Benefits of adaptive cognitive training on cognitive abilities in women treated for primary breast cancer: Findings from a 1-year randomised control trial intervention.

OBJECTIVE: While adaptive cognitive training is beneficial for women with a breast cancer diagnosis, transfer effects of training benefits on perceived and objective measures of cognition are not substantiated. We investigated the transfer effects of online adaptive cognitive training (dual n-back training) on subjective and objective cognitive markers in a longitudinal design. METHODS: Women with a primary diagnosis of breast cancer completed 12 sessions of adaptive cognitive training or active control training over 2 weeks. Objective assessments of working memory capacity (WMC), as well as performance on a response inhibition task, were taken while electrophysiological measures were recorded. Self-reported measures of cognitive and emotional health were collected pre-training, post-training, 6-month, and at 1-year follow-up times. RESULTS: Adaptive cognitive training resulted in greater WMC on the Change Detection Task and improved cognitive efficiency on the Flanker task together with improvements in perceived cognitive ability and depression at 1-year post-training. CONCLUSIONS: Adaptive cognitive training can improve cognitive abilities with implications for long-term cognitive health in survivorship.

Using clustering algorithms to examine the association between working memory training trajectories and therapeutic outcomes among psychiatric and healthy populations.

Working memory (WM) training has gained interest due to its potential to enhance cognitive functioning and reduce symptoms of mental disorders. Nevertheless, inconsistent results suggest that individual differences may have an impact on training efficacy. This study examined whether individual differences in training performance can predict therapeutic outcomes of WM training, measured as changes in anxiety and depression symptoms in sub-clinical and healthy populations. The study also investigated the association between cognitive abilities at baseline and different training improvement trajectories. Ninety-six participants (50 females, mean age = 27.67, SD = 8.84) were trained using the same WM training task (duration ranged between 7 to 15 sessions). An algorithm was then used to cluster them based on their learning trajectories. We found three main WM training trajectories, which in turn were related to changes in anxiety symptoms following the training. Additionally, executive function abilities at baseline predicted training trajectories. These findings highlight the potential for using clustering algorithms to reveal the benefits of cognitive training to alleviate maladaptive psychological symptoms.

A neurocognitive account of attentional control theory: how does trait anxiety affect the brain's attentional networks?

Attentional control theory (ACT) was proposed to account for trait anxiety's effects on cognitive performance. According to ACT, impaired processing efficiency in high anxiety is mediated through inefficient executive processes that are needed for effective attentional control. Here we review the central assumptions and predictions of ACT within the context of more recent empirical evidence from neuroimaging studies. We then attempt to provide an account of ACT within a framework of the relevant cognitive processes and their associated neural mechanisms and networks, particularly the fronto-parietal, cingular-opercula, and default mode networks. Future research directions, including whether a neuroscience-informed model of ACT can provide a platform for novel neurocognitive intervention for anxiety, are also discussed.

Exploring primary breast cancer survivors' self-management of sustained cancer-related cognitive impairment in the workplace.

OBJECTIVE: Work plays a central role in return to a more 'normal' life among women diagnosed with primary breast cancer. However, ongoing cancer-related cognitive impairment (CRCI) and cancer-related sequelae continue to detrimentally impact workability. Only a few studies have explored the long-term consequences of CRCI and self-management coping strategies applied in the workplace. This study explored women's experiences of sustained post-treatment CRCI and its impact on workability beyond the initial return-to-work (RTW), as well as experiences of self-management coping strategies. METHOD: Forty employed women with a diagnosis of primary breast cancer who were between 6 and 60 months post-active treatment completed a semi-structured telephone interview. A 'framework' analysis approach was used. RESULTS: Two superordinate themes were identified: 'Sustained consequences of CRCI' and 'Self-management coping strategies to support work-related performance'. We found that the impact of CRCI extends beyond the initial RTW. The adopted self-management coping strategies could provoke mixed emotions, including emotional distress. Reduced workability was experienced up to 5-years post-active-treatment. CONCLUSION: Sustained CRCI induces negative emotions, fatigue and diminishes confidence reducing workability long into survivorship beyond RTW. The self-management coping strategies implemented to manage these sequelae generate mixed feelings, with some describing the strategies as problematic and of little benefit.

Cognitive function and emotional vulnerability in metastatic breast cancer: Moderating effects of age and social support.

