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Rabner JC, Ney JS, Kendall PC. Cognitive Functioning in Youth with Anxiety Disorders: A Systematic Review. Clin Child Fam Psychol Rev 2024; 27:357-380. [PMID: 38829508 PMCID: PMC11222226 DOI: 10.1007/s10567-024-00480-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2024] [Indexed: 06/05/2024]
Abstract
Anxiety disorders are disorders involving cognition. Research on cognition in youth with anxiety can focus on cognitive content (e.g., self-talk) as well cognitive functioning. The present review examines domains of cognitive functioning (i.e., episodic memory, language, attention, executive functioning, motor skills, and visual functioning) in youth diagnosed with an anxiety disorder. A database search of Embase, PsycINFO, and PubMed yielded 28 studies that met inclusion criteria of youth aged 17 years or younger, a sample diagnosed with a principal anxiety disorder and a comparison sample of controls, a comparison between those samples, and use of a behavioral measure of neuropsychological performance. Findings did not identify any cognitive functioning strengths for anxious youth. Deficits were found in two domains (i.e., receptive language and motor skills) whereas no deficits were found in attention, visuospatial skills and one domain of executive functioning (i.e., inhibition). Most domains had mixed findings. Additional analysis indicated that anxiety disorders in youth are not associated with diminished IQ. Directions for future research are identified including (a) the prioritization of studies with larger, representative samples (b) the role of cognitive functioning as a predictor of anxiety treatment outcome (c) the examination of the effect of treatment on cognitive performance, and (d) the course of anxiety and potential impairment in cognitive functioning.
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Affiliation(s)
- Jonathan C Rabner
- Department of Psychology and Neuroscience, Temple University, 1701 North 13th Street, Philadelphia, PA, 19122, USA.
- Behavioral Psychology Department, Kennedy Krieger Institute, Baltimore, MD, USA.
- The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Julia S Ney
- Department of Psychology and Neuroscience, Temple University, 1701 North 13th Street, Philadelphia, PA, 19122, USA
| | - Philip C Kendall
- Department of Psychology and Neuroscience, Temple University, 1701 North 13th Street, Philadelphia, PA, 19122, USA.
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2
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Xu C, Wei H. The effect of working memory training on test anxiety symptoms and attentional control in adolescents. BMC Psychol 2024; 12:101. [PMID: 38414009 PMCID: PMC10900565 DOI: 10.1186/s40359-024-01597-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 02/15/2024] [Indexed: 02/29/2024] Open
Abstract
OBJECTIVE The percentage of adolescents with test anxiety is increasing rapidly. Working memory (WM) training has been demonstrated to reduce anxiety levels and enhance attentional control in individuals. Therefore, we investigated whether adaptive dual n-back WM training could lower test anxiety level and improve attentional control in adolescents. METHODS Forty adolescents were allocated to either adaptive dual n-back WM training (n = 21) or non-adaptive dual 1-back WM training (n = 19) for 10 days. The Test Anxiety Scale was applied to measure individuals' test anxiety symptoms. The Attentional Control Scale (ACS), the flanker task, and the Go/Nogo task were used to measure attentional control. RESULTS Compared with the control group, the training group reported significantly relief of test anxiety symptoms; however, there were no significant differences between the two groups in pre-to-post changes in ACS scores or performance on the flanker task and Go/Nogo task. CONCLUSION In sum, adaptive dual n-back WM training effectively reduced adolescents' level of test anxiety but did not improve their attentional control.
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Affiliation(s)
- Chunling Xu
- Department of Psychology, Suzhou University of Science and Technology, 99 Xuefu Road, Huqiu District, 215009, Suzhou, Jiangsu, China
| | - Hua Wei
- Department of Psychology, Suzhou University of Science and Technology, 99 Xuefu Road, Huqiu District, 215009, Suzhou, Jiangsu, China.
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3
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du Toit SA, Schweizer S, Moustafa AA, Wong QJJ. Can Emotional Working Memory Training Improve Cognitive Behavioral Therapy Outcomes for Social Anxiety Disorder: A Pilot Study. J Cogn Psychother 2024; 38:33-52. [PMID: 38320773 DOI: 10.1891/jcp-2022-0013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
Social anxiety disorder (SAD) models highlight maladaptive attention as a maintaining factor of SAD, potentially negatively impacting how individuals with SAD engage with cognitive behavioral therapy (CBT) content in a therapist's presence. Emotional working memory training (eWMT) has been shown to improve affective attentional control. This pilot study assessed the proposed methodology for a randomized controlled trial (RCT) to determine whether eWMT, by improving attentional control prior to internet-based CBT (iCBT), results in better CBT outcomes. The RCT would be considered feasible if the pilot study achieved rates ≥80% for eligible participants recruited, study measures completion, intervention completion, and participant retention. Results from 10 randomized participants showed rates ≥80% for recruitment of eligible participants and iCBT intervention completion. Completion of study measures, eWMT and Placebo training interventions, and participant retention were <80%. Results highlight the need to consider strategies to improve the methodology prior to the RCT.
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Affiliation(s)
- Simone A du Toit
- School of Psychology, Western Sydney University, Sydney, Australia
| | - Susanne Schweizer
- School of Psychology, University of New South Wales, Sydney, Australia
- Department of Psychology, University of Cambridge, Cambridge, United Kingdom
| | - Ahmed A Moustafa
- Department of Human Anatomy and Physiology, Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa
- School of Psychology, Faculty of Society and Design, Bond University, Gold Coast, QLD, Australia
| | - Quincy J J Wong
- School of Psychology, Western Sydney University, Sydney, Australia
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Becker HC, Beltz AM, Himle JA, Abelson JL, Block SR, Taylor SF, Fitzgerald KD. Changes in Brain Network Connections After Exposure and Response Prevention Therapy for Obsessive-Compulsive Disorder in Adolescents and Adults. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2024; 9:70-79. [PMID: 37820789 PMCID: PMC10842137 DOI: 10.1016/j.bpsc.2023.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 09/08/2023] [Accepted: 09/26/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND Functional alterations of tripartite neural networks during cognitive control (i.e., frontoparietal network [FPN], cingulo-opercular network, and default mode network) occur in patients with obsessive-compulsive disorder (OCD) and may contribute to illness expression. However, the degree to which changes in these networks are elicited by gold standard treatment (e.g., exposure and response prevention [EX/RP]) remains unknown. Understanding how EX/RP modulates network connectivity in adolescent versus adult patients with OCD may aid the identification of developmentally sensitive treatment targets that enhance cognitive control. METHODS Data from a total of 169 adolescents (13-17 years) and adults (25-40 years; 57% female) were analyzed, including healthy control participants (n = 58) and patients with OCD (n = 111) who were randomized to either EX/RP or an active control therapy (stress management training). Participants performed a flanker task during functional magnetic resonance imaging pre- and posttreatment. To retain sensitivity to individual differences in connectivity, group iterative multiple model estimation was used to assess functional connectivity (i.e., density) within and between brain networks. RESULTS Significant increases in FPN density and decreases in FPN-default mode network density were observed from pre- to posttreatment in patients who received EX/RP. The opposite patterns of change occurred in patients who received stress management training. These treatment-related changes in network density did not differ across age group. CONCLUSIONS Results suggest EX/RP-specific changes in task-based connectivity in patients with OCD. Given baseline differences between healthy control participants and patients by age group, these treatment-related changes may indicate restoration of healthy FPN and default mode network development across patients, providing targets for improving response to EX/RP.
