The role of consciousness in threat extinction learning.

Extinction learning is regarded as a core mechanism underlying exposure therapy. The extent to which learned threats can be extinguished without conscious awareness is a controversial and on-going debate. We investigated whether implicit vs. explicit exposure to a threatened stimulus can modulate defence responses measured using pupillometry. Healthy participants underwent a threat conditioning paradigm in which one of the conditioned stimuli (CS) was perceptually suppressed using continuous flash suppression (CFS). Participants' pupillary responses, CS pleasantness ratings, and trial-by-trial awareness of the CS were recorded. During Extinction, participants' pupils dilated more in the trials in which they were unaware of the CS than in those in which they were aware of it (Cohen's d = 0.57). After reinstatement, the percentage of fear recovery was greater for the CFS-suppressed CS than the CS with full awareness. The current study suggests that the modulation of fear responses by extinction with reduced visual awareness is weaker compared to extinction with full perceptual awareness.

The Impact of Interpretation Biases on Psychological Responses to the COVID-19 Pandemic: a Prospective Study.

BACKGROUND: This study investigates the longitudinal role of interpretation biases in the development and maintenance of health anxiety during the pandemic. Individual differences in behavioural responses to the virus outbreak and decision-making were also examined. METHODS: Two hundred seventy-nine individuals from a pre-pandemic study of interpretation bias and health anxiety completed an online survey during the third wave of the COVID-19 pandemic in Hong Kong. Participants' health anxiety, interpretation biases, and COVID-specific behaviours (i.e. practice of social distancing, adherence to preventive measures, information seeking), and health decision-making were assessed. RESULTS: Pre-pandemic tendencies to interpret ambiguous physical sensations as signals for illness did not predict health anxiety during the pandemic, b = -0.020, SE = 0.024, t = -0.843, p = .400, 99% CI [-0.082, 0.042], but were associated with a preference for risky treatment option for COVID-19, b = 0.026, SE = 0.010, Wald = 2.614, p = .009, OR = 1.026, 99% CI [1.001, 1.054]. Interpretation biases and health anxiety symptoms during the pandemic were associated with each other and were both found to be significant predictors of practice of social distancing, adherence to preventive measures, and information seeking behaviour. CONCLUSIONS: This study adds to the growing evidence of the role of interpretation biases in health anxiety and the way that people respond to the ongoing pandemic.

Large-scale remote fear conditioning: Demonstration of associations with anxiety using the FLARe smartphone app.

OBJECTIVES: We aimed to examine differences in fear conditioning between anxious and nonanxious participants in a single large sample. MATERIALS AND METHODS: We employed a remote fear conditioning task (FLARe) to collect data from participants from the Twins Early Development Study (n = 1,146; 41% anxious vs. 59% nonanxious). Differences between groups were estimated for their expectancy of an aversive outcome towards a reinforced conditional stimulus (CS+) and an unreinforced conditional stimulus (CS-) during acquisition and extinction phases. RESULTS: During acquisition, the anxious group (vs. nonanxious group) showed greater expectancy towards the CS-. During extinction, the anxious group (vs. nonanxious group) showed greater expectancy to both CSs. These comparisons yielded effect size estimates (d = 0.26-0.34) similar to those identified in previous meta-analyses. CONCLUSION: The current study demonstrates that remote fear conditioning can be used to detect differences between groups of anxious and nonanxious individuals, which appear to be consistent with previous meta-analyses including in-person studies.

Specificity and detail in autobiographical memory retrieval: a multi-site (re)investigation.

This investigation examined conflicting suggestions regarding the association between problems retrieving specific autobiographical memories and the tendency to retrieve the details of these memories. We also examined whether these tendencies are differentially related to depression symptoms. U.S., Belgian, Hong Kong and Japanese participants retrieved memories related to cue words. Responses were coded for if they referred to a specific event (i.e., an event lasting less than 24 h) and their details (What? Where? Who?). Across sites, and in meta-analyses, the retrieval of more specific memories was associated with retrieval of more details. Memories that were specific included more detail than non-specific memories. Across sites, retrieval of more specific memories and more detail was associated with less severe depression symptoms. Episodic specificity and detailedness are related but separable constructs. Future investigations of autobiographical memory specificity, and methods for alleviating problematic specificity, should consider measures of episodic detailedness.

