Cognitive bias modification training of attention and interpretation to reduce expectations of social rejection in adolescents with eating disorders: A small efficacy randomized controlled trial.

OBJECTIVE: This study aimed to investigate whether a computerized cognitive bias modification training delivered remotely would reduce expectations of rejection in adolescents with eating disorders. METHOD: Sixty-seven adolescents aged 12-18 (99.5% female) with an eating disorder diagnosis (94% anorexia nervosa) and receiving specialist treatment were recruited. Participants were randomized to an intervention condition (n = 37) which included treatment as usual (TAU) supplemented by nine sessions of online cognitive bias modification training for social stimuli (CBMT + TAU), or a control condition (n = 30), which included TAU only. Participants were invited to complete assessments at baseline and post-intervention. RESULTS: In the intervention condition, 22/37 participants completed six or more training sessions and post-intervention measures, the pre-defined criteria to be considered "completers." In the control condition, 28/30 participants completed the post-intervention measures. Participants who completed the intervention displayed a significantly greater reduction in negative interpretations of ambiguous social scenarios, with a medium effect size (p = .048, ηp2 = .090), and eating disorder psychopathology, with a medium effect size (p = .027, ηp2 = .105), compared to participants in the control condition. No significant between-group differences were found on emotional response to criticism, and anxiety and depression symptoms post-intervention (ps > .05; small effect sizes). DISCUSSION: Enhancing treatment as usual with CBMT targeting expectations of social rejection might be feasible and effective to reduce expectations of social rejection and eating disorder psychopathology in adolescents with eating disorders. Training adaptations might be necessary to impact on emotional processing and comorbid psychological distress. PUBLIC SIGNIFICANCE: Adolescents with eating disorders who completed a brief (4-week) online cognitive training intervention, alongside their usual treatment, reported greater reductions in expectations of social rejection and eating disorder psychopathology after the intervention, compared to a separate group of patients who received their usual treatment only. This brief and accessible intervention may be a helpful treatment adjunct for adolescents with eating disorders.

Emotional mental imagery generation during spontaneous future thinking: relationship with optimism and negative mood.

Optimism is known to buffer against negative mood. Thus, understanding the factors that contribute to individual variation in optimism may inform interventions for mood disorders. Preliminary evidence suggests that the generation of mental imagery-based representations of positive relative to negative future scenarios is related to optimism. This study investigated the hypothesis that an elevated tendency to generate positive relative to negative mental imagery during spontaneous future thinking would be associated with reduced negative mood via its relationship to higher optimism. Participants (N = 44) with varied levels of naturally occurring negative mood reported current levels of optimism and the real-time occurrence and characteristics of spontaneous thoughts during a sustained attention computer task. Consistent with hypotheses, higher optimism statistically mediated the relationship between a higher proportional frequency of positive relative to negative mental imagery during spontaneous future thinking and lower negative mood. Further, the relationship between emotional mental imagery and optimism was found for future, but not past, thinking, nor for verbal future or past thinking. Thus, a greater tendency to generate positive rather than negative imagery-based mental representations when spontaneously thinking about the future may influence how optimistic one feels, which in turn may influence one's experience of negative mood.

Attentional Bias to Alcohol Information: a Novel Dual-Probe Task.

BACKGROUND: Even when motivated to consume less alcohol, attempts to do so are not always successful. Attentional bias to positive and negative alcohol-related information may play a role in shaping unintended drinking behaviour. The present exploratory study adapted a novel attentional bias task, to test whether selective attention to positive relative to negative information about alcohol consumption predicts mismatch between alcohol consumption intention and alcohol consumption behaviour. METHOD: Thirty-five university students attempting to reduce their alcohol consumption participated in the study. Participants completed a novel attentional bias assessment task where two positive and negative audio-visual messages about alcohol consumption were simultaneously presented. At random intervals during these messages, two different probes were briefly and simultaneously presented, so that only one could be detected. Attention to positive vs. negative messages was inferred from the location of the probe recorded by the participant. Alcohol consumption in relation to participants' goals was measured using a real-time diary over the subsequent 7 days. RESULTS: An attentional bias towards positive (relative to negative) messages about alcohol consumption predicted the degree to which participants consumed more alcohol than planned, but did not predict alcohol consumption itself. CONCLUSION: This is the first study to our knowledge that has investigated the relationship between biased attention to alcohol-related information and variation in the success of intended reduction in alcohol consumption, and we suggest that it paves the way for further research into the role of attentional biases in health risk behaviours.

Attentional control moderates the relationship between social anxiety and selective attentional responding to negative social information: evidence from objective measures of attentional processes.