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Affiliation(s)
- Hannah C Becker
- Department of Psychology, University of Michigan, Ann Arbor, Michigan; Department of Psychiatry, University of Michigan, Ann Arbor, Michigan.
| | - Adriene M Beltz
- Department of Psychology, University of Michigan, Ann Arbor, Michigan
| | - Joseph A Himle
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan; School of Social Work, University of Michigan, Ann Arbor, Michigan
| | - James L Abelson
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
| | | | - Stephan F Taylor
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
| | - Kate D Fitzgerald
- Columbia University and New York State Psychiatric Institute, New York, New York
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Caudle MM, Dugas N, Stout DM, Ball TM, Bomyea J. Adjunctive cognitive training with exposure enhances fear and neural outcomes in social anxiety. Psychiatry Res 2023; 327:115416. [PMID: 37604041 DOI: 10.1016/j.psychres.2023.115416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 07/26/2023] [Accepted: 08/11/2023] [Indexed: 08/23/2023]
Abstract
Exposure-based cognitive behavioral therapy (CBT) is the gold standard for treating social anxiety disorder (SAD), yet response is not universal. CBT is thought to operate via extinction-related learning during exposure, which in turn relies on cognitive processes such as working memory. The present proof-of-concept study investigates the potential for training working memory to improve anxiety related outcomes following exposure. Thirty-three adults with elevated social anxiety were randomized to complete a working memory training or sham training condition. Post-training, participants completed a working memory assessment, speech exposure session, and two fMRI tasks. Participants who received working memory training demonstrated lower distress ratings by the end of the speech exposures and better performance on the fMRI working memory task than those in sham. Working memory training completers had greater neural activation in frontoparietal regions during an in-scanner working memory task and exhibited less neural activation in the fusiform gyrus in response to an emotional face processing task than those in sham. Adding working memory training to exposure procedures could strengthen functioning of frontoparietal regions and alter emotional processing - key mechanisms implicated in extinction learning. Findings provide preliminary evidence that training working memory in conjunction with exposure may enhance exposure success.
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Affiliation(s)
- M M Caudle
- San Diego State University, University of California San Diego Joint Doctoral Program in Clinical Psychology, 6363 Alvarado Court, Suite 103, San Diego, CA 92120, United States; Department of Veteran Affairs Medical Center, 3350 La Jolla Village Dr, San Diego, CA 92161, United States; Department of Psychiatry, University of California, 9500 Gilman Dr, La Jolla, CA 92093, United States
| | - N Dugas
- Department of Veteran Affairs Medical Center, 3350 La Jolla Village Dr, San Diego, CA 92161, United States; Department of Psychiatry, University of California, 9500 Gilman Dr, La Jolla, CA 92093, United States
| | - D M Stout
- Department of Psychiatry, University of California, 9500 Gilman Dr, La Jolla, CA 92093, United States; VA San Diego Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Dr, San Diego, CA 92161, United States
| | - T M Ball
- Department of Psychiatry & Behavioral Sciences, Stanford School of Medicine, 401 Quarry Road, Stanford, CA, 94305, United States
| | - J Bomyea
- Department of Psychiatry, University of California, 9500 Gilman Dr, La Jolla, CA 92093, United States; VA San Diego Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Dr, San Diego, CA 92161, United States.
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Wei H, Beuckelaer AD, Zhou R. EEG correlates of neutral working memory training induce attentional control improvements in test anxiety. Biol Psychol 2022; 174:108407. [PMID: 35952863 DOI: 10.1016/j.biopsycho.2022.108407] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 07/17/2022] [Accepted: 08/07/2022] [Indexed: 11/17/2022]
Abstract
Attentional control theory states that high test anxious (HTA) individuals suffer from impaired attentional control. However, through working memory training it may be possible to improve such individuals' attentional control ability. This study investigated whether 20 days of working memory training (with emotionally neutral stimuli) does result in improved HTA individuals' attentional control ability. Pre- and post-outcomes of attentional control were measured using Flanker and Go/Nogo experimental tasks in a test-related stress situation, and EEG data were also collected. Results only showed a significant decrease in Nogo alpha power in HTA individuals after neutral working memory training (i.e., post-outcome versus pre-outcome). However, we failed to provide evidence for beneficial transfer effects of neutral working memory training on enhanced task performance in both the Flanker and the Go/Nogo tasks. So, the present study demonstrates that neutral working memory training is clearly associated with important neurophysiological correlates while performing the Go/Nogo task, but the transfer effect is rather limited.
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Affiliation(s)
- Hua Wei
- Department of Psychology, Suzhou University of Science and Technology, Suzhou, Jiangsu, China; Department of Psychology, Nanjing University, Nanjing, Jiangsu, China
| | - Alain De Beuckelaer
- Institute for Management Research, Radboud University, Nijmegen, the Netherlands; Department of Work, Organisation and Society, Ghent University, Ghent, Belgium
| | - Renlai Zhou
- Department of Psychology, Nanjing University, Nanjing, Jiangsu, China; State Key Laboratory of Media Convergence Production Technology and Systems, Beijing, China.
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Schroder HS, Ip KI, Hruschak JL, Horbatch F, Hall M, Liu Y, Mannella K, Muzik M, Rosenblum KL, Moser JS, Fitzgerald KD. Targeting cognitive control to reduce anxiety in very young children: A proof of concept study. Depress Anxiety 2022; 39:646-656. [PMID: 35708131 DOI: 10.1002/da.23270] [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] [Received: 07/04/2021] [Revised: 04/15/2022] [Accepted: 05/09/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Underdeveloped cognitive control (CC)-the capacity to flexibly adjust to changing environments-may predispose some children to early onset anxiety disorders and represents a promising intervention target. The current study established and pilot-tested "Camp Kidpower"-a novel group-based, interactive CC training intervention-and assessed its impacts on behavioral and neurophysiological indices of CC among preschool children with elevated anxiety symptoms. METHODS Forty-four anxious children (4-6 years) were enrolled in Camp Kidpower, delivered in four sessions over 10 days. Before and after camp, children's capacity for CC was measured using well-validated, non-trained behavioral tasks and error-related negativity (ERN). Child anxiety symptoms were measured by parent report on the Spence Preschool Anxiety Scale. RESULTS Thirty-two children completed the study, as defined by completion of pre- and follow-up assessments and at least three camp sessions. From baseline to after camp, performance on behavioral tests of CC improved, ERN amplitude increased, and anxiety symptoms decreased. CONCLUSION Results provide initial evidence that play-based cognitive training targeted to behavioral and brain markers of CC reduces anxiety in preschoolers.