A multi-method comparison of autobiographical memory impairments amongst younger and older adults.

Objectives: Research indicates that, compared to younger adults, older adults have difficulty recalling memories of specific past events (those lasting less than 24 h) and this difficulty is associated with depression. These studies are largely confined to a single measure of specific memory recall and there are conflicting findings when alternative measures are used. This investigation provides the first comparison of memory specificity between younger and older adults using several different measures.Method: Older (n = 105) and younger (n = 88) adults completed the Autobiographical Memory Test (AMT), Autobiographical Memory Interview (AMI) and Sentence Completion for Events from the Past Test (SCEPT) and the number of specific memories was quantified for each measure. Participants also completed the Beck Depression Inventory Version II (BDI-II).Results: Compared to younger adults, older adults recalled fewer specific memories in the AMT and more specific memories in the AMI. This latter effect was particularly pronounced for memories related to childhood. There was no group difference in responses in the SCEPT. There was no evidence of an association between memory specificity and depression for any of the measures.Conclusion: Older adults have difficulty retrieving specific memories after cuing by nouns and adjectives, as in the AMT, but they have enhanced recall of specific memories after cuing by life periods, as in the AMI, and this is particularly true of memories related to childhood. Individual differences in memory specificity are not related to depression symptoms in healthy samples.

Differential associations between impaired autobiographical memory recall and future thinking in people with and without schizophrenia.

OBJECTIVES: The ability to think about future events serves a range of important functions. People with schizophrenia show impairments in future thinking. However, whether these impairments are specific to positive or negative events and to what extent they are associated with impairments in verbal fluency and autobiographical memory remains poorly understood. METHODS: People with schizophrenia (n = 93) and people without psychiatric diagnoses (n = 111) were asked to generate future events and retrieve past autobiographical events and they also completed a test of verbal fluency. Participants also completed questionnaire measures of the positive and negative dimensions of schizophrenia and depression symptoms. RESULTS: People with schizophrenia generated significantly fewer positive and negative future events than controls. In a linear regression, the interaction between diagnosis and autobiographical memory retrieval explained a significant amount of variance in the number of future events that participants generated even when accounting for symptoms and verbal fluency. Past and future thinking abilities were correlated in controls but not in people with schizophrenia. CONCLUSIONS: People with schizophrenia may not rely on autobiographical content to imagine the future and may rely instead on semantic processes. Interventions that improve past and future thinking amongst people with schizophrenia are warranted. PRACTITIONER POINTS: Compared to control participants, people with schizophrenia have marked difficulty generating possible, positive and negative, future events. Unlike controls, for people with schizophrenia there is no relation between their ability to remember past events and their ability to think about the future. People with schizophrenia may have difficulty using their memories for their past to imagine and simulate possible future events.

Understanding visual attention to face emotions in social anxiety using hidden Markov models.

Theoretical models propose that attentional biases might account for the maintenance of social anxiety symptoms. However, previous eye-tracking studies have yielded mixed results. One explanation is that existing studies quantify eye-movements using arbitrary, experimenter-defined criteria such as time segments and regions of interests that do not capture the dynamic nature of overt visual attention. The current study adopted the Eye Movement analysis with Hidden Markov Models (EMHMM) approach for eye-movement analysis, a machine-learning, data-driven approach that can cluster people's eye-movements into different strategy groups. Sixty participants high and low in self-reported social anxiety symptoms viewed angry and neutral faces in a free-viewing task while their eye-movements were recorded. EMHMM analyses revealed novel associations between eye-movement patterns and social anxiety symptoms that were not evident with standard analytical approaches. Participants who adopted the same face-viewing strategy when viewing both angry and neutral faces showed higher social anxiety symptoms than those who transitioned between strategies when viewing angry versus neutral faces. EMHMM can offer novel insights into psychopathology-related attention processes.

