Predicting CBT modality, treatment participation, and reliable improvements for individuals with anxiety and depression in a specialized mental health centre: a retrospective population-based cohort study.

BACKGROUND: Cognitive Behaviour Therapy (CBT) is one of the most successful therapeutic approaches for treating anxiety and depression. Clinical trials show that for some clients, internet-based CBT (eCBT) is as effective as other CBT delivery modes. However, the fidelity of these effects may be weakened in real-world settings where clients and providers have the freedom to choose a CBT delivery mode and switch treatments at any time. The purpose of this study is to measure the CBT attendance rate and identify client-level characteristics associated with delivery mode selection and having reliable and clinically significant improvement (RCSI) of treatment in each delivery mode in a real-world CBT outpatient program. METHODS: This is a retrospective cohort analysis of electronic medical records collected between May 1, 2019, and March 31, 2022, at Ontario Shores Centre for Mental Health Sciences. Regression models were used to investigate the impact of individual client characteristics on participation and achieving RCSI of different CBT delivery modes. RESULTS: Our data show a high attendance rate for two and more CBT sessions across all modalities (98% of electronic, 94% of group, 100% of individual, and 99% of mixed CBT). Individuals were more likely to enter mixed and group CBT modality if they were younger, reported being employed, and reported higher depression severity at the baseline. Among the four modalities of CBT delivery, group CBT clients were least likely to have RCSI. Of those who started sessions, clients were significantly more likely to experience RCSI on the Patient Health Questionnaire (PHQ)-9 and the Generalized Anxiety Disorder (GAD)-7 if they were employed, reported more severe symptoms at baseline, and were living in the most deprived neighborhoods. CONCLUSIONS: This study will contribute to the body of knowledge about the implementation and treatment planning of different CBT delivery modes in real-world settings. With the changing clinical environment, it is possible to advocate for the adoption of the eCBT intervention to improve therapy practices and achieve better treatment success. The findings can help guide future CBT program planning based on client socio-demographic characteristics, allowing the optimal therapy type to be targeted to the right client at the right time.

Examining Cognitive Biases Uniquely Associated with Schizotypy.

INTRODUCTION: Individuals with schizotypy can experience a number of cognitive biases that may increase their risk in developing schizophrenia-spectrum psychopathology. However, cognitive biases are also present in mood and anxiety disorders, and it is currently unclear which biases are specific to schizotypy and which may be a result of comorbid depression and/or anxiety. METHODS: 462 participants completed measures of depression, anxiety, cognitive biases, cognitive schemas, and schizotypy. Correlation analyses were conducted to examine the relationship between these constructs. Three hierarchical regression analyses were conducted to examine if schizotypy, depression, and anxiety explained a statistically significant amount of variance in cognitive biases after controlling for depression and anxiety, schizotypy and anxiety, and schizotypy and depression, respectively. Moderated regression analyses were also conducted to investigate the moderating role of biological sex and ethnicity in the association between cognitive biases and schizotypy. RESULTS: Self-referential processing, belief inflexibility, and attention for threat were associated with schizotypy. The belief inflexibility bias and social cognition problems were specifically associated with schizotypy after controlling for depression and anxiety and were not directly associated with either depression or anxiety. These associations were not moderated by biological sex or ethnicity. CONCLUSION: The belief inflexibility bias may be an important cognitive bias underlying schizotypal personality, and further research will be important to determine whether this bias is also associated with an increased likelihood of transitioning to psychosis.

COVID-19 conspiracy beliefs: Relations with anxiety, quality of life, and schemas.