Cognitive theories of social anxiety implicate greater attention to negative social information in the development and maintenance of heightened social anxiety. Empirical evidence for this proposal, however, has been inconsistent. The aim of the current study was to examine the role of attentional control, which is one's ability to deploy attention to goal-relevant information as a potential moderator of the association between selective attentional responding to negative social information and social anxiety. Eighty-nine adults were recruited through Mechanical Turk platform and completed the Social Interaction Anxiety Scale as well as a novel paradigm designed to measure selective attentional responding to negative social information (angry faces) and attentional control. Attentional control was operationalised as the capacity to direct attention to the specified target stimuli. The results supported the hypothesis that attentional control plays this moderating role. Specifically, while participants with low levels of attentional control exhibited a positive association between social anxiety and selective attentional responding to negative social information, this association was eliminated among participants with high levels of attentional control. This finding may explain the heterogeneity of research findings in this area. Implications, limitations and directions for future research are discussed.

Cognitive bias modification to prevent depression (COPE): results of a randomised controlled trial.

BACKGROUND: Although efficacious treatments for major depression are available, efficacy is suboptimal and recurrence is common. Effective preventive strategies could reduce disability associated with the disorder, but current options are limited. Cognitive bias modification (CBM) is a novel and safe intervention that attenuates biases associated with depression. This study investigated whether the delivery of a CBM programme designed to attenuate negative cognitive biases over a period of 1 year would decrease the incidence of major depression among adults with subthreshold symptoms of depression. METHODS: Randomised double-blind controlled trial delivered an active CBM intervention or a control intervention over 52 weeks. Two hundred and two community-dwelling adults who reported subthreshold levels of depression were randomised (100 intervention, 102 control). The primary outcome of interest was the incidence of major depressive episode assessed at 11, 27 and 52 weeks. Secondary outcomes included onset of clinically significant symptoms of depression, change in severity of depression symptoms and change in cognitive biases. RESULTS: Adherence to the interventions was modest though did not differ between conditions. Incidence of major depressive episodes was low. Conditions did not differ in the incidence of major depressive episodes. Likewise, conditions did not differ in the incidence of clinically significant levels of depression, change in the severity of depression symptoms or change in cognitive biases. CONCLUSIONS: Active CBM intervention did not decrease the incidence of major depressive episodes as compared to a control intervention. However, adherence to the intervention programme was modest and the programme failed to modify the expected mechanism of action.

Group rumination-focused cognitive-behavioural therapy (CBT) v. group CBT for depression: phase II trial.

BACKGROUND: Although cognitive-behavioural therapy (CBT) is an effective treatment for depression, less than half of patients achieve satisfactory symptom reduction during treatment. Targeting known psychopathological processes such as rumination may increase treatment efficacy. The aim of this study was to test whether adding group rumination-focused CBT (RFCBT) that explicitly targets rumination to routine medical management is superior to adding group CBT to routine medical management in treating major depression. METHODS: A total of 131 outpatients with major depression were randomly allocated to 12 sessions group RFCBT v. group CBT, each in addition to routine medical management. The primary outcome was observer-rated symptoms of depression at the end of treatment measured on the Hamilton Rating Scale for Depression. Secondary outcomes were rumination at post-treatment and depressive symptoms at 6 months follow-up (Trial registered: NCT02278224). RESULTS: RFCBT significantly improved observer-rated depressive symptoms (Cohen's d 0.38; 95% CI 0.03-0.73) relative to group CBT at post-treatment on the primary outcome. No post-treatment differences were found in rumination or in depressive symptoms at 6 months follow-up, although these secondary analyses may have been underpowered. CONCLUSIONS: This is the first randomized controlled trial providing evidence of benefits of RFCBT in major depression compared with CBT. Group RFCBT may be a beneficial alternative to group CBT for major depression.

Trait anxiety and the alignment of attentional bias with controllability of danger.

Attentional bias to threat cues is most adaptive when the dangers they signal can readily be controlled by timely action. This study examined whether heightened trait anxiety is associated with impaired alignment between attentional bias to threat and variation in the controllability of danger, and whether this is moderated by executive functioning. Participants completed a task in which threat cues signalled money loss and an aversive noise burst (the danger). In 'high control' blocks, attending to the threat cue offered a high chance of avoiding this danger. In 'low control' blocks, attending to the threat cue offered little control over the danger. The task yielded measures of attentional monitoring for threat, and attentional orienting to threat. Results indicated all participants showed greater attentional orienting to threat cues in high control relative to low control blocks (indicative of proper alignment), however, high trait-anxious participants showed no difference in attentional monitoring for threat between block types, whereas low trait-anxious participants did. This effect was moderated by N-Back scores. These results suggest heightened trait anxiety may be associated with impaired alignment of attentional monitoring for threat cues, and that such alignment deficit may be attenuated by high executive functioning.