Lower Sleep Duration Is Associated With Reduced Autobiographical Memory Specificity.

Objective/Background: Sleep can have an important influence on memory. However, it is unclear whether there is any relation between sleep quality and the specificity with which autobiographical memories are retrieved, a key factor associated with vulnerability for, and the presence of, depression and other psychiatric diagnoses. The present study provides the first investigation of the association between sleep quality and autobiographical memory specificity. Participants and Method: Fifty-four unselected community participants completed the Autobiographical Memory Test (AMT) to assess memory specificity, while subjective and objective measures of total sleep time and sleep onset latency were provided through a daily diary and an actigraphy wristwatch worn for a week. Participants also completed questionnaires that measure known correlates of AMT specificity: the Ruminative Response Scale (RRS) and Beck Depression Inventory (BDI-II). Results: Shorter sleep duration, measured using actigraphy, was associated with reduced autobiographical memory specificity. There was no evidence of an association between total sleep time recorded by self-report diaries, or of sleep onset latency recorded using actigraphy or diaries and memory specificity. The relation between actigraphy-assessed total sleep time and memory specificity was independent of the effects of rumination or depressive symptoms on these variables. Conclusions: Shorter sleep duration is associated with reduced memory specificity. Future research examining memory specificity and its association with psychopathology should consider the role of sleep quality around the time of memory recall in specificity.

Valence-related impairments in the retrieval of specific autobiographical memories amongst patients with schizophrenia.

OBJECTIVES: People with schizophrenia have difficulty recalling specific autobiographical events from their past. However, the nature of this difficulty (e.g., whether these problems are only for memories that are negative or positive) and the mechanisms associated with it remain poorly understood. METHODS: The present investigation asked patients with schizophrenia (n = 91) and healthy controls (n = 109) to recall memories related to several positive and negative cue words. Participants also completed self-report measures of rumination and depressive symptoms and a measure of verbal fluency to assess executive functioning. Participants' memories were coded for specificity (whether or not they referred to a specific event lasting <24 hr) and valence (positive vs. negative). RESULTS: Patients recalled fewer specific memories than controls and they showed particular difficulty recalling specific negative memories cued by negative words. For healthy controls, impoverished verbal fluency was associated with recall of fewer specific memories and particularly recall of fewer positive specific memories. These variables were unrelated to specificity amongst patients. Rumination was not associated with specificity in either group. CONCLUSIONS: These findings are discussed with reference to other mechanisms that might contribute towards reduced specificity in schizophrenia, such as the tendency to avoid negative affect, and the implications of this for interventions for schizophrenia and memory specificity problems. PRACTITIONER POINTS: The experience of schizophrenia is associated with problems recalling specific events from one's past. In particular, patients have difficulty recalling specific negative memories from their past. These memory problems are independent of executive functioning difficulties, ruminative tendencies, and also depression symptoms. Interventions for memory problems in schizophrenia must target the difficulty people have in recalling specific negative events.

Depression diagnoses, but not individual differences in depression symptoms, are associated with reduced autobiographical memory specificity.

OBJECTIVES: Difficulties recalling specific events from one's autobiographical past have been associated with a range of emotional disorders. We present the first examination of whether diagnoses of depression or individual differences in depression severity explain the most variance in autobiographical memory specificity. We also examine the contribution of other key cognitive factors associated with reduced memory specificity - rumination and verbal fluency - to these effects. METHODS: Participants with (n = 21) and without (n = 25) major depressive disorder completed self-report measures of depression severity (Beck Depression Inventory version II; BDI-II) and ruminative tendency (Ruminative Response Scale), a measure of verbal fluency, and the Autobiographical Memory Test (AMT) to assess memory specificity. RESULTS: People diagnosed with depression recalled significantly fewer specific memories in the AMT relative to healthy controls. In a linear regression, diagnostic status explained a significant amount of unique variance in specificity whereas BDI-II scores did not. Diagnostic group differences in verbal fluency also explained a significant amount of variance in specificity. CONCLUSIONS: Our findings extend our understanding of the mechanisms involved in reduced memory specificity but future research must explore the causal contribution of weak executive functioning to reduced memory specificity. PRACTITIONERS POINTS: Diagnoses of depression were associated with problems recalling specific events from one's past. Problems with memory specificity amongst depressed people were associated with executive functioning difficulties. Problems with specificity were not associated with individual differences in depression severity or ruminative tendencies.