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Affiliation(s)
- Hans S Schroder
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Ka I Ip
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan, USA.,Department of Psychology, Yale University, New Haven, Connecticut, USA
| | - Jessica L Hruschak
- Department of Psychology, Wayne State University, Detroit, Michigan, USA
| | - Faith Horbatch
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Melissa Hall
- Department of Psychology, University of Notre Dame, Notre Dame, Indiana, USA
| | - Yanni Liu
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Kristin Mannella
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Maria Muzik
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Kate L Rosenblum
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Jason S Moser
- Department of Psychology, Michigan State University, E. Lansing, Michigan, USA
| | - Kate D Fitzgerald
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan, USA.,Department of Psychiatry, Columbia University/New York State Psychiatric Institute, New York, New York, USA
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Edwards EJ, Zec D, Campbell M, Hoorelbeke K, Koster EHW, Derakshan N, Wynne J. Cognitive control training for children with anxiety and depression: A systematic review. J Affect Disord 2022; 300:158-171. [PMID: 34983006 DOI: 10.1016/j.jad.2021.12.108] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 12/20/2021] [Accepted: 12/24/2021] [Indexed: 10/19/2022]
Abstract
Cognitive control training has gained traction as an intervention for reducing anxiety and depression vulnerability in adults. There are, however, a limited number of studies investigating such training interventions for reducing symptomology of anxiety and depression in children and adolescents. Thus, we aimed to provide a robust review and qualitative synthesis of the available research in young people. Twelve articles met the inclusion criteria, and all were randomised control trials. Evidence of the efficacy of cognitive control training for relief of symptoms are reported separately for anxiety, depression, and other related psychological factors, and on the basis of type of cognitive control training paradigm. A lack of standardisation in relation to type of intervention, duration and context, outcome measures and population was observed. Results are discussed in terms of these variations and recommendations for future research are provided.
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Affiliation(s)
| | - Dajana Zec
- School of Education, The University of Queensland, QLD 4072, Australia
| | - Marilyn Campbell
- School of Early Childhood and Inclusive Education, Queensland University of Technology, Brisbane, Australia
| | - Kristof Hoorelbeke
- Department of Experimental Clinical and Health Psychology, Ghent University, Belgium
| | - Ernst H W Koster
- Department of Experimental Clinical and Health Psychology, Ghent University, Belgium
| | - Nazanin Derakshan
- Department of Psychological Science, Birkbeck University College of London, United Kingdom
| | - Jeffrey Wynne
- School of Education, The University of Queensland, QLD 4072, Australia
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Minihan S, Samimi Z, Schweizer S. The effectiveness of affective compared to neutral working memory training in university students with test anxiety. Behav Res Ther 2021; 147:103974. [PMID: 34624665 PMCID: PMC7611905 DOI: 10.1016/j.brat.2021.103974] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 09/14/2021] [Accepted: 09/23/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Test anxiety (TA), defined as the emotional, physiological, and behavioural responses surrounding situations involving formal evaluation of performance, is a relatively common occurrence, and, when present, can be a disruptive factor in students' academic careers. Research indicates that working memory, in particular, affective working memory, is impaired in individuals with TA. The current study therefore explored whether training the application of working memory in affective contexts could reduce TA and associated cognitive and affective impairments. METHOD 60 Iranian university students (50% female; 19-22 years) with TA symptoms were randomized to receive 20 sessions of affective working memory training (aWMT), neutral working memory training (nWMT) or to a no-training control group. Prior and immediately after training, all participants completed measures of TA, working memory, cognitive control, and emotion regulation. RESULTS Compared to the control group, both the aWMT and the nWMT groups demonstrated improved cognitive and affective functioning from pre-to post-training. However, the reduction in TA symptoms and improvement in emotion regulation was greater in the aWMT group compared to the nWMT group. CONCLUSION aWMT may be an effective means of not only reducing TA, but also enhancing cognitive and affective functioning. These preliminary findings are promising given the potential for free and easy dissemination of aWMT in schools and online settings, including low- and middle-income countries.
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Affiliation(s)
- Savannah Minihan
- University of New South Wales, School of Psychology, Developmental Affective Science Lab, Australia
| | - Zobair Samimi
- International University of Chabahar, Department of Educational Science, Chabahar, Iran
| | - Susanne Schweizer
- University of New South Wales, School of Psychology, Developmental Affective Science Lab, Australia; University of Cambridge, Department of Psychology, Developmental Cognitive Neuroscience Group, UK.
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Emerging Domain-Based Treatments for Pediatric Anxiety Disorders. Biol Psychiatry 2021; 89:716-725. [PMID: 33451677 DOI: 10.1016/j.biopsych.2020.08.030] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 08/19/2020] [Accepted: 08/19/2020] [Indexed: 12/25/2022]
Abstract
Domain-specific cognitive training treatments for pediatric anxiety disorders rely on accurate and reliable identification of specific underlying deficits and biases in neurocognitive functions. Once identified, such biases can serve as specific targets for therapeutic intervention. Clinical translations typically reflect mechanized training protocols designed to rectify the identified biases. Here, we review and synthesize research on key neurocognitive processes that emerge as potential targets for specialized cognitive training interventions in pediatric anxiety disorders in the domains of attention, interpretation, error monitoring, working memory, and fear learning. For each domain, we describe the current status of target establishment (i.e., an association between pediatric anxiety and a specific neurocognitive process), and then review extant translational efforts regarding these targets and the evidence supporting their clinical utility in youths. We then localize each of the domains within the path leading to efficacious, evidence-supported treatments for pediatric anxiety, providing a roadmap for future research. The review indicates that specific cognitive targets in pediatric anxiety have been established in all the reviewed domains except for fear learning, where a clear target is yet to be elucidated. In contrast, evidence for clinical efficacy emerged only in the threat-related attention domain, with some preliminary findings in the domains of interpretation and working memory. The path to clinical translation in the domain of error monitoring is yet unclear. Implications and potential avenues for future research and translation are discussed.