BACKGROUND: The COVID-19 pandemic has produced a worldwide mental health crisis. Conspiracy beliefs regarding the origin of COVID-19 are prevalent, however, mental health consequences and factors associated with the likelihood of endorsing COVID-19 conspiracy theories have not yet been examined. The current study examined predictors and mental health consequences of conspiracy beliefs. METHODS: Participants in Canada and the United States were surveyed via Amazon Mechanical Turk in April 2020 (N = 797), approximately one month after the WHO declared COVID-19 a pandemic, and again in May 2020 (N = 395). RESULTS: Approximately half of the sample (49.7%) believed at least one conspiracy theory. Greater Covid-19 conspiracy beliefs were associated with more anxiety at follow up but not quality of life. Religiosity/spirituality, not knowing someone at high-risk for COVID-19, and non-white ethnicity were associated with greater conspiracy beliefs. Lower positive other-schemas were associated with greater conspiracy beliefs, only at low and moderate levels of positive self-schemas. CONCLUSIONS: There is substantial conspiracy belief endorsement during the COVID-19 pandemic and conspiracy beliefs are associated with anxiety, but not quality of life. Positive self-schemas protect against believing conspiracy theories and interventions to increase positive self-schemas may be effective to reduce the negative effects of conspiracy beliefs.

Information seeking and health anxiety during the COVID-19 pandemic: The mediating role of catastrophic cognitions.

Cognitive-behavioural models of health anxiety propose a positive association between information seeking and health anxiety; however, it is unclear the extent to which cognitive mechanisms may mediate this relationship. Catastrophic cognitions are one type of cognition that may mediate this relationship, and the COVID-19 pandemic has presented an opportunity to examine these relationships within the context of a global health catastrophe. The current study investigated both cross-sectional (N = 797) and longitudinal (n = 395) relationships between information seeking, health anxiety and catastrophizing during the pandemic. Data were collected using Amazon Mechanical Turk during April and May 2020. Information seeking and health anxiety were positively associated both cross-sectionally and longitudinally (rs = .25-.29). Catastrophic cognitions significantly mediated the relationship between information seeking and health anxiety both cross-sectionally and longitudinally. Developing effective methods of reducing information seeking and catastrophizing may serve to reduce health anxiety during global health crises such as the current pandemic.

Cognitive and functional deficits in bipolar disorder and schizophrenia as a function of the presence and history of psychosis.

OBJECTIVES: Schizophrenia and bipolar disorder overlap considerably. Schizophrenia is a primary psychotic disorder, whereas approximately half of people with bipolar disorder will experience psychosis. In this study, we examined the extent to which cognitive and functional impairments are related to the presence and history of psychosis across the two disorders. METHOD: A total of 633 participants with bipolar disorder I, schizophrenia, and schizoaffective disorder were recruited for a study on the genetics of cognition and functioning in bipolar disorder and schizophrenia. Participants were classified into five groups: bipolar disorder with current psychosis (N = 30), bipolar disorder with a history of psychosis (N = 162), bipolar disorder with no history of psychosis (N = 92), schizophrenia with current psychosis (N = 245), and schizophrenia with past psychosis (N = 104). RESULTS: Cognitive profiles of all groups were similar in pattern; however, both current psychosis (P < .02) and a diagnosis of schizophrenia (P < .03) were associated with greater impairment. Schizophrenia with current psychosis was also associated with a superimposed severe impairment in processing speed. Both psychosis (P < .03) and schizophrenia diagnosis (P < .01) were associated with poorer functional competence. Individuals with bipolar disorder and schizophrenia experienced similar impairments in real-world functioning if they were experiencing current psychosis (P = .32). CONCLUSION: The presence of active psychosis is an important cross-diagnostic factor in cognition and functioning in both schizophrenia and bipolar disorder. Characterization and treatment of cognition and functional deficits in bipolar disorder should consider the effects of both current and history of psychosis.

Neurocognition, functional competence and self-reported functional impairment in psychometrically defined schizotypy.