Anxiety & inhibition: dissociating the involvement of state and trait anxiety in inhibitory control deficits observed on the anti-saccade task.

The existence of a relationship between heightened anxiety and impaired inhibitory control is well established. However, it remains unknown whether such reduced inhibitory control is a stable characteristic of elevated trait anxiety, is driven by elevated state anxiety, or is a joint function of both trait and state anxiety. The present study sought to resolve this issue, by having high and low trait anxious participants complete an anti-saccade task, following a manipulation of state anxiety level using a video-based state anxiety induction procedure. We found that impaired inhibitory control was interactively determined by trait and state anxiety. Specifically, in high but not low trait anxious participants, the induction of heightened state anxiety served to impair inhibitory control. In addition to shedding light on how inhibitory control may potentially contribute to dispositional anxiety, these findings suggest that the anxiolytic benefits of inhibitory control training procedures may be greatest when delivered to high trait anxious individuals during periods of elevated state anxiety.

Anxiety-Linked Attentional Bias: Is It Reliable?

There is substantial evidence that heightened anxiety vulnerability is characterized by increased selective attention to threatening information. The reliability of this anxiety-linked attentional bias has become the focus of considerable recent interest. We distinguish between the potential inconsistency of anxiety-linked attentional bias and inconsistency potentially reflecting the psychometric properties of the assessment approaches used to measure it. Though groups with heightened anxiety vulnerability often exhibit, on average, elevated attention to threat, the evidence suggests that individuals are unlikely to each display a stable, invariant attentional bias to threat. Moreover, although existing assessment approaches can differentiate between groups, they do not exhibit the internal consistency or test-retest reliability necessary to classify individuals in terms of their characteristic pattern of attentional responding to threat. We discuss the appropriate uses of existing attentional bias assessment tasks and propose strategies for enhancing classification of individuals in terms of their tendency to display an attentional bias to threat.

Confusing procedures with process when appraising the impact of cognitive bias modification on emotional vulnerability†.

If meta-analysis is to provide valuable answers, then it is critical to ensure clarity about the questions being asked. Here, we distinguish two important questions concerning cognitive bias modification research that are not differentiated in the meta-analysis recently published by Cristea et al (2015) in this journal: (1) do the varying procedures that investigators have employed with the intention of modifying cognitive bias, on average, significantly impact emotional vulnerability?; and (2) does the process of successfully modifying cognitive bias, on average, significantly impact emotional vulnerability? We reanalyse the data from Cristea et al to address this latter question. Our new analyses demonstrate that successfully modifying cognitive bias does significantly alter emotional vulnerability. We revisit Cristea et al's conclusions in light of these findings.

Heightened ruminative disposition is associated with impaired attentional disengagement from negative relative to positive information: support for the "impaired disengagement" hypothesis.

Information processing accounts of rumination propose that impaired attentional disengagement from negative information may underpin heightened disposition to experience ruminative brooding in response to negative mood. The present study examined the relationship between individual differences in ruminative disposition and selective attention, using a paradigm capable of distinguishing between biases in the engagement and disengagement of attention. Results showed that higher dispositional ruminative brooding, as measured by both the brooding subscale of the RRS and an in-vivo assessment of ruminative disposition, was associated with greater relative impairment disengaging attention from negative compared to positive stimuli. These findings thus provide support for the "impaired disengagement" account of ruminative brooding.

Enhanced probing of attentional bias: the independence of anxiety-linked selectivity in attentional engagement with and disengagement from negative information.

Cognitive models of anxiety posit that an attentional bias to negative information plays a causal role in elevated anxiety vulnerability and dysfunction. There has been considerable recent interest in determining whether this attentional bias reflects facilitated attentional engagement with and/or impaired attentional disengagement from negative information. We concur with the claim of investigators who have noted that the methodologies previously employed to dissociate engagement and disengagement biases are not optimal for this purpose. In the present study, we employ a novel methodology, the Attentional Response to Distal vs. Proximal Emotional Information (ARDPEI) task, which enables the discrete assessment of these two types of attentional selectivity. The findings demonstrate that facilitated attentional engagement with and impaired attentional disengagement from negative information both characterise elevated anxiety vulnerability. Further, these biases represent distinctive facets of anxiety-linked attentional selectivity. We discuss the potentially differing roles that engagement and disengagement biases may play in the development and/or maintenance of anxiety vulnerability and dysfunction.