OBJECTIVE: Previous literature has established a relationship between cognitive function and symptoms of anxiety, depression, and post-traumatic stress in primary breast cancer, but not in metastatic breast cancer (MBC). The current study examined the relationship between cognitive function and symptoms of anxiety, depression, and post-traumatic stress as well as the moderating effects of age, time since MBC diagnosis, and social support. METHODS: Subjective and objective measures of cognitive function as well as self-reports of emotional vulnerability were completed by 59 women diagnosed with MBC who were recruited through social media and support groups. RESULTS: Emotional vulnerability scores were associated with perceived measures of cognitive function. Additionally, low levels of perceived cognitive function were met with increased levels of depression with social support moderating this relationship buffering against depression. Age was found to moderate the relationship between cognitive function and post-traumatic stress with younger women at a greater risk of vulnerability. Out of all the emotional vulnerability measures, only anxiety negatively correlated with objective task performance. CONCLUSIONS: This study established a relationship between cognitive function and emotional vulnerability in MBC patients. It emphasised how vulnerable younger MBC women are to post-traumatic stress, and the importance of the combined effects of cognitive function and social support in buffering against depression. Our results have important implications for developing new interventions and treatment plans that consider the roles of these factors in ensuring a better quality of life in MBC.

Adaptive working memory training can reduce anxiety and depression vulnerability in adolescents.

Adolescents can be at heightened risk for anxiety and depression, with accumulating research reporting on associations between anxiety and depression and cognitive impairments, implicating working memory and attentional control deficits. Several studies now point to the promise of adaptive working memory training to increase attentional control in depressed and anxious participants and reduce anxiety and depression symptoms, but this has not been explored in a non-clinical adolescent population. The current study explored the effects of adaptive dual n-back working memory training on sub-clinical anxiety and depression symptomology in adolescents. Participants trained on either an online adaptive working memory task or non-adaptive control task for up to 20 days. Primary outcome measures were self-reported anxiety and depression symptomology, before and after intervention, and at 1-month follow-up. Self-reported depression (p = 0.003) and anxiety (p = 0.04) decreased after training in the adaptive n-back group relative to the non-adaptive control group in the intention-to-treat sample (n = 120). These effects were sustained at follow-up. Our findings constitute proof of principle evidence that working memory training may help reduce anxiety and depression vulnerability in a non-clinical adolescent population. We discuss the findings' implications for reducing risk of internalizing disorders in youth and the need for replication.

Training cognitive control to reduce emotional vulnerability in breast cancer.

OBJECTIVES: Breast cancer enhances anxiety and depressive vulnerability, profoundly impairing the quality of life in survivors. Hinging on recent research that training attentional control can reduce emotional vulnerability, we assess how improving cognitive function could reduce emotional vulnerability in female survivors of breast cancer. METHODS: Participants took part in a course of adaptive dual n-back cognitive training (Training Group) or a non-adaptive active control group (Active Control) for 12 days across a 2-week period. Transfer-related training gains were assessed immediately after the intervention, at a shorter 1-month follow-up and at a longer follow-up time of approximately 15 months post intervention, to assess sustainability of training effects. RESULTS: Adaptive cognitive training reduced anxiety and rumination with effects evident at shorter and longer term follow-up assessments. CONCLUSIONS: Our results are among the first to suggest that adaptive cognitive training can reduce emotional vulnerability in breast cancer, with the potential to enhance quality of life in survivorship. Our findings have profound implications for designing interventions targeting cognitive function in populations who have suffered from cancer.

The effects of active worrying on working memory capacity.

According to the attentional control theory, worry, a crucial component of anxiety, impairs task performance through its direct effect on working memory capacity (WMC) by using up the limited resources available for performance thus reducing attentional control. We tested this hypothesis in the current study by examining the causal influence of active worrying on WMC in a sample of undergraduate university students (n = 64) assigned either to a worry condition or to a non-worry control condition. Participants performed a change detection task before and after the worry/control manipulation. Mediation analyses showed that the level of self-reported worry mediated the effects of condition on change in WMC as demonstrated by the significant indirect effect of worry and the resulting non-significant direct effect of condition on change in WMC. Similar results were obtained when using state anxiety measures as mediating factors. Results of the current study are amongst the first to demonstrate that worry impairs WMC and as such have important implications for understanding the impact of worry.

Adaptive Working Memory Training Reduces the Negative Impact of Anxiety on Competitive Motor Performance.

Optimum levels of attentional control are essential to prevent athletes from experiencing performance breakdowns under pressure. The current study explored whether training attentional control using the adaptive dual n-back paradigm, designed to directly target processing efficiency of the main executive functions of working memory (WM), would result in transferrable effects on sports performance outcomes. A total of 30 tennis players were allocated to an adaptive WM training or active control group and underwent 10 days of training. Measures of WM capacity as well as performance and objective gaze indices of attentional control in a tennis volley task were assessed in low- and high-pressure posttraining conditions. Results revealed significant benefits of training on WM capacity, quiet eye offset, and tennis performance in the high-pressure condition. Our results confirm and extend previous findings supporting the transfer of cognitive training benefits to objective measures of sports performance under pressure.

Training Attentional Control Improves Cognitive and Motor Task Performance.

Attentional control is a necessary function for the regulation of goal-directed behavior. In three experiments we investigated whether training inhibitory control using a visual search task could improve task-specific measures of attentional control and performance. In Experiment 1 results revealed that training elicited a near-transfer effect, improving performance on a cognitive (antisaccade) task assessing inhibitory control. In Experiment 2 an initial far-transfer effect of training was observed on an index of attentional control validated for tennis. The principal aim of Experiment 3 was to expand on these findings by assessing objective gaze measures of inhibitory control during the performance of a tennis task. Training improved inhibitory control and performance when pressure was elevated, confirming the mechanisms by which cognitive anxiety impacts performance. These results suggest that attentional control training can improve inhibition and reduce taskspecific distractibility with promise of transfer to more efficient sporting performance in competitive contexts.

Can templates-for-rejection suppress real-world affective objects in visual search?

Previous evidence has suggested that feature-based templates-for-rejection can be maintained in working memory to suppress matching features in the environment. Currently, this effect has only been demonstrated using abstract neutral shapes, meaning that it is unclear whether this generalizes to real-world images, including aversive stimuli. In the current investigation, participants searched amongst an array of real-world objects for a target, after being precued with either a distractor template, target template, or a no template baseline. In Experiment 1, where both distractor and target template cues were presented randomly on a trial-by-trial basis, there was moderate evidence of increased capture by aversive distractors after the distractor template cue. In Experiment 2a, however, when distractor templates were the only available cue and more time was given to encode the cue features, there was moderate evidence of effective distractor inhibition for real-world aversive and neutral stimuli. In Experiment 2b, when the task required a slower more effortful comparison of target features to stereotypical object representations, there was weaker evidence of inhibition, though there was still modest evidence suggesting effective inhibition of aversive distractors. A Bayesian meta-analysis revealed that across Experiment 2, aversive distractors showed strong cumulative evidence of effective inhibition, but inconsistent inhibition for neutral distractors. The results are interpreted from a rational search behaviour framework, which suggests that individuals utilize informative cues when they enable the most beneficial strategy and are accessible, and apply these to distractors when they cause sufficient disruption, either to search speed or emotional state.

Infographics on signs and symptoms of metastatic (secondary) breast cancer can empower women with a breast cancer diagnosis.

We investigated the usefulness of a metastatic (secondary) breast cancer Infographics designed to enhance knowledge about symptoms of metastatic breast cancer in women diagnosed with breast cancer. Women with a primary or metastatic diagnosis of breast cancer who had not been in receipt of the Infographics previously, were sent the Infographics and asked to complete a questionnaire measuring their views of the usefulness of the Infographics in a number of domains. They were also asked to complete questionnaires on, anxiety and depression, coping, emotion regulation strategies and perceived cognitive functioning. Results showed that women advocated the use of the Infographics in medical and health care settings, as well as its ability in equipping themwith the relevant knowledge on signs of recurrence, its benefits in empowering control and reducing fears and uncertainties regarding metastatic breast cancer. Exploratory analysis showed that individual differences in trait vulnerability to anxiety and in emotion regulation strategies modulated women's responses suggesting the use of tailored approaches in the communication of the Infographics with patients. Our results point to the overall benefits of the Infographics in a number of domains. Implications for applications in healthcare settings are discussed.

The role of consciousness in attentional control differences in trait anxiety.

Trait anxiety has long been associated with impaired selective attention to task-irrelevant threat stimuli, both when threat is presented consciously and outside of awareness. However recent research has suggested broader deficits in selective attention, with poorer ability to ignore supraliminal non-emotional information in anxiety. Here, we investigated whether anxiety could equally be associated with poorer selective attention for non-emotional stimuli in a subliminal context. Participants performed a simple arrow discrimination task, where prior incompatible or compatible response primes were presented before targets either unmasked (supraliminal) or masked (subliminal). While distractor interference was evident in both conditions, trait anxiety was associated with increased task-irrelevant processing only in the supraliminal condition; group effects were eliminated when primes were masked. Our findings are in line with traditional accounts suggesting that differences in selective attention and cognitive control solely modulate conscious distractor processing.

Quality of working life can protect against cognitive and emotional vulnerability in women living with metastatic breast cancer: a cross-sectional study.

PURPOSE: Research focusing on the cognitive and emotional health of women with metastatic breast cancer (MBC) is limited. The focal aim of the current study was to explore how quality of working life was related to global health, perceived cognitive function, anxiety and depression. To this end, women's experience of employers after MBC diagnosis and its relationship to quality of working life was also explored. METHODS: Women living with MBC (N = 88) completed online questionnaires assessing their global health status, perceived cognitive and emotional vulnerability and their experience of employers following diagnosis. Women working at the time of the study also reported on their quality of working life. RESULTS: Women's experience of employers after MBC diagnosis was positively related to their quality of working life. Importantly, greater quality of working life met with better perceived cognitive function and global health, as well as lower levels of depression in working women. CONCLUSIONS: Our study is the first to establish the role of quality of working life in protecting against levels of cognitive vulnerability and emotional vulnerability to depression in women with MBC. We also highlight the importance of having a positive experience with employers. Our findings suggest that educational programmes can be provided to employers to enhance their understanding and awareness of the needs of women with MBC. IMPLICATIONS FOR CANCER SURVIVORS: Women with MBC may benefit from employers accessing educational (or support) programmes that can increase their awareness of the treatment-related sequelae and needs of women with MBC in the workplace.

Experiences of cognitive training on primary breast cancer survivor's cognitive impairments at work: A longitudinal qualitative study.

OBJECTIVES: Cancer-related cognitive impairment (CRCI) is associated with adverse work-related outcomes in women living with a history of primary breast cancer. We explored the perceived impact of receiving adaptive cognitive training (dual n-back training) or active control training (dual 1-back training) on CRCI. Furthermore, we explored the perceived transfer effects of cognitive training on work-related self-management methods for cognitive impairment and work-related outcomes such as career development. DESIGN: Longitudinal qualitative study. METHODS: A 'framework' analysis approach was used to analyse semi-structured telephone interviews completed by women with a history of primary breast cancer before training (N = 40), one month (N = 30) and six months (N = 29) post-training. RESULTS: Four main themes were identified: (1) impact of cognitive impairment at work, (2) perceived impact of cognitive training on impaired cognitive function, (3) perceived effects of training on work-related self-management methods for cognitive impairment and (4) perceived impact on women's career development and progression. Compared to baseline, women who received adaptive dual n-back training reported sustained improvement in multiple cognitive domains including memory and attention up to six months post-training when the follow-up interviews were conducted. Perceived improvements in cognitive function were associated with greater self-confidence and better emotional well-being in work. These improvements were found to lower dependency on self-management methods for cognitive impairment and enhance effectiveness as well as prompt career development or progression for many women. Although some findings of a similar nature were reported in the active control dual 1-back training group the perceived effects were more pronounced and consistent in the dual n-back group. CONCLUSIONS: Adaptive cognitive training (dual n-back training) improves perceived CRCI experienced by women in the workplace, enhancing their self-confidence and general emotional well-being. These perceived improvements, in turn, can decrease reliance on self-management methods for cognitive impairment and improve work efficiency and contribute to career development and progression.

Cognitive control training for children with anxiety and depression: A systematic review.

Cognitive control training has gained traction as an intervention for reducing anxiety and depression vulnerability in adults. There are, however, a limited number of studies investigating such training interventions for reducing symptomology of anxiety and depression in children and adolescents. Thus, we aimed to provide a robust review and qualitative synthesis of the available research in young people. Twelve articles met the inclusion criteria, and all were randomised control trials. Evidence of the efficacy of cognitive control training for relief of symptoms are reported separately for anxiety, depression, and other related psychological factors, and on the basis of type of cognitive control training paradigm. A lack of standardisation in relation to type of intervention, duration and context, outcome measures and population was observed. Results are discussed in terms of these variations and recommendations for future research are provided.

Depressive symptoms and cognitive control in a mixed antisaccade task: specific effects of depressive rumination.

Growing empirical evidence suggests that cognitive and affective problems in depression may be a reflection of cognitive control impairments. However, to date, the nature of such impairments is still poorly understood and further investigation of this topic is required to advance current knowledge on the underlying vulnerability factors for depression. Using a mixed antisaccade paradigm, the present study examined if depressive symptoms in general, and more specifically rumination, are related to impairments in cognitive control functions such as inhibition and switching. The results on antisaccade latency and error rates indicated that depressive symptoms in general were not related to impairments in inhibition and switching. However, rumination was associated with impaired inhibition such that high, compared to low, ruminators had slower antisaccade latencies. No group differences were observed on antisaccade error rates. Implications for understanding the underlying vulnerability factors for the development of depressive symptoms are discussed.

Neurocognitive efficiency in breast cancer survivorship: A performance monitoring ERP study.

Breast cancer diagnosis and treatment can lead to longer term cognitive and emotional vulnerability, making the ability to efficiently adapt to setbacks critical. Whilst cancer-related cognitive impairments (CRCI) are often reported amongst breast cancer survivors, investigation into the capacity to efficiently process errors is limited. The present study investigated the neurocognitive correlates of cognitive-control related performance monitoring, an important function influencing behavioural adjustment to mistakes. 62 participants (30 Breast Cancer Survivors, 32 Non-Cancer) completed a modified flanker task designed to challenge response inhibition as we measured neurocognitive indices of performance monitoring (ERN, the error-related negativity; CRN, the correct-response negativity; Pe, the error positivity). Findings indicated a blunted CRN and larger ∆ERN in the breast cancer survivors compared to the non-cancer group, in the absence of performance effects. This was followed by a larger Pe in the breast cancer survivors' group, indicating an exaggerated performance monitoring response. For women affected by breast cancer, findings suggest an early disrupted neural response to monitoring cognitive performance, followed by the requirement for more effortful processing in the conscious response to errors, indicating deficits in neurocognitive efficiency. These findings have important implications for developing cognitive rehabilitation programmes for breast cancer survivors affected by cognitive dysfunction to assist in the monitoring and adjustment of performance required to meet established goals in the face of adversity.

Rethinking cognitive training: The moderating roles of emotional vulnerability and perceived cognitive impact of training in high worriers.

Trait worry is a hallmark feature of anxiety and depression, interfering with attentional control and impairing cognitive performance. Previous research has shown the adaptive dual n-back training is effective in improving attentional control and reducing emotional vulnerability, but not for everyone. The current randomised controlled trial explored the role of baseline emotional vulnerability and perceived cognitive impact in training-related cognitive and emotional improvements in 60 high worriers randomly assigned to 10 sessions of the adaptive dual n-back training or non-adaptive 1-back training. Pre-training, post-training and one-month follow-up measures of cognitive performance were assessed using an emotional Flanker task, a cued task-switching task, and the MaRs-IB task. Self-report questionnaires assessed worry, anxiety, depression, somatisation, and self-efficacy, as well as participants' perceived cognitive impact of the training. Participants with higher levels of baseline emotional vulnerability presented the largest improvements in non-verbal reasoning and emotional vulnerability one month after the training, as well as the greatest perceived cognitive impact. Perceived cognitive impact was predicted by working memory improvement on the adaptive n-back training at high baseline levels of anxiety. These results suggest that the adaptive n-back training presents the greatest emotional and cognitive benefits for individuals experiencing severe levels of emotional vulnerability.

The Impact of COVID-19 Outbreak on Emotional and Cognitive Vulnerability in Iranian Women With Breast Cancer.

The psychological cost on emotional well-being due to the collateral damage brought about by COVID-19 in accessing oncological services for breast cancer diagnosis and treatment has been documented by recent studies in the United Kingdom. The current study set out to examine the effect of delays to scheduled oncology services on emotional and cognitive vulnerability in women with a breast cancer diagnosis in Iran, one of the very first countries to be heavily impacted by COVID-19. One hundred thirty-nine women with a diagnosis of primary breast cancer answered a series of online questionnaires to assess the current state of rumination, worry, and cognitive vulnerability as well as the emotional impact of COVID-19 on their mental health. Results indicated that delays in accessing oncology services significantly increased COVID related emotional vulnerability. Regression analyses revealed that after controlling for the effects of sociodemographic and clinical variables, women's COVID related emotional vulnerability explained higher levels of ruminative response and chronic worry as well as poorer cognitive function. This study is the first in Iran to demonstrate that the effects of COVID-19 on emotional health amongst women affected by breast cancer can exaggerate anxiety and depressive related symptoms increasing risks for clinical levels of these disorders. Our findings call for an urgent need to address these risks using targeted interventions exercising resilience.