Social support from friends predicts changes in memory specificity following a stressful life event.

Exposure to negative life stress has been associated with difficulty retrieving memories for specific autobiographical events, with important consequences for the emergence of emotional disorders. We examined whether social support can protect against the effects of negative events on memory specificity. University students (N = 143) were assigned to groups based on whether or not they experienced a negative stressor, operationalised as whether or not their recent exam performance was in line with their expectations. After receiving their exam results (T1), and one month later (T2), participants completed measures of memory specificity, their attitudes towards themselves and the occurrence of other stress-related events. Participants also completed a general measure of perceived social support from friends, family, and significant others, and an equivalent measure for social support related to performance. For participants who experienced an exam-related stressor, reduced performance-specific social support from friends was associated with reduced memory specificity at T2, even when accounting for T1 memory specificity, individual differences in attitudes towards self, the experience of additional stressors, and gender. No such relation was present for participants who did not experience a stressor. These findings provide new understanding of the influence of social variables on autobiographical memory specificity.

Reduced autobiographical memory specificity affects general distress through poor social support.

Sharing specific autobiographical events is likely to influence the support people give us; a person who shares little detail of their lives may be unlikely to attract social support and this may in turn contribute towards anxious and depressive symptoms. Participants (N = 142) reported memories evoked by negative and positive cue words and these memories were coded for whether or not they referred to a specific event lasting less than 24 h. At this time (T1) and one year later (T2), participants also completed the UCLA Life Stress Interview (LSI), which includes a measure of social support, and measures of depression and anxiety comprising a general distress latent construct. The tendency to recall fewer specific memories was associated with lower social support given by friends and romantic partners and this was in turn associated with elevated general distress at T2, even when accounting for T1 social support and general distress. Our findings contribute to the literature regarding the social function of memory and suggest another route via which reduced specificity contributes to emotional disorders.

Remediating Reduced Autobiographical Memory in Healthy Older Adults With Computerized Memory Specificity Training (c-MeST): An Observational Before-After Study.

BACKGROUND: The ability to retrieve specific autobiographical memories decreases with cognitive aging. This decline is clinically relevant due to its association with impairments in problem solving, daily functioning, and depression. A therapist-delivered group training protocol, Memory Specificity Training (MeST), has been shown to enhance the retrieval of specific memories while ameliorating the impairments and negative outcomes associated with reduced specificity. The therapist-delivered nature of this intervention means it is relatively expensive to deliver and difficult for people with mobility impairments, such as older people, to receive. OBJECTIVE: The objective of this study was to test if a novel, Web-based computerized version of a group training protocol called Memory Specificity Training, has the potential to increase autobiographical memory specificity and impact associated secondary psychological processes. METHODS: A total of 21 participants (13 female; mean age 67.05, SD 6.55) who experienced a deficit in retrieving specific autobiographical memory were trained with c-MeST. We assessed memory specificity at preintervention and postintervention, as well as secondary processes such as depressive symptoms, rumination, and problem-solving skills. RESULTS: Memory specificity increased significantly after participants completed c-MeST (r=.57). Session-to-session scores indicated that autobiographical memory specificity improved most from the online baseline assessment to the first Web-based session. Symptoms or secondary processes such as problem-solving skills did not change significantly. CONCLUSIONS: A Web-based automated individual version of MeST is a feasible, low-cost intervention for reduced memory specificity in healthy older adults. Future studies should clarify the preventive impact of c-MeST in other at-risk sample populations with longer follow-up times.

