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Rooney T, Sharpe L, Todd J, Michalski SC, Van Ryckeghem D, Crombez G, Colagiuri B. Beyond the modified dot-probe task: A meta-analysis of the efficacy of alternate attention bias modification tasks across domains. Clin Psychol Rev 2024; 110:102436. [PMID: 38696911 DOI: 10.1016/j.cpr.2024.102436] [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] [Received: 07/19/2023] [Revised: 02/25/2024] [Accepted: 04/25/2024] [Indexed: 05/04/2024]
Abstract
Attention biases towards disease-relevant cues have been implicated in numerous disorders and health conditions, such as anxiety, cancer, drug-use disorders, and chronic pain. Attention bias modification (ABM) has shown that changing attention biases can change related emotional processes. ABM most commonly uses a modified dot-probe task, which has received increasing criticism regarding its reliability and inconsistent findings. The purpose of the present review was thus to systematically review and meta-analyse alternative tasks used in ABM research. We sought to examine whether alternative tasks significantly changed attention biases and emotional outcomes, and critically examined whether relevant sample, task and intervention characteristics moderated each of these effect sizes. Seventy-four (completer n = 15,294) study level comparisons were included in the meta-analysis. Overall, alternative ABM designs had a medium effect on changing biases (g = 0.488), and a small, but significant effect on improving clinical outcomes (g = 0.117). We found this effect to be significantly larger for studies which successfully changed biases compared to those that did not. Across all tasks, it appeared that targeting engagement biases results in the largest change to attention biases. Importantly, we found tasks incorporating gaze-contingency - encouraging engagement with non-biased stimuli - show the most promise for improving emotional outcomes.
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Affiliation(s)
- Tessa Rooney
- School of Psychology, Faculty of Science, The University of Sydney, Australia.
| | - Louise Sharpe
- School of Psychology, Faculty of Science, The University of Sydney, Australia
| | - Jemma Todd
- School of Psychology, Faculty of Science, The University of Sydney, Australia
| | - Stefan Carlo Michalski
- Department of Developmental Disability Neuropsychiatry, Faculty of Medicine and Health, The University of New South Wales, Australia
| | - Dimitri Van Ryckeghem
- Department of Experimental-Clinical and Health Psychology, Ghent University, Belgium; Department of Clinical Psychological Science, Maastricht University, Maastricht, Netherlands; Department of Behavioural and Cognitive Sciences, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Geert Crombez
- Department of Experimental-Clinical and Health Psychology, Ghent University, Belgium
| | - Ben Colagiuri
- School of Psychology, Faculty of Science, The University of Sydney, Australia
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Vrijsen JN, Grafton B, Koster EHW, Lau J, Wittekind CE, Bar-Haim Y, Becker ES, Brotman MA, Joormann J, Lazarov A, MacLeod C, Manning V, Pettit JW, Rinck M, Salemink E, Woud ML, Hallion LS, Wiers RW. Towards implementation of cognitive bias modification in mental health care: State of the science, best practices, and ways forward. Behav Res Ther 2024; 179:104557. [PMID: 38797055 DOI: 10.1016/j.brat.2024.104557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 04/17/2024] [Accepted: 05/06/2024] [Indexed: 05/29/2024]
Abstract
Cognitive bias modification (CBM) has evolved from an experimental method testing cognitive mechanisms of psychopathology to a promising tool for accessible digital mental health care. While we are still discovering the conditions under which clinically relevant effects occur, the dire need for accessible, effective, and low-cost mental health tools underscores the need for implementation where such tools are available. Providing our expert opinion as Association for Cognitive Bias Modification members, we first discuss the readiness of different CBM approaches for clinical implementation, then discuss key considerations with regard to implementation. Evidence is robust for approach bias modification as an adjunctive intervention for alcohol use disorders and interpretation bias modification as a stand-alone intervention for anxiety disorders. Theoretical predictions regarding the mechanisms by which bias and symptom change occur await further testing. We propose that CBM interventions with demonstrated efficacy should be provided to the targeted populations. To facilitate this, we set a research agenda based on implementation frameworks, which includes feasibility and acceptability testing, co-creation with end-users, and collaboration with industry partners.
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Affiliation(s)
- Janna N Vrijsen
- Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands; Depression Expertise Center, Pro Persona Mental Health Care, Nijmegen, the Netherlands.
| | - Ben Grafton
- Centre for the Advancement of Research on Emotion, School of Psychological Science, University of Western Australia, Australia
| | - Ernst H W Koster
- Department of Experimental-Clinical and Health Psychology, Ghent University, Belgium
| | - Jennifer Lau
- Youth Resilience Unit, Queen Mary University of London, UK
| | - Charlotte E Wittekind
- Department of Psychology, Clinical Psychology and Psychotherapy, LMU Munich, Germany
| | - Yair Bar-Haim
- School of Psychological Sciences, Tel-Aviv University, Tel Aviv-Yafo, Israel; School of Neuroscience, Tel-Aviv University, Tel Aviv-Yafo, Israel
| | - Eni S Becker
- Behavioural Science Institute, Radboud University, Nijmegen, the Netherlands
| | - Melissa A Brotman
- Emotion and Development Branch, National Institute of Mental Health Intramural Research Program, National Institutes of Health, Bethesda, MD, USA
| | - Jutta Joormann
- Department of Psychology, Yale University, New Haven, Conneticut, USA
| | - Amit Lazarov
- School of Neuroscience, Tel-Aviv University, Tel Aviv-Yafo, Israel
| | - Colin MacLeod
- Centre for the Advancement of Research on Emotion, School of Psychological Science, University of Western Australia, Australia
| | - Victoria Manning
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia; Turning Point, Eastern Health, Melbourne, Victoria, Australia
| | - Jeremy W Pettit
- Department of Psychology and Center for Children and Families, Florida International University, Miami, FL, USA
| | - Mike Rinck
- Emotion and Development Branch, National Institute of Mental Health Intramural Research Program, National Institutes of Health, Bethesda, MD, USA
| | - Elske Salemink
- Department of Clinical Psychology, Faculty of Social and Behavioural Sciences, Utrecht University, the Netherlands
| | - Marcella L Woud
- Clinical Psychology and Experimental Psychopathology, Georg-Elias-Mueller-Institute of Psychology, University of Göttingen, Göttingen, Germany; Mental Health Research and Treatment Center, Ruhr-University Bochum, Bochum, Germany
| | | | - Reinout W Wiers
- Addiction Development and Psychopathology (ADAPT) Lab, Department of Psychology, and Centre for Urban Mental Health, University of Amsterdam, Amsterdam, the Netherlands
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Haller SP, Linke JO, Grassie HL, Jones EL, Pagliaccio D, Harrewijn A, White LK, Naim R, Abend R, Mallidi A, Berman E, Lewis KM, Kircanski K, Fox NA, Silverman WK, Kalin NH, Bar-Haim Y, Brotman MA. Normalization of Fronto-Parietal Activation by Cognitive-Behavioral Therapy in Unmedicated Pediatric Patients With Anxiety Disorders. Am J Psychiatry 2024; 181:201-212. [PMID: 38263879 DOI: 10.1176/appi.ajp.20220449] [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] [Indexed: 01/25/2024]
Abstract
OBJECTIVE Anxiety disorders are prevalent among youths and are often highly impairing. Cognitive-behavioral therapy (CBT) is an effective first-line treatment. The authors investigated the brain mechanisms associated with symptom change following CBT. METHODS Unmedicated youths diagnosed with an anxiety disorder underwent 12 weeks of CBT as part of two randomized clinical trials testing the efficacy of adjunctive computerized cognitive training. Across both trials, participants completed a threat-processing task during functional MRI before and after treatment. Age-matched healthy comparison youths completed two scans over the same time span. The mean age of the samples was 13.20 years (SD=2.68); 41% were male (youths with anxiety disorders, N=69; healthy comparison youths, N=62). An additional sample including youths at temperamental risk for anxiety (N=87; mean age, 10.51 years [SD=0.43]; 41% male) was utilized to test the stability of anxiety-related neural differences in the absence of treatment. Whole-brain regional activation changes (thresholded at p<0.001) were examined using task-based blood-oxygen-level-dependent response. RESULTS Before treatment, patients with an anxiety disorder exhibited altered activation in fronto-parietal attention networks and limbic regions relative to healthy comparison children across all task conditions. Fronto-parietal hyperactivation normalized over the course of treatment, whereas limbic responses remained elevated after treatment. In the at-risk sample, overlapping clusters emerged between regions showing stable associations with anxiety over time and regions showing treatment-related changes. CONCLUSIONS Activation in fronto-parietal networks may normalize after CBT in unmedicated pediatric anxiety patients. Limbic regions may be less amenable to acute CBT effects. Findings from the at-risk sample suggest that treatment-related changes may not be attributed solely to the passage of time.
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Affiliation(s)
- Simone P Haller
- Emotion and Development Branch, NIMH, Bethesda, Md. (Haller, Grassie, Jones, Mallidi, Berman, Lewis, Kircanski, Brotman); Department of Psychology, University of Freiburg, Freiburg, Germany (Linke); Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York (Pagliaccio); Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, the Netherlands (Harrewijn); Department of Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia (White); Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel (Abend); Department of Human Development and Quantitative Methodology, University of Maryland, College Park (Fox); Yale Child Study Center, Yale School of Medicine, New Haven, Conn. (Silverman); Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison (Kalin); School of Psychological Sciences (Bar-Heim, Naim) and Sagol School of Neuroscience (Bar-Haim), Tel Aviv University, Tel Aviv, Israel
| | - Julia O Linke
- Emotion and Development Branch, NIMH, Bethesda, Md. (Haller, Grassie, Jones, Mallidi, Berman, Lewis, Kircanski, Brotman); Department of Psychology, University of Freiburg, Freiburg, Germany (Linke); Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York (Pagliaccio); Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, the Netherlands (Harrewijn); Department of Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia (White); Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel (Abend); Department of Human Development and Quantitative Methodology, University of Maryland, College Park (Fox); Yale Child Study Center, Yale School of Medicine, New Haven, Conn. (Silverman); Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison (Kalin); School of Psychological Sciences (Bar-Heim, Naim) and Sagol School of Neuroscience (Bar-Haim), Tel Aviv University, Tel Aviv, Israel
| | - Hannah L Grassie
- Emotion and Development Branch, NIMH, Bethesda, Md. (Haller, Grassie, Jones, Mallidi, Berman, Lewis, Kircanski, Brotman); Department of Psychology, University of Freiburg, Freiburg, Germany (Linke); Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York (Pagliaccio); Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, the Netherlands (Harrewijn); Department of Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia (White); Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel (Abend); Department of Human Development and Quantitative Methodology, University of Maryland, College Park (Fox); Yale Child Study Center, Yale School of Medicine, New Haven, Conn. (Silverman); Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison (Kalin); School of Psychological Sciences (Bar-Heim, Naim) and Sagol School of Neuroscience (Bar-Haim), Tel Aviv University, Tel Aviv, Israel
| | - Emily L Jones
- Emotion and Development Branch, NIMH, Bethesda, Md. (Haller, Grassie, Jones, Mallidi, Berman, Lewis, Kircanski, Brotman); Department of Psychology, University of Freiburg, Freiburg, Germany (Linke); Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York (Pagliaccio); Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, the Netherlands (Harrewijn); Department of Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia (White); Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel (Abend); Department of Human Development and Quantitative Methodology, University of Maryland, College Park (Fox); Yale Child Study Center, Yale School of Medicine, New Haven, Conn. (Silverman); Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison (Kalin); School of Psychological Sciences (Bar-Heim, Naim) and Sagol School of Neuroscience (Bar-Haim), Tel Aviv University, Tel Aviv, Israel
| | - David Pagliaccio
- Emotion and Development Branch, NIMH, Bethesda, Md. (Haller, Grassie, Jones, Mallidi, Berman, Lewis, Kircanski, Brotman); Department of Psychology, University of Freiburg, Freiburg, Germany (Linke); Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York (Pagliaccio); Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, the Netherlands (Harrewijn); Department of Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia (White); Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel (Abend); Department of Human Development and Quantitative Methodology, University of Maryland, College Park (Fox); Yale Child Study Center, Yale School of Medicine, New Haven, Conn. (Silverman); Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison (Kalin); School of Psychological Sciences (Bar-Heim, Naim) and Sagol School of Neuroscience (Bar-Haim), Tel Aviv University, Tel Aviv, Israel
| | - Anita Harrewijn
- Emotion and Development Branch, NIMH, Bethesda, Md. (Haller, Grassie, Jones, Mallidi, Berman, Lewis, Kircanski, Brotman); Department of Psychology, University of Freiburg, Freiburg, Germany (Linke); Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York (Pagliaccio); Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, the Netherlands (Harrewijn); Department of Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia (White); Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel (Abend); Department of Human Development and Quantitative Methodology, University of Maryland, College Park (Fox); Yale Child Study Center, Yale School of Medicine, New Haven, Conn. (Silverman); Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison (Kalin); School of Psychological Sciences (Bar-Heim, Naim) and Sagol School of Neuroscience (Bar-Haim), Tel Aviv University, Tel Aviv, Israel
| | - Lauren K White
- Emotion and Development Branch, NIMH, Bethesda, Md. (Haller, Grassie, Jones, Mallidi, Berman, Lewis, Kircanski, Brotman); Department of Psychology, University of Freiburg, Freiburg, Germany (Linke); Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York (Pagliaccio); Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, the Netherlands (Harrewijn); Department of Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia (White); Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel (Abend); Department of Human Development and Quantitative Methodology, University of Maryland, College Park (Fox); Yale Child Study Center, Yale School of Medicine, New Haven, Conn. (Silverman); Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison (Kalin); School of Psychological Sciences (Bar-Heim, Naim) and Sagol School of Neuroscience (Bar-Haim), Tel Aviv University, Tel Aviv, Israel
| | - Reut Naim
- Emotion and Development Branch, NIMH, Bethesda, Md. (Haller, Grassie, Jones, Mallidi, Berman, Lewis, Kircanski, Brotman); Department of Psychology, University of Freiburg, Freiburg, Germany (Linke); Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York (Pagliaccio); Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, the Netherlands (Harrewijn); Department of Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia (White); Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel (Abend); Department of Human Development and Quantitative Methodology, University of Maryland, College Park (Fox); Yale Child Study Center, Yale School of Medicine, New Haven, Conn. (Silverman); Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison (Kalin); School of Psychological Sciences (Bar-Heim, Naim) and Sagol School of Neuroscience (Bar-Haim), Tel Aviv University, Tel Aviv, Israel
| | - Rany Abend
- Emotion and Development Branch, NIMH, Bethesda, Md. (Haller, Grassie, Jones, Mallidi, Berman, Lewis, Kircanski, Brotman); Department of Psychology, University of Freiburg, Freiburg, Germany (Linke); Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York (Pagliaccio); Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, the Netherlands (Harrewijn); Department of Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia (White); Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel (Abend); Department of Human Development and Quantitative Methodology, University of Maryland, College Park (Fox); Yale Child Study Center, Yale School of Medicine, New Haven, Conn. (Silverman); Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison (Kalin); School of Psychological Sciences (Bar-Heim, Naim) and Sagol School of Neuroscience (Bar-Haim), Tel Aviv University, Tel Aviv, Israel
| | - Ajitha Mallidi
- Emotion and Development Branch, NIMH, Bethesda, Md. (Haller, Grassie, Jones, Mallidi, Berman, Lewis, Kircanski, Brotman); Department of Psychology, University of Freiburg, Freiburg, Germany (Linke); Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York (Pagliaccio); Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, the Netherlands (Harrewijn); Department of Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia (White); Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel (Abend); Department of Human Development and Quantitative Methodology, University of Maryland, College Park (Fox); Yale Child Study Center, Yale School of Medicine, New Haven, Conn. (Silverman); Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison (Kalin); School of Psychological Sciences (Bar-Heim, Naim) and Sagol School of Neuroscience (Bar-Haim), Tel Aviv University, Tel Aviv, Israel
| | - Erin Berman
- Emotion and Development Branch, NIMH, Bethesda, Md. (Haller, Grassie, Jones, Mallidi, Berman, Lewis, Kircanski, Brotman); Department of Psychology, University of Freiburg, Freiburg, Germany (Linke); Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York (Pagliaccio); Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, the Netherlands (Harrewijn); Department of Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia (White); Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel (Abend); Department of Human Development and Quantitative Methodology, University of Maryland, College Park (Fox); Yale Child Study Center, Yale School of Medicine, New Haven, Conn. (Silverman); Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison (Kalin); School of Psychological Sciences (Bar-Heim, Naim) and Sagol School of Neuroscience (Bar-Haim), Tel Aviv University, Tel Aviv, Israel
| | - Krystal M Lewis
- Emotion and Development Branch, NIMH, Bethesda, Md. (Haller, Grassie, Jones, Mallidi, Berman, Lewis, Kircanski, Brotman); Department of Psychology, University of Freiburg, Freiburg, Germany (Linke); Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York (Pagliaccio); Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, the Netherlands (Harrewijn); Department of Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia (White); Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel (Abend); Department of Human Development and Quantitative Methodology, University of Maryland, College Park (Fox); Yale Child Study Center, Yale School of Medicine, New Haven, Conn. (Silverman); Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison (Kalin); School of Psychological Sciences (Bar-Heim, Naim) and Sagol School of Neuroscience (Bar-Haim), Tel Aviv University, Tel Aviv, Israel
| | - Katharina Kircanski
- Emotion and Development Branch, NIMH, Bethesda, Md. (Haller, Grassie, Jones, Mallidi, Berman, Lewis, Kircanski, Brotman); Department of Psychology, University of Freiburg, Freiburg, Germany (Linke); Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York (Pagliaccio); Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, the Netherlands (Harrewijn); Department of Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia (White); Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel (Abend); Department of Human Development and Quantitative Methodology, University of Maryland, College Park (Fox); Yale Child Study Center, Yale School of Medicine, New Haven, Conn. (Silverman); Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison (Kalin); School of Psychological Sciences (Bar-Heim, Naim) and Sagol School of Neuroscience (Bar-Haim), Tel Aviv University, Tel Aviv, Israel
| | - Nathan A Fox
- Emotion and Development Branch, NIMH, Bethesda, Md. (Haller, Grassie, Jones, Mallidi, Berman, Lewis, Kircanski, Brotman); Department of Psychology, University of Freiburg, Freiburg, Germany (Linke); Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York (Pagliaccio); Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, the Netherlands (Harrewijn); Department of Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia (White); Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel (Abend); Department of Human Development and Quantitative Methodology, University of Maryland, College Park (Fox); Yale Child Study Center, Yale School of Medicine, New Haven, Conn. (Silverman); Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison (Kalin); School of Psychological Sciences (Bar-Heim, Naim) and Sagol School of Neuroscience (Bar-Haim), Tel Aviv University, Tel Aviv, Israel
| | - Wendy K Silverman
- Emotion and Development Branch, NIMH, Bethesda, Md. (Haller, Grassie, Jones, Mallidi, Berman, Lewis, Kircanski, Brotman); Department of Psychology, University of Freiburg, Freiburg, Germany (Linke); Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York (Pagliaccio); Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, the Netherlands (Harrewijn); Department of Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia (White); Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel (Abend); Department of Human Development and Quantitative Methodology, University of Maryland, College Park (Fox); Yale Child Study Center, Yale School of Medicine, New Haven, Conn. (Silverman); Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison (Kalin); School of Psychological Sciences (Bar-Heim, Naim) and Sagol School of Neuroscience (Bar-Haim), Tel Aviv University, Tel Aviv, Israel
| | - Ned H Kalin
- Emotion and Development Branch, NIMH, Bethesda, Md. (Haller, Grassie, Jones, Mallidi, Berman, Lewis, Kircanski, Brotman); Department of Psychology, University of Freiburg, Freiburg, Germany (Linke); Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York (Pagliaccio); Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, the Netherlands (Harrewijn); Department of Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia (White); Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel (Abend); Department of Human Development and Quantitative Methodology, University of Maryland, College Park (Fox); Yale Child Study Center, Yale School of Medicine, New Haven, Conn. (Silverman); Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison (Kalin); School of Psychological Sciences (Bar-Heim, Naim) and Sagol School of Neuroscience (Bar-Haim), Tel Aviv University, Tel Aviv, Israel
| | - Yair Bar-Haim
- Emotion and Development Branch, NIMH, Bethesda, Md. (Haller, Grassie, Jones, Mallidi, Berman, Lewis, Kircanski, Brotman); Department of Psychology, University of Freiburg, Freiburg, Germany (Linke); Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York (Pagliaccio); Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, the Netherlands (Harrewijn); Department of Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia (White); Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel (Abend); Department of Human Development and Quantitative Methodology, University of Maryland, College Park (Fox); Yale Child Study Center, Yale School of Medicine, New Haven, Conn. (Silverman); Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison (Kalin); School of Psychological Sciences (Bar-Heim, Naim) and Sagol School of Neuroscience (Bar-Haim), Tel Aviv University, Tel Aviv, Israel
| | - Melissa A Brotman
- Emotion and Development Branch, NIMH, Bethesda, Md. (Haller, Grassie, Jones, Mallidi, Berman, Lewis, Kircanski, Brotman); Department of Psychology, University of Freiburg, Freiburg, Germany (Linke); Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York (Pagliaccio); Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, the Netherlands (Harrewijn); Department of Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia (White); Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel (Abend); Department of Human Development and Quantitative Methodology, University of Maryland, College Park (Fox); Yale Child Study Center, Yale School of Medicine, New Haven, Conn. (Silverman); Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison (Kalin); School of Psychological Sciences (Bar-Heim, Naim) and Sagol School of Neuroscience (Bar-Haim), Tel Aviv University, Tel Aviv, Israel
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Frommelt T, Traykova M, Platt B, Wittekind CE. The influence of outcome expectancy on interpretation bias training in social anxiety: an experimental pilot study. Pilot Feasibility Stud 2023; 9:144. [PMID: 37592317 PMCID: PMC10433573 DOI: 10.1186/s40814-023-01371-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 07/25/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND Cognitive bias modification for interpretation (CBM-I) trainings have shown positive effects on interpretation bias in both active interpretation bias training conditions and structurally similar control conditions. Outcome expectations have been suggested to contribute to these placebo effects. The goal of this pilot experimental study was to test the feasibility of positive expectancy induction, to gain preliminary insight into whether this has implications for the efficacy of CBM-I training, and to assess the feasibility of recruitment and the overall study design. METHODS Socially anxious individuals aged 18 years and older received a single session (approx. 45 min) of either CBM-I or placebo training preceded by either a positive expectancy induction or no expectancy induction. We first tested whether the expectancy induction had modified participants' expectations of training. We then explored the effects of CBM-I training and expectancy induction on interpretation bias. Finally, we assessed the feasibility of recruitment and further study procedures. RESULTS Due to pandemic-related difficulties, fewer participants were recruited than initially planned. Thirty-four (22 females and 12 males) participants were randomly assigned to one of four conditions (interpretation bias training + high expectancy = 10, interpretation bias training + no expectancy = 8, placebo training + high expectancy = 11, placebo training + no expectancy = 5). Participants in the positive expectancy condition had more positive expectations of the training (CBM-I or placebo) than participants in the no expectancy condition. We were unable to conduct the planned 2 × 2 × 2 analysis of interpretation bias due to the small sample size. When looking at these groups individually, we found that participants in the active training condition and participants in the high expectancy condition showed increases in positive interpretation bias and decreases in negative interpretation bias from pre- to post-training, while participants in the placebo and no expectancy conditions showed no change. CONCLUSIONS These findings suggest that the expectancy manipulation utilized in this study may be adopted by future studies which investigate outcome expectations as an unspecific mechanism of CBM-I. Preliminary analyses suggest that participants' expectations are likely to play a role in the effect of CBM-I training, although these effects require replication in a larger sample. Several observations about the study feasibility were made which could inform future trials. TRIAL REGISTRATION Retrospectively registered on the August 23, 2022, through the German Clinical Trials Register ( DRKS00029768 ).
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Affiliation(s)
- Tonya Frommelt
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, LMU University Hospital Munich, Nußbaumstr. 5, Munich, 80336, Germany.
| | - Milena Traykova
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, LMU University Hospital Munich, Nußbaumstr. 5, Munich, 80336, Germany
| | - Belinda Platt
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, LMU University Hospital Munich, Nußbaumstr. 5, Munich, 80336, Germany
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Beltzer ML, Daniel KE, Daros AR, Teachman BA. Changes in Learning From Social Feedback After Web-Based Interpretation Bias Modification: Secondary Analysis of a Digital Mental Health Intervention Among Individuals With High Social Anxiety Symptoms. JMIR Form Res 2023; 7:e44888. [PMID: 37556186 PMCID: PMC10448289 DOI: 10.2196/44888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 05/26/2023] [Accepted: 06/20/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Biases in social reinforcement learning, or the process of learning to predict and optimize behavior based on rewards and punishments in the social environment, may underlie and maintain some negative cognitive biases that are characteristic of social anxiety. However, little is known about how cognitive and behavioral interventions may change social reinforcement learning in individuals who are anxious. OBJECTIVE This study assessed whether a scalable, web-based cognitive bias modification for interpretations (CBM-I) intervention changed social reinforcement learning biases in participants with high social anxiety symptoms. This study focused on 2 types of social reinforcement learning relevant to social anxiety: learning about other people and learning about one's own social performance. METHODS Participants (N=106) completed 2 laboratory sessions, separated by 5 weeks of ecological momentary assessment tracking emotion regulation strategy use and affect. Approximately half (n=51, 48.1%) of the participants completed up to 6 brief daily sessions of CBM-I in week 3. Participants completed a task that assessed social reinforcement learning about other people in both laboratory sessions and a task that assessed social reinforcement learning about one's own social performance in the second session. Behavioral data from these tasks were computationally modeled using Q-learning and analyzed using mixed effects models. RESULTS After the CBM-I intervention, participants updated their beliefs about others more slowly (P=.04; Cohen d=-0.29) but used what they learned to make more accurate decisions (P=.005; Cohen d=0.20), choosing rewarding faces more frequently. These effects were not observed among participants who did not complete the CBM-I intervention. Participants who completed the CBM-I intervention also showed less-biased updating about their social performance than participants who did not complete the CBM-I intervention, learning similarly from positive and negative feedback and from feedback on items related to poor versus good social performance. Regardless of the intervention condition, participants at session 2 versus session 1 updated their expectancies about others more from rewarding (P=.003; Cohen d=0.43) and less from punishing outcomes (P=.001; Cohen d=-0.47), and they became more accurate at learning to avoid punishing faces (P=.001; Cohen d=0.20). CONCLUSIONS Taken together, our results provide initial evidence that there may be some beneficial effects of both the CBM-I intervention and self-tracking of emotion regulation on social reinforcement learning in individuals who are socially anxious, although replication will be important.
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Affiliation(s)
- Miranda L Beltzer
- Center for Behavioral Intervention Technologies, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Department of Psychology, University of Virginia, Charlottesville, VA, United States
| | - Katharine E Daniel
- Department of Psychology, University of Virginia, Charlottesville, VA, United States
| | - Alexander R Daros
- Department of Psychology, University of Virginia, Charlottesville, VA, United States
| | - Bethany A Teachman
- Department of Psychology, University of Virginia, Charlottesville, VA, United States
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Zech JM, Patel TA, Cougle JR. Safety Behaviors Predict Long-Term Treatment Outcome Following Internet-Based Treatment of Adults with Social Anxiety Disorder. COGNITIVE THERAPY AND RESEARCH 2023. [DOI: 10.1007/s10608-023-10368-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
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7
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Zeng K, Cao F, Wu Y, Zhang M, Ding X. Effects of interpretation bias modification on hostile attribution bias and reactive cyber-aggression in Chinese adolescents: a randomized controlled trial. CURRENT PSYCHOLOGY 2023:1-14. [PMID: 37359704 PMCID: PMC9999074 DOI: 10.1007/s12144-023-04433-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2023] [Indexed: 03/12/2023]
Abstract
Highly aggressive individuals tend to interpret others' motives and intentions as hostile in both offline and online social situations. The current study examined whether hostile interpretation bias can be modified to influence cyber-aggression in Chinese middle school students using an interpretation bias modification program. Gender differences and the heterogeneity of cyber-aggression were also investigated since previous studies suggest that they play important roles in determining the intervention effect. One hundred and twenty-one middle school students were randomized to receive either an eight-session interpretation bias modification task (CBM-I; n = 61) or an eight-session placebo control task (PCT; n = 60) over four weeks. Measures of hostile attribution bias and cyber-aggression were administered at baseline, post-training, and at one week follow-up. Results showed that compared to PCT, participants in CBM-I showed a significant reduction in reactive cyber-aggression. However, contrary to our expectation, there was no significant difference between the two groups in the reduction of hostile attribution bias after training. The moderated mediation analysis revealed that the effect of CBM-I on hostile attribution bias and the mediating role of hostile attribution bias in the relationship between CBM-I condition and reactive cyber-aggression was only observed among females, but not among males. These findings provide initial evidence for the potential of CBM-I in reducing hostile attribution bias and cyber-aggression. However, for male students, CBM-I might not be effective enough as expected. Supplementary Information The online version contains supplementary material available at 10.1007/s12144-023-04433-3.
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Affiliation(s)
- Ke Zeng
- Department of Medical Psychology, School of Medical Humanities, Capital Medical University, Beijing, China
| | - Feizhen Cao
- Department of Psychology, Ningbo University, Ningbo, China
| | - Yajun Wu
- Fengqiao Middle School, Jiaxing, China
| | - Manhua Zhang
- Department of Medical Psychology, School of Medical Humanities, Capital Medical University, Beijing, China
| | - Xinfang Ding
- Department of Medical Psychology, School of Medical Humanities, Capital Medical University, Beijing, China
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Dhakal S, Gupta S, Sharma NP, Upadhyay A, Oliver A, Sumich A, Kumari V, Niraula S, Pandey R, Lau JYF. Can we challenge attention and interpretation threat biases in rescued child labourers with a history of physical abuse using a computerised cognitive training task? Data on feasibility, acceptability and target engagement. Behav Res Ther 2023; 162:104267. [PMID: 36780810 DOI: 10.1016/j.brat.2023.104267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 12/11/2022] [Accepted: 01/25/2023] [Indexed: 01/30/2023]
Abstract
Child labourers are more likely to have experienced physical victimisation, which may increase risk for anxiety/depression, by shaping threat biases in information-processing. To target threat biases and vulnerability for anxiety/depression, we evaluated whether Cognitive Bias Modification (CBM) training could be feasibly and acceptably delivered to rescued youth labourers. Seventy-six physically abused rescued labourers aged 14-17 (40 from Nepal, 36 from India) in out-of-home care institutions received either multi-session computerised CBM or control training. Training targeted attention away from threat to positive cues and the endorsement of benign over threat interpretations. Feasibility and acceptability data were gathered along with pre and post intervention measures of attention and interpretation bias and emotional and behavioural symptoms. In terms of feasibility, uptake (proportion of those who completed the pre-intervention assessment from those who consented) and retention (proportion of those who completed the post-intervention assessment from those who completed the pre-intervention assessment) were above 75% in both countries. Average acceptability ratings were mostly 'moderate' on most indices for both countries, and none of the participants reported experiencing serious adverse events or reactions in response to or during the trial. Secondarily, CBM participants showed increased attention to positive and decreased attention to threatening stimuli, as well as increased endorsement of benign interpretation and decreased endorsement in negative interpretations of ambiguous social situations. Symptom changes were less clear. Delivering CBM to former child labourers in out-of-home care institutions has interventive potential. ClinicalTrials.gov Identifier: NCT03625206, Date of registration: August 10, 2018.
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Affiliation(s)
- Sandesh Dhakal
- Central Department of Psychology, Tribhuvan University, Kathmandu, Nepal
| | - Shulka Gupta
- Department of Psychology, Banaras Hindu University, Varanasi, 221 005, UP, India
| | | | - Aakanksha Upadhyay
- Department of Psychology, Banaras Hindu University, Varanasi, 221 005, UP, India
| | - Abigail Oliver
- Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Alex Sumich
- Division of Psychology, Nottingham Trent University, Nottingham, UK
| | - Veena Kumari
- Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK; Centre for Cognitive Neuroscience, College of Health, Medicine and Life Sciences, Brunel University London, Uxbridge, UB8 3PH, UK
| | - Shanta Niraula
- Central Department of Psychology, Tribhuvan University, Kathmandu, Nepal
| | - Rakesh Pandey
- Department of Psychology, Banaras Hindu University, Varanasi, 221 005, UP, India
| | - Jennifer Y F Lau
- Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK; Youth Resilience Unit, Wolfson Institute of Population Health, Queen Mary, University of London, London, E1 4NS, UK.
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Danylova T, Bonchuk R, Hoian I, Parasiei-Hocher A, Mokhnatiuk I, Honcharenko M, Sierova Y. GAZING INTO THE ABYSS: TOWARD A PHILOSOPHICAL UNDERSTANDING OF ANXIETY AND FEAR. WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 2023; 76:2082-2088. [PMID: 37898948 DOI: 10.36740/wlek202309126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
OBJECTIVE The aim: This paper deals with anxiety or fear-related disorders and philosophical interpretations of the phenomena of fear and anxiety. PATIENTS AND METHODS Materials and methods: The authors used integrative anthropological approach, interpretive research paradigm, hermeneutical approach. The data collec¬tion was carried out using Scopus, Web of Science, PubMed, Google Scholar databases. Research papers were identified according to search terms: "anxiety or fear-related disorders", "fear", "anxiety", "phobia", "psychology", "psychotherapy", "mental health", "philosophy", "being-in-the-world", "human existence". CONCLUSION Conclusion: It is obvious that philosophical interpretations of the phenomena of fear and anxiety cannot be defined in clinical terms, especially given the fact that modern psychology, psychotherapy, and psychiatry are shifting towards evidence-based practices. Furthermore, there are significant differences in determining the causes that provoke mental health disorders (nature, nurture, their interaction or something else) and accordingly in choosing treatment methods. Apparently, the position of the researchers/practitioners will be determined by their understanding of the root cause. However, more and more researchers are coming to the conclusion that the contemporary world demonstrates the urgent need for an integral, holistic paradigm of a human as an undivided, alive and organic, ideal and material being that should be understood in the context, taking into account the socio-cultural, biological, narrative, self-relational dimensions and his/her ability to transcend them. That is why the most effective way to help people with anxiety or fear-related disorders is to develop "the optimal combination of social assistance, psychological therapy, transpersonal experience, and medical treatment. It should be based on a new transdisciplinary paradigm and implemented by an interdisciplinary team of specialists". In this process, a special role should be assigned to philosophy, which is able to expand horizons and find an approach to the core of a human being.
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Affiliation(s)
- Tetiana Danylova
- INSTITUTE OF SOCIAL AND POLITICAL PSYCHOLOGY, NATIONAL ACADEMY OF EDUCATIONAL SCIENCES OF UKRAINE, KYIV, UKRAINE; THE GRADUATE SCHOOL FOR SOCIAL RESEARCH, INSTITUTE OF PHILOSOPHY AND SOCIOLOGY OF THE POLISH ACADEMY OF SCIENCES, WARSAW, POLAND
| | - Roman Bonchuk
- VASYL STEFANYK PRECARPATHIAN NATIONAL UNIVERSITY, IVANO-FRANKIVSK, UKRAINE
| | - Ihor Hoian
- VASYL STEFANYK PRECARPATHIAN NATIONAL UNIVERSITY, IVANO-FRANKIVSK, UKRAINE
| | | | | | | | - Yuliia Sierova
- TARAS SHEVCHENKO NATIONAL UNIVERSITY OF KYIV, KYIV, UKRAINE
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10
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Fadardi JS, Memarian S, Parkinson J, Cox WM, Stacy AW. Scary in the eye of the beholder: Attentional bias and attentional retraining for social anxiety. J Psychiatr Res 2023; 157:141-151. [PMID: 36463629 DOI: 10.1016/j.jpsychires.2022.11.005] [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: 05/12/2022] [Revised: 10/20/2022] [Accepted: 11/12/2022] [Indexed: 11/21/2022]
Abstract
UNLABELLED Consistent with cognitive models of social anxiety, socially anxious individuals show cognitive biases that magnify their perceived level of threat in the environment. OBJECTIVES The first objective was to determine whether attentional bias for socially threatening stimuli occurs after concomitant depression has been controlled. The second objective was to test the effectiveness of the Attention Control Training Program for Social Anxiety (ACTP-SA) for reducing social anxiety attentional bias and improving therapeutic indices in people with social anxiety. METHOD In the first study, socially anxious (N = 30) and non-anxious individuals (N = 30) completed the Beck Depression Inventory-II, Spielberger's State-Trait Anxiety Inventory, Conner's Social Phobia Inventory, a social-anxiety Stroop test, and a clinical interview. In the second study, individuals with social anxiety (N = 30) were randomly assigned to an experimental group that received 4 sessions of ACTP-SA, or to a sham-intervention control condition. At the post-test and a 3-month follow-up, both groups completed the same measures as in Study 1. RESULTS In Study 1, socially anxious individuals showed higher attentional bias for threatening stimuli than the controls, after depression had been controlled for. In Study 2, participants in the experimental group, compared with the controls, showed greater reductions in attentional bias, social anxiety, and trait anxiety at post-test and follow-up. CONCLUSIONS The results underscore the importance of information processing biases in social anxiety and the benefits of attentional bias training as a complementary intervention for modifying symptoms of social anxiety.
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Affiliation(s)
- Javad S Fadardi
- Claremont Graduate University, United States; Bangor University, UK; Ferdowsi University of Mashhad, Iran.
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11
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Attention and interpretation cognitive bias change: A systematic review and meta-analysis of bias modification paradigms. Behav Res Ther 2022; 157:104180. [PMID: 36037642 DOI: 10.1016/j.brat.2022.104180] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 07/29/2022] [Accepted: 08/08/2022] [Indexed: 12/15/2022]
Abstract
This systematic review and meta-analysis examines the effect of Cognitive Bias Modification for attention (CBM-A) and interpretation (CBM-I) on reducing the targeted biases and investigates moderators of each approach. PsycINFO, PsychArticles, and PubMED databases were searched for randomized-controlled studies published before March 2020 with pre- and post-CBM cognitive bias outcome measures, resulting in 91 CBM-A (n = 5914 individuals) and 70 CBM-I samples (n = 4802 individuals). Random-effects models and Hedge's g calculation showed significant medium overall effects of bias reduction with moderate to high heterogeneity (CBM-A g = 0.49 [0.36, 0.64], I2 = 85.19%; CBM-I g = 0.58 [0.48, 0.68], I2 = 70.92%). Effect sizes did not differ between approaches and remained significant after trim-and-fill adjustment for possible publication bias. Moderator variables were investigated with meta-regression and subgroup analyses. Participant age, symptom type, control condition and number of trials moderated CBM-A; student and clinical status moderated CBM-I effect size. Results support attention and interpretation modification in controlled laboratory and variable (online) training settings for non-clinical and clinical samples across various symptom types (anxiety, depression, substance use, eating disorders). Further empirical evidence is necessary to determine optimal sample and methodological combinations most strongly associated with adaptive behavioral outcomes.
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12
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Technology-Mediated Sexual Interactions, Social Anxiety, and Sexual Wellbeing: A Scoping Review. Eur J Investig Health Psychol Educ 2022; 12:904-932. [PMID: 36005215 PMCID: PMC9407275 DOI: 10.3390/ejihpe12080066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 07/19/2022] [Accepted: 07/22/2022] [Indexed: 11/17/2022] Open
Abstract
Technology-mediated sexual interactions (TMSI) are interpersonal exchanges via technology of self-created sexual material, including photos, videos, and auditory or text messages. There is little research on the factors that predict both TMSI experiences and their sexual wellbeing outcomes. Social anxiety is anxiety experienced in response to social or performance situations. From a cognitive–behavioural perspective, people higher in social anxiety may avoid TMSI, preventing positive or negative consequences. They also may use TMSI to avoid the anxiety caused by in-person sexual interactions, benefiting from access to sexual interactions while perpetuating anxiety about them. The purpose of this scoping review was to explore the role of social anxiety in TMSI and its sexual wellbeing outcomes. We executed a comprehensive search strategy across eight academic databases and searched reference lists of included articles. We included 19 articles written in English or French that had a human sample and were published between 1991 and 2021 and evaluated connections between social anxiety constructs (e.g., shyness, anxiety) and TMSI-related experiences (e.g., sexting, internet sex addiction). The pattern of results suggested that social anxiety constructs may predict some but not all forms of TMSI. Future research from a cognitive–behavioural perspective will expand knowledge on social anxiety, TMSI, and its sexual wellbeing outcomes.
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13
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Heaton LJ, Leroux BG, Ramsay DS. Development and Testing of an Interpretational Bias Measure of Dental Anxiety. FRONTIERS IN DENTAL MEDICINE 2022. [DOI: 10.3389/fdmed.2022.871039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
ObjectivesWe hypothesized that individuals with dental care-related anxiety and fear would interpret ambiguous dental situations more negatively than non-anxious individuals. The objectives of these studies were to develop and test a Measure of Dental Anxiety Interpretational Bias (MoDAIB).MethodsIn the development phase, participants completing an online survey provided qualitative and quantitative assessments of dental scenarios that could be interpreted in either positive or negative ways. Scenarios producing the greatest difference in visual analog (VAS) scores between individuals with high vs. low dental anxiety as measured by the Modified Dental Anxiety Scale (MDAS) were included in the MoDAIB. In the testing phase, participants completed an online survey including the newly developed MoDAIB and dental anxiety measures.ResultsIn the development phase, participants (N = 355; 65.6% female) high in dental anxiety (MDAS ≥ 19) gave significantly higher (i.e., more negative) VAS scores to all the dental scenarios than did those low in dental anxiety (p's < 0.05). In the testing phase, the MoDAIB was significantly and positively correlated with the MDAS (r = 0.68, p < 0.001), meaning that those who were high in dental anxiety selected negative interpretations of ambiguous dental scenarios significantly more often than did individuals low in dental anxiety (p's <0.05). The MoDAIB showed good content validity and test-retest reliability.ConclusionsIndividuals high in dental anxiety interpret ambiguous dental situations more negatively than do less anxious individuals. Understanding individuals' interpretational styles may help dental providers avoid miscommunications. Interventions that train dentally anxious patients to consider more positive interpretations may reduce dental anxiety and should be investigated.
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14
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Leung CJ, Yiend J, Trotta A, Lee TMC. The combined cognitive bias hypothesis in anxiety: A systematic review and meta-analysis. J Anxiety Disord 2022; 89:102575. [PMID: 35594749 DOI: 10.1016/j.janxdis.2022.102575] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 04/23/2022] [Accepted: 04/27/2022] [Indexed: 01/09/2023]
Abstract
Cognitive theories have postulated the relational nature of different cognitive biases in the development and maintenance of anxiety disorders. To test this combined cognitive bias hypothesis, this review addressed the following questions: (i) whether different cognitive biases are associated with each other and (ii) whether one bias influences another bias. We identified 36 articles that studied the relationship between cognitive biases (attention, interpretation and memory bias). Of these, 31 studies were entered into two meta-analyses. Sixteen studies were included in the first meta-analysis of the correlation between cognitive bias indices. A further 15 studies were included in another meta-analysis to examine the transfer effects of cognitive bias modification (CBM) to another bias. Both meta-analyses yielded small but significant overall pooled effect sizes after the removal of outliers (r = 0.11 and g = 0.19 respectively). Moderator analyses revealed that the relationship between interpretation and memory bias was significantly stronger than other types of cognitive bias correlations and CBM is more potent in modifying biases when it was delivered in the laboratory compared with online. Our review quantifies the strength of the relationships between biases and transfer effects following CBM, which serves as a basis to further understand the mechanisms underlying biased information processing.
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Affiliation(s)
- Chantel J Leung
- Laboratory of Neuropsychology, The University of Hong Kong, Hong Kong; King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychosis Studies, London, UK
| | - Jenny Yiend
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychosis Studies, London, UK.
| | - Antonella Trotta
- Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Tony Hillis Unit, Lambeth Hospital, South London and Maudsley NHS Foundation Trust, London, UK
| | - Tatia M C Lee
- Laboratory of Neuropsychology, The University of Hong Kong, Hong Kong; The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong; Center for Brain Science and Brain-Inspired Intelligence, Guangdong-Hong Kong-Macao Greater Bay Area, China.
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15
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Trapp W, Heid A, Röder S, Wimmer F, Hajak G. Cognitive Remediation in Psychiatric Disorders: State of the Evidence, Future Perspectives, and Some Bold Ideas. Brain Sci 2022; 12:brainsci12060683. [PMID: 35741569 PMCID: PMC9221116 DOI: 10.3390/brainsci12060683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 05/15/2022] [Accepted: 05/20/2022] [Indexed: 12/10/2022] Open
Abstract
Many people with psychiatric disorders experience impairments in cognition. These deficits have a significant impact on daily functioning and sometimes even on the further course of their disease. Cognitive remediation (CR) is used as an umbrella term for behavioral training interventions to ameliorate these deficits. In most but not all studies, CR has proven effective in improving cognition and enhancing everyday functional outcomes. In this paper, after quickly summarizing the empirical evidence, practical advice to optimize the effects of CR interventions is provided. We advocate that CR interventions should be as fun and motivating as possible, and therapists should at least consider using positively toned emotional stimuli instead of neutral stimuli. Participants should be screened for basic processing deficits, which should be trained before CR of higher-order cognitive domains. CR should stimulate metacognition and utilize natural settings to invoke social cognition. Wherever possible, CR tasks should link to tasks that participants face in their everyday life. Therapists should consider that participants might also benefit from positive side effects on symptomatology. Finally, the CR approach might even be utilized in settings where the treatment of cognitive impairments is not a primary target.
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Affiliation(s)
- Wolfgang Trapp
- Department of Psychiatry and Psychotherapy, Social Foundation Bamberg, 96049 Bamberg, Germany; (A.H.); (S.R.); (F.W.); (G.H.)
- Fachhochschule des Mittelstands, Department of Psychology, University of Applied Sciences, 96050 Bamberg, Germany
- Correspondence:
| | - Andreas Heid
- Department of Psychiatry and Psychotherapy, Social Foundation Bamberg, 96049 Bamberg, Germany; (A.H.); (S.R.); (F.W.); (G.H.)
| | - Susanne Röder
- Department of Psychiatry and Psychotherapy, Social Foundation Bamberg, 96049 Bamberg, Germany; (A.H.); (S.R.); (F.W.); (G.H.)
| | - Franziska Wimmer
- Department of Psychiatry and Psychotherapy, Social Foundation Bamberg, 96049 Bamberg, Germany; (A.H.); (S.R.); (F.W.); (G.H.)
| | - Göran Hajak
- Department of Psychiatry and Psychotherapy, Social Foundation Bamberg, 96049 Bamberg, Germany; (A.H.); (S.R.); (F.W.); (G.H.)
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Crum J, Ronca F, Herbert G, Funk S, Carmona E, Hakim U, Jones I, Hamer M, Hirsch J, Hamilton A, Tachtsidis I, Burgess PW. Decreased Exercise-Induced Changes in Prefrontal Cortex Hemodynamics Are Associated With Depressive Symptoms. FRONTIERS IN NEUROERGONOMICS 2022; 3:806485. [PMID: 38235451 PMCID: PMC10790946 DOI: 10.3389/fnrgo.2022.806485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 04/27/2022] [Indexed: 01/19/2024]
Abstract
People with a depressed mood tend to perform poorly on executive function tasks, which require much of the prefrontal cortex (PFC), an area of the brain which has also been shown to be hypo-active in this population. Recent research has suggested that these aspects of cognition might be improved through physical activity and cognitive training. However, whether the acute effects of exercise on PFC activation during executive function tasks vary with depressive symptoms remains unclear. To investigate these effects, 106 participants were given a cardiopulmonary exercise test (CPET) and were administered a set of executive function tests directly before and after the CPET assessment. The composite effects of exercise on the PFC (all experimental blocks) showed bilateral activation changes in dorsolateral (BA46/9) and ventrolateral (BA44/45) PFC, with the greatest changes occurring in rostral PFC (BA10). The effects observed in right ventrolateral PFC varied depending on level of depressive symptoms (13% variance explained); the changes in activation were less for higher levels. There was also a positive relationship between CPET scores (VO2peak) and right rostral PFC, in that greater activation changes in right BA10 were predictive of higher levels of aerobic fitness (9% variance explained). Since acute exercise ipsilaterally affected this PFC subregion and the inferior frontal gyrus during executive function tasks, this suggests physical activity might benefit the executive functions these subregions support. And because physical fitness and depressive symptoms explained some degree of cerebral upregulation to these subregions, physical activity might more specifically facilitate the engagement of executive functions that are typically associated with hypoactivation in depressed populations. Future research might investigate this possibility in clinical populations, particularly the neural effects of physical activity used in combination with mental health interventions.
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Affiliation(s)
- James Crum
- Institute of Cognitive Neuroscience, Faculty of Brain Sciences, University College London, London, United Kingdom
| | - Flaminia Ronca
- Institute of Sport Exercise and Health, Faculty of Medical Sciences, University College London, London, United Kingdom
| | - George Herbert
- Institute of Cognitive Neuroscience, Faculty of Brain Sciences, University College London, London, United Kingdom
| | - Sabina Funk
- Institute of Cognitive Neuroscience, Faculty of Brain Sciences, University College London, London, United Kingdom
| | - Estela Carmona
- Institute of Sport Exercise and Health, Faculty of Medical Sciences, University College London, London, United Kingdom
| | - Uzair Hakim
- Department of Medical Physics and Biomedical Engineering, Faculty of Engineering Sciences, University College London, London, United Kingdom
| | - Isla Jones
- Institute of Cognitive Neuroscience, Faculty of Brain Sciences, University College London, London, United Kingdom
| | - Mark Hamer
- Institute of Sport Exercise and Health, Faculty of Medical Sciences, University College London, London, United Kingdom
| | - Joy Hirsch
- Department of Medical Physics and Biomedical Engineering, Faculty of Engineering Sciences, University College London, London, United Kingdom
- Department of Comparative Medicine, School of Medicine, Yale University, New Haven, CT, United States
- Department of Psychiatry, School of Medicine, Yale University, New Haven, CT, United States
- Department of Neuroscience, School of Medicine, Yale University, New Haven, CT, United States
| | - Antonia Hamilton
- Institute of Cognitive Neuroscience, Faculty of Brain Sciences, University College London, London, United Kingdom
| | - Ilias Tachtsidis
- Department of Medical Physics and Biomedical Engineering, Faculty of Engineering Sciences, University College London, London, United Kingdom
| | - Paul W. Burgess
- Institute of Cognitive Neuroscience, Faculty of Brain Sciences, University College London, London, United Kingdom
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Leichsenring F, Steinert C, Rabung S, Ioannidis JP. The efficacy of psychotherapies and pharmacotherapies for mental disorders in adults: an umbrella review and meta-analytic evaluation of recent meta-analyses. World Psychiatry 2022; 21:133-145. [PMID: 35015359 PMCID: PMC8751557 DOI: 10.1002/wps.20941] [Citation(s) in RCA: 123] [Impact Index Per Article: 61.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Mental disorders represent a worldwide public health concern. Psychotherapies and pharmacotherapies are recommended as first line treatments. However, evidence has emerged that their efficacy may be overestimated, due to a variety of shortcomings in clinical trials (e.g., publication bias, weak control conditions such as waiting list). We performed an umbrella review of recent meta-analyses of randomized controlled trials (RCTs) of psychotherapies and pharmacotherapies for the main mental disorders in adults. We selected meta-analyses that formally assessed risk of bias or quality of studies, excluded weak comparators, and used effect sizes for target symptoms as primary outcome. We searched PubMed and PsycINFO and individual records of the Cochrane Library for meta-analyses published between January 2014 and March 2021 comparing psychotherapies or pharmacotherapies with placebo or treatment-as-usual (TAU), or psychotherapies vs. pharmacotherapies head-to-head, or the combination of psychotherapy with pharmacotherapy to either monotherapy. One hundred and two meta-analyses, encompassing 3,782 RCTs and 650,514 patients, were included, covering depressive disorders, anxiety disorders, post-traumatic stress disorder, obsessive-compulsive disorder, somatoform disorders, eating disorders, attention-deficit/hyperactivity disorder, substance use disorders, insomnia, schizophrenia spectrum disorders, and bipolar disorder. Across disorders and treatments, the majority of effect sizes for target symptoms were small. A random effect meta-analytic evaluation of the effect sizes reported by the largest meta-analyses per disorder yielded a standardized mean difference (SMD) of 0.34 (95% CI: 0.26-0.42) for psychotherapies and 0.36 (95% CI: 0.32-0.41) for pharmacotherapies compared with placebo or TAU. The SMD for head-to-head comparisons of psychotherapies vs. pharmacotherapies was 0.11 (95% CI: -0.05 to 0.26). The SMD for the combined treatment compared with either monotherapy was 0.31 (95% CI: 0.19-0.44). Risk of bias was often high. After more than half a century of research, thousands of RCTs and millions of invested funds, the effect sizes of psychotherapies and pharmacotherapies for mental disorders are limited, suggesting a ceiling effect for treatment research as presently conducted. A paradigm shift in research seems to be required to achieve further progress.