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Fitzgerald KD, Schroder HS, Marsh R. Cognitive Control in Pediatric Obsessive-Compulsive and Anxiety Disorders: Brain-Behavioral Targets for Early Intervention. Biol Psychiatry 2021; 89:697-706. [PMID: 33454049 PMCID: PMC8353584 DOI: 10.1016/j.biopsych.2020.11.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 10/19/2020] [Accepted: 11/03/2020] [Indexed: 12/18/2022]
Abstract
The DSM provides distinct criteria for obsessive-compulsive disorder (OCD) and various types of anxiety disorders, but phenomenological overlap, high rates of comorbidity, and early onset suggest common underlying mechanisms. This notion is further supported by use of the same treatments-cognitive behavioral therapy and serotonin reuptake inhibitor medication-for managing both OCD and non-OCD anxiety disorders in clinical settings. While early intervention with these gold standard treatments is recommended for pediatric OCD and anxiety disorders, young patients often remain symptomatic even after treatment. To guide the development of novel, mechanistically targeted treatments to better resolve OCD and anxiety symptoms, the identification of neural circuits underlying psychological constructs with relevance across disorders has been recommended. One construct that may be relevant for understanding pediatric OCD and anxiety disorders is cognitive control, given the difficulty that young patients experience in dismissing obsessions, compulsions, and worry despite recognition that these symptoms are excessive and unreasonable. In this review, we examine findings from a growing body of literature implicating brain-behavioral markers of cognitive control in pediatric OCD and anxiety disorders, including before and after treatment. We conclude by suggesting that interventions designed to enhance the functioning of the task control circuits underlying cognitive control may facilitate brain maturation to help affected youth overcome symptoms.
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Affiliation(s)
- Kate D Fitzgerald
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan.
| | - Hans S Schroder
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan; Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, Michigan
| | - Rachel Marsh
- Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York, New York; Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
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12
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Veloso GC, Ty WEG. The Effects of Emotional Working Memory Training on Trait Anxiety. Front Psychol 2021; 11:549623. [PMID: 33519576 PMCID: PMC7838065 DOI: 10.3389/fpsyg.2020.549623] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 12/14/2020] [Indexed: 11/25/2022] Open
Abstract
Background Trait anxiety is a pervasive tendency to attend to and experience fears and worries to a disproportionate degree, across various situations. Decreased vulnerability to trait anxiety has been linked to having higher working memory capacity and better emotion regulation; however, the relationship between these factors has not been well-established. Objective This study sought to determine if participants who undergo emotional working memory training will have significantly lower trait anxiety post-training. The study also sought to determine if emotion regulation mediated the relationship between working memory training and trait anxiety. Method An experimental group comprising of 49 participants underwent 20 days of computerized emotional working memory training, which involved viewing a continuous stream of emotionally-charged content on a grid, and then remembering the location and color of items presented on the grid. The control group comprised of 51 participants. Results Participants of the experimental group had significantly lower trait anxiety compared to controls, post-training. Subsequent mediation analysis determined that working memory training capacity gains were significantly related to anxiety reduction as measured by form Y2 of the Spielberger State-Trait Anxiety Inventory (STAI-Y2). Emotion regulation, as measured by the Emotional Regulation Questionnaire (ERQ), was found not to mediate between working memory capacity gains and trait anxiety reduction. Conclusion Working memory capacity gains and reductions in levels of trait anxiety were observed following emotional working memory training. The study may therefore be useful in informing interventions targeted at improving working memory capacity, and reducing levels of trait anxiety. Moreover, it proposes for future research to further look into the mediating role of emotion regulation via the development or utilization of more comprehensive measures of emotion regulation.
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Ramdhonee-Dowlot K, Balloo K, Essau CA. Effectiveness of the Super Skills for Life programme in enhancing the emotional wellbeing of children and adolescents in residential care institutions in a low- and middle-income country: A randomised waitlist-controlled trial. J Affect Disord 2021; 278:327-338. [PMID: 32980656 DOI: 10.1016/j.jad.2020.09.053] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 06/07/2020] [Accepted: 09/11/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND The present study examined the effectiveness of a transdiagnostic prevention programme, Super Skills for Life (SSL), among children and adolescents with emotional problems in residential care institutions (RCIs) in the low- and middle-income country of Mauritius using a randomised waitlist-controlled trial (RCT). SSL is based on the principles of cognitive behavioural therapy, behavioural activation, social skills training, and uses video-feedback and cognitive preparation as part of the treatment. METHODS The RCT involved 100 children and adolescents aged 9 to 14 years, from six RCIs, randomly allocated to either an SSL intervention group (IG) or a waitlist-control (WLC) group. A set of questionnaires measuring internalising and externalising problems, emotion regulation and self-esteem, and experimental tasks measuring attentional bias and inhibitory control, were completed at baseline, post-intervention and 3-month follow-up. Participants also completed a 2-min video speech task during the first and final sessions of the SSL intervention. RESULTS Children and adolescents in the IG showed significant improvements in internalising symptoms (e.g. anxiety and depression), externalising symptoms (e.g. conduct problems and hyperactivity), and inhibitory control, and an increase in adaptive (except putting into perspective strategy) and decrease in maladaptive emotion regulation strategies, at both post-intervention and follow-up. These findings were not replicated among children in the WLC. LIMITATIONS The small sample size and lack of an active control group were the major limitations of this study. CONCLUSIONS This study provides evidence for the effectiveness of a transdiagnostic prevention programme for emotional problems in RCIs in a low- and middle-income country.
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14
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Hugh-Jones S, Beckett S, Tumelty E, Mallikarjun P. Indicated prevention interventions for anxiety in children and adolescents: a review and meta-analysis of school-based programs. Eur Child Adolesc Psychiatry 2021; 30:849-860. [PMID: 32535656 PMCID: PMC8140963 DOI: 10.1007/s00787-020-01564-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Accepted: 05/21/2020] [Indexed: 11/09/2022]
Abstract
Anxiety disorders are among the most common youth mental health disorders. Early intervention can reduce elevated anxiety symptoms. School-based interventions exist but it is unclear how effective targeted approaches are for reducing symptoms of anxiety. This review and meta-analysis aimed to determine the effectiveness of school-based indicated interventions for symptomatic children and adolescents. The study was registered with PROSPERO [CRD42018087628]. We searched MEDLINE, EMBASE, PsycINFO, and the Cochrane Library for randomised-controlled trials comparing indicated programs for child and adolescent (5-18 years) anxiety to active or inactive control groups. Data were extracted from papers up to December 2019. The primary outcome was efficacy (mean change in anxiety symptom scores). Sub-group and sensitivity analyses explored intervention intensity and control type. We identified 20 studies with 2076 participants. Eighteen studies were suitable for meta-analysis. A small positive effect was found for indicated programs compared to controls on self-reported anxiety symptoms at post-test (g = - 0.28, CI = - 0.50, - 0.05, k = 18). This benefit was maintained at 6 (g = - 0.35, CI = - 0.58, - 0.13, k = 9) and 12 months (g = - 0.24, CI = - 0.48, 0.00, k = 4). Based on two studies, > 12 month effects were very small (g = - 0.01, CI = - 0.38, 0.36). No differences were found based on intervention intensity or control type. Risk of bias and variability between studies was high (I2 = 78%). Findings show that school-based indicated programs for child and adolescent anxiety can produce small beneficial effects, enduring for up to 12 months. Future studies should include long-term diagnostic assessments.