INTRODUCTION: Schizotypy is phenologically and genetically related to schizophrenia-spectrum illness. Previous studies find cognitive function to be mildly impaired, but specific impairments and their relationship to functioning are not well understood. In this study, we sought to examine how cognitive load affects performance in schizotypy and to examine whether impairments might manifest in functional capacity and quality of life. METHODS: Undergraduate students were screened for abnormally high levels of schizotypy (N = 72) and compared to those without psychopathology (N = 80) on a standard battery of neuropsychological tests, cognitive tests with varying cognitive load, functional capacity measures and quality of life. RESULTS: The high schizotypy group did not differ from controls on traditional measures of neuropsychological functioning, but an interaction of group by cognitive load was observed, where those with schizotypy manifested a greater decline in performance as information processing load was parametrically increased. Differences in functioning were observed and cognitive impairment was associated with impaired functioning. CONCLUSIONS: Cognitive and functional impairment can be observed in those with high schizotypal traits who are non-treatment seeking. The sensitivity of cognitive tests to impairment in this population might be a function of their ability to parametrically increase cognitive load.

Examining the influence of self-referential thinking on aberrant salience and jumping to conclusions bias in individuals with schizophrenia-spectrum disorders.

BACKGROUND AND OBJECTIVES: Cognitive processes such as aberrant salience and the jumping to conclusions (JTC) bias are implicated in the development of delusions. Self-referential thinking is implicated in this process; however, it is unknown how it may interact with aberrant salience and JTC bias in individuals with schizophrenia-spectrum disorders (SSDs). This study examined associations of self-referential thinking with aberrant salience, JTC bias, and delusion severity, and whether self-referential stimuli led to an increase in aberrant salience and JTC bias in SSDs (n = 20) relative to psychiatrically healthy controls (n = 20). METHODS: To assess aberrant salience and JTC bias, participants were asked to complete both self-referential and neutral versions of the Salience Attribution Test (SAT) and the Beads Task, as well as self-report measures of aberrant salience and JTC bias. RESULTS: Self-referential task condition interacted with clinical group to predict JTC beads task scores, such that participants with SSDs exhibited greater levels of JTC bias than psychiatrically healthy controls during the neutral task condition, when controlling for levels of motivation, cognitive insight, and functioning. Self-referential thinking was significantly associated with aberrant salience, JTC bias, and delusion severity. LIMITATIONS: This experiment examined trait-level relationships between variables, so does not provide information about state-level interrelationships and would benefit from replication using more dynamic methods such as ecological momentary assessment. CONCLUSIONS: These findings highlight the interrelationships between self-referential thinking, JTC bias, aberrant salience, and delusion severity, in individuals with SSDs, and support the interactive role of self-referential thinking in predicting JTC bias.

Examining the effects of diagnostic awareness, positive symptoms, and negative symptoms on stigmatizing attitudes and social exclusion towards schizophrenia.

BACKGROUND: Social exclusion towards schizophrenia can occur as a response to symptom presentations and/or diagnostic knowledge. The present study examined stigma towards schizophrenia as a function of diagnostic awareness, positive symptoms, and negative symptoms. METHODS: 559 participants were presented with one of eight vignettes depicting an individual in a social situation based on a 2 (label: present, absent) x 2 (positive symptoms: present, absent) x 2 (negative symptoms: present, absent) design. Participants then completed various measures of social exclusion and stigmatizing attitudes. RESULTS: A significant three-way interaction between positive symptoms, negative symptoms, and a diagnostic label was found for stigmatizing attitudes such that knowledge of diagnosis was associated with less stigma when symptoms were present but resulted in more stigma when symptoms were absent. A significant interaction between diagnostic label and negative symptoms was found on social distance such that knowledge of diagnosis increased desire for social distance when negative symptoms were present. CONCLUSION: Diagnostic awareness increases stigmatizing attitudes and social distance when symptoms are not present. However, when contextualized with the presence of symptoms, diagnostic awareness may reduce exclusion by providing an explanation for those symptoms. Determining when and to whom to disclose one's diagnosis may be helpful to improve social functioning in schizophrenia.

Borderline personality disorder stigma: Examining the effects of diagnostic disclosure, behavior, and gender as sources of stigma in the general population.

Borderline personality disorder (BPD) is a severe mental disorder characterized by a pervasive pattern of emotional and behavioral dysregulation. Dysfunction and distress may be compounded by stigmatizing beliefs held by members of the community. There is a lack of research focusing on stigmatizing beliefs about BPD held by the general population. This study addressed this gap by examining the relationship between BPD and a variety of stigma domains in a community sample. The current study explored whether (a) stigma is more strongly related to BPD symptomatic behavior or the diagnostic label of BPD, (b) attaching a diagnosis of BPD to symptomatic behavior or nonclinical behavior influences stigma, and (c) the gender of a vignette character influences the stigmatization of BPD. A total of 295 participants read vignettes and completed questionnaires assessing stigma type and intensity. Findings from the current study suggest that stigma is higher for BPD symptomatic behavior than for the diagnosis itself. Attaching a diagnostic label of BPD to BPD symptomatic behavior did not significantly impact the resultant stigma; however, the diagnosis was found to increase stigma for nonclinical behavior. Findings concerning BPD stigma and gender are in line with broader gender stereotypes. Specifically, there was greater pity for women displaying BPD behavior, whereas there was greater anger for men displaying the same behavior. BPD symptomatic behavior vignettes depicting a man also received a higher level of dangerousness and fear. Study limitations and future directions are discussed. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Culturally adapted cognitive behavioral therapy for psychosis (CaCBTp): A review of key features of cultural adaptation and considerations for psychologists.

Cognitive behavioral therapy for psychosis is an effective treatment for psychosis. However, psychosis presents differentially according to an individual's cultural context, and it is currently unclear which methods have been used to formulate culturally adapted cognitive behavioral therapy for psychosis (CaCBTp). The current systematic review examines the approaches to CaCBTp that have been evaluated to date and comments on preliminary evidence for the efficacy of CaCBTp. Key features of CaCBTp interventions are discussed in reference to broader cultural adaptations of psychosocial interventions for psychosis and culturally adapted cognitive behavioral therapy for other disorders. Overall, our results identified 12 studies and highlighted five overarching themes of cultural adaptation that clinicians should integrate into the design of future CaCBTp interventions, including family members in treatment, targeting stigma, relying on spiritual leaders, using multifaceted models of mental health, and ensuring adequate language match. The results of this review also highlight the paucity of literature in global CaCBTp interventions, as only 10 studies examining CaCBTp interventions were found. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Overlap between individual differences in cognition and symptoms of schizophrenia.

BACKGROUND: Neurocognitive impairment is a core feature of schizophrenia spectrum disorders (SSDs), and the relationship between cognition and symptoms in SSDs has been widely researched. Negative symptoms are related to a wide range of cognitive impairments; however, the aspects of negative symptoms that underpin this relationship have yet to be specified. STUDY DESIGN: We used iterative Constrained Principal Component Analysis (iCPCA) to explore the relationship between 18 cognitive measures (including processing speed, attention, working, spatial and verbal memory and executive functions) and 46 symptoms in schizophrenia at the individual item level while minimizing the risk of Type I errors. ICPCA was conducted on a sample of SSD patients in the early stages of psychiatric treatment (n = 121) to determine the components of cognition overlapping with symptoms measured by the Scale for the Assessment of Negative Symptoms (SANS) and the Scale for the Assessment of Positive Symptoms (SAPS). RESULTS: We found that a verbal memory component was associated with items from SANS and SAPS related to impoverished and disorganized emotional communication, language, and thought. In contrast, a working memory component was associated with SANS items related to motor system impoverishment. CONCLUSIONS: The iCPCA allowed us to explore the associations between individual items, optimized to understand the overlap between symptoms and cognition. The specific symptoms linked to verbal and working memory impairments imply distinct brain networks, which further investigation may lead to our deeper understanding of the illness and the development of treatment methods.

Utility of the Berlin questionnaire for predicting obstructive sleep apnea in individuals with treatment-resistant depression.

