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Sicouri G, Daniel EK, Spoelma MJ, Salemink E, McDermott EA, Hudson JL. Cognitive bias modification of interpretations for anxiety and depression in children and adolescents: A meta-analysis. JCPP ADVANCES 2024; 4:e12207. [PMID: 38486951 PMCID: PMC10933640 DOI: 10.1002/jcv2.12207] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 10/19/2023] [Indexed: 03/17/2024] Open
Abstract
Background Evidence suggests that cognitive bias modification of interpretations (CBM-I) is effective in modifying interpretation biases and has a small effect on reducing anxiety in children and adolescents. However, most evidence to date is based on studies which report anxiety or general distress using ad-hoc Likert-type or Visual Analogue Scales, which are useful but do not reliably index symptoms of clinical importance. This meta-analysis aimed to establish the effects of CBM-I for children and adolescents on both anxiety and depression using psychometrically validated symptom measures, as well as state negative affect and negative and positive interpretation bias. Methods We identified studies through a systematic search. To be eligible for inclusion, studies needed to target interpretation biases, not combine CBM-I with another intervention, randomly allocate participants to CBM-I or a control condition, assess a mental health outcome (i.e., anxiety or depression symptoms using validated measures or state measures of negative affect) and/or interpretation bias and have a mean age less than 18 years. Results We identified 36 studies for inclusion in the meta-analysis. CBM-I had a small and non-significant unadjusted effect on anxiety symptoms (g = 0.16), no effect on depression symptoms (g = -0.03), and small and non-significant unadjusted effects on state negative affect both at post-training (g = 0.16) and following a stressor task (g = 0.23). In line with previous findings, CBM-I had moderate to large unadjusted effects on negative and positive interpretations (g = 0.78 and g = 0.52). No significant moderators were identified. Conclusions CBM-I is effective at modifying interpretation bias, however there were no effects on mental health outcomes. The substantial variability across studies and paucity of studies using validated symptom measures highlight the need to establish randomized controlled trial protocols that evaluate CBM-I in clinical youth samples to determine its future as a clinical intervention.
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Affiliation(s)
- Gemma Sicouri
- Black Dog InstituteUniversity of New South WalesSydneyNew South WalesAustralia
- School of PsychologyUniversity of New South WalesSydneyNew South WalesAustralia
| | - Emily K. Daniel
- Black Dog InstituteUniversity of New South WalesSydneyNew South WalesAustralia
| | - Michael J. Spoelma
- Black Dog InstituteUniversity of New South WalesSydneyNew South WalesAustralia
- Discipline of Psychiatry and Mental HealthSchool of Clinical MedicineFaculty of Medicine and HealthUniversity of New South WalesSydneyNew South WalesAustralia
| | - Elske Salemink
- Department of Clinical PsychologyUtrecht UniversityUtrechtthe Netherlands
| | - Emma A. McDermott
- Black Dog InstituteUniversity of New South WalesSydneyNew South WalesAustralia
| | - Jennifer L. Hudson
- Black Dog InstituteUniversity of New South WalesSydneyNew South WalesAustralia
- School of PsychologyUniversity of New South WalesSydneyNew South WalesAustralia
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Jones EL, Rozenman M. Social Evaluation in Emerging Adults: Associations with Interpretation Bias and Perceived Social Support. Child Psychiatry Hum Dev 2024:10.1007/s10578-023-01663-1. [PMID: 38329648 DOI: 10.1007/s10578-023-01663-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/27/2023] [Indexed: 02/09/2024]
Abstract
Social anxiety symptoms are one of the most common mental health concerns across the lifespan (Bandelow and Michaelis in Dialogues Clin Neurosci 17(3):327-335, 2015. https://doi.org/10.31887/DCNS.2015.17.3/bbandelow ) and are especially relevant during emerging adulthood, when social feedback occurs daily (Auxier and Anderson in Social media use in 2021, 2021. https://www.pewresearch.org/internet/2021/04/07/social-media-use-in-2021/ ) as emerging adults navigate new social environments. Two cognitive processes have been identified as relevant to social anxiety: high threat interpretation bias (i.e., the tendency to appraise threat from ambiguity; Rozenman et al. in Behav Ther 45(5):594-605, 2014. https://doi.org/10.1016/j.beth.2014.03.009 ; J Anxiety Disord 45:34-42, 2017. https://doi.org/10.1016/j.janxdis.2016.11.004 ) is associated with high social anxiety, whereas high perceived social support is associated with low social anxiety. In this study, emerging adults (N = 303) completed an online adaptation of the Chatroom task (Guyer et al. in Arch Gener Psychiatry 65(11):1303-1312, 2008. https://doi.org/10.1001/archpsyc.65.11.1303 ), an experimental paradigm designed to simulate social acceptance and rejection, as well as a performance-based measure of interpretation bias (Word Sentence Association Paradigm; Beard and Amir in Behav Res Ther 46(10):1135-1141, 2008. https://doi.org/10.1016/j.brat.2008.05.012 ), and a self-report measure of perceived social support (Multidimensional Scale of Perceived Social Support; Zimet et al. in J Pers Assess 52(1), 30-41, 1988. https://doi.org/10.1207/s15327752jpa5201_2 ). Social anxiety symptoms did not increase as a function of acceptance or rejection during the Chatroom task. However, there were significant interactions between each cognitive predictor and social anxiety change: emerging adults with low interpretation bias towards threat and emerging adults with high perceived social support both experienced decreases in social anxiety from pre- to post-Chatroom task, regardless of whether they were accepted or rejected during the Chatroom task. If replicated, low interpretation bias and high perceived social support may serve as promotive factors in social interactions for emerging adults.