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Affiliation(s)
| | - Sophie Beckett
- grid.6572.60000 0004 1936 7486The Barberry National Centre for Mental Health, University of Birmingham, Birmingham, B15 2FG UK
| | - Ella Tumelty
- grid.6572.60000 0004 1936 7486The Barberry National Centre for Mental Health, University of Birmingham, Birmingham, B15 2FG UK
| | - Pavan Mallikarjun
- grid.6572.60000 0004 1936 7486The Barberry National Centre for Mental Health, University of Birmingham, Birmingham, B15 2FG UK
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15
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Mewton L, Hodge A, Gates N, Visontay R, Lees B, Teesson M. A randomised double-blind trial of cognitive training for the prevention of psychopathology in at-risk youth. Behav Res Ther 2020; 132:103672. [PMID: 32629291 DOI: 10.1016/j.brat.2020.103672] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 05/21/2020] [Accepted: 06/04/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the effectiveness of online cognitive training as a means of reducing psychopathology in at-risk youth. METHODS In a double-blind randomised controlled trial, 228 youths (mean age = 18.6, 74.6% female) were randomly allocated to either an intervention group (n = 114; online cognitive training focused on executive functioning) and a control group (n = 114; online cognitive training focused on other cognitive abilities). Participants were assessed online at baseline, post-training, 3-, 6- and 12-month follow-up. The primary outcome of the study was overall psychopathology as measured by the Strengths and Difficulties Questionnaire. Secondary outcomes were executive functioning ability (assessed using the n-back, trail-making and Stroop tasks), day-to-day functioning and risky drinking. RESULTS Mixed model intention-to-treat analyses indicated that psychopathology increased and day-to-day functioning decreased, regardless of intervention group. Those in the intervention group improved more than those in the control group in terms of the n-back task, but this was not statistically significant after adjusting for multiple comparisons. There were no statistically significant effects on risky drinking, or the trail-making and Stroop tasks. CONCLUSION This study failed to provide evidence for the efficacy of cognitive training as a stand-alone intervention for psychopathology.
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Affiliation(s)
- Louise Mewton
- Centre for Healthy Brain Ageing, University of New South Wales, Sydney, Australia.
| | - Antoinette Hodge
- Child Development Unit, The Children's Hospital, Westmead, Australia
| | - Nicola Gates
- Centre for Healthy Brain Ageing, University of New South Wales, Sydney, Australia
| | - Rachel Visontay
- The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Sydney, Australia
| | - Briana Lees
- The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Sydney, Australia
| | - Maree Teesson
- The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Sydney, Australia
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16
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Mohlman J. Neurocognitive predictors of long-term outcome in CBT for late life generalized anxiety disorder. J Anxiety Disord 2020; 74:102246. [PMID: 32603993 DOI: 10.1016/j.janxdis.2020.102246] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 04/16/2020] [Accepted: 05/22/2020] [Indexed: 01/08/2023]
Abstract
Generalized anxiety disorder (GAD) is currently recognized as one of the most common and impairing psychiatric conditions in adults age 65 and over. Although clinical trials have indicated that cognitive behavior therapy (CBT) is efficacious, it has not shown consistent superiority over other types of psychosocial interventions. This study sought to identify baseline neurocognitive predictors of posttreatment and distal follow-up outcome of CBT for late life GAD, which could be used to estimate response and optimize the intervention. First, results indicated that CBT was effective in reducing worry and other symptoms immediately following and 18 months after the last full session of treatment. Regression models of baseline predictors included pretreatment worry scores, the number of comorbid conditions, hypertension, and scores on a working memory task or hippocampal volumes as predictors of endpoint PSWQ scores. Results replicated known baseline predictors of outcome at both assessment points, and identified one new predictor of distal outcome. Clinicians may benefit from including working memory tasks as assessment and augmentation tools in treating older GAD patients.
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Affiliation(s)
- Jan Mohlman
- William Paterson University, 300 Pompton Rd., Science Hall 250, Wayne, NJ, 07470, United States.
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17
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Crochiere RJ, Hughes Lansing A, Carracher A, Vaid E, Stanger C. Attentional bias to diabetes cues mediates disease management improvements in a pilot randomized controlled trial for adolescents with type 1 diabetes. J Health Psychol 2020; 26:2699-2710. [PMID: 32508201 DOI: 10.1177/1359105320926535] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
For type 1 diabetes management, the role of attentional bias remains unclear. This secondary analysis examined type 1 diabetes attentional bias and adolescent type 1 diabetes management prior to and during a cognitive and behavioral intervention. Youth with type 1 diabetes and above target glycemic control were assigned to intervention or usual care control. Participants completed baseline and follow-up type 1 diabetes Stroop tasks, HbA1c tests, and blood glucose meter downloads. Intervention was associated with greater reductions in type 1 diabetes attentional bias than control, and these reductions partially mediated the effect of treatment on diabetes management behaviors. Type 1 diabetes attentional bias is a potential target to improve type 1 diabetes management.
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18
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Grillon C, Lago T, Stahl S, Beale A, Balderston N, Ernst M. Better cognitive efficiency is associated with increased experimental anxiety. Psychophysiology 2020; 57:e13559. [PMID: 32180239 DOI: 10.1111/psyp.13559] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 02/04/2020] [Accepted: 02/10/2020] [Indexed: 12/22/2022]
Abstract
There is increased interest in the development of cognitive training targeting working memory (WM) to alleviate anxiety symptoms, but the effectiveness of such an approach is unclear. Improved understanding of the effect of cognitive training on anxiety may facilitate the development of more effective cognitive training treatment for anxiety disorders. This study uses an experimental approach to examine the interplay of WM and anxiety following WM training. Previous studies show that increased demand on WM reduces concurrent anxiety evoked by threat of shock (induced anxiety). However, improving WM pharmacologically or via exercise prevents this anxiolytic effect. Conceivably, improving WM frees up cognitive resources to process threat information, thereby increasing anxiety. The present study tested the hypothesis that practicing a high load WM (i.e., increased demand) task would improve WM, and thus, free cognitive resources to process threat of shock, resulting in more anxiety (i.e., greater startle) during a subsequent WM task. Participants were randomly assigned to two training groups. The active-training group (N = 20) was trained on a 1- (low load) & 3-back (high load) WM task, whereas the control-training group (N = 20) performed a 0-back WM task. The experimental phase, similar in both groups, consisted of a 1- & 3-back WM task performed during both threat of shock and safety. As predicted, active training improved WM accuracy and increased anxiety during the experimental 3-back WM task. Therefore, improving WM efficiency can increase anxiety, possibly by freeing WM resources to process threat information.