PURPOSE: Obstructive sleep apnea is a disabling sleep disorder characterized by obstructions or near obstructions of the upper airway. Sleep apnea shares many common features with major depressive disorder, which is a serious psychiatric disorder that can persist despite multiple treatment attempts. The current study utilizes baseline data from a study designed to evaluate the effectiveness of continuous positive airway pressure treatment in patients with comorbid treatment-resistant depression and sleep apnea. The aim of this study is to examine the effectiveness of the Berlin questionnaire in predicting which individuals with treatment-resistant depression have obstructive sleep apnea. METHODS: Eighty-two outpatients with treatment-resistant depression completed the Berlin questionnaire and underwent overnight polysomnography to determine whether they were suffering from undiagnosed obstructive sleep apnea. RESULTS: Scoring in the high-risk category on the Berlin questionnaire predicted an apnea/hypopnea index greater than 5 with a sensitivity of 25 % and a specificity of 85.4 %, an apnea/hypopnea index greater than 10 with a sensitivity of 24.5 % and a specificity of 91.7 %, and an apnea/hypopnea index greater than 15 with a sensitivity of 22.2 % and a specificity of 92.9 %. The Berlin questionnaire was better at predicting the presence of sleep apnea in our sample of predominantly pre-menopausal women than men, and category 2 of the questionnaire (daytime somnolence) was the poorest predictor of sleep apnea. CONCLUSIONS: The Berlin questionnaire appears to be a valid instrument for ruling out obstructive sleep apnea in treatment-resistant depression and may be a helpful tool in assisting with the allocation of diagnostic resources.

Examining the Role of Failure and Success Experiences on Task Persistence and Neurocognition in Schizophrenia-Spectrum Disorders.

BACKGROUND: Recent theoretical models suggest that a variety of psychological and contextual factors account for a significant proportion of the observed neurocognitive impairment in schizophrenia-spectrum disorders (SSD). Numerous non-neurocognitive mechanisms of neurocognitive functioning have been proposed that warrant investigation; however, few studies have empirically examined these factors. This cross-over study examined whether the experience of failure or success affects task persistence and neurocognition differentially between individuals with SSD and healthy controls. METHODS: Twenty-nine participants with SSD and 30 healthy controls (Mage = 29.33, SD = 10.72) completed success and failure inductions, psychological questionnaires, an anagram persistence task, and brief neurocognitive testing remotely at two time-points. RESULTS: Both groups demonstrated significantly lower persistence and worse decision-making skills in the failure condition relative to the success condition. Individuals with SSD demonstrated slower processing speed, but this was not affected by prior failure or success. CONCLUSIONS: This study demonstrates that the experience of failure is similarly detrimental to persistence and decision-making in healthy controls and individuals with SSD but does not contribute to processing speed performance. This suggests that higher-order executive functions are more susceptible to manipulation by contextual factors compared to lower-order cognitive functions.

Efficacy of Remotely Delivered Evidence-Based Psychosocial Treatments for Schizophrenia-Spectrum Disorders: A Series of Systematic Reviews and Meta-Analyses.

BACKGROUND: Schizophrenia is among the most persistent and debilitating mental health conditions worldwide. The American Psychological Association (APA) has identified 10 psychosocial treatments with evidence for treating schizophrenia and these treatments are typically provided in person. However, in-person services can be challenging to access for people living in remote geographic locations. Remote treatment delivery is an important option to increase access to services; however, it is unclear whether evidence-based treatments for schizophrenia are similarly effective when delivered remotely. STUDY DESIGN: The current study consists of a series of systematic reviews and meta-analyses examining the evidence-base for remote-delivery of each of the 10 APA evidence-based treatments for schizophrenia. RESULTS: Of the 10 treatments examined, only cognitive remediation (CR), cognitive-behavioral therapy (CBT), and family psychoeducation had more than 2 studies examining their efficacy for remote delivery. Remote delivery of CBT produced moderate effects on symptoms (g = 0.43) and small effects on functioning (g = 0.26). Remote delivery of CR produced small-moderate effects on neurocognition (g = 0.35) and small effects on functioning (g = 0.21). There were insufficient studies of family psychoeducation with equivalent outcome measures to assess quantitatively, however, studies of remotely delivered family psychoeducation suggested that it is feasible, acceptable, and potentially effective. CONCLUSIONS: Overall, the evidence-base for remotely delivered treatment for schizophrenia is limited. Studies to date suggest that remote adaptations may be effective; however, more rigorous trials are needed to assess efficacy and methods of remote delivery that are most effective.