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Affiliation(s)
- Falk Leichsenring
- Department of Psychosomatics and PsychotherapyUniversity of GiessenGiessenGermany,Department of Psychosomatics and PsychotherapyUniversity of RostockRostockGermany
| | - Christiane Steinert
- Department of Psychosomatics and PsychotherapyUniversity of GiessenGiessenGermany,International Psychoanalytic UniversityBerlinGermany
| | - Sven Rabung
- Department of PsychologyUniversity of KlagenfurtKlagenfurtAustria
| | - John P.A. Ioannidis
- Department of MedicineStanford University School of MedicineStanfordCAUSA,Department of Epidemiology and Population HealthStanford University School of MedicineStanfordCAUSA,Department of Biomedical Data ScienceStanford University School of MedicineStanfordCAUSA
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18
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Rasouli S, Gupta G, Nilsen E, Dautenhahn K. Potential Applications of Social Robots in Robot-Assisted Interventions for Social Anxiety. Int J Soc Robot 2022; 14:1-32. [PMID: 35096198 PMCID: PMC8787185 DOI: 10.1007/s12369-021-00851-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2021] [Indexed: 12/31/2022]
Abstract
AbstractSocial anxiety disorder or social phobia is a condition characterized by debilitating fear and avoidance of different social situations. We provide an overview of social anxiety and evidence-based behavioural and cognitive treatment approaches for this condition. However, treatment avoidance and attrition are high in this clinical population, which calls for innovative approaches, including computer-based interventions, that could minimize barriers to treatment and enhance treatment effectiveness. After reviewing existing assistive technologies for mental health interventions, we provide an overview of how social robots have been used in many clinical interventions. We then propose to integrate social robots in conventional behavioural and cognitive therapies for both children and adults who struggle with social anxiety. We categorize the different therapeutic roles that social robots can potentially play in activities rooted in conventional therapies for social anxiety and oriented towards symptom reduction, social skills development, and improvement in overall quality of life. We discuss possible applications of robots in this context through four scenarios. These scenarios are meant as ‘food for thought’ for the research community which we hope will inspire future research. We discuss risks and concerns for using social robots in clinical practice. This article concludes by highlighting the potential advantages as well as limitations of integrating social robots in conventional interventions to improve accessibility and standard of care as well as outlining future steps in relation to this research direction. Clearly recognizing the need for future empirical work in this area, we propose that social robots may be an effective component in robot-assisted interventions for social anxiety, not replacing, but complementing the work of clinicians. We hope that this article will spark new research, and research collaborations in the highly interdisciplinary field of robot-assisted interventions for social anxiety.
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Affiliation(s)
- Samira Rasouli
- Department of Electrical and Computer Engineering, University of Waterloo, 200 University Avenue West, Waterloo, Ontario N2L 3G1 Canada
| | - Garima Gupta
- Department of Psychology, University of Waterloo, Waterloo, Ontario Canada
| | - Elizabeth Nilsen
- Department of Psychology, University of Waterloo, Waterloo, Ontario Canada
| | - Kerstin Dautenhahn
- Department of Electrical and Computer Engineering, University of Waterloo, 200 University Avenue West, Waterloo, Ontario N2L 3G1 Canada
- Department of Systems Design Engineering, University of Waterloo, Waterloo, Ontario Canada
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19
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Doolan EL, Bryant RA. Modifying insecure attachment style with cognitive bias modification. J Behav Ther Exp Psychiatry 2021; 73:101664. [PMID: 34087690 DOI: 10.1016/j.jbtep.2021.101664] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 03/22/2021] [Accepted: 05/19/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVES Attachment theory suggests that internal working models developed from early experiences with attachment figures biases cognitive appraisals a person makes of themselves and others. The current paper investigates whether attachment-related interpretative biases can be altered using Cognitive Bias Modification (CBM-I). METHODS Eighty anxiously attached participants were randomly assigned to receive either secure or insecure CBM-I training. To measure training effects on attachment-related interpretation bias, participants read scenarios involving attachment figures whereby the availability of the attachment figure was undetermined, followed by test sentences that assigned an attachment-secure or -insecure interpretation to the situations. Participants rated the similarity of these sentences to the previously read ambiguous situations. RESULTS Participants who received secure CBM-I training ascribed higher similarity ratings to secure sentence interpretations of ambiguous scenarios compared to insecure sentence interpretations. Attachment anxiety increased after CBM-I training for those who received insecure training, but did not differ for those who received secure training. LIMITATIONS This study was limited to healthy participants and did not include clinical participants. These findings need to be replicated by assessing the effects of CBM-I over an extended period. CONCLUSIONS CBM-I training may provide a viable means of modulating attachment anxiety. If validated with more potent strategies for secure attachment training, this approach could have significant implications for the treatment of affective disorders characterized by insecure attachments.
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20
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Sakaki K, Nozawa T, Ikeda S, Kawashima R. Neural correlates of cognitive bias modification for interpretation. Soc Cogn Affect Neurosci 2021; 15:247-260. [PMID: 32322880 PMCID: PMC7304515 DOI: 10.1093/scan/nsaa026] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 12/31/2019] [Accepted: 03/06/2020] [Indexed: 11/30/2022] Open
Abstract
The effectiveness of cognitive bias modification for interpretation (CBM-I), a treatment method employed to reduce social anxiety (SA), has been examined. However, the neural correlates of CBM-I remain unclear, and we aimed to elucidate brain activities during intervention and activity changes associated with CBM-I effectiveness in a pre–post intervention comparison. Healthy participants divided into two groups (CBM, control) were scanned before, during and after intervention using functional magnetic resonance imaging. Ambiguous social situations followed by positive outcomes were repeatedly imagined by the CBM group during intervention, while half of the outcomes in the control group were negative. Whole-brain analysis revealed that activation of the somatomotor and somatosensory areas, occipital lobe, fusiform gyrus and thalamus during intervention was significantly greater in the CBM than in the control group. Furthermore, altered activities in the somatomotor and somatosensory areas, occipital lobe and posterior cingulate gyrus during interpreting ambiguous social situations showed a significant group × change in SA interaction. Our result suggests that when facing ambiguous social situations, positive imagery instilled by CBM-I is recalled, and interpretations are modified to contain social reward. These findings may help to suggest an alternative manner of enhancing CBM-I effectiveness from a cognitive-neuroscience perspective.
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Affiliation(s)
- Kohei Sakaki
- Department of Functional Brain Imaging, Graduate School of Medicine, Tohoku University, Sendai 980-8575, Japan.,Division for Interdisciplinary Advanced Research and Education, Tohoku University, Sendai 980-8578, Japan.,Japan Society for the Promotion of Science, Tokyo 102-0083, Japan
| | - Takayuki Nozawa
- Research Institute for the Earth Inclusive Sensing Empathizing with Silent Voices, Tokyo Institute of Technology, Tokyo 152-8550, Japan
| | - Shigeyuki Ikeda
- Department of Ubiquitous Sensing, Institute of Development, Aging and Cancer, Tohoku University, Sendai 980-8575, Japan
| | - Ryuta Kawashima
- Department of Ubiquitous Sensing, Institute of Development, Aging and Cancer, Tohoku University, Sendai 980-8575, Japan.,Department of Functional Brain Imaging, Institute of Development, Aging and Cancer, Tohoku University, Sendai 980-8575, Japan
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21
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Weisberg RB, Gonsalves MA, Ramadurai R, Braham H, Fuchs C, Beard C. Development of a cognitive bias modification intervention for anxiety disorders in primary care. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2021; 61 Suppl 1:73-92. [PMID: 33629751 DOI: 10.1111/bjc.12281] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 11/30/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVES There is a great need for low-intensity, scalable treatments in primary care, where most anxious patients first present for treatment. We describe Stage IA treatment development and a Stage IB feasibility trial of cognitive bias modification (CBM) for transdiagnostic anxiety in primary care. METHODS The online intervention, Mental Habits, comprised eight sessions of a personalized CBM targeting attention and interpretation biases. Coaches assisted patients in using the website, monitored progress via a dashboard, and shared information with primary care providers. We evaluated Mental Habits in an open trial (N = 14) and a randomized controlled trial (RCT) (N = 40) in primary care patients with anxiety disorders. RESULTS We compared results to a priori benchmarks of clinically meaningful outcomes. In the open trial, Mental Habits met feasibility, acceptability, and efficacy benchmarks. In the pilot RCT, there was greater dropout at one study site which ultimately closed. In the intent-to-treat analyses, Mental Habits met the benchmark for self-report, but not the interview measure of anxiety. Symptom Tracking did not meet the benchmark for self-report or interview measures of anxiety. In per-protocol analyses, Mental Habits exceeded the benchmark for both self-report and interview measures, whereas Symptom Tracking met the benchmark for self-report. Interpretation bias improved in the Mental Habits group, but not in Symptom Tracking. No effects were observed for attention bias. CONCLUSION The online CBM intervention demonstrated good acceptability and, when delivered at a stable primary care clinic, preliminary effectiveness in primary care. A larger RCT is warranted to test effectiveness. PRACTITIONER POINTS A personalized, transdiagnostic Cognitive Bias Modification (CBM) intervention for anxiety in primary care is acceptable to primary care patients with social anxiety disorder, generalized anxiety disorder, and/or panic disorder /agoraphobia. With training and supervision from licensed mental health clinicians, bachelor's-level coaches can assist primary care patients to self-administer CBM. Offering a low-intensity, self-directed anxiety intervention in primary care can greatly expand the reach of anxiety treatment, with minimal need for additional resources. Interpretation bias may be an important clinical target for primary care patients with anxiety.
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Affiliation(s)
- Risa B Weisberg
- VA Boston Healthcare System, Massachusetts, USA.,Department of Psychiatry, Boston University School of Medicine, Massachusetts, USA.,Department of Family Medicine, Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Meghan A Gonsalves
- Neuroscience Graduate Program, Brown University, Providence, Rhode Island, USA
| | - Ramya Ramadurai
- Department of Psychiatry, McLean Hospital, Belmont, Massachusetts, USA
| | | | - Cara Fuchs
- Department of Psychiatry, Boston University School of Medicine, Massachusetts, USA.,Boston Medical Center, Massachusetts, USA
| | - Courtney Beard
- Department of Psychiatry, McLean Hospital, Belmont, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
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22
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Romano M, Moscovitch DA, Saini P, Huppert JD. The effects of positive interpretation bias on cognitive reappraisal and social performance: Implications for social anxiety disorder. Behav Res Ther 2020; 131:103651. [PMID: 32504886 DOI: 10.1016/j.brat.2020.103651] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 04/15/2020] [Accepted: 05/21/2020] [Indexed: 11/15/2022]
Abstract
People with social anxiety disorder (SAD) lack non-socially anxious individuals' tendency to interpret ambiguous social information in a positively biased manner. To gain a better understanding of the specific in-vivo social consequences of positive interpretation bias, we recruited 38 individuals with SAD and 31 healthy controls (HC) to participate in an in-vivo social task. We tested whether a positive interpretation bias, measured using a sentence completion task, might confer benefits for the adaptive emotion regulation strategy of cognitive reappraisal, and whether such benefits depended on participants' emotional states. We also examined whether positive interpretation bias might confer additional benefits such as improved self-perceived and observer-rated social performance. In support of prior research, HC participants exhibited a positive interpretation bias on the sentence completion task, whereas participants with SAD did not. Regression analyses revealed that positive interpretation bias predicted greater cognitive reappraisal during social stress, particularly when state positive affect was low. Moreover, positive interpretation bias predicted more positive self-perception of social performance and reduced underestimations of performance relative to observer ratings. These results suggest that positive interpretations of ambiguous social information may be related to increased use of cognitive reappraisal and more positive self-perceptions of social performance.
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Affiliation(s)
- Mia Romano
- Dept. of Psychology & Centre for Mental Health Research & Treatment, University of Waterloo, Canada
| | - David A Moscovitch
- Dept. of Psychology & Centre for Mental Health Research & Treatment, University of Waterloo, Canada.
| | - Prabhjot Saini
- Dept. of Psychology & Centre for Mental Health Research & Treatment, University of Waterloo, Canada
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23
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Cognitive Bias Modification for the Induction of Negative Versus Benign Interpretations of the Self in Individuals with Elevated Social Anxiety: Effects on Self-related and Anxiety Outcomes. COGNITIVE THERAPY AND RESEARCH 2020. [DOI: 10.1007/s10608-019-10074-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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24
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Podina IR, Cosmoiu A, Rusu P, Chivu A. Positive Thinking is Not Adaptive Thinking: A Cognitive-Behavioral Take on Interpretation Bias Modification for Social Anxiety. JOURNAL OF RATIONAL-EMOTIVE AND COGNITIVE-BEHAVIOR THERAPY 2020. [DOI: 10.1007/s10942-020-00344-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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25
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Biagianti B, Conelea C, Brambilla P, Bernstein G. A systematic review of treatments targeting cognitive biases in socially anxious adolescents: Special Section on "Translational and Neuroscience Studies in Affective Disorders" Section Editor, Maria Nobile MD, PhD. J Affect Disord 2020; 264:543-551. [PMID: 32056778 PMCID: PMC7024067 DOI: 10.1016/j.jad.2019.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 11/13/2019] [Accepted: 12/02/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND Adolescence is a period of brain plasticity that is affected by social and affective stimuli. Adaptive neurodevelopmental changes in the context of complex social situations may precipitate or exacerbate cognitive biases (i.e., attention and/or interpretation biases) and predispose at-risk individuals to symptoms of social anxiety. METHODS This systematic review followed the PRISMA guidelines. Nine adolescent studies were examined including 3 studies using Cognitive Bias Modification Training (CBMT) to target attention biases (CBMT-A), 3 studies using CBMT to target interpretation biases (CBMT-I), and 3 aimed at reducing both attention and interpretation biases. RESULTS The studies of CBMT-A alone did not find significant effects on cognitive and clinical outcomes. However, studies of CBMT-I alone showed some improvement in interpretation bias. The combination of CBMT-A and CBMT-I appeared promising in reducing both attentionl and interpretation biases. LIMITATIONS The paucity of studies and the heterogeneity across studies (e.g., format of CBMT, assessment measures) limit the calculation of overall effect sizes and the examination of predictors, moderators, and mediators of outcome. CONCLUSIONS Technology-driven interventions such as CBMT have the potential to extend treatments outside the clinic setting and to augment current therapies for social anxiety. Further research is needed to develop CBMT procedures that optimize learning in group and real-world settings and to identify predictors of treatment response. Understanding the neural correlates of response to CBMT may help identify future targets for intervention.
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Affiliation(s)
- Bruno Biagianti
- Department of R&D, Posit Science Corporation, San Francisco, CA, USA; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
| | - Christine Conelea
- Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA
| | - Paolo Brambilla
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy,Department of Neurosciences and Mental Health, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Gail Bernstein
- Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA
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26
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Interpretation Bias Modification Versus Progressive Muscle Relaxation for Social Anxiety Disorder: A Web-Based Controlled Trial. Behav Ther 2020; 51:99-112. [PMID: 32005343 DOI: 10.1016/j.beth.2019.05.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 05/13/2019] [Accepted: 05/14/2019] [Indexed: 01/30/2023]
Abstract
Computerized interpretation bias modification (IBM) programs show promise for the treatment of anxiety disorders, though they have rarely been compared to active treatments. The goal of the present study was to compare the efficacy of IBM to progressive muscle relaxation (PMR) for the treatment of social anxiety disorder (SAD). Sixty-four participants with SAD were recruited from across the United States and randomly assigned to 8 internet-delivered twice-weekly sessions of IBM or PMR. Participants were administered assessments of primary symptom outcomes and interpersonal suicide risk factors at posttreatment and 3-month follow-up. IBM led to significantly lower negative interpretation bias than PMR at posttreatment but not follow-up. Both conditions experienced comparable reductions in social anxiety from pretreatment to follow-up (IBM d = 1.37, PMR d = 1.28). They also experienced significant reductions in depression and general anxiety that did not differ from one another. Additionally, IBM led to greater reductions in thwarted belongingness than PMR at posttreatment but not follow-up. Overall, these findings suggest IBM is not more effective than PMR for reducing social anxiety, though there was some evidence of its superiority in decreasing suicide risk. Limitations and directions for future research are discussed.
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27
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Lisk S, Vaswani A, Linetzky M, Bar-Haim Y, Lau JYF. Systematic Review and Meta-Analysis: Eye-Tracking of Attention to Threat in Child and Adolescent Anxiety. J Am Acad Child Adolesc Psychiatry 2020; 59:88-99.e1. [PMID: 31265874 DOI: 10.1016/j.jaac.2019.06.006] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 05/24/2019] [Accepted: 06/26/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Attention biases for threat may reflect an early risk marker for anxiety disorders. Yet questions remain regarding the direction and time-course of anxiety-linked biased attention patterns in youth. A meta-analysis of eye-tracking studies of biased attention for threat was used to compare the presence of an initial vigilance toward threat and a subsequent avoidance in anxious and nonanxious youths. METHOD PubMed, PsycARTICLES, Medline, PsychINFO, and Embase were searched using anxiety, children and adolescent, and eye-tracking-related key terms. Study inclusion criteria were as follows: studies including participants ≤18 years of age; reported anxiety using standardized measures; measured attention bias using eye tracking with a free-viewing task; comparison of attention toward threatening and neutral stimuli; and available data to allow effect size computation for at least one relevant measure. A random effects model estimated between- and within-group effects of first fixations toward threat and overall dwell time on threat. RESULTS Thirteen eligible studies involving 798 participants showed that neither youths with or without anxiety showed significant bias in first fixation to threat versus neutral stimuli. However anxious youths showed significantly less overall dwell time on threat versus neutral stimuli than nonanxious controls (g = -0.26). CONCLUSION Contrasting with adult eye-tracking data and child and adolescent data from reaction time indices of attention biases to threat, there was no vigilance bias toward threat in anxious youths. Instead, anxious youths were more avoidant of threat across the time course of stimulus viewing. Developmental differences in brain circuits contributing to attention deployment to emotional stimuli and their relationship with anxiety are discussed.
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Affiliation(s)
- Stephen Lisk
- Institute of Psychiatry, Psychology and Neuroscience, King's College London
| | - Ayesha Vaswani
- Institute of Psychiatry, Psychology and Neuroscience, King's College London
| | - Marian Linetzky
- School of Psychological Sciences, Tel Aviv University, Israel
| | - Yair Bar-Haim
- School of Psychological Sciences, Tel Aviv University, Israel; Sagol School of Neuroscience, Tel Aviv University, Israel
| | - Jennifer Y F Lau
- Institute of Psychiatry, Psychology and Neuroscience, King's College London.
