Interpretation Bias and Anticipated Distress in the Face of Ambiguity: Predictors of Change in Cognitive Behavioral Therapy for Youth Anxiety.

This study examined associations among children's anxiety, interpretation bias, and anticipated distress before and after cognitive behavioral therapy (CBT) and investigated baseline levels of interpretation bias and anticipated distress as well as changes in these cognitive biases following treatment as predictors of treatment outcome. Clinically anxious youth (N = 39) were treated with brief CBT augmented with a smartphone app. Children completed measures assessing their anxiety, interpretation bias, and anticipated distress at baseline, post-treatment, and 2-month follow-up. Children's anxiety, interpretation bias, and anticipated distress significantly decreased following treatment. Anticipated distress was associated with higher anxiety at all time points; however, interpretation bias was not significantly associated with anxiety before or after treatment. Reductions in anticipated distress following treatment predicted concurrent and prospective reductions in anxiety. Reduced anticipated distress following treatment may contribute to enhanced treatment outcomes and may be more strongly related to the maintenance of youth anxiety than interpretation bias.

Competition or collaboration in regional Australia? A cross-border and multi-university approach to maximising rural health investments, community health and health workforce outcomes.

AIM: To describe the establishment of a cross-border and multi-university collaboration in rural Australia to mitigate potential competition, maximise Rural Health Multidisciplinary Training (RHMT) Programme investments and regional health workforce outcomes. CONTEXT: Rural Health Multidisciplinary Training programme investments have enabled the establishment of 19 Australian University Departments of Rural Health (UDRH) and 17 Rural Clinical Schools. The importance of these investments is acknowledged. However, in regional settings, due to limited clinical placement and training opportunities, there is potential for heightened competition between universities who are operating within shared geographical footprints. Competition between universities risks focusing RHMT programme activity on individual reporting requirements and activities, in preference to: regional needs; existing community-university relationships; and place-based approaches to health workforce development. PARTICIPANTS: A rural New South Wales and Victorian RHMT-funded departments, collectively known as the Sunraysia Collaboration. APPROACH: Strategic and operational processes, structures and actions underpinning collaboration formation and relationship consolidation will be described. Co-design methodologies employed to collectively define collaboration vision and aims, governance framework and guiding principles, reporting structures and co-contributions to teaching, research and service will be discussed. Collaboration sensitivity to the social, cultural, relationship and economic connectedness within the region and existing health workforce flows will also be explored. CONCLUSION: The Sunraysia collaboration demonstrates one approach towards mitigating potential competition between RHMT Programme funded universities within rural and remote Australia. The collaboration is an exemplar of co-design in action providing an alternative approach to address RHMT Programme parameters and regional needs whilst supporting rural-remote health workforce training and education innovations.

Examining the bidirectional relationships between maternal intrusiveness and child internalizing symptoms in a community sample: A longitudinal study from infancy to middle childhood.

BACKGROUND: Myriad parenting behaviors have been linked to the development of internalizing disorders in children. Intrusive parenting, characterized by autonomy-limiting behaviors that hold the parent's agenda above that of the child, may uniquely contribute to the development of child internalizing symptoms. The current study investigates bidirectional effects between maternal intrusiveness and internalizing symptomology from infancy to middle childhood. METHODS: Participants were a community sample of 218 infant-mother dyads assessed at 7 time points (5 and 10 months; 2, 3, 4, 6, and 9 years). Maternal intrusiveness was behaviorally coded at all timepoints; mothers completed the CBCL for their child at ages 3, 4, 6, and 9 years. The empirically derived Internalizing subscale was used to assess child internalizing symptoms. RESULTS: About 1/3 to ½ of mothers displayed maternal intrusiveness across infancy and childhood, with the exception of ages 2-3 years, when an increase in the number of mothers displaying intrusiveness was observed. A cross-lagged panel model showed that intrusiveness and internalizing symptoms were concurrently related at 3 years, but this relationship disappeared when we controlled for maternal education. There was no evidence of prospective relationships between our constructs. CONCLUSIONS: Mothers in a community-based sample may increase intrusiveness in the toddler and early preschool years as children strive for more autonomy. Intrusiveness may play more of a maintenance role in child internalizing symptoms, and associations between maternal intrusiveness and child internalizing symptomatology may be weaker than hypothesized, varying by maternal education. Suggestions for assessing intrusive parenting in future studies are discussed.

Using mobile eye-tracking technology to examine adolescent daughters' attention to maternal affect during a conflict discussion.