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Affiliation(s)
- Christian Grillon
- Section on Neurobiology of Fear and Anxiety, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, USA
| | - Tiffany Lago
- Department of Psychiatry, VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Sara Stahl
- Section on Neurobiology of Fear and Anxiety, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, USA
| | - Alexis Beale
- Section on Neurobiology of Fear and Anxiety, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, USA
| | - Nicholas Balderston
- Center for Neuromodulation in Depression and Stress, Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Monique Ernst
- Section on Neurobiology of Fear and Anxiety, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, USA
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19
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du Toit SA, Kade SA, Danielson CT, Schweizer S, Han J, Torok M, Wong QJJ. The effect of emotional working memory training on emotional and cognitive outcomes in individuals with elevated social anxiety. J Affect Disord 2020; 261:76-83. [PMID: 31605835 DOI: 10.1016/j.jad.2019.09.085] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 08/18/2019] [Accepted: 09/30/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Although cognitive-behavioural therapy is the gold standard psychological treatment for individuals with social anxiety disorder (SAD), it does not benefit everyone. Emotional working memory training (eWMT) is a promising alternative intervention. This study examined the effects of eWMT versus control training (CT) on emotional and cognitive outcomes in individuals with elevated social anxiety. METHODS Forty participants with elevated social anxiety were randomly allocated to eWMT (n = 21) or CT (n = 19), each consisting of six training sessions. At pre- and post-training, participants completed: a working memory task, an impromptu speech, and self-reported measures of emotional and cognitive outcomes (anticipatory processing, peak anxiety and attentional focus during the speech, post-event processing). RESULTS Participants in both training conditions exhibited performance improvements on their respective training tasks. As expected, there was a Time x Condition interaction for peak anxiety, reflecting a decrease in peak anxiety for the eWMT condition but not the CT condition. Exploratory analyses also indicated a Time x Condition interaction for an aspect of post-event processing, reflecting a decrease in thinking about the past for the eWMT condition but not the CT condition. LIMITATIONS Although the level of social anxiety of the current sample is comparable to that of samples of individuals diagnosed with SAD in the literature, participant diagnoses were not assessed in this study. CONCLUSIONS The findings suggest that eWMT has potential as an alternative intervention for individuals with elevated social anxiety.
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Affiliation(s)
- Simone A du Toit
- School of Social Sciences and Psychology, Western Sydney University, Sydney, New South Wales, Australia
| | - Saif A Kade
- School of Social Sciences and Psychology, Western Sydney University, Sydney, New South Wales, Australia
| | - Craig T Danielson
- School of Social Sciences and Psychology, Western Sydney University, Sydney, New South Wales, Australia
| | - Susanne Schweizer
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Jin Han
- Black Dog Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Michelle Torok
- Black Dog Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Quincy J J Wong
- School of Social Sciences and Psychology, Western Sydney University, Sydney, New South Wales, Australia.
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20
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Zhao X, Dang C, Maes JHR. Effects of working memory training on EEG, cognitive performance, and self-report indices potentially relevant for social anxiety. Biol Psychol 2020; 150:107840. [PMID: 31904404 DOI: 10.1016/j.biopsycho.2019.107840] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 12/03/2019] [Accepted: 12/30/2019] [Indexed: 10/25/2022]
Abstract
Social anxiety (SA) is quite common and associated with multiple comorbidities. Here, we examined the effects of working memory (WM) training on various indices potentially related to SA. Pre-selected university students with elevated self-reported SA symptoms were assigned to a WM training (n = 21) or an active control treatment condition (n = 21). Pre- and post-treatment assessments were made using questionnaires related to (social) anxiety and depression, and tasks measuring WM, interference control, and attentional biases towards, and event-related potentials (ERPs) elicited by, angry faces. The training enhanced WM transfer task performance, reduced SA symptoms, and changed the amplitude of the P1, N170, P2, and N2 ERP components. However, the latter changes did not mediate the effect of WM training on SA symptoms. These data provide preliminary evidence of the usefulness of WM trainings to reduce potential indices of SA, but further research is necessary to unravel the causal relation among these indices.
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Affiliation(s)
- Xin Zhao
- Behavior Rehabilitation Training Research Institution, School of Psychology, Northwest Normal University, 967 East Anning Road, Lanzhou, 730070, China
| | - Chen Dang
- Behavior Rehabilitation Training Research Institution, School of Psychology, Northwest Normal University, 967 East Anning Road, Lanzhou, 730070, China
| | - Joseph H R Maes
- Donders Institute for Brain, Cognition and Behaviour, Centre for Cognition, Radboud University, PO. Box 9104, Nijmegen, 6500 HE, The Netherlands.
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21
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Working memory moderates the association between early institutional care and separation anxiety symptoms in late childhood and adolescence. Dev Psychopathol 2019; 31:989-997. [PMID: 31038094 DOI: 10.1017/s0954579419000452] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Adverse caregiving, for example, previous institutionalization (PI), is often associated with emotion dysregulation that increases anxiety risk. However, the concept of developmental multifinality predicts heterogeneity in anxiety outcomes. Despite this well-known heterogeneity, more work is needed to identify sources of this heterogeneity and how these sources interact with environmental risk to influence mental health. Here, working memory (WM) was examined during late childhood/adolescence as an intra-individual factor to mitigate the risk for separation anxiety, which is particularly susceptible to caregiving adversities. A modified "object-in-place" task was administered to 110 youths (10-17 years old), with or without a history of PI. The PI youths had elevated separation anxiety scores, which were anticorrelated with morning cortisol levels, yet there were no group differences in WM. PI youths showed significant heterogeneity in separation anxiety symptoms and morning cortisol levels, and WM moderated the link between caregiving and separation anxiety and mediated the association between separation anxiety and morning cortisol in PI youth. Findings suggest that (a) institutional care exerts divergent developmental consequences on separation anxiety versus WM, (b) WM interacts with adversity-related emotion dysregulation, and (c) WM may be a therapeutic target for separation anxiety following early caregiving adversity.
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22
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Beloe P, Derakshan N. Adaptive working memory training can reduce anxiety and depression vulnerability in adolescents. Dev Sci 2019; 23:e12831. [DOI: 10.1111/desc.12831] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Revised: 01/17/2019] [Accepted: 03/18/2019] [Indexed: 12/29/2022]
Affiliation(s)
- Patricia Beloe
- Department of Psychological Sciences Birkbeck University of London London UK
| | - Nazanin Derakshan
- Department of Psychological Sciences Birkbeck University of London London UK
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23
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Hur J, Stockbridge MD, Fox AS, Shackman AJ. Dispositional negativity, cognition, and anxiety disorders: An integrative translational neuroscience framework. PROGRESS IN BRAIN RESEARCH 2019; 247:375-436. [PMID: 31196442 PMCID: PMC6578598 DOI: 10.1016/bs.pbr.2019.03.012] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
When extreme, anxiety can become debilitating. Anxiety disorders, which often first emerge early in development, are common and challenging to treat, yet the underlying mechanisms have only recently begun to come into focus. Here, we review new insights into the nature and biological bases of dispositional negativity, a fundamental dimension of childhood temperament and adult personality and a prominent risk factor for the development of pediatric and adult anxiety disorders. Converging lines of epidemiological, neurobiological, and mechanistic evidence suggest that dispositional negativity increases the likelihood of psychopathology via specific neurocognitive mechanisms, including attentional biases to threat and deficits in executive control. Collectively, these observations provide an integrative translational framework for understanding the development and maintenance of anxiety disorders in adults and youth and set the stage for developing improved intervention strategies.
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Affiliation(s)
- Juyoen Hur
- Department of Psychology, University of Maryland, College Park, MD, United States.
| | | | - Andrew S Fox
- Department of Psychology, University of California, Davis, CA, United States; California National Primate Research Center, University of California, Davis, CA, United States
| | - Alexander J Shackman
- Department of Psychology, University of Maryland, College Park, MD, United States; Neuroscience and Cognitive Science Program, University of Maryland, College Park, MD, United States; Maryland Neuroimaging Center, University of Maryland, College Park, MD, United States.
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24
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Opris AM, Cheie L, Trifan CM, Visu-Petra L. Internalising symptoms and verbal working memory in school-age children: A processing efficiency analysis. INTERNATIONAL JOURNAL OF PSYCHOLOGY 2018; 54:828-838. [PMID: 30289169 DOI: 10.1002/ijop.12537] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 08/16/2018] [Indexed: 12/26/2022]
Abstract
The current study investigated differential contributions of internalising symptoms (state anxiety, trait anxiety, depression) to school-age children's verbal short-term (STM) and working memory (WM) span accuracy and efficiency (microanalysis of response times). Children's (N = 125, Mage = 11.44 years) STM/WM was assessed with simple/complex span tasks. Our analyses revealed that: (a) children with high levels of state anxiety displayed reduced simple span accuracy (on Word span) and poorer efficiency on both simple (preparatory intervals, interword pauses) and complex span (preparatory intervals) response time segments; (b) trait anxiety was a negative predictor of children's complex span accuracy, as well as their efficiency on both simple (word durations) and complex span (interword pauses) response time measures; (3) depressive symptoms predicted longer simple span interword pauses. Findings indicate that while all internalising symptoms were predictive of children's poorer memory search efficiency, especially during the "silent", executive intervals (interword pauses), anxiety symptoms were specifically predictive of children's impaired span accuracy and other efficiency indicators (preparatory intervals, word durations). The study highlights the differential contributions of state, trait anxiety, and depressive symptoms to STM/WM in children, emphasising the need to measure both accuracy and efficiency to assess the role that such symptoms play in children's performance.
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Affiliation(s)
- Alexandra M Opris
- Developmental Psychology Lab, Department of Psychology, Babeş-Bolyai University, Cluj-Napoca, Romania
| | - Lavinia Cheie
- Developmental Psychology Lab, Department of Psychology, Babeş-Bolyai University, Cluj-Napoca, Romania
| | - Cristina M Trifan
- Developmental Psychology Lab, Department of Psychology, Babeş-Bolyai University, Cluj-Napoca, Romania
| | - Laura Visu-Petra
- Developmental Psychology Lab, Department of Psychology, Babeş-Bolyai University, Cluj-Napoca, Romania
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25
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Kavanaugh BC, Tuncer OF, Wexler BE. Measuring and Improving Executive Functioning in the Classroom. JOURNAL OF COGNITIVE ENHANCEMENT 2018. [DOI: 10.1007/s41465-018-0095-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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26
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Boendermaker WJ, Gladwin TE, Peeters M, Prins PJM, Wiers RW. Training Working Memory in Adolescents Using Serious Game Elements: Pilot Randomized Controlled Trial. JMIR Serious Games 2018; 6:e10. [PMID: 29792294 PMCID: PMC5990857 DOI: 10.2196/games.8364] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 01/17/2018] [Accepted: 02/24/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Working memory capacity has been found to be impaired in adolescents with various psychological problems, such as addictive behaviors. Training of working memory capacity can lead to significant behavioral improvements, but it is usually long and tedious, taxing participants' motivation to train. OBJECTIVE This study aimed to evaluate whether adding game elements to the training could help improve adolescents' motivation to train while improving cognition. METHODS A total of 84 high school students were allocated to a working memory capacity training, a gamified working memory capacity training, or a placebo condition. Working memory capacity, motivation to train, and drinking habits were assessed before and after training. RESULTS Self-reported evaluations did not show a self-reported preference for the game, but participants in the gamified working memory capacity training condition did train significantly longer. The game successfully increased motivation to train, but this effect faded over time. Working memory capacity increased equally in all conditions but did not lead to significantly lower drinking, which may be due to low drinking levels at baseline. CONCLUSIONS We recommend that future studies attempt to prolong this motivational effect, as it appeared to fade over time.
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Affiliation(s)
- Wouter J Boendermaker
- Addiction Development and Psychopathology (ADAPT)-Lab, Department of Psychology, University of Amsterdam, Amsterdam, Netherlands.,Department of Interdisciplinary Social Science, Utrecht University, Utrecht, Netherlands
| | - Thomas E Gladwin
- Department of Psychology & Counselling, University of Chichester, Chichester, United Kingdom
| | - Margot Peeters
- Addiction Development and Psychopathology (ADAPT)-Lab, Department of Psychology, University of Amsterdam, Amsterdam, Netherlands.,Department of Interdisciplinary Social Science, Utrecht University, Utrecht, Netherlands
| | - Pier J M Prins
- Addiction Development and Psychopathology (ADAPT)-Lab, Department of Psychology, University of Amsterdam, Amsterdam, Netherlands
| | - Reinout W Wiers
- Addiction Development and Psychopathology (ADAPT)-Lab, Department of Psychology, University of Amsterdam, Amsterdam, Netherlands
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27
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Luxford S, Hadwin JA, Kovshoff H. Evaluating the Effectiveness of a School-Based Cognitive Behavioural Therapy Intervention for Anxiety in Adolescents Diagnosed with Autism Spectrum Disorder. J Autism Dev Disord 2018; 47:3896-3908. [PMID: 27440250 PMCID: PMC5676836 DOI: 10.1007/s10803-016-2857-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
This study evaluated the effectiveness of a school-based Cognitive Behavioural Therapy (CBT) on symptoms of anxiety, social worry and social responsiveness, and indices of attentional control and attentional biases to threat in adolescents diagnosed with Autism Spectrum Disorder. Thirty-five young people (11–14 years; IQ > 70) with ASD and elevated teacher or parent reported anxiety were randomly assigned to 6 sessions of the Exploring Feelings CBT intervention (Attwood in Exploring feelings (anxiety). Future Horizons, Arlington, 2004) (n = 18) or a wait-list control group (n = 17). The intervention (compared to the wait-list control) group showed positive change for parent, teacher and self-reported anxiety symptoms, and more marginal effects of increased teacher-reported social responsiveness. The discussion highlights the potential value and limitations of school-based CBT for young people with ASD.
