Single-Session, Internet-Based Cognitive Behavioral Therapy to Improve Parenting Skills to Help Children Cope With Anxiety During the COVID-19 Pandemic: Feasibility Study.

BACKGROUND: The COVID-19 pandemic has had a major impact on families' daily routines and psychosocial well-being, and technology has played a key role in providing socially distanced health care services. OBJECTIVE: The first objective of this paper was to describe the content and delivery of a single-session, internet-based cognitive behavioral therapy (iCBT) intervention, which has been developed to help parents cope with children's anxiety and manage daily situations with their children. The second objective was to report user adherence and satisfaction among the first participants who completed the intervention. METHODS: The Let's Cope Together intervention has been developed by our research group. It combines evidence-based CBT elements, such as psychoeducation and skills to manage anxiety, with parent training programs that strengthen how parents interact with their child and handle daily situations. A pre-post design was used to examine user satisfaction and the skills the parents learned. Participants were recruited using advertisements, media activity, day care centers, and schools and asked about background characteristics, emotional symptoms, and parenting practices before they underwent the iCBT. After they completed the 7 themes, they were asked what new parenting skills they had learned from the iCBT and how satisfied they were with the program. RESULTS: Of the 602 participants who filled in the baseline survey, 196 (32.6%) completed the program's 7 themes, and 189 (31.4%) completed the postintervention survey. Most (138/189, 73.0%) of the participants who completed the postintervention survey were satisfied with the program and had learned skills that eased both their anxiety (141/189, 74.6%) and their children's anxiety (157/189, 83.1%). The majority (157/189, 83.1%) reported that they learned how to organize their daily routines better, and just over one-half (100/189, 53.0%) reported that the program improved how they planned each day with their children. CONCLUSIONS: The single-session iCBT helped parents to face the psychological demands of the COVID-19 pandemic. Future studies should determine how the participation rate and adherence can be optimized in digital, universal interventions. This will help to determine what kinds of programs should be developed, including their content and delivery.

Digitalized Cognitive Behavioral Interventions for Depressive Symptoms During Pregnancy: Systematic Review.

BACKGROUND: Studies have shown a high prevalence of depression during pregnancy, and there is also evidence that cognitive behavioral therapy (CBT) is one of the most effective psychosocial interventions. Emerging evidence from randomized controlled trials (RCTs) has shown that technology has been successfully harnessed to provide CBT interventions for other populations. However, very few studies have focused on their use during pregnancy. This approach has become increasingly important in many clinical areas due to the COVID-19 pandemic, and our study aimed to expand the knowledge in this particular clinical area. OBJECTIVE: Our systematic review aimed to bring together the available research-based evidence on digitalized CBT interventions for depression symptoms during pregnancy. METHODS: A systematic review of the Web of Science, Cochrane Central Register of Controlled Trials, CINAHL, MEDLINE, Embase, PsycINFO, Scopus, ClinicalTrials.gov, and EBSCO Open Dissertations databases was carried out from the earliest available evidence to October 27, 2021. Only RCT studies published in English were considered. The PRISMA (Preferred Reporting Items of Systematic Reviews and Meta-analyses) guidelines were followed, and the protocol was registered on the Prospective Register of Systematic Reviews. The risk of bias was assessed using the revised Cochrane risk-of-bias tool for randomized trials. RESULTS: The review identified 7 studies from 5 countries (the United States, China, Australia, Norway, and Sweden) published from 2015 to 2021. The sample sizes ranged from 25 to 1342 participants. The interventions used various technological elements, including text, images, videos, games, interactive features, and peer group discussions. They comprised 2 guided and 5 unguided approaches. Using digitalized CBT interventions for depression during pregnancy showed promising efficacy, with guided intervention showing higher effect sizes (Hedges g=1.21) than the unguided interventions (Hedges g=0.14-0.99). The acceptability of the digitalized CBT interventions was highly encouraging, based on user feedback. Attrition rates were low for the guided intervention (4.5%) but high for the unguided interventions (22.1%-46.5%). A high overall risk of bias was present for 6 of the 7 studies. CONCLUSIONS: Our search only identified a small number of digitalized CBT interventions for pregnant women, despite the potential of this approach. These showed promising evidence when it came to efficacy and positive outcomes for depression symptoms, and user feedback was positive. However, the overall risk of bias suggests that the efficacy of the interventions needs to be interpreted with caution. Future studies need to consider how to mitigate these sources of biases. Digitalized CBT interventions can provide prompt, effective, evidence-based interventions for pregnant women. This review increases our understanding of the importance of digitalized interventions during pregnancy, including during the COVID-19 pandemic. TRIAL REGISTRATION: PROSPERO International Prospective Register of Systematic Reviews CRD42020216159; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=216159.