Factor analysis and validation of a self-report measure of impaired fear inhibition.

Difficulties with inhibiting fear have been associated with the emergence of anxiety problems and poor response to cognitive-behavioural treatment. Fear inhibition problems measured using experimental paradigms involving aversive stimuli may be inappropriate for vulnerable samples and may not capture fear inhibition problems evident in everyday life. We present the Fear Inhibition Questionnaire (FIQ), a self-report measure of fear inhibition abilities. We assess the FIQ's factor structure across two cultures and how well it correlates with fear inhibition indices derived experimentally. Adolescent participants from Hong Kong and England completed the FIQ, with the English participants also completing a conditioning and extinction task to assess fear inhibition problems. Across both cultures, the FIQ showed a single factor structure and low FIQ scores, or worse fear inhibition problems, were associated with self-reports of heightened anxiety. Correlation of FIQ scores with experimental indices, whilst controlling for anxious symptoms, suggests that the FIQ represents a valid and unique measure of fear inhibition abilities. The FIQ might be used to assess more ecologically valid fear inhibition problems particularly amongst people who have or who are at risk of anxiety diagnoses.

Meta-Analysis of the Association Between Autobiographical Memory Specificity and Exposure to Trauma.

Cognitive models of emotional disorders suggest that reduced autobiographical memory specificity that results from exposure to traumatic events may play an important role in the aetiology and maintenance of these disorders. However, there has yet to be a comprehensive meta-analysis of the association between trauma exposure and memory specificity, and the role of posttraumatic stress symptoms on this association. We searched PsycINFO and MEDLINE databases and extracted data from studies regarding the mean number or proportion of specific memories that participants with and without trauma exposure recalled on the Autobiographical Memory Test. We also extracted data on differences between groups in terms of posttraumatic stress and depressive symptoms, along with data on trauma timing and participants' ages at the time of assessment. The effect size of memory specificity between participants with and without exposure to trauma was large, d = 0.77, and differed significantly from zero, p < .001. In metaregression, trauma timing was a significant predictor of the heterogeneity in trauma-exposure specificity effect sizes, but posttraumatic stress and depressive symptoms were not. Compromised memory specificity represents an important cognitive consequence of trauma exposure that might have an important influence on risk for, and maintenance of, subsequent emotional pathologies.

Meta-analysis of the association between rumination and reduced autobiographical memory specificity.

The CaRFAX model, proposed by Williams J. M. G. (2006. Capture and rumination, functional avoidance, and executive control (CaRFAX): Three processes that underlie overgeneral memory. Cognition and Emotion, 20, 548-568. doi: 10.1080/02699930500450465 ; Williams, J. M. G., Barnhofer, T., Crane, C., Herman, D., Raes, F., Watkins, E., & Dalgleish, T. (2007). Autobiographical memory specificity and emotional disorder. Psychological Bulletin, 133(1), 122-148. doi: 10.1037/0033-2909.133.1.122 ) posits that reduced autobiographical memory specificity, a key factor associated with the emergence and maintenance of emotional disorders, may result from heightened rumination. We provide the first meta-analysis of the relation between autobiographical memory specificity and trait rumination. PsycINFO, PsycARTICLES and MEDLINE databases were searched and the following were extracted: the correlation between the number of specific memories recalled in the Autobiographical Memory Test and self-reported trait rumination scores, and its sub-factors - brooding and reflection. The pooled effect size for the correlation between memory specificity and trait rumination was small (d = -.05) and did not differ significantly from zero (p = .09). The effect sizes for the correlation with brooding and reflection were not significantly different from zero. There is limited support for the association between trait rumination and memory specificity suggested in CaRFAX.

Meta-analysis of the influence of age on symptom change following cognitive-behavioural treatment for anxiety disorders.

INTRODUCTION: Adolescents, relative to adults, show impairments in learning to reduce or extinguish fear. Furthermore, they may struggle with the use of reappraisal techniques to regulate affect. Both learning and reappraisals are critical to cognitