reality through a process of adaptation when behaviors, directed by rational thinking, repeatedly create cues that signify lack of reward or threat. Such behaviors occur when social or other obligations lead people to choose behaviors that fail to satisfy their own unique goals in life and approach threatening situations, contrary to their automatic reactions. Therapeutic interventions and lifestyle change reverse these adaptive processes by positive experiences that create positive implicit beliefs, a change effected in different ways by contextual and specific mechanisms both of which correct the same fault of negative implicit beliefs. Effective therapeutic relationships and interventions are achieved by detecting and responding to a patient's unique needs and goals and their associated implicit beliefs. Mental health requires not only that people experience life as good as defined by their own goals and beliefs but also the avoidance of contexts where social and other pressures induce people to behave in ways inconsistent with their automatically generated feelings.

Predicting relapse in patients with severe alcohol use disorder: The role of alcohol insight and implicit alcohol associations

Low insight is reported as a risk factor for relapse among patients treated for alcohol use disorders. However, to date, little is known on why patients with low insight are at higher risk for relapse. In this study, we tested the hypothesis that an implicit preference for alcohol over abstinence predicts relapse in patients with low, but not high, alcohol insight. Participants consisted of 77 patients who had received treatment for severe alcohol use disorder in a hospital in France. During hospitalization, they completed a self-report measure of insight and an implicit association test to assess implicit preference for alcohol over abstinence. The primary outcome was relapse assessed one month after discharge. Control variables were gender, age, cognitive deficit, anxiety, depression, craving, and impulsivity. Data were analysed using logistic regression analysis. After adjusting for demographic and clinical variables, relapse was predicted by the interaction between insight and implicit preference for alcohol but not by their main effects alone. Implicit preference for alcohol predicted relapse among patients with relatively low insight, but not among those with relatively high insight. These findings suggest that patients with low insight and strong implicit preference for alcohol are at a higher risk of relapse. Clinicians may therefore focus on and tailor specific interventions to prevent relapse in this vulnerable and at-risk population.

The Implicit Association of High-Fat Food and Shame Among Women Recovered From Eating Disorders

BACKGROUND

Despite the growing literature about recovery from eating disorders (EDs), it is still unknown if women who report being recovered from EDs present with differing implicit attitudes about high-fat (vs. low-fat) food relative to women who report having a current ED and women who report never having had an ED.

METHODS

Female volunteers (N = 2,785) to the Project Implicit Mental Health (PIMH) website (https://implicit.harvard.edu/) were divided into three ED groups: current ED (n = 335), prior ED (n = 393), and healthy controls (n = 1,843). Participants completed, between 2016 and 2017, a background questionnaire, together with the Implicit Association Test (IAT), measuring implicit associations between high-fat (vs. low-fat) food and shame (vs. acceptableness). Linear regression models were conducted to examine cross-sectional differences between groups.

RESULTS

Women with prior EDs had stronger implicit associations relative to healthy controls (p = 0.041) and similar implicit associations relative to women with current EDs (p = 0.424).

DISCUSSION

The implicit association between high-fat food and shame may not diminish over time among women with EDs. Future longitudinal studies are warranted to clarify whether an experience of EDs may leave a "scar," manifested in specific implicit associations, that may potentially lead to recurrence after remission.

Exploring the association of social comparison with depression and anxiety: A systematic review and meta-analysis

Research has highlighted the role of social comparison processes in varying affect and psychological wellbeing. These processes can provide greater insight into cognitions and behaviours related to depression and anxiety disorders. This review aimed to examine the relationship of social comparison with depression and anxiety in clinically relevant samples, using a process-based approach. Studies of clinical and subclinical populations that utilized observational or experimental social comparison assessment were considered for review. A systematic literature search in Medline and PsycInfo databases produced 54 relevant studies (49 studies on adults and five on child and adolescent populations), 14 of which were suitable for a meta-analysis. A meta-analysis of the association of social comparison evaluation with depression and anxiety in clinical populations revealed weighted correlations of -0.53 and - 0.39, respectively. No subclinical studies were included in a meta-analysis due to a lack of comparable outcomes. Evidence suggests differences between depression and anxiety disorders in information seeking, where frequency and diversity of social comparisons vary; however, studies comparing disorders are lacking. Heterogeneity of experimental studies precluded inclusion in a meta-analysis. A narrative review of experimental data indicated depression and anxiety status is related to reactions to upward comparisons in the domains of affect and behaviour, where individual differences in evaluation can determine affective reactions and how comparison information is further sought. This review suggests social comparison has a significant association with depression and anxiety. However, the limited number of studies with clinical populations necessitates further research on social comparison processes in clinical samples.

Executive Function and Psychopathology: A Neurodevelopmental Perspective

Executive function (EF) skills are neurocognitive skills that support the reflective, top-down coordination and control of other brain functions, and there is neural and behavioral evidence for a continuum from more "cool" EF skills activated in emotionally neutral contexts to more "hot" EF skills needed for the reversal of motivationally significant tendencies. Difficulties in EF are transdiagnostic indicators of atypical development. A neurodevelopmental model traces the pathway from adverse childhood experiences and stress to disruption of the development of neural systems supporting reflection and EF skills to an increased risk for general features of psychopathology. Research indicates that EF skills can be cultivated through scaffolded training and are a promising target for therapeutic and preventive intervention. Intervention efficacy can be enhanced by mitigating disruptive bottom-up influences such as stress, training both hot and cool EF skills, and adding a reflective, metacognitive component to promote far transfer of trained skills.