The role of expectancies and selective interrogation of information in trait anxiety-linked affect when approaching potentially stressful future events.

The present study examined cognitive mechanisms underpinning the increased tendency of individuals with high trait anxiety to experience inflation of negative affect when approaching potential stressors. Specifically, the roles of (1) disproportionately negative relative to positive expectancies (i.e., negative expectancy bias) and (2) disproportionately interrogating negative relative to positive information (i.e., negative interrogation bias), each concerning the potential stressor, were examined. High and low trait anxiety participants (N = 286) completed the experimental session, in which they were informed they may view a potentially stressful film. As participants approached the putative film viewing, participants' negative and positive affect, as well as their negative and positive expectancies were assessed. Additionally, negative interrogation bias was assessed by providing participants the opportunity to selectively interrogate information from a larger pool of negative and positive information concerning the putative film viewing. Our findings provide evidence indirect associations between trait anxiety and inflation of negative affect is serially mediated via negative interrogation bias and, in turn, negative expectancy bias. Findings are discussed with regards to limitations and potential implications for public health campaigns, and cognitive interventions for anxiety, highlighting the utility of further examining negative interrogation bias as an avenue for improving the efficacy of each.

The impact of self-referential processing on depression-linked negative interpretive bias.

BACKGROUND AND OBJECTIVES: Cognitive theories propose that individuals with heightened depression are characterized by biases in memory and interpretation, favoring the processing of negative information. Individuals with heightened depression exhibit a negative memory bias, and this bias is disproportionately evident when emotional information is processed in a self-referential manner. In studies investigating whether individuals with heightened depression exhibit a negative interpretative bias, the measures employed have often been compromised by serious methodological limitations. When interpretation has been measured using an eye-blink modulation approach, which overcomes these limitations, evidence of depression-linked negative interpretive bias has emerged. However, the important issue of whether this bias depends upon self-referential processing has gone unresolved. METHOD: In the present study, we assessed interpretation using the eye blink modulation approach, in participants scoring high or low on the Beck Depression Inventory-II. A simple manipulation ensured that ambiguous information either was, or was not, processed in a self-referential manner. RESULTS: The results showed that, when ambiguous information was processed in a self-referential manner, participants scoring high on the BDI-II displayed blink magnitudes indicating greater negative interpretative bias compared to participants scoring low on the BDI-II. This was not the case when ambiguous information was processed in an other-referential manner. LIMITATIONS: The present findings do not permit the inference that this negative interpretive bias causally contributes to depressive symptomatology. CONCLUSIONS: The results support the hypothesis that people with high levels of depression display greater negative interpretive bias than people with low levels of depression, but only when ambiguous information is processed in a self-referential manner.

Towards implementation of cognitive bias modification in mental health care: State of the science, best practices, and ways forward.

Cognitive bias modification (CBM) has evolved from an experimental method testing cognitive mechanisms of psychopathology to a promising tool for accessible digital mental health care. While we are still discovering the conditions under which clinically relevant effects occur, the dire need for accessible, effective, and low-cost mental health tools underscores the need for implementation where such tools are available. Providing our expert opinion as Association for Cognitive Bias Modification members, we first discuss the readiness of different CBM approaches for clinical implementation, then discuss key considerations with regard to implementation. Evidence is robust for approach bias modification as an adjunctive intervention for alcohol use disorders and interpretation bias modification as a stand-alone intervention for anxiety disorders. Theoretical predictions regarding the mechanisms by which bias and symptom change occur await further testing. We propose that CBM interventions with demonstrated efficacy should be provided to the targeted populations. To facilitate this, we set a research agenda based on implementation frameworks, which includes feasibility and acceptability testing, co-creation with end-users, and collaboration with industry partners.

The independent roles of attentional engagement with, and disengagement from, negative information in intrusive re-experiencing of negative events.