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Affiliation(s)
- Emily L Jones
- Department of Psychology, University of Denver, Denver, CO, USA.
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Cognitive mechanisms predicting resilient functioning in adolescence: Evidence from the CogBIAS longitudinal study. Dev Psychopathol 2022; 34:345-353. [DOI: 10.1017/s0954579420000668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractResilience 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
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Rodgers NH, Lau JYF, Zebrowski PM. Examining the Effects of Stuttering and Social Anxiety on Interpretations of Ambiguous Social Scenarios Among Adolescents. JOURNAL OF COMMUNICATION DISORDERS 2022; 95:106179. [PMID: 34902801 DOI: 10.1016/j.jcomdis.2021.106179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 11/05/2021] [Accepted: 12/06/2021] [Indexed: 06/14/2023]
Abstract
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.
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Affiliation(s)
- Naomi H Rodgers
- Department of Special Education and Communication Sciences and Disorders, University of Nebraska-Lincoln United States.
| | - Jennifer Y F Lau
- Youth Resilience Research Unit, Queen Mary University of London England
| | - Patricia M Zebrowski
- Department of Communication Sciences and Disorders, University of Iowa United States
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Rowlands K, Grafton B, Cerea S, Simic M, Hirsch C, Cruwys T, Yellowlees R, Treasure J, Cardi V. A multifaceted study of interpersonal functioning and cognitive biases towards social stimuli in adolescents with eating disorders and healthy controls. J Affect Disord 2021; 295:397-404. [PMID: 34500369 DOI: 10.1016/j.jad.2021.07.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 07/02/2021] [Accepted: 07/12/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Cognitive biases towards social stimuli have been identified as one of the putative modifiable mechanisms to remediate interpersonal difficulties in adolescents with mental disorders. However, evidence for these biases in adolescents with eating disorders is scarce. METHODS This study assessed interpersonal sensitivity, cognitive biases towards social stimuli, and quantity and quality of social group memberships in adolescents with eating disorders (n = 80), compared to healthy controls (n = 78), and examined whether a negative interpretation bias would mediate the relationship between interpersonal sensitivity, eating disorder symptoms and positive group memberships. RESULTS Adolescents with eating disorders displayed greater interpersonal awareness, negative interpretation biases of ambiguous social information and poorer quality relationships with their social groups compared to healthy controls. In a simple mediation model, interpersonal awareness predicted eating disorder symptoms, and this effect was partially mediated by a negative interpretation bias. CONCLUSIONS Psychological interventions which aim to reduce a negative interpretation bias might help to reduce the severity of eating disorder symptoms in adolescents with eating disorders.
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Affiliation(s)
- Katie Rowlands
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.
| | - Ben Grafton
- Centre for the Advancement of Research on Emotion, School of Psychological Science, University of Western Australia, Crawley, Australia
| | - Silvia Cerea
- Department of General Psychology, University of Padova, Italy
| | - Mima Simic
- Child and Adolescent Eating Disorders Service, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Colette Hirsch
- Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Tegan Cruwys
- Research School of Psychology, The Australian National University, Canberra ACT 2601, Australia
| | - Robyn Yellowlees
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Janet Treasure
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Valentina Cardi
- Department of General Psychology, University of Padova, Italy
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Lau JYF, Watkins-Muleba R, Lee I, Pile V, Hirsch CR. Promoting helpful attention and interpretation patterns to reduce anxiety and depression in young people: weaving scientific data with young peoples' lived experiences. BMC Psychiatry 2021; 21:403. [PMID: 34429091 PMCID: PMC8386061 DOI: 10.1186/s12888-021-03320-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 05/19/2021] [Indexed: 12/21/2022] Open
Abstract
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.
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Affiliation(s)
- Jennifer Y. F. Lau
- grid.13097.3c0000 0001 2322 6764Psychology Department, IOPPN, King’s College London, Denmark Hill, London, SE5 8AF UK ,grid.4868.20000 0001 2171 1133Youth Resilience Research Unit, Queen Mary University of London, London, UK
| | - Rebecca Watkins-Muleba
- grid.13097.3c0000 0001 2322 6764Psychology Department, IOPPN, King’s College London, Denmark Hill, London, SE5 8AF UK
| | - Isabelle Lee
- grid.13097.3c0000 0001 2322 6764Psychology Department, IOPPN, King’s College London, Denmark Hill, London, SE5 8AF UK
| | - Victoria Pile
- grid.13097.3c0000 0001 2322 6764Psychology Department, IOPPN, King’s College London, Denmark Hill, London, SE5 8AF UK ,grid.4970.a0000 0001 2188 881XRoyal Holloway University of London, London, UK
| | - Colette R. Hirsch
- grid.13097.3c0000 0001 2322 6764Psychology Department, IOPPN, King’s College London, Denmark Hill, London, SE5 8AF UK
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Rozenman M, Gonzalez A, Logan C, Goger P. Cognitive bias modification for threat interpretations: Impact on anxiety symptoms and stress reactivity. Depress Anxiety 2020; 37:438-448. [PMID: 32301579 PMCID: PMC7299169 DOI: 10.1002/da.23018] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 05/15/2019] [Accepted: 06/15/2019] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Cognitive bias modification for interpretations (CBM-I) is a computerized intervention that has received increasing attention in the last decade as a potential experimental intervention for anxiety. Initial CBM-I trials with clinical populations suggest the potential utility of this approach. However, most CBM-I experiments have been conducted with unaffected samples, few (one or two) training sessions, and have not examined transfer effects to anxiety-related constructs such as stress reactivity. METHOD This study compared a 12-session CBM-I intervention (n = 12) to an interpretation control condition (ICC; n = 12) in individuals (N = 24) with elevated trait anxiety on interpretation bias, anxiety symptom, and stress reactivity outcomes (electrodermal activity, heart rate, and respiratory sinus arrhythmia). RESULTS Compared to the ICC group, participants assigned to CBM-I experienced significantly greater improvements in interpretation bias and anxiety symptoms by post-intervention 4 weeks later, with impact on anxiety maintained at 1-month follow-up. While CBM-I and ICC groups did not differ in stress reactivity during an acute stressor at pre-intervention, the CBM-I group evidenced improved stress reactivity at post-intervention compared to ICC on two psychophysiological indices, electrodermal activity and heart rate. CONCLUSIONS The results of this pilot study suggest that CBM-I may hold promise for reducing anxiety symptoms, as well as impact psychophysiological arousal during an acute stressor.
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Affiliation(s)
- Michelle Rozenman
- University of Denver Department of Psychology / UCLA Division of Child & Adolescent Psychiatry
| | | | - Christina Logan
- California State University Long Beach Department of Psychology
| | - Pauline Goger
- SDSU/UCSD Joint Doctoral Program in Clinical Psychology
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Stuijfzand S, Creswell C, Field AP, Pearcey S, Dodd H. Research Review: Is anxiety associated with negative interpretations of ambiguity in children and adolescents? A systematic review and meta-analysis. J Child Psychol Psychiatry 2018; 59:1127-1142. [PMID: 29052865 PMCID: PMC6849625 DOI: 10.1111/jcpp.12822] [Citation(s) in RCA: 88] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/29/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND The tendency to interpret ambiguity as threat (negative interpretation) has been implicated in cognitive models of anxiety. A significant body of research has examined the association between anxiety and negative interpretation, and reviews suggest there is a robust positive association in adults. However, evidence with children and adolescents has been inconsistent. This study aimed to provide a systematic quantitative assessment of the association between anxiety and negative interpretation in children and adolescents. METHOD Following systematic searches and screening for eligibility, 345 effects sizes from 77 studies were meta-analysed. RESULTS Overall a medium positive association was found between anxiety and negative interpretation in children and adolescents ( d ^ = .62). Two variables significantly moderated this effect. Specifically, the association increased in strength with increasing age and when the content of ambiguous scenarios matched the anxiety subtype under investigation. CONCLUSIONS Results extend findings from adult literature by demonstrating an association in children and adolescents with evidence for content specificity in the association. Age effects imply a role for development. Results raise considerations for when and for whom clinical treatments for anxiety focusing on interpretation bias are appropriate. The vast majority of studies included in the review have used correlational designs and there are a limited number of studies with young children. The results should be considered with these limitations in mind.
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Affiliation(s)
- Suzannah Stuijfzand
- School of Psychology and Clinical Language SciencesUniversity of ReadingReadingUK
| | - Cathy Creswell
- School of Psychology and Clinical Language SciencesUniversity of ReadingReadingUK
| | | | - Samantha Pearcey
- School of Psychology and Clinical Language SciencesUniversity of ReadingReadingUK
| | - Helen Dodd
- School of Psychology and Clinical Language SciencesUniversity of ReadingReadingUK
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Krebs G, Pile V, Grant S, Degli Esposti M, Montgomery P, Lau JYF. Research Review: Cognitive bias modification of interpretations in youth and its effect on anxiety: a meta-analysis. J Child Psychol Psychiatry 2018; 59:831-844. [PMID: 29052837 DOI: 10.1111/jcpp.12809] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/03/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Emerging evidence suggests that cognitive bias modification of interpretations (CBM-I) is effective in altering interpretation biases and reducing anxiety in adults. Less is known about the impact of CBM-I in young people, but some recent findings, including a meta-analysis of combined cognitive bias modification of interpretation and attention techniques, have cast doubt on its clinical utility. Given the current debate, this meta-analysis sought to establish the independent effects of CBM-I on interpretations biases and anxiety in youth. METHODS Studies were identified through a systematic literature search of PsycINFO, Ovid MEDLINE, PsycARTICLES, Web of Science and EMBASE between January 1992 and March 2017. Eligible studies aimed to target interpretation biases; did not combine CBM-I with another intervention; included a control condition; randomly allocated participants to conditions; assessed interpretation bias and/or anxiety as an outcome; included individuals up to age 18; and did not present previously reported data. Reference lists of included articles were checked for further eligible studies, and authors were contacted for unpublished data. RESULTS We identified 26 studies meeting eligibility criteria that included in the meta-analysis. CBM-I had moderate effects on negative and positive interpretations (g = -0.70 and g = -0.52, respectively) and a small but significant effect on anxiety assessed after training (g = -0.17) and after a stressor (g = -0.34). No significant moderators were identified. CONCLUSIONS In contrast to previous meta-analytic findings, our results indicate that CBM-I has potential but weak anxiolytic effects in youth. Our findings suggest that it may be premature to disregard the potential value of CBM-I research and further research in this field is warranted.
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Affiliation(s)
- Georgina Krebs
- OCD & Related Disorders Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK.,Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Victoria Pile
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Sean Grant
- Centre for Evidence-Based Intervention, University of Oxford, Oxford, UK.,RAND Corporation, Santa Monica, CA, USA
| | | | - Paul Montgomery
- Department of Social Policy and Social Work, University of Birmingham, Birmingham, UK
| | - Jennifer Y F Lau
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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Lisk SC, Pile V, Haller SPW, Kumari V, Lau JYF. Multisession Cognitive Bias Modification Targeting Multiple Biases in Adolescents with Elevated Social Anxiety. COGNITIVE THERAPY AND RESEARCH 2018; 42:581-597. [PMID: 30237649 PMCID: PMC6133013 DOI: 10.1007/s10608-018-9912-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Research studies applying cognitive bias modification of attention (CBM-A) and interpretations (CBM-I) training to reduce adolescent anxiety by targeting associated cognitive biases have found mixed results. This study presents a new multi-session, combined bias CBM package, which uses a mix of training techniques and stimuli to enhance user-engagement. We present preliminary data on its viability, acceptability and effectiveness on reducing symptoms and biases using an A–B case series design. 19 adolescents with elevated social anxiety reported on their social anxiety, real-life social behaviours, general anxiety, depression, and cognitive biases at pre/post time-points during a 2-week baseline phase and a 2-week intervention phase. Retention rate was high. Adolescents also reported finding the CBM training helpful, particularly CBM-I. Greater reductions in social anxiety, negative social behaviour, and general anxiety and depression, characterised the intervention but not baseline phase. There was a significant correlation between interpretation bias change and social anxiety symptom change. Our enhanced multi-session CBM programme delivered in a school-setting appeared viable and acceptable. Training-associated improvements in social anxiety will require further verification in a study with an active control condition/group.
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Affiliation(s)
- Stephen C Lisk
- 1Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 8AF UK
| | - Victoria Pile
- 1Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 8AF UK
| | - Simone P W Haller
- 2Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Veena Kumari
- 3Centre for Cognitive Neuroscience, College of Health and Life Sciences, Brunel University London, London, UK
| | - Jennifer Y F Lau
- 1Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 8AF UK
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Klein AM, Salemink E, de Hullu E, Houtkamp E, Papa M, van der Molen M. Cognitive Bias Modification Reduces Social Anxiety Symptoms in Socially Anxious Adolescents with Mild Intellectual Disabilities: A Randomized Controlled Trial. J Autism Dev Disord 2018; 48:3116-3126. [PMID: 29680962 PMCID: PMC6096836 DOI: 10.1007/s10803-018-3579-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The goal of this study was to examine the effects of Cognitive Bias Modification training for Interpretation (CBM-I) in socially anxious adolescents with Mild Intellectual Disabilities (MID). A total of 69 socially anxious adolescents with MID were randomly assigned to either a positive or a neutral control-CMB-I-training. Training included five sessions in a 3-week period, and each session consisted of 40 training items. Adolescents in the positive training group showed a significant reduction in negative interpretation bias on the two interpretation bias tasks after training compared to adolescents in the control-training group. Furthermore, in contrast to the control-training group, adolescents in the positive training reported a significant reduction of their social anxiety symptoms 10 weeks post-training.
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Affiliation(s)
- Anke M Klein
- Clinical, Neuro, and Developmental Psychology, VU Amsterdam, Amsterdam, The Netherlands.
- Developmental Psychology, University of Amsterdam, Nieuwe Achtergracht 129B, Amsterdam, The Netherlands.
| | - Elske Salemink
- Developmental Psychology, University of Amsterdam, Nieuwe Achtergracht 129B, Amsterdam, The Netherlands
| | - Eva de Hullu
- Clinical Psychology, Open University, Heerlen, The Netherlands
| | - Esther Houtkamp
- Clinical, Neuro, and Developmental Psychology, VU Amsterdam, Amsterdam, The Netherlands
| | - Marlissa Papa
- Clinical, Neuro, and Developmental Psychology, VU Amsterdam, Amsterdam, The Netherlands
| | - Mariët van der Molen
- Clinical, Neuro, and Developmental Psychology, VU Amsterdam, Amsterdam, The Netherlands
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de Voogd L, Wiers RW, de Jong PJ, Zwitser RJ, Salemink E. A randomized controlled trial of multi-session online interpretation bias modification training: Short- and long-term effects on anxiety and depression in unselected adolescents. PLoS One 2018; 13:e0194274. [PMID: 29543838 PMCID: PMC5854362 DOI: 10.1371/journal.pone.0194274] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 02/28/2018] [Indexed: 11/30/2022] Open
Abstract
Introduction Negatively biased interpretations play an important role in anxiety and depression, which are highly prevalent in adolescence, and changing such biases might thus reduce or prevent emotional disorders. We investigated the short- and long-term effects of an online interpretation bias modification training in unselected adolescents to explore its potential in preventing anxiety and depression. Methods Participants (N = 173) were randomly allocated to eight online sessions of interpretation or placebo training. Interpretation bias was assessed pre- and post-training. Primary outcomes of anxiety and depression, and secondary measures of emotional resilience were assessed pre- and post-training and at three, six, and twelve months follow-up. Results Compared to placebo, interpretation training marginally increased positive interpretations. Irrespective of training condition, symptoms of anxiety and depression showed a decline post-training and at follow-up, and indices of resilience showed an increase. Change in interpretation bias, baseline interpretation bias, stressful life events, or number of training sessions completed did not moderate the effects on anxiety or depression. Conclusions Results suggest that interpretation training as implemented in this study has no added value in reducing symptoms or enhancing resilience in unselected adolescents.
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Affiliation(s)
- Leone de Voogd
- Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
- * E-mail:
| | - Reinout W. Wiers
- Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Peter J. de Jong
- Department of Clinical Psychology, University of Groningen, Groningen, The Netherlands
| | - Robert J. Zwitser
- Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Elske Salemink
- Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
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Imagine the bright side of life: A randomized controlled trial of two types of interpretation bias modification procedure targeting adolescent anxiety and depression. PLoS One 2017; 12:e0181147. [PMID: 28715495 PMCID: PMC5513454 DOI: 10.1371/journal.pone.0181147] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 06/23/2017] [Indexed: 11/20/2022] Open
Abstract
Introduction Anxiety and depression are highly prevalent during adolescence and characterized by negative interpretation biases. Cognitive bias modification of interpretations (CBM-I) may reduce such biases and improve emotional functioning. However, as findings have been mixed and the traditional scenario training is experienced as relatively boring, a picture-based type of training might be more engaging and effective. Methods The current study investigated short- and long-term effects (up to 6 months) and users’ experience of two types of CBM-I procedure in adolescents with heightened symptoms of anxiety or depression (N = 119, aged 12–18 year). Participants were randomized to eight online sessions of text-based scenario training, picture-word imagery training, or neutral control training. Results No significant group differences were observed on primary or secondary emotional outcomes. A decrease in anxiety and depressive symptoms, and improvements in emotional resilience were observed, irrespective of condition. Scenario training marginally reduced negative interpretation bias on a closely matched assessment task, while no such effects were found on a different task, nor for the picture-word or control group. Subjective evaluations of all training paradigms were relatively negative and the imagery component appeared particularly difficult for adolescents with higher symptom levels. Conclusions The current results question the preventive efficacy and feasibility of both CBM-I procedures as implemented here in adolescents.
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15
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Rozenman M, Vreeland A, Piacentini J. Thinking anxious, feeling anxious, or both? Cognitive bias moderates the relationship between anxiety disorder status and sympathetic arousal in youth. J Anxiety Disord 2017; 45:34-42. [PMID: 27923164 PMCID: PMC5863750 DOI: 10.1016/j.janxdis.2016.11.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 11/01/2016] [Accepted: 11/15/2016] [Indexed: 01/10/2023]
Abstract
Cognitive bias and physiological arousal are two putative markers that may underlie youth anxiety. However, data on relationships between cognitive bias and arousal are limited, and typically do not include behavioral measurement of these constructs in order to tap real-time processes. We aimed to examine the relationship between performance-based cognitive bias and sympathetic arousal during stress in clinically anxious and typically-developing youth. The sample included children and adolescents ages 9 to 17 (Mean age=13.18, SD=2.60) who either met diagnostic criteria for primary generalized anxiety, social phobia, or separation anxiety (N=24) or healthy controls who had no history of psychopathology (N=22). Youth completed performance-based measures of attention and interpretation bias. Electrodermal activity was assessed while youth participated in the Trier Social Stress Test for Children (TSST-C; Buske-Kirschbaum, Jobst, & Wustmans, 1997). A mixed models analysis indicated significant linear and non-linear changes in skin conductance, with similar slopes for both groups. Interpretation bias, but not attention bias, moderated the relationship between group status and sympathetic arousal during the TSST-C. Arousal trajectories did not differ for anxious and healthy control youth who exhibited high levels of threat interpretation bias. However, for youth who exhibited moderate and low levels of interpretation bias, the anxious group demonstrated greater arousal slopes than healthy control youth. Results provide initial evidence that the relationship between anxiety status and physiological arousal during stress may be moderated by level of interpretation bias for threat. These findings may implicate interpretation bias as a marker of sympathetic reactivity in youth. Implications for future research and limitations are discussed.
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Affiliation(s)
- Michelle Rozenman
- Division of Child & Adolescent Psychiatry, UCLA Semel Institute for Neuroscience & Human Behavior, United States.
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16
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Mental Imagery-Based Training to Modify Mood and Cognitive Bias in Adolescents: Effects of Valence and Perspective. COGNITIVE THERAPY AND RESEARCH 2016; 41:73-88. [PMID: 28239214 PMCID: PMC5306169 DOI: 10.1007/s10608-016-9795-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Mental imagery has a powerful impact on emotion and cognitive processing in adults, and is implicated in emotional disorders. Research suggests the perspective adopted in mental imagery modulates its emotional impact. However, little is known about the impact of mental imagery in adolescence, despite adolescence being the key time for the onset of emotional dysfunction. We administered computerised positive versus mixed valence picture-word mental imagery training to male adolescent participants (N = 60, aged 11–16 years) across separate field and observer perspective sessions. Positive mood increased more following positive than mixed imagery; pleasantness ratings of ambiguous pictures increased following positive versus mixed imagery generated from field but not observer perspective; negative interpretation bias on a novel scrambled sentences task was smaller following positive than mixed imagery particularly when imagery was generated from field perspective. These findings suggest positive mental imagery generation alters mood and cognition in male adolescents, with the latter moderated by imagery perspective. Identifying key components of such training, such as imagery perspective, extends understanding of the relationship between mental imagery, mood, and cognition in adolescence.
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17
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Vassilopoulos SP, Moberly NJ, Lau JYF. Cognitive Bias Modification Training in Children Affects Anxiety During Anticipatory Processing of Social Evaluation. Int J Cogn Ther 2015. [DOI: 10.1521/ijct.2015.8.4.318] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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18
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Waite P, Codd J, Creswell C. Interpretation of ambiguity: Differences between children and adolescents with and without an anxiety disorder. J Affect Disord 2015; 188:194-201. [PMID: 26363617 PMCID: PMC4641870 DOI: 10.1016/j.jad.2015.08.022] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 08/07/2015] [Accepted: 08/11/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND Theory and treatment of anxiety disorders in young people are commonly based on the premise that interpretation biases found in anxious adults are also found in children and adolescents. Although there is some evidence that this may be the case, studies have not typically taken age into account, which is surprising given the normative changes in cognition that occur throughout childhood. The aim of the current study was to identify whether associations between anxiety disorder status and interpretation biases differed in children and adolescents. METHODS The responses of children (7-10 years) and adolescents (13-16 years) with and without anxiety disorders (n=120) were compared on an ambiguous scenarios task. RESULTS Children and adolescents with an anxiety disorder showed significantly higher levels of threat interpretation and avoidant strategies than non-anxious children and adolescents. However, age significantly moderated the effect of anxiety disorder status on interpretation of ambiguity, in that adolescents with anxiety disorders showed significantly higher levels of threat interpretation and associated negative emotion than non-anxious adolescents, but a similar relationship was not observed among children. CONCLUSIONS The findings suggest that theoretical accounts of interpretation biases in anxiety disorders in children and adolescents should distinguish between different developmental periods. For both ages, treatment that targets behavioral avoidance appears warranted. However, while adolescents are likely to benefit from treatment that addresses interpretation biases, there may be limited benefit for children under the age of ten.
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Affiliation(s)
- Polly Waite
- School of Psychology and Clinical Language Sciences, University of Reading, Reading RG6 6AL, UK.
| | - Jon Codd
- Talking Therapies, Shinfield Medical Practice, Reading, UK
| | - Cathy Creswell
- School of Psychology and Clinical Language Sciences, University of Reading, Reading RG6 6AL, UK
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19
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Salemink E, Wolters L, de Haan E. Augmentation of Treatment As Usual with online Cognitive Bias Modification of Interpretation training in adolescents with Obsessive Compulsive Disorder: A pilot study. J Behav Ther Exp Psychiatry 2015; 49:112-9. [PMID: 25724385 DOI: 10.1016/j.jbtep.2015.02.003] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 02/06/2015] [Accepted: 02/08/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND OBJECTIVES Cognitive Behavioral Therapy for children and adolescents with Obsessive Compulsive Disorder (OCD) is effective. However, since almost half of patients remain symptomatic after treatment, there remains room for improvement. Cognitive Bias Modification training of Interpretations (CBM-I) is a promising new intervention, as it targets misinterpretation of intrusions, which is seen as an important characteristic in OCD. To date, there have been no published studies of CBM-I in adolescents with OCD. The aim of the current pilot study was to examine the added value of online CBM-I training as an adjunctive treatment to the Treatment As Usual (TAU; that included CBT and pharmacotherapy) in adolescents with OCD. METHODS Patients receiving TAU were randomly assigned to either an additional CBM-I training (n = 9), or to an additional placebo variant of this procedure (n = 7). RESULTS Immediate, on-line interpretations changed in response to the CBM-I training, while no such effects were observed on slower retrospective off-line interpretations. Patients in the CBM-I training condition reported fewer obsessive compulsive symptoms after training, and clinicians rated them as having fewer obsessive symptoms (corresponding to medium-large effect sizes). No such changes were observed in the placebo group. LIMITATIONS The small sample size precludes strong conclusions and replication is necessary to test the robustness of the findings. CONCLUSIONS This small randomized controlled trial is suggestive, although not conclusive, regarding the promising additive value of OC-related CBM-I training as an adjunctive intervention to TAU in an adolescent clinical population.
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Affiliation(s)
- Elske Salemink
- Addiction, Development and Psychopathology Lab (Adapt Lab), Department of Developmental Psychology, Research Priority Areas 'Yield', and 'Amsterdam Brain and Cognition', University of Amsterdam, The Netherlands; Department of Obsessive Compulsive-, Anxiety- and Tic Disorders, Academic Center for Child and Adolescent Psychiatry, de Bascule, Amsterdam, The Netherlands.
| | - Lidewij Wolters
- Department of Obsessive Compulsive-, Anxiety- and Tic Disorders, Academic Center for Child and Adolescent Psychiatry, de Bascule, Amsterdam, The Netherlands; Academic Medical Center, Department of Child and Adolescent Psychiatry, Amsterdam, The Netherlands
| | - Else de Haan
- Department of Obsessive Compulsive-, Anxiety- and Tic Disorders, Academic Center for Child and Adolescent Psychiatry, de Bascule, Amsterdam, The Netherlands; Child Development and Education, University of Amsterdam, The Netherlands
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20
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Chan SWY, Lau JYF, Reynolds SA. Is cognitive bias modification training truly beneficial for adolescents? J Child Psychol Psychiatry 2015; 56:1239-48. [PMID: 25471444 DOI: 10.1111/jcpp.12368] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/21/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Cognitive Bias Modification (CBM) has been shown to change interpretation biases commonly associated with anxiety and depression and may help ameliorate symptoms of these disorders. However, its evidence base for adolescents is scarce. Previous results have been hard to interpret because of methodological issues. In particular, many studies have used negative bias training as the control condition. This would tend to inflate any apparent benefits of CBM compared to a neutral control. Most studies also only examined the effects of a single training session and lacked follow-up assessment or ecologically valid outcome measures. METHOD Seventy-four adolescents, aged 16-18 years, were randomised to two sessions of CBM training or neutral control. Interpretation bias and mood were assessed three times: at baseline, immediately post-training and 1 week post-training. A controlled experimental stressor was also used, and responses to everyday stressors were recorded for 1 week after training to assess responses to psychological challenges. Feedback for the training programme was collected. RESULTS The CBM group reported a greater reduction in negative affect than control participants. However, other hypothesised advantages of CBM were not demonstrated. Regardless of training group, participants reported increased positive interpretations, decreased negative interpretations, reduced depressive symptoms and no change in trait anxiety. The two groups did not differ in their stress reactivity. After controlling for group differences in training performance, all the mood effects disappeared. CONCLUSIONS When tested under stringent experimental conditions the effects of CBM in healthy adolescents appear to be minimal. Future studies should concentrate on participants with elevated cognitive biases and/or mood symptoms who may be more sensitive to CBM.
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Affiliation(s)
- Stella W Y Chan
- Section of Clinical Psychology, University of Edinburgh, Edinburgh, UK.,University of East Anglia, Norwich, UK
| | - Jennifer Y F Lau
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Shirley A Reynolds
- University of East Anglia, Norwich, UK.,School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
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21
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Interpretation modification training reduces social anxiety in clinically anxious children. Behav Res Ther 2015; 75:78-84. [PMID: 26580081 DOI: 10.1016/j.brat.2015.10.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 10/15/2015] [Accepted: 10/20/2015] [Indexed: 11/20/2022]
Abstract
The present study was designed to examine the effects of training in positive interpretations in clinically anxious children. A total of 87 children between 7 and 12 years of age were randomly assigned to either a positive cognitive bias modification training for interpretation (CMB-I) or a neutral training. Training included 15 sessions in a two-week period. Children with an interpretation bias prior to training in the positive training group showed a significant reduction in interpretation bias on the social threat scenarios after training, but not children in the neutral training group. No effects on interpretation biases were found for the general threat scenarios or the non-threat scenarios. Furthermore, children in the positive training did not self-report lower anxiety than children in the neutral training group. However, mothers and fathers reported a significant reduction in social anxiety in their children after positive training, but not after neutral training. This study demonstrated that clinically anxious children with a prior interpretation bias can be trained away from negative social interpretation biases and there is some evidence that this corresponds to reductions in social anxiety. This study also highlights the importance of using specific training stimuli.
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22
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Zhang Y, Zhou X, James AC, Qin B, Whittington CJ, Cuijpers P, Del Giovane C, Liu Y, Cohen D, Weisz JR, Xie P. Comparative efficacy and acceptability of psychotherapies for acute anxiety disorders in children and adolescents: study protocol for a network meta-analysis. BMJ Open 2015; 5:e008572. [PMID: 26443658 PMCID: PMC4606384 DOI: 10.1136/bmjopen-2015-008572] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 08/29/2015] [Accepted: 09/09/2015] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION Anxiety disorders are associated with significant public health burden in young individuals. Cognitive-behavioural therapy (CBT) is the most commonly used psychotherapy for anxiety disorders in children and adolescents, but previous reviews were hindered by a limited number of trials with direct comparisons between different psychotherapies and their deliveries. Consequently, the main aim of this research was to investigate the comparative efficacy and acceptability of various types and deliveries of psychotherapies for anxiety disorders in children and adolescents. METHODS AND ANALYSIS We will systematically search PubMed, EMBASE, Cochrane, Web of Science, PsycINFO, CINAHL, ProQuest Dissertations and LiLACS for randomised controlled trials, regardless of whether participants received blinding or not, published from 1 January 1966 to 30 January 2015 (updated to 1 July 2015), that compared any psychotherapy with either a control condition or an active comparator with different types and/or different delivery formats for the acute treatment of anxiety disorders in children and adolescents. Data extraction, risk of bias and quality assessments will be independently extracted by two reviewers. The primary outcome for efficacy will be mean overall change scores in anxiety symptoms (self-rated or assessor-rated) from baseline to post-treatment between two groups. The acceptability of treatment will be measured as the proportion of patients who discontinued treatment during the acute phase of treatment. We will assess efficacy, based on the standardised mean difference (SMD), and acceptability, based on the OR, using a random-effects network meta-analysis within a Bayesian framework. Subgroup and sensitivity analyses will be conducted to assess the robustness of the findings. ETHICS AND DISSEMINATION No ethical issues are foreseen. The results will be published in a peer-reviewed journal and will be disseminated electronically and in print. The meta-analysis may be updated to inform and guide management of anxiety in children and adolescents. TRIAL REGISTRATION NUMBER PROSPERO CRD42015016283.
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Affiliation(s)
- Yuqing Zhang
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xinyu Zhou
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Anthony C James
- Department of Psychiatry, University of Oxford, Oxford, UK
- Highfield Family and Adolescent Unit, Warneford Hospital, Oxford, UK
| | - Bin Qin
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Craig J Whittington
- Research Department of Clinical, Educational & Health Psychology, Centre for Outcomes Research and Effectiveness, University College London, London, UK
| | - Pim Cuijpers
- Department of Clinical Psychology, VU University Amsterdam, Amsterdam, The Netherlands
| | - Cinzia Del Giovane
- Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Yiyun Liu
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - David Cohen
- Department of Child and Adolescent Psychiatry, Institut des Systèmes Intelligents et de Robotiques, UPMC Univ Paris 06, UMR 7222, Sorbonne Universités, AP-HP, Hôpital Pitié-Salpétrière, Paris, France
| | - John R Weisz
- Department of Psychology, Harvard University, Cambridge, Massachusetts, USA
| | - Peng Xie
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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23
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Cristea IA, Mogoașe C, David D, Cuijpers P. Practitioner Review: Cognitive bias modification for mental health problems in children and adolescents: a meta-analysis. J Child Psychol Psychiatry 2015; 56:723-734. [PMID: 25640876 DOI: 10.1111/jcpp.12383] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/24/2014] [Indexed: 12/21/2022]
Abstract
BACKGROUND Despite accumulating research and bold claims about the efficacy of cognitive bias modification (CBM) for young populations, no meta-analysis has attempted to synthesize the research literature so far. We examined whether there was empirical evidence for the clinical efficacy of CBM interventions in youths, while also considering the methodological quality of this evidence. METHODS Studies were identified through systematic searches in bibliographical databases (PubMed, PsychInfo, Cochrane Library and EMBASE to June 2014). We included randomized controlled trials of CBM interventions, and considered both clinical outcomes and targeted biases. We examined the quality of the trials, as well as potential publication bias and possible moderators. RESULTS We identified 23 trials that reported on four types of outcomes: mental health, anxiety, depression and bias. Effect sizes were small and nonsignificant for all symptom outcomes considered. We found a moderate significant effect size for bias outcomes (Hedges' g of 0.53), with significant heterogeneity. There were no differences between types of CBM interventions, or between one versus multiple-session applications. A small but significant effect size for mental health problems arose when the intervention was delivered in schools. The quality of almost all of the included studies was suboptimal and the vast majority did not include information needed for allowing quality assessment. CONCLUSIONS We conducted the first meta-analysis of CBM interventions for children and adolescents and found no effects for mental health outcomes, but we did find moderate and significant effects on the targeted biases. Our results cast serious doubts on CBM interventions having any clinical utility for nonadult populations. Demand characteristics might play an important part in CBM research.