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Affiliation(s)
- Sarah Luxford
- Developmental Brain-Behaviour Laboratory, Department of Psychology, University of Southampton, Highfield, Southampton, S017 1BJ, UK.,Oxfordshire Educational Psychology Service, Samuelson House, Tramway Road, Banbury, Oxford, OX16 5AU, UK
| | - Julie A Hadwin
- Developmental Brain-Behaviour Laboratory, Department of Psychology, University of Southampton, Highfield, Southampton, S017 1BJ, UK
| | - Hanna Kovshoff
- Developmental Brain-Behaviour Laboratory, Department of Psychology, University of Southampton, Highfield, Southampton, S017 1BJ, UK.
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28
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Rossignoli-Palomeque T, Perez-Hernandez E, González-Marqués J. Brain Training in Children and Adolescents: Is It Scientifically Valid? Front Psychol 2018; 9:565. [PMID: 29780336 PMCID: PMC5946581 DOI: 10.3389/fpsyg.2018.00565] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 04/04/2018] [Indexed: 01/14/2023] Open
Abstract
Background: Brain training products are becoming increasingly popular for children and adolescents. Despite the marketing aimed at their use in the general population, these products may provide more benefits for specific neurologically impaired populations. A review of Brain Training (BT) products analyzing their efficacy while considering the methodological limitations of supporting research is required for practical applications. Method: searches were made of the PubMed database (until March 2017) for studies including: (1) empirical data on the use of brain training for children or adolescents and any effects on near transfer (NT) and/or far transfer (FT) and/or neuroplasticity, (2) use of brain training for cognitive training purposes, (3) commercially available training applications, (4) computer-based programs for children developed since the 1990s, and (5) relevant printed and peer-reviewed material. Results: Database searches yielded a total of 16,402 references, of which 70 met the inclusion criteria for the review. We classified programs in terms of neuroplasticity, near and far transfer, and long-term effects and their applied methodology. Regarding efficacy, only 10 studies (14.2%) have been found that support neuroplasticity, and the majority of brain training platforms claimed to be based on such concepts without providing any supporting scientific data. Thirty-six studies (51.4%) have shown far transfer (7 of them are non-independent) and only 11 (15.7%) maintained far transfer at follow-up. Considering the methodology, 40 studies (68.2%) were not randomized and controlled; for those randomized, only 9 studies (12.9%) were double-blind, and only 13 studies (18.6%) included active controls in their trials. Conclusion: Overall, few independent studies have found far transfer and long-term effects. The majority of independent results found only near transfer. There is a lack of double-blind randomized trials which include an active control group as well as a passive control to properly control for contaminant variables. Based on our results, Brain Training Programs as commercially available products are not as effective as first expected or as they promise in their advertisements.
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Affiliation(s)
- Teresa Rossignoli-Palomeque
- Department of Basic Psychology II, Complutense University of Madrid, Madrid, Spain.,Department of Psychology and Education, Centro Universitario Cardenal Cisneros, Alcalá de Henares, Madrid, Spain
| | - Elena Perez-Hernandez
- Department of Development and Educational Psychology, Autonomous University of Madrid, Madrid, Spain
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29
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A randomised controlled trial investigating the benefits of adaptive working memory training for working memory capacity and attentional control in high worriers. Behav Res Ther 2018; 100:67-77. [DOI: 10.1016/j.brat.2017.10.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 08/29/2017] [Accepted: 10/24/2017] [Indexed: 01/04/2023]
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Cognitive mechanisms for worry in early adolescence: Re-examining the role of high verbal intelligence. PERSONALITY AND INDIVIDUAL DIFFERENCES 2018. [DOI: 10.1016/j.paid.2017.08.044] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Justicia-Galiano MJ, Martín-Puga ME, Linares R, Pelegrina S. Math anxiety and math performance in children: The mediating roles of working memory and math self-concept. BRITISH JOURNAL OF EDUCATIONAL PSYCHOLOGY 2017; 87:573-589. [DOI: 10.1111/bjep.12165] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Revised: 05/02/2017] [Indexed: 11/28/2022]
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Gold AK, Montana RE, Sylvia LG, Nierenberg AA, Deckersbach T. Cognitive Remediation and Bias Modification Strategies in Mood and Anxiety Disorders. Curr Behav Neurosci Rep 2016; 3:340-349. [PMID: 27917364 PMCID: PMC5127202 DOI: 10.1007/s40473-016-0090-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
PURPOSE OF REVIEW Cognitive impairments and biases, which are prevalent in patients with mood and anxiety disorders, can affect quality of life and functioning. Traditional treatments are only insufficiently addressing these impairments and biases. We review the cognitive impairments and biases present in these disorders as well as treatments targeting these domains. RECENT FINDINGS Interventions aimed at improving cognitive impairments and biases may help improve cognitive deficits and overall functioning in patients with mood and anxiety disorders. Direct comparisons of treatments for cognitive impairments or biases versus more traditional psychosocial interventions have produced diverse results. SUMMARY Overall, treatments for cognitive impairments and cognitive biases warrant additional study in clinical trials. Future research should explore cognitive remediation and cognitive bias modification adjunctive to psychosocial treatments to optimize patient outcomes in mood and anxiety disorders.
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Affiliation(s)
- Alexandra K. Gold
- Department of Psychiatry, Massachusetts General Hospital, 50 Staniford Street, Suite 580 Boston, MA 02114
| | - Rebecca E. Montana
- Department of Psychiatry, Massachusetts General Hospital, 50 Staniford Street, Suite 580 Boston, MA 02114
| | - Louisa G. Sylvia
- Department of Psychiatry, Massachusetts General Hospital, 50 Staniford Street, Suite 580 Boston, MA 02114
- Harvard Medical School, 25 Shattuck Street, Boston, MA 02115
| | - Andrew A. Nierenberg
- Department of Psychiatry, Massachusetts General Hospital, 50 Staniford Street, Suite 580 Boston, MA 02114
- Harvard Medical School, 25 Shattuck Street, Boston, MA 02115
| | - Thilo Deckersbach
- Department of Psychiatry, Massachusetts General Hospital, 50 Staniford Street, Suite 580 Boston, MA 02114
- Harvard Medical School, 25 Shattuck Street, Boston, MA 02115
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