BACKGROUND AND OBJECTIVES: Intrusive re-experiencing of negative events represents a key vulnerability factor for Post-Traumatic Stress Disorder. Thus, delineating attentional mechanisms that might contribute to key facets of intrusive re-experiencing would be highly advantageous. The present study sought to evaluate the novel hypothesis that biased attentional engagement and disengagement differentially contribute to two central facets of intrusive re-experiencing, frequency and controllability, respectively. METHODS: One hundred undergraduates were exposed to an acutely negative event, followed by completion of an attentional task that permitted the discrete assessment of biased attentional engagement with, and biased attentional disengagement from, negative vs. non-negative information. Intrusions concerning this negative event were assessed daily, for the subsequent seven days, by means of an electronic diary. RESULTS: Results revealed that enhanced attentional engagement with negative vs. non-negative information predicted unique variance in intrusion frequency, whereas impaired attentional disengagement from negative vs. non-negative information predicted unique variance in intrusion controllability. These intrusion-linked patterns of attentional selectivity were evident at shorter (500 ms) stimulus exposure durations only, and not at longer (1000 ms) stimulus exposure durations. LIMITATIONS: The current study did not assess attentional selectivity prior to the negative event. Additionally, a time-based approach, rather than an event-based approach, was employed in the assessment of intrusions. CONCLUSIONS: The current findings suggest that engagement bias and disengagement bias may underpin differing facets of intrusive re-experiencing, raising the possibility that therapeutically targeting each type of attentional bias may attenuate a distinctive aspect of intrusive re-experiencing.

Two probes and better than one: Development of a psychometrically reliable variant of the attentional probe task.

Cognitive models contend that attentional bias to negative information contributes to elevated anxiety vulnerability and dysfunction. The most common approach for assessing such bias is the attentional probe task. In this task, participants are presented with stimulus pairs, usually comprising a negative and benign member. A single visual probe subsequently appears in the locus where either stimulus was displayed, and remains on-screen until the participant identifies it. Attentional distribution is inferred from relative speed to identify probes in the location of each stimulus. Recently, investigators have raised concerns about the psychometric reliability of this attentional probe task as a measure of attentional bias, and have called for the development of new tasks with the capacity to more reliably assess variation in biased attentional responding to target stimuli. In response to this call, we report the development of a new dual probe attentional assessment approach, in which two probes are briefly presented on each trial, and attentional distribution is inferred from relative accuracy to identify probes appearing in each screen location. Across four studies, we show that this dual probe approach demonstrates much higher psychometric reliability than the single probe task, and can sensitively detect anxiety-linked attentional bias to negative information.

Craving mediates the association between attentional bias to alcohol and in vivo alcoholic beverage consumption in young social drinkers.

OBJECTIVE: Franken's attentional bias hypothesis proposes that attentional bias to alcohol (ABA) activates craving, which motivates alcohol consumption behavior. While this hypothesis was put forward to account for alcohol dependence, the present study tested whether Franken's model may potentially contribute to explaining variation in beer consumption among young social drinkers. METHOD: ABA was measured by presenting participants with dual videos, one showing alcoholic beverages and the other non-alcoholic beverages, and assessing relative attention to each using a visual probe procedure. Self-reported alcohol craving was assessed four times over the session. In vivo alcoholic beverage consumption was assessed by the remaining weight of alcohol bottle following consumption, measured at conclusion of the experiment. RESULTS: The study revealed that ABA positively predicted alcohol craving (p < .01) and in vivo beer consumption (p < .01). The relationship between ABA and beer consumption was fully mediated by craving (ß = .63, 95% CI [.04, 1.29]). CONCLUSIONS: To our knowledge, this is the first study to show that the relationship between ABA and in vivo alcoholic beverage consumption is fully mediated by alcohol craving. Future research can extend understanding of the causal relationship between ABA, craving, and consumption, by determining whether direct modification of ABA influences alcohol consumption by altering craving. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

When Alcohol Adverts Catch the Eye: A Psychometrically Reliable Dual-Probe Measure of Attentional Bias.

Existing tasks assessing substance-related attentional biases are characterized by low internal consistency and test-retest reliability. This study aimed to assess the psychometric properties of a novel dual-probe task to measure alcohol-related attentional bias. Undergraduate students were recruited in June 2019 (N = 63; final N = 57; mean age = 20.88, SD = 2.63, 67% females). In the dual-probe task, participants were presented with simultaneous visual streams of adverts promoting either alcoholic or non-alcoholic drinks, and probes were presented in both streams. The dual-probe task measured the percentage of accurately identified probes that appeared on alcohol adverts in relation to total accuracy. The dual-probe task displayed excellent split-half reliability (M = 0.90, SD = 0.11; α = 0.90; 95% CI [0.84, 0.93]), and the derived attentional bias measure was significantly positively associated with beer drinking in a taste-test (r (57) = 0.33, p = 0.013; 95% CI [0.07, 0.54]), with habitual drinking (r (57) = 0.27, p = 0.045; 95% CI [0.01, 0.49]), and with increased craving (r (57) = 0.29, p = 0.031; 95% CI [0.03, 0.51]). Thus, the dual-probe task assessed attentional bias with excellent internal consistency and was associated with laboratory and habitual drinking measures, demonstrating initial support for the task's utility in addiction research.