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Affiliation(s)
- Ioana A Cristea
- Department of Clinical Psychology and Psychotherapy, Babeş-Bolyai University, Cluj-Napoca, Romania.,Clinical Psychology Branch, Department of Surgical, Medical, Molecular and Critical Pathology, University of Pisa, Pisa, Italy
| | - Cristina Mogoașe
- Department of Clinical Psychology and Psychotherapy, Babeş-Bolyai University, Cluj-Napoca, Romania
| | - Daniel David
- Department of Clinical Psychology and Psychotherapy, Babeş-Bolyai University, Cluj-Napoca, Romania.,Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Pim Cuijpers
- Department of Clinical Psychology, VU University, Amsterdam, The Netherlands.,EMGO Institute for Health and Care Research, VU University and VU University Medical Centre, Amsterdam, The Netherlands
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24
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Cognitive Bias Modification Training in Adolescents: Persistence of Training Effects. COGNITIVE THERAPY AND RESEARCH 2014. [DOI: 10.1007/s10608-014-9627-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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25
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Lau JY. Cognitive bias modification of interpretations: A viable treatment for child and adolescent anxiety? Behav Res Ther 2013; 51:614-22. [DOI: 10.1016/j.brat.2013.07.001] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2013] [Revised: 06/25/2013] [Accepted: 07/01/2013] [Indexed: 11/29/2022]
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26
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Burnett Heyes S, Lau JYF, Holmes EA. Mental imagery, emotion and psychopathology across child and adolescent development. Dev Cogn Neurosci 2013; 5:119-33. [PMID: 23523985 PMCID: PMC6987813 DOI: 10.1016/j.dcn.2013.02.004] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Revised: 01/28/2013] [Accepted: 02/16/2013] [Indexed: 12/24/2022] Open
Abstract
Mental imagery-based interventions are receiving increasing interest for the treatment of psychological disorders in adults. This is based on evidence that mental imagery potently influences the experience of emotion in non-clinical samples, and that a number of psychological disorders are marked by syndrome-specific, distressing abnormalities in mental imagery. During childhood and adolescence, neurocognitive development impacting mental imagery processes may moderate its relationship with clinically-relevant emotional symptoms at a number of potential loci. Crucially, these changes could impact vulnerability to distressing mental imagery and the efficacy of mental imagery-based clinical interventions. This review synthesises evidence pertaining to developmental changes in the role and content of mental imagery, and in the cognitive sub-processes required to generate and sustain mental images. Subsequently, we discuss implications for understanding the developmental relationship between mental imagery, emotion and psychopathology. Translational cognitive neuroscience research investigating the content, emotional impact and neurocognitive substrates of mental imagery across development may reveal insights into trajectories of vulnerability to symptoms of a number of psychological disorders. If proper consideration is given to developmental factors, techniques based on mental imagery may be valuable as part of a treatment armoury for child and adolescent clinical populations and those at risk of emotional disorders.
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Affiliation(s)
- S Burnett Heyes
- Department of Experimental Psychology, University of Oxford, Oxford, UK.
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27
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Fu X, Du Y, Au S, Lau JY. Reducing negative interpretations in adolescents with anxiety disorders: a preliminary study investigating the effects of a single session of cognitive bias modification training. Dev Cogn Neurosci 2013; 4:29-37. [PMID: 23219491 PMCID: PMC6987770 DOI: 10.1016/j.dcn.2012.11.003] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Revised: 11/05/2012] [Accepted: 11/06/2012] [Indexed: 11/29/2022] Open
Abstract
Anxiety disorders are globally prevalent, debilitating and onset in early life. Cognitive bias modification of interpretations (CBM-I) training has emerged as a targeted intervention for early emerging anxiety problems. While CBM-I can alter interpretational styles in unselected and clinical-analogue samples of adolescents, no studies have assessed its capacity to change biases in clinical samples. Here, we assessed training efficacy in ameliorating interpretation biases and anxious mood in adolescents with anxiety disorders. Twenty-eight Chinese adolescents meeting criteria for a current anxiety disorder were randomly assigned to receive positive or neutral CBM-I training. Training involved completing a word-fragment to resolve the outcomes of sixty ambiguous scenarios. During positive training, scenarios ended with benign/positive resolutions, but during neutral training, half of the scenarios were resolved positively and half negatively. Positively trained patients interpreted new ambiguous scenarios less negatively than the neutral training group although training effects were not observed on a questionnaire measure of interpretation bias. Training effects on mood were also absent. Before the clinical implications of CBM-I can be considered in adolescents, research needs to establish optimal training parameters for symptom-changes to occur.
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Affiliation(s)
- Xiaoxue Fu
- Department of Psychology, Pennsylvania State University, PA 16802, USA
- Department of Experimental Psychology, University of Oxford, OX1 3UD, UK
| | - Yasong Du
- Department of Child and Adolescent Psychiatry, Shanghai Mental Health Centre, Shanghai 200030, China
| | - Shun Au
- Chinese Mental Health Association, London EC2A 3QY, UK
| | - Jennifer Y.F. Lau
- Department of Experimental Psychology, University of Oxford, OX1 3UD, UK
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