EXPRESS: From task-general towards task-specific cognitive operations in a few minutes? Working memory performance as an adaptive process.

Measurement of cognitive functions is typically based on the implicit assumption that the mental architecture underlying cognitive task performance is constant throughout the task. In contrast, skill learning theory implies that cognitively demanding task performance is an adaptive process that progresses from initial heavy engagement of effortful and task-general metacognitive and executive control processes towards more automatic and task-specific performance. However, this hypothesis is rarely applied to the short time spans of traditional cognitive tasks such as working memory (WM) tasks. We utilized longitudinal structural equation models on two well-powered data sets to test the hypothesis that the initial stages of WM task performances load heavily on a task-general g-factor and then start to diverge towards factors specific to task structure. In line with the hypothesis, data from the first experiment (N = 296) was successfully fitted in a model with task-initial unity of the WM paradigm-specific latent factors, after which their intercorrelations started to diverge. The second experiment (N = 201) replicated this pattern except for one paradigm-specific latent factor. These preliminary results suggest that the processes underlying working memory task performance tend to progress rapidly from more task-general towards task-specific, in line with the cognitive skill learning framework. Such task-internal dynamics has important implications for the measurement of complex cognitive functions.

Stimulus novelty, task demands, and strategy use in episodic memory.

Cognitive task performance is a dynamic process that evolves over time, starting from the first encounters with a task. An important aspect of these task dynamics is the employment of strategies to support successful performance and task acquisition. Focusing on episodic memory performance, we: (1) tested two hypotheses on the effects of novelty and task difficulty on strategy use, (2) replicated our previous results regarding strategy use in a novel memory task, and (3) evaluated whether repeated open-ended strategy queries affect task performance and/or strategy use. The present pre-registered online study comprised 161 adult participants who were recruited through the Prolific crowdsourcing platform. We employed two separate 5-block list learning tasks, one with 10 pseudowords and the other with 18 common nouns, and collected recall performance and strategy reports for each block. Using Bayesian linear mixed effects models, the present findings (1) provide some support for the hypothesis that task-initial strategy development is not triggered only by task novelty, but can appear also in a familiar, moderately demanding task; (2) replicate earlier findings from an adaptive working memory task indicating strategy use from the beginning of a task, associations between strategy use and objective task performance, and only modest agreement between open-ended versus list-based strategy reports; and (3) indicate that repeated open-ended strategy reports do not affect objective recall. We conclude that strategy use is an important aspect of memory performance right from the start of a task, and it undergoes development at the initial stages depending on task characteristics. In a larger perspective, the present results concur with the views of skill learning and adaptivity in cognitive task performance.

Spontaneous strategy use during a working memory updating task.

Cognitive skill learning postulates strategy generation and implementation when people learn to perform new tasks. Here we followed self-reported strategy use and objective performance in a working memory (WM) updating task to reveal strategy development that should take place when faced with this novel task. In two pre-registered online experiments with healthy adults, we examined short-term strategy acquisition in a ca 20-30-minute adaptive n-back WM task with 15 task blocks by collecting participants' strategy reports after each block. Experiment 1 showed that (a) about half of the participants reported using a strategy already during the very first task block, (b) changes in selected strategy were most common during the initial task blocks, and (c) more elaborated strategy descriptions predicted better task performance. Experiment 2 mostly replicated these findings, and it additionally showed that compared to open-ended questions, the use of repeated list-based strategy queries influenced subsequent strategy use and task performance, and also indicated higher rates of strategy implementation and strategy change during the task. Strategy use was also a significant predictor of n-back performance, albeit some of the variance it explained was shared with verbal productivity that was measured with a picture description task. The present results concur with the cognitive skill learning perspective and highlight the dynamics of carrying out a demanding cognitive task.

Beginning of the Pandemic: COVID-19-Elicited Anxiety as a Predictor of Working Memory Performance.

Increasing evidence indicates that the coronavirus disease 2019 (COVID-19) pandemic is associated with adverse psychological effects, including heightened levels of anxiety. This study examined whether COVID-19-related anxiety levels during the early stage of the pandemic predicted demanding working memory (WM) updating performance. Altogether, 201 healthy adults (age range, 18-50) mostly from North America and the British Isles were recruited to this study via the crowdsourcing site www.prolific.co. The results showed that higher levels of COVID-19-related anxiety during the first weeks of the pandemic outbreak were associated with poorer WM performance as measured by the n-back paradigm. Critically, the unique role of COVID-19-related anxiety on WM could not be explained by demographic factors, or other psychological factors such as state and trait anxiety or fluid intelligence. Moreover, across three assessment points spanning 5-6 weeks, COVID-19-related anxiety levels tended to decrease over time. This pattern of results may reflect an initial psychological "shock wave" of the pandemic, the cognitive effects of which may linger for some time, albeit the initial anxiety associated with the pandemic would change with habituation and increasing information. Our results contribute to the understanding of cognitive-affective reactions to a major disaster.

Trait reactance and trust in doctors as predictors of vaccination behavior, vaccine attitudes, and use of complementary and alternative medicine in parents of young children.

OBJECTIVE: The aim of the present study was to investigate whether anti-vaccination attitudes and behavior, and positive attitudes to complementary and alternative medicine (CAM), are driven by trait reactance and a distrust in medical doctors. METHODS: The sample consisted of 770 Finnish parents who filled out an online survey. Structural equation modeling (SEM) was used to examine if trait reactance plays a role in vaccination decisions, vaccine attitudes, and in the use of CAM, and whether that relationship is mediated by trust in medical doctors. RESULTS: Parents with higher trait reactance had lower trust in doctors, more negative attitudes to vaccines, a higher likelihood of not accepting vaccines for their children and themselves, and a higher likelihood to use CAM treatments that are not included in evidence-based medicine. Our analyses also revealed associations between vaccination behavior and CAM use and vaccine attitudes and CAM use, but there was no support for the previous notion that these associations would be explained by trait reactance and trust in doctors. CONCLUSIONS: Taken together, higher trait reactance seems to be relevant for attitudes and behaviors that go against conventional medicine, because trait reactance is connected to a distrust in medical doctors. Our findings also suggest that high trait reactance and low trust in doctors function differently for different people: For some individuals they might be associated with anti-vaccination attitudes and behavior, while for others they might be related to CAM use. We speculate that this is because people differ in what is important to them, leading them to react against different aspects of conventional medicine.

The Relationship of Anxiety and Stress With Working Memory Performance in a Large Non-depressed Sample.

Clinical anxiety and acute stress caused by major life events have well-documented detrimental effects on cognitive processes, such as working memory (WM). However, less is known about the relationships of state anxiety or everyday stress with WM performance in non-clinical populations. We investigated the associations between these two factors and three WM composites (verbal WM, visuospatial WM, and n-back updating performance) in a large online sample of non-depressed US American adults. We found a trend for a negative association between WM performance and anxiety, but not with stress. Thus, WM performance appears rather robust against normal variation in anxiety and everyday stress.

Video gaming and working memory: a large-scale cross-sectional correlative study.

Studies have indicated that video gaming is positively associated with cognitive performance in select cognitive domains, but the magnitudes of these associations have been called into question, as they have frequently been based on extreme groups analyses that have compared video gamers with non-gamers. When including the whole range of participants, and not just extreme cases, these effects were observed to reduce markedly (Unsworth et al., 2015). To further study this issue, we compared the associations between video gaming and aspects of working memory (WM) performance in an extreme groups design to those of a design that includes the full range of participants in a large adult sample (n = 503). WM was measured with three composite scores (verbal WM, visuospatial WM, n-back). The extreme groups analyses showed that video gamers performed better than non-gamers on all three WM measures, while the whole sample analyses indicated weak positive associations between the time spent playing video games and visuospatial WM and n-back performance. Thus, study design modulated the effects, but two of the three associations between WM and video gaming were consistent across both analysis techniques. A separate study confirmed that our questionnaire-based estimate of gaming hours was reliable when compared with one-week diaries of videogame playing. While the present cross-sectional results preclude causal inferences, possible mechanisms of WM - videogame playing associations and future research directions are discussed. Overall, our results indicate that cognition - videogame playing relationships, albeit weak, are not solely due to recently discussed methodological artefacts concerning the particular analytical approach and survey reliability.

The early effects of external and internal strategies on working memory updating training.

The mechanisms underlying working memory training remain unclear, but one possibility is that the typically limited transfer effects of this training reflect adoption of successful task-specific strategies. Our pre-registered randomized controlled trial (N = 116) studied the early effects of externally given vs. internally generated strategies in an updating task (n-back) over a 5-day period with a single 30-minute training session. Three groups were employed: n-back training with strategy instruction (n = 40), n-back training without strategy instruction (n = 37), and passive controls (n = 39). We found that both external and internal strategy use was associated with significantly higher posttest performance on the trained n-back task, and that training with n-back strategy instruction yielded positive transfer on untrained n-back tasks, resembling the transfer pattern typically seen after the ordinary uninstructed 4-6-week working memory training. In the uninstructed participants, the level of detail and type of internally generated n-back strategies at posttest was significantly related to their posttest n-back performance. Our results support the view that adoption of task-specific strategies plays an important role in working memory training outcomes, and that strategy-based effects are apparent right at the start of training.

Bilingualism and working memory performance: Evidence from a large-scale online study.

The bilingual executive advantage (BEA) hypothesis has attracted considerable research interest, but the findings are inconclusive. We addressed this issue in the domain of working memory (WM), as more complex WM tasks have been underrepresented in the previous literature. First, we compared early and late bilingual vs. monolingual WM performance. Second, we examined whether certain aspects of bilingual experience, such as language switching frequency, are related to bilinguals' WM scores. Our online sample included 485 participants. They filled in an extensive questionnaire including background factors such as bilingualism and second language (L2) use, and performed 10 isomorphic verbal and visuospatial WM tasks that yielded three WM composite scores (visuospatial WM, verbal WM, n-back). For verbal and visuospatial WM composites, the group comparisons did not support the BEA hypothesis. N-back analysis showed an advantage of late bilinguals over monolinguals and early bilinguals, while the latter two groups did not differ. This between-groups analysis was followed by a regression analysis relating features of bilingual experience to n-back performance, but the results were non-significant in both bilingual groups. In sum, group differences supporting the BEA hypothesis were limited only to the n-back composite, and this composite was not predicted by bilingualism-related features. Moreover, Bayesian analyses did not give consistent support for the BEA hypothesis. Possible reasons for the failure to find support for the BEA hypothesis are discussed.

Pattern of Near Transfer Effects Following Working Memory Training With a Dual N-Back Task.

In a randomized controlled trial, we investigated the pattern of near transfer effects of working memory (WM) training with an adaptive auditory-visuospatial dual n-back training task in healthy young adults. The results revealed significant task-specific transfer to an untrained single n-back task, and more general near transfer to a WM updating composite score plus a nearly significant effect on a composite score measuring interference control in WM. No transfer effects were seen on Active or Passive WM composites. The results are discussed in the light of cognitive versus strategy-related overlap between training and transfer tasks.

A Latent Factor Analysis of Working Memory Measures Using Large-Scale Data.

Working memory (WM) is a key cognitive system that is strongly related to other cognitive domains and relevant for everyday life. However, the structure of WM is yet to be determined. A number of WM models have been put forth especially by factor analytical studies. In broad terms, these models vary by their emphasis on WM contents (e.g., visuospatial, verbal) vs. WM processes (e.g., maintenance, updating) as critical, dissociable elements. Here we conducted confirmatory and exploratory factor analyses on a broad set of WM tasks, half of them numerical-verbal and half of them visuospatial, representing four commonly used task paradigms: simple span, complex span, running memory, and n-back. The tasks were selected to allow the detection of both content-based (visuospatial, numerical-verbal) and process-based (maintenance, updating) divisions. The data were collected online which allowed the recruitment of a large and demographically diverse sample of adults (n = 711). Both factor analytical methods pointed to a clear division according to task content for all paradigms except n-back, while there was no indication for a process-based division. Besides the content-based division, confirmatory factor analyses supported a model that also included a general WM factor. The n-back tasks had the highest loadings on the general factor, suggesting that this factor reflected high-level cognitive resources such as executive functioning and fluid intelligence that are engaged with all WM tasks, and possibly even more so with the n-back. Together with earlier findings that indicate high variability of process-based WM divisions, we conclude that the most robust division of WM is along its contents (visuospatial vs. numerical-verbal), rather than along its hypothetical subprocesses.

Increased dopamine release after working-memory updating training: Neurochemical correlates of transfer.

Previous work demonstrates that working-memory (WM) updating training results in improved performance on a letter-memory criterion task, transfers to an untrained n-back task, and increases striatal dopamine (DA) activity during the criterion task. Here, we sought to replicate and extend these findings by also examining neurochemical correlates of transfer. Four positron emission tomography (PET) scans using the radioligand raclopride were performed. Two of these assessed DAD2 binding (letter memory; n-back) before 5 weeks of updating training, and the same two scans were performed post training. Key findings were (a) pronounced training-related behavioral gains in the letter-memory criterion task, (b) altered striatal DAD2 binding potential after training during letter-memory performance, suggesting training-induced increases in DA release, and (c) increased striatal DA activity also during the n-back transfer task after the intervention, but no concomitant behavioral transfer. The fact that the training-related DA alterations during the transfer task were not accompanied by behavioral transfer suggests that increased DA release may be a necessary, but not sufficient, condition for behavioral transfer to occur.

Transfer after Working Memory Updating Training.

During the past decade, working memory training has attracted much interest. However, the training outcomes have varied between studies and methodological problems have hampered the interpretation of results. The current study examined transfer after working memory updating training by employing an extensive battery of pre-post cognitive measures with a focus on near transfer. Thirty-one healthy Finnish young adults were randomized into either a working memory training group or an active control group. The working memory training group practiced with three working memory tasks, while the control group trained with three commercial computer games with a low working memory load. The participants trained thrice a week for five weeks, with one training session lasting about 45 minutes. Compared to the control group, the working memory training group showed strongest transfer to an n-back task, followed by working memory updating, which in turn was followed by active working memory capacity. Our results support the view that working memory training produces near transfer effects, and that the degree of transfer depends on the cognitive overlap between the training and transfer measures.

Morphological learning in a novel language: A cross-language comparison.

Being able to extract and interpret the internal structure of complex word forms such as the English word dance+r+s is crucial for successful language learning. We examined whether the ability to extract morphological information during word learning is affected by the morphological features of one's native tongue. Spanish and Finnish adult participants performed a word-picture associative learning task in an artificial language where the target words included a suffix marking the gender of the corresponding animate object. The short exposure phase was followed by a word recognition task and a generalization task for the suffix. The participants' native tongues vary greatly in terms of morphological structure, leading to two opposing hypotheses. On the one hand, Spanish speakers may be more effective in identifying gender in a novel language because this feature is present in Spanish but not in Finnish. On the other hand, Finnish speakers may have an advantage as the abundance of bound morphemes in their language calls for continuous morphological decomposition. The results support the latter alternative, suggesting that lifelong experience on morphological decomposition provides an advantage in novel morphological learning.

Set shifting training with categorization tasks.

The very few cognitive training studies targeting an important executive function, set shifting, have reported performance improvements that also generalized to untrained tasks. The present randomized controlled trial extends set shifting training research by comparing previously used cued training with uncued training. A computerized adaptation of the Wisconsin Card Sorting Test was utilized as the training task in a pretest-posttest experimental design involving three groups of university students. One group received uncued training (n = 14), another received cued training (n = 14) and the control group (n = 14) only participated in pre- and posttests. The uncued training group showed posttraining performance increases on their training task, but neither training group showed statistically significant transfer effects. Nevertheless, comparison of effect sizes for transfer effects indicated that our results did not differ significantly from the previous studies. Our results suggest that the cognitive effects of computerized set shifting training are mostly task-specific, and would preclude any robust generalization effects with this training.