Social exclusion in psychotic disorders: An interactional processing model.

Psychotic disorders are among the most highly stigmatized mental disorders, and individuals with psychosis experience significant exclusion from the community. Stigma reduction programs have done little to reduce social exclusion of individuals with psychosis, and there are significant limitations to the traditional stigma model as it applies to social exclusion. Herein, we present the Interactional Processing Model (IPM) of social exclusion towards individuals with psychosis. The IPM considers social exclusion to be the result of two interacting pathways with additional consideration for a feedback loop through which social exclusion sets in motion natural behavioural responses of individuals with psychosis that inadvertently perpetuates exclusion. The IPM considers initial social exclusion to be the result of an interaction between these two pathways. The first path aligns with the traditional stigma model and consists of the community becoming aware that an individual is diagnosed with a psychotic disorder and then excluding the individual based on pre-existing, generalized knowledge about the disorder. The second path to exclusion involves the observation of atypical behaviours from the individual, and generation of an individualized exclusion response. We provide initial empirical support for the IPM of social exclusion, outline testable hypotheses stemming from the model, and discuss implications for novel ways to consider both societal stigma reduction and personalized intervention.

Can cognitive remediation therapy be delivered remotely? A review examining feasibility and acceptability of remote interventions.

Cognitive remediation (CR) is an effective treatment for schizophrenia. However, issues such as motivational impairments, geographic limitations, and limited availability of specialized clinicians to deliver CR, can impede dissemination. Remote delivery of CR provides an opportunity to implement CR on a broader scale. While empirical support for the efficacy of in-person CR is robust, the evidence-base for virtual delivery of CR is limited. Thus, in this review we aimed to evaluate the feasibility and acceptability of remote CR interventions. Nine (n = 847) fully remote and one hybrid CR intervention were included in this review. Attrition rates for remote CR were generally high compared to control groups. Acceptability rates for remote CR interventions were high and responses from caregivers were positive. Further research using more methodologically rigorous designs is required to evaluate appropriate adaptations for remote treatment and determine which populations may benefit more from remote CR.

Examining the association of life course neurocognitive ability with real-world functioning in schizophrenia-spectrum disorders.

There is considerable variability in neurocognitive functioning within schizophrenia-spectrum disorders, and neurocognitive performance ranges from severe global impairment to normative performance. Few investigations of neurocognitive clusters have considered the degree to which deterioration relative to premorbid neurocognitive abilities is related to key illness characteristics. Moreover, while neurocognition and community functioning are strongly related, understanding of the sources of variability in the association between these two domains is also limited; it is unknown what proportion of participants would over-perform or under-perform the level of functioning expected based on current neurocognitive performance vs. lifelong attainment. This study examined data from 954 outpatients with schizophrenia-spectrum disorders across three previous studies. Neurocognition, community functioning, and symptoms were assessed. Neurocognitive subgroups were created based on current neurocognition, estimated premorbid IQ, and degree of deterioration from premorbid using z-score cut-offs; functional subgroups were created with cluster analysis based on the Specific Level of Functioning Scale and current neurocognition. The sample was neurocognitively heterogeneous; 65% displayed current neurocognitive impairment and 84% experienced some level of deterioration. Thirty percent of our sample was relatively higher functioning despite significant neurocognitive impairment. Individuals with better community functioning, regardless of neurocognitive performance, had lower symptom severity compared to those with worse functioning. These results highlight the variability in neurocognition and its role in functioning. Understanding individual differences in neurocognitive and functional profiles and the interaction between prior and current cognitive functioning can guide individualized treatment and selection of participants for clinical treatment studies.