Attention to socio-emotional stimuli (i.e., affect-biased attention) is an integral component of emotion regulation and human communication. Given the strong link between maternal affect and adolescent behavior, maternal affect may be a critical influence on adolescent affect-biased attention during mother-child interaction. However, prior methodological constraints have precluded fine-grained examinations of factors such as maternal affect on adolescent attention during real-world social interaction. Therefore, this pilot study capitalized on previously validated technological advances by using mobile eye-tracking and facial affect coding software to quantify the influence of maternal affect on adolescents' attention to the mother during a conflict discussion. Results from 7,500 to 9,000 time points sampled for each mother-daughter dyad (n = 28) indicated that both negative and positive maternal affect, relative to neutral, elicited more adolescent attentional avoidance of the mother (ORs = 2.68-9.20), suggesting that typically developing adolescents may seek to avoid focusing on maternal affect of either valence during a conflict discussion. By examining the moment-to-moment association between in vivo displays of maternal affect and subsequent adolescent attention toward the mother's face, these results provide preliminary evidence that maternal affect moderates adolescent attention. Our findings are consistent with cross-species approach-avoidance models suggesting that offspring respond to affectively charged conversations with greater behavioral avoidance or deference.

Looking for the negative: Depressive symptoms in adolescent girls are associated with sustained attention to a potentially critical judge during in vivo social evaluation.

Attention biases toward negative stimuli are implicated in the development and maintenance of depression. However, research is needed to understand how depression affects attention biases as they unfold in a dynamic social environment, particularly during adolescence when depression rates significantly increase due to enhanced reactivity to social stress. To examine attention biases in a live, socially evaluative environment, 26 adolescent girls from the community gave a speech in front of a potentially critical judge and a positive judge while wearing mobile eye tracking glasses. Girls' depressive symptoms were measured using the Moods and Feelings Questionnaire. Across the sample, girls looked at the positive judge more frequently and for longer periods of time compared with the potentially critical judge. In contrast, higher depressive symptoms were associated with looking at the potentially critical judge for longer periods of time. When directly comparing attention to the potentially critical judge relative to the positive judge, dysphoric girls looked at the potentially critical judge more frequently and for longer periods of time compared with the positive judge. Findings suggest that adolescent depressive symptoms are related to sustained attention toward potentially critical evaluation at the exclusion of positive evaluation. This novel approach allowed for an in vivo examination of attention biases as they unfold during social evaluation, which begins to illuminate the interpersonal significance of attention biases. If replicated and extended longitudinally, this research could be used to identify adolescents at high risk for future depression and potentially be leveraged clinically in attention bias modification treatment.

Adolescent Gaze-Directed Attention During Parent-Child conflict: The Effects of Depressive Symptoms and Parent-Child Relationship Quality.

Although dysfunctions in attention have been implicated in the development and maintenance of depression in adults, findings from studies of depressed adolescents have been inconsistent. While some research has shown that youth with depressive symptoms exhibit increased attention to negative stimuli, other findings demonstrated attentional avoidance. Additionally, given the increase in parent-child conflict during adolescence, parent-child relationship quality may be an important moderating factor in the association between depressive symptoms and attention. To examine how depressive symptoms and parent-child relationship quality during adolescence influence attention, 25 mother-daughter pairs (girls ages 11-16) completed a conflict discussion task while wearing mobile eye-tracking glasses. Results suggest that girls with low positive parent-child relationship quality and greater depressive symptoms may have difficulty disengaging from their mother during negative interactions, which may exacerbate depressive symptoms. Therefore, the parent-child relationship should be further considered in treatments that target maladaptive attention patterns in youth with depressive symptoms.

Linking Maternal Socialization of Emotion Regulation to Adolescents' Co-rumination With Peers.

Mounting research supports that co-rumination, the tendency to seek peer support by engaging in extensive negatively focused discussion, is a risk factor for adolescent psychopathology. It is unclear, though, how this interpersonal tendency develops. Parental responses to adolescents' negative affect likely shape how youth utilize peer relationships to regulate distress, as they shift to reliance on peer support during this developmental stage. For example, nonsupportive parental responses may fail to instill healthy regulation strategies, resulting in ineffective forms of peer support, such as co-rumination. Conversely, high levels of supportive parental responses to adolescents' negative affect may motivate youth to also express more negative affect with peers, leading to co-rumination. Eighty-nine healthy adolescents (9-17) and their mothers completed surveys and a support-seeking interaction. Only supportive maternal responses, including maternal affection, were associated with adolescents' co-rumination. These analyses indicate that some forms of parental support are associated with adolescents' tendency to co-ruminate.

Parental autonomy granting and child perceived control: effects on the everyday emotional experience of anxious youth.

BACKGROUND: Childhood anxiety is associated with low levels of parental autonomy granting and child perceived control, elevated child emotional reactivity and deficits in child emotion regulation. In early childhood, low levels of parental autonomy granting are thought to decrease child perceived control, which in turn leads to increases in child negative emotion. Later in development, perceived control may become a more stable, trait-like characteristic that amplifies the relationship between parental autonomy granting and child negative emotion. The purpose of this study was to test mediation and moderation models linking parental autonomy granting and child perceived control with child emotional reactivity and emotion regulation in anxious youth. METHODS: Clinically anxious youth (N = 106) and their primary caregivers were assessed prior to beginning treatment. Children were administered a structured diagnostic interview and participated in a parent-child interaction task that was behaviorally coded for parental autonomy granting. Children completed an ecological momentary assessment protocol during which they reported on perceived control, emotional reactivity (anxiety and physiological arousal) and emotion regulation strategy use in response to daily negative life events. RESULTS: The relationship between parental autonomy granting and both child emotional reactivity and emotion regulation strategy use was moderated by child perceived control: the highest levels of self-reported physiological responding and the lowest levels of acceptance in response to negative events occurred in children low in perceived control with parents high in autonomy granting. Evidence for a mediational model was not found. In addition, child perceived control over negative life events was related to less anxious reactivity and greater use of both problem solving and cognitive restructuring as emotion regulation strategies. CONCLUSION: Both parental autonomy granting and child perceived control play important roles in the everyday emotional experience of clinically anxious children.

Parent Management Training and Collaborative & Proactive Solutions: A Randomized Control Trial for Oppositional Youth.

This study examined the efficacy of Collaborative & Proactive Solutions (CPS) in treating oppositional defiant disorder (ODD) in youth by comparing this novel treatment to Parent Management Training (PMT), a well-established treatment, and a waitlist control (WLC) group. One hundred thirty-four youth (ages 7-14, 61.9% male, 83.6% White) who fulfilled Diagnostic and Statistical Manual of Mental Disorders (4th ed.) criteria for ODD were randomized to CPS, PMT, or WLC groups. ODD was assessed with semistructured diagnostic interviews, clinical global severity and improvement ratings, and parent report measures. Assessments were completed pretreatment, posttreatment, and at 6 months following treatment. Responder and remitter analyses were undertaken using intent-to-treat mixed-models analyses. Chronological age, gender, and socioeconomic status as well as the presence of comorbid attention deficit/hyperactivity and anxiety disorders were examined as predictors of treatment outcome. Both treatment conditions were superior to the WLC condition but did not differ from one another in either our responder or remitter analyses. Approximately 50% of youth in both active treatments were diagnosis free and were judged to be much or very much improved at posttreatment, compared to 0% in the waitlist condition. Younger age and presence of an anxiety disorder predicted better treatment outcomes for both PMT and CPS. Treatment gains were maintained at 6-month follow-up. CPS proved to be equivalent to PMT and can be considered an evidence-based, alternative treatment for youth with ODD and their families.

A Brief Measure of Positive and Negative Interpretation Biases: Development and Validation of the Ambiguous Social Scenarios Questionnaire.

Positive and negative interpretation biases have been conceptualized as distinct constructs related to anxiety and social anxiety, but the field lacks psychometrically sound self-report measures to assess positive and negative interpretations of social ambiguity. This study examined the psychometric properties of the Ambiguous Social Scenarios Questionnaire (ASSQ) in two samples of 2,188 and 454 undergraduates with varying levels of anxiety. Results supported a bifactor model with a general interpretation bias factor and specific factors assessing positive and negative interpretation biases. The ASSQ demonstrated measurement invariance across genders and levels of social anxiety, as well as convergent and incremental validity with two existing measures of interpretation bias. It also demonstrated concurrent validity with attentional control, intolerance of uncertainty, total anxiety, and social anxiety and discriminant validity with emotional awareness. Findings support the ASSQ as a brief, valid, and reliable measure of positive and negative interpretation biases toward ambiguous social situations.

An Integrative Model of Youth Anxiety: Cognitive-Affective Processes and Parenting in Developmental Context.

Multiple theoretical frameworks have been proposed to provide a more comprehensive picture of the risk factors that influence anxiety-related developmental trajectories. Nonetheless, there remains a need for an integrative model that outlines: (1) which risk factors may be most pertinent at different points in development, and (2) how parenting may maintain, exacerbate, or attenuate an affective style that is characterized by high negative emotional reactivity to unfamiliar, uncertain, and threatening situations. A developmentally informed, integrative model has the potential to guide treatment development and delivery, which is critical to reducing the public health burden associated with these disorders. This paper outlines a model integrating research on many well-established risk mechanisms for anxiety disorders, focusing on (1) the developmental progression from emotional reactivity constructs early in life to those involving higher-level cognitive processes later in youth, and (2) potential pathways by which parenting may impact the stability of youth's cognitive-affective responses to threat-relevant information across development.

Introduction to the Special Issue: Interplay of Family Factors and Cognitive-Affective Processes in Youth.

Substantial research suggests that caregivers and families are powerful socialization agents when it comes to how youth process and regulate cognitive-affective information, which in turn can be a risk or resilience factor for various forms of developmental psychopathology. To this end, Clinical Child and Family Psychology Review features this special journal issue on the "Interplay of Family Factors & Cognitive-Affective Processes in Youth." Featured articles review a wide array of methodologies and highlight numerous forms of cognitive-affective processing and family contextual factors. Multiple themes emerged across the twelve articles, emphasizing the need to examine (1) complex pathways within families, (2) the quality of cognitive-affective processes across individuals, (3) neurodevelopmental pathways linking socialization and cognitive-affective processes, (4) nuanced methods to assess "in-the-moment" cognitive-affective processes, (5) the impact of cultural background on how family factors intersect with youth cognitive-affective processes, and (6) the socialization of positive emotion. These papers showcase the applicability of this significant area of research for future efforts in prevention and intervention with youth at risk for, or already experiencing, some form of psychopathology.

"Don't judge me!": Links between in vivo attention bias toward a potentially critical judge and fronto-amygdala functional connectivity during rejection in adolescent girls.

During adolescence, increases in social sensitivity, such as heightened attentional processing of social feedback, may be supported by developmental changes in neural circuitry involved in emotion regulation and cognitive control, including fronto-amygdala circuitry. Less negative fronto-amygdala circuitry during social threat processing may contribute to heightened attention to social threat in the environment. However, "real-world" implications of altered fronto-amygdala circuitry remain largely unknown. In this study, we used multiple novel methods, including an in vivo attention bias task implemented using mobile eye-tracking glasses and socially interactive fMRI task, to examine how functional connectivity between the amygdala and prefrontal cortex (PFC) during rejection and acceptance feedback from peers is associated with heightened attention towards potentially critical social evaluation in a real-world environment. Participants were 77 early adolescent girls (ages 11-13) oversampled for shy/fearful temperament. Results support the reliability of this in vivo attention task. Further, girls with more positive functional connectivity between the right amygdala and anterior PFC during both rejection and acceptance feedback attended more to potentially critical social evaluation during the attention task. Findings could suggest that dysfunction in prefrontal regulation of the amygdala's response to salient social feedback supports heightened sensitivity to socially evaluative threat during adolescence.

Validating a mobile eye tracking measure of integrated attention bias and interpretation bias in youth.

INTRODUCTION: This study sought to validate a real-world speech task designed to assess attention and interpretation bias in an integrated and ecologically valid manner. METHODS: Thirty adolescent girls gave a speech in front of an emotionally ambiguous judge and a positive judge while wearing mobile eye tracking glasses to assess how long they looked at each judge (i.e., attention bias). They also reported their interpretations of the ambiguous judge and distress associated with the task (i.e., interpretation bias). RESULTS: These task-based measures correlated with self-report of interpretation bias and mother-report of attentional control, demonstrating convergent validity. They did not correlate with frustration or high intensity pleasure, indicating discriminant validity. Task-based measures of interpretation bias also showed predictive and incremental validity in relation to child distress during the speech. DISCUSSION: This proof-of-concept study demonstrates the initial validity of a novel task designed to assess attention and interpretation bias as they manifest in real-world social interactions.

Freshwater microalgae (Schizochytrium sp.) as a substitute to fish oil for shrimp feed.

Micro-algae, Schizochytrium sp., is rich source of docosahexaenoic acid, DHA (66%-lipid with 27%-DHA). Eight nutritionally balanced-diets were formulated: diet 1 (control) consisted of only fish oil (FO); diets 2 and 3 had increasing amounts of algae-meal and soybean oil (SBO) at the expense of FO; diet 4 consisted of a combination of algae meal (37-g/kg), SBO (21-g/kg), and linseed oil (LSO) at 4-g/kg each; diet 5 had microalgae meal at 50-g/kg and equal amounts of LSO and SBO at 8-g/kg; diets 6 and 7 contained equal amounts of algae-meal at 62-g/kg, but with LSO or SBO added at 8-mg/g, respectively; diet 8 contained only algae-meal at 75-mg/g. Growth and feeding efficiencies of L. vannamei were not significantly different among treatments. Fatty acid composition of muscle generally reflected that of the diet. The amount of muscle sub-epidermal adipose tissue was significantly higher for shrimp fed diets 3 and 7, while intestinal lipase was significantly higher in shrimp fed diets 7 and 8. Muscle lipid peroxidation was unaffected by the dietary treatments, although antioxidant activities were significantly higher in shrimp fed diet 7 compared to those fed diet 1. Overall algal-meal can completely replace the FO in shrimp feed.

Emotion Socialization in Anxious Youth: Parenting Buffers Emotional Reactivity to Peer Negative Events.

Anxious youth exhibit heightened emotional reactivity, particularly to social-evaluative threat, such as peer evaluation and feedback, compared to non-anxious youth. Moreover, normative developmental changes during the transition into adolescence may exacerbate emotional reactivity to peer negative events, particularly for anxious youth. Therefore, it is important to investigate factors that may buffer emotional reactivity within peer contexts among anxious youth. The current study examined the role of parenting behaviors in child emotional reactivity to peer and non-peer negative events among 86 anxious youth in middle childhood to adolescence (Mean age = 11.29, 54 % girls). Parenting behavior and affect was observed during a social-evaluative laboratory speech task for youth, and ecological momentary assessment (EMA) methods were used to examine youth emotional reactivity to typical daily negative events within peer and non-peer contexts. Results showed that parent positive behaviors, and low levels of parent anxious affect, during the stressful laboratory task for youth buffered youth negative emotional reactivity to real-world negative peer events, but not non-peer events. Findings inform our understanding of parenting influences on anxious youth's emotional reactivity to developmentally salient negative events during the transition into adolescence.

Vigilance in the laboratory predicts avoidance in the real world: A dimensional analysis of neural, behavioral, and ecological momentary data in anxious youth.

Vigilance and avoidance of threat are observed in anxious adults during laboratory tasks, and are posited to have real-world clinical relevance, but data are mixed in anxious youth. We propose that vigilance-avoidance patterns will become evident in anxious youth through a focus on individual differences and real-world strategic avoidance. Decreased functional connectivity between the amygdala and prefrontal cortex (PFC) could play a mechanistic role in this link. 78 clinically anxious youth completed a dot-probe task to assess vigilance to threat while undergoing fMRI. Real-world avoidance was assessed using Ecological Momentary Assessment (EMA) of self-reported suppression and distraction during negative life events. Vigilance toward threat was positively associated with EMA distraction and suppression. Functional connectivity between a right amygdala seed region and dorsomedial and right dorsolateral PFC regions was inversely related to EMA distraction. Dorsolateral PFC-amygdalar connectivity statistically mediated the relationship between attentional vigilance and real-world distraction. Findings suggest anxious youth showing attentional vigilance toward threat are more likely to use suppression and distraction to regulate negative emotions. Reduced PFC control over limbic reactivity is a possible neural substrate of this pattern. These findings lend ecological validity to laboratory vigilance assessments and suggest PFC-amygdalar connectivity is a neural mechanism bridging laboratory and naturalistic contexts.

From anxious youth to depressed adolescents: Prospective prediction of 2-year depression symptoms via attentional bias measures.

Anxious youth are at heightened risk for subsequent development of depression; however, little is known regarding which anxious youth are at the highest prospective risk. Biased attentional patterns (e.g., vigilance and avoidance of negative cues) are implicated as key mechanisms in both anxiety and depression. Aberrant attentional patterns may disrupt opportunities to effectively engage with, and learn from, threatening aspects of the environment during development and/or treatment, compounding risk over time. Sixty-seven anxious youth (ages 9-14; 36 female) completed a dot-probe task to assess baseline attentional patterns provoked by fearful-neutral face pairs. The time course of attentional patterns both during and after threat was assessed via eye-tracking and pupilometry. Self-reported depressive and anxiety symptoms were assessed 2 years after the conclusion of a larger psychotherapy treatment trial. Eye-tracking patterns indicating threat avoidance predicted greater 2-year depression scores, over and above baseline and posttreatment symptoms. Sustained, postthreat pupillary avoidance (reflecting preferential neural engagement with the neutral relative to the previously threatening location) predicted additional variance in depression scores, suggesting sustained avoidance in the wake of threat further exacerbated risk. Identical eye-tracking and pupil indices were not predictive of anxiety at 2 years. These biobehavioral markers imply that avoidant attentional processing in the context of anxiety may be a gateway to depression across a key maturational window. Excessive avoidance of threat could interfere with acquisition of adaptive emotion regulation skills during development, culminating in the broad behavioral deactivation that typifies depression. Prevention efforts explicitly targeting avoidant attentional patterns may be warranted.