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28
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What is top-down about seeing enemies? Social anxiety and attention to threat. Atten Percept Psychophys 2019; 82:1779-1792. [DOI: 10.3758/s13414-019-01920-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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29
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Leichsenring F, Steinert C, Ioannidis JPA. Toward a paradigm shift in treatment and research of mental disorders. Psychol Med 2019; 49:2111-2117. [PMID: 31474241 DOI: 10.1017/s0033291719002265] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Falk Leichsenring
- University of Giessen, Department of Psychosomatics and Psychotherapy, 35392 Giessen, Germany
| | - Christiane Steinert
- University of Giessen, Department of Psychosomatics and Psychotherapy, 35392 Giessen, Germany
- MSB Medical School Berlin, Department of Psychology, 12447 Berlin, Germany
| | - John P A Ioannidis
- Stanford University School of Medicine, Department of Medicine, Stanford, CA 94305, USA
- Stanford University School of Medicine, Department of Health Research and Policy, Stanford, CA 94305, USA
- Stanford University School of Medicine, Department of Biomedical Data Science, Stanford, CA 94305, USA
- Stanford University School of Humanities and Sciences, Department of Statistics, Stanford, CA 94305, USA
- Meta-Research Innovation Center at Stanford (METRICS), Stanford, CA 94305, USA
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30
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Linke JO, Jones E, Pagliaccio D, Swetlitz C, Lewis KM, Silverman WK, Bar-Haim Y, Pine DS, Brotman MA. Efficacy and mechanisms underlying a gamified attention bias modification training in anxious youth: protocol for a randomized controlled trial. BMC Psychiatry 2019; 19:246. [PMID: 31391027 PMCID: PMC6686536 DOI: 10.1186/s12888-019-2224-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Accepted: 07/29/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Attention bias modification training (ABMT) and cognitive behavioral therapy (CBT) likely target different aspects of aberrant threat responses in anxiety disorders and may be combined to maximize therapeutic benefit. However, studies investigating the effect of ABMT in the context of CBT have yielded mixed results. Here, we propose an enhanced ABMT to target the attentional bias towards threat, in addition to classic CBT for anxiety disorders in youth. This enhanced ABMT integrates the modified dot-probe task used in previous studies, where a target is always presented at the previous location of the neutral and not the simultaneously presented threatening stimulus, with a visual search, where the targets are always presented distally of threatening distractors. These two training elements (modified dot-probe and visual search) are embedded in an engaging game to foster motivation and adherence. Our goal is to determine the efficacy of the enhanced ABMT in the context of CBT. Further, we aim to replicate two previous findings: (a) aberrant amygdala connectivity being the neurobiological correlate of the attentional bias towards threat at baseline; and (b) amygdala connectivity being a mediator of the ABMT effect. We will also explore moderators of treatment response (age, sex, depressive symptoms and irritability) on a behavioral and neuronal level. METHODS One hundred and twenty youth (8-17 years old) with a primary anxiety disorder diagnosis all receive CBT and are randomized to nine weeks of either active or control ABMT and symptom improvement will be compared between the two study arms. We will also recruit 60 healthy comparison youth, who along with eligible anxious youth, will be assessed with the dot-probe task during fMRI (anxious youth: before and after training; healthy volunteers: second measurement twelve weeks after initial assessment). DISCUSSION The present study will contribute to the literature by (1) potentially replicating that aberrant amygdala connectivity mediates the attentional bias towards threat in anxious youth; (2) determining the efficacy of enhanced ABMT; and (3) advancing our understanding of the mechanisms underlying ABMT. TRIAL REGISTRATION Clinicaltrials.gov: NCT03283930 Trial registration date: September 14th 2017. The trial registration took place retrospectively. Data acquisition started February 1st 2017.
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Affiliation(s)
- Julia O. Linke
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, 9000 Rockville Pike, MSC-2670, Building 15K, Bethesda, MD 20892-2670 USA
| | - Emily Jones
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, 9000 Rockville Pike, MSC-2670, Building 15K, Bethesda, MD 20892-2670 USA
| | - David Pagliaccio
- Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, Columbia University, New York, NY USA
| | - Caroline Swetlitz
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, 9000 Rockville Pike, MSC-2670, Building 15K, Bethesda, MD 20892-2670 USA
| | - Krystal M. Lewis
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, 9000 Rockville Pike, MSC-2670, Building 15K, Bethesda, MD 20892-2670 USA
| | | | - Yair Bar-Haim
- School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Daniel S. Pine
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, 9000 Rockville Pike, MSC-2670, Building 15K, Bethesda, MD 20892-2670 USA
| | - Melissa A. Brotman
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, 9000 Rockville Pike, MSC-2670, Building 15K, Bethesda, MD 20892-2670 USA
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31
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Abstract
Advances in the study of brain networks can be applied to our understanding of anxiety disorders (eg, generalized anxiety, obsessive-compulsive, and posttraumatic stress disorders) to enable us to create targeted treatments. These disorders have in common an inability to control thoughts, emotions, and behaviors related to a perceived threat. Here we review animal and human imaging studies that have revealed separate brain networks related to various negative emotions. Research has supported the idea that brain networks of attention serve to control emotion networks as well as the thoughts and behaviors related to them. We discuss how attention networks can modulate both positive and negative affect. Disorders arise from both abnormal activation of negative affect and a lack of attentional control. Training attention has been one way to foster improved attentional control. We review attention training studies as well as efforts to generally improve attention networks through stimulation in self-regulation.
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Beard C, Rifkin LS, Silverman AL, Björgvinsson T. Translating CBM-I Into Real-World Settings: Augmenting a CBT-Based Psychiatric Hospital Program. Behav Ther 2019; 50:515-530. [PMID: 31030870 DOI: 10.1016/j.beth.2018.09.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 09/05/2018] [Accepted: 09/06/2018] [Indexed: 11/28/2022]
Abstract
Cognitive bias modification for interpretation (CBM-I) is an appealing augmentation to cognitive-behavioral therapy (CBT) because it targets cognitive bias efficiently via computerized training. Few studies have tested the combination of CBM-I and CBT, and none have translated lab-based CBM-I protocols to an acute psychiatric setting. The present study describes the development and implementation of CBM-I as an augmentation to a CBT-based partial hospital. We developed a transdiagnostic CBM-I based on the word-sentence association paradigm (WSAP), which reinforces individuals for endorsing benign interpretations and rejecting negative interpretations of ambiguous sentences. Over two iterations of development, we randomly assigned patients (N = 127; M age = 34.21; 58% female, 40% male, 2% nonbinary) to either CBM-I or a control group (Phase 1: neutral WSAP task; Phase 2: treatment as usual). CBM-I comprised daily sessions (10 minutes) completed during program hours, and number of sessions varied naturalistically according to patient length of stay. Primary outcomes included feasibility, acceptability, and target engagement (interpretation bias). CBM-I was feasible and acceptable to acute psychiatric patients, and successfully shifted interpretation for novel stimuli. Patient feedback suggested that participants viewed CBM-I as bolstering their primary CBT-based care. Exploratory analyses examining clinical benefit revealed a small between-group effect on anxiety severity (d = 0.378), but no group differences on depression outcomes (d = 0.008). Findings indicate that CBM-I is a feasible and acceptable augmentation to CBT-based partial hospital care. Future studies are warranted to determine who is most likely to benefit from this low-intensity approach.
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Huppert JD, Kivity Y, Cohen L, Strauss AY, Elizur Y, Weiss M. A pilot randomized clinical trial of cognitive behavioral therapy versus attentional bias modification for social anxiety disorder: An examination of outcomes and theory-based mechanisms. J Anxiety Disord 2018; 59:1-9. [PMID: 30103187 DOI: 10.1016/j.janxdis.2018.08.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Revised: 07/11/2018] [Accepted: 08/04/2018] [Indexed: 12/15/2022]
Abstract
No studies have compared face-to-face cognitive-behavioral therapy (CBT) and attention bias modification (ABM) for social anxiety disorder (SAD) and their purported mechanisms. We asked: 1) Is CBT more effective than ABM? and 2) Are changes in attentional biases and cognitions temporally related to symptom change? Forty-three patients were randomly assigned to 8 sessions of ABM or up to 20 sessions of individual CBT. Intent-to-treat results revealed that CBT was superior to ABM in response rates and on symptom measures at endpoint, but not on other measures. No differences were found on measures in rates of change between CBT and ABM. Frequency of negative cognitions changed in both groups and negative beliefs changed only in CBT. Attentional bias did not change in either group. Cognitive changes bidirectionally correlated with symptom change in cross-lagged analyses in CBT, but not in ABM, suggesting a reciprocal relationship. Trial-level bias away from negative faces was simultaneously related to symptom change in ABM only. Results suggest that CBT is superior to ABM when administered at their typical doses, but raise questions given the similar rates of change. In addition, results support theories of cognitive change and raise questions about changes in attentional biases in CBT.
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Affiliation(s)
| | - Yogev Kivity
- Department of Psychology, The Hebrew University of Jerusalem, Israel
| | - Lior Cohen
- Department of Psychology, The Hebrew University of Jerusalem, Israel
| | - Asher Y Strauss
- Department of Psychology, The Hebrew University of Jerusalem, Israel
| | - Yoni Elizur
- Department of Psychology, The Hebrew University of Jerusalem, Israel
| | - Michal Weiss
- Department of Psychology, The Hebrew University of Jerusalem, Israel
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Rawdon C, Murphy D, Motyer G, Munafò MR, Penton-Voak I, Fitzgerald A. An investigation of emotion recognition training to reduce symptoms of social anxiety in adolescence. Psychiatry Res 2018; 263:257-267. [PMID: 29602534 DOI: 10.1016/j.psychres.2018.02.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 02/06/2018] [Accepted: 02/06/2018] [Indexed: 12/21/2022]
Abstract
This study aimed to examine the effect of emotion recognition training on social anxiety symptoms among adolescents, aged 15-18 years. The study included a screening session, which identified participants who scored above a cut-off on a self-report measure of social anxiety for enrolment into a randomized controlled trial (Clinical Trials ID: NCT02550379). Participants were randomized to an intervention condition designed to increase the perception of happiness over disgust in ambiguous facial expressions or a sham intervention control condition, and completed self-report measures of social anxiety, fear of negative evaluation, anxiety-related disorders, and depressive symptoms. The intervention group demonstrated a strong shift in the balance point at which they perceived happiness over disgust in ambiguous facial expressions. This increase in positive perception was not associated with any changes in the primary outcome of social anxiety; however, some evidence of improvement in symptomatology was observed on one of a number of secondary outcomes. Those in the intervention group had lower depression symptoms at 2-week follow-up, compared to those in the control group who received the sham intervention training. Potential reasons for why the shift in balance point measurement was not associated with a concurrent shift in symptoms of social anxiety are discussed.
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Affiliation(s)
- Caroline Rawdon
- School of Nursing and Human Sciences, Dublin City University, Glasnevin, Dublin 9, Ireland.
| | - Daria Murphy
- University College Dublin School of Psychology, Newman Building Belfield, Dublin 4 Dublin, Leinster Ireland.
| | - Gillian Motyer
- University College Dublin School of Psychology, Newman Building Belfield, Dublin 4 Dublin, Leinster Ireland.
| | - Marcus R Munafò
- School of Experimental Psychology, University of Bristol, 12a Priory Road, Bristol BS8 1TU, United Kingdom; MRC Integrative Epidemiology Unit, University of Bristol, 12a Priory Road, Bristol BS8 1TU, United Kingdom; National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, United Kingdom.
| | - Ian Penton-Voak
- School of Experimental Psychology, University of Bristol, 12a Priory Road, Bristol BS8 1TU, United Kingdom; National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, United Kingdom.
| | - Amanda Fitzgerald
- University College Dublin School of Psychology, Newman Building Belfield, Dublin 4 Dublin, Leinster Ireland.
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