Stigma towards individuals with schizophrenia: Examining the effects of negative symptoms and diagnosis awareness on preference for social distance.

Social exclusion towards individuals with schizophrenia can occur as a result of stigmatizing attitudes towards the diagnosis or as a response to observing atypical behaviours resulting from symptoms. The present study examined social exclusion towards schizophrenia as a function of diagnosis awareness and presence of negative symptoms. 64 healthy participants watched four different videos of confederates who were either labelled / not labelled with schizophrenia and displayed / did not display negative symptoms. Participants ranked their preference for social interaction with individuals in ten different activities and were told that they would complete the activities based on their rankings. A significant interaction between label and symptoms was found as knowledge of diagnosis increased desire for social distance if symptoms were absent and decreased desire for social distance if symptoms were present. A main effect of symptom presence was also found as participants displayed greater desire to complete activities with individuals not displaying symptoms than participants displaying symptoms but there was no effect of diagnostic label. Social exclusion appears to be dependent on both presence of negative symptoms and knowledge of diagnosis. It may be useful to focus on increasing public acceptance of specific symptom presentations in public mental health campaigns.

Predictors and consequences of loneliness during the COVID-19 Pandemic.

The COVID-19 pandemic has created a global context in which social isolation has become normative in order to reduce the risk of COVID-19 transmission. As a result of social distancing policies, the risk for loneliness and associated decline in quality of life has increased. The current study examined factors associated with loneliness and quality of life during the COVID-19 pandemic cross-sectionally (n = 797) and longitudinally (n = 395). Older age and larger social network size were associated with less loneliness, whereas having multiple physical or mental health diagnoses was associated with greater loneliness. Greater virtual social contact was also associated with increased loneliness. Greater loneliness was associated with all domains of quality of life both cross-sectionally and longitudinally. Understanding factors associated with loneliness is critical to developing effective strategies at reducing loneliness and improving quality of life during the pandemic. Contrary to popular perceptions, older age was associated with less loneliness and more virtual social contact was associated with more loneliness. Thus, it may be prudent to deemphasize virtual social contact in public campaigns and to emphasize safe methods of interacting in person.

Attention bias modification in depression: A randomized trial using a novel, reward-based, eye-tracking approach.

BACKGROUND AND OBJECTIVES: Biased attention to negative information is a mechanism for risk and relapse in depression. Attentional bias modification (ABM) paradigms manipulate attention away from negative information to reduce this bias. ABM results have been mixed due to inconsistent methodologies and stimuli design. This randomized controlled trial used a novel approach to modifying attentional bias. METHODS: An eye tracker manipulated stimuli in response to participants' fixations to preferentially reward attention to positive stimuli by obscuring or enhancing image quality of negative and positive stimuli, respectively. Participants with major depressive disorder completed three 35-min sessions of active (n = 20) or sham (n = 20) ABM training. Attentional bias, memory for emotional words, and mood were assessed pre- and post-training. RESULTS: Training reduced negative attentional bias; relative to sham, active training participants focused significantly more on positive compared to negative stimuli in a free-viewing eye-tracker task (p = .038, ηp2 = 0.109) and, at trend, disengaged from sad information more quickly in a computerized task (p = .052, ηp2 = 0.096). Active training participants remembered more happy than sad words in an emotional word learning task, indicating a distal transfer of training to emotional memory (p = .036, ηp2 = 0.11). Training did not significantly affect mood in the one-week trial. LIMITATIONS: Future studies should build on this proof-of-principle study with larger sample sizes and more intensive treatment to explore which mechanisms of training may lead to improvements in mood. CONCLUSIONS: Attention biases in depression are modifiable through reward-based, eye-tracking training. These data suggest generalizability of training to other cognitive faculties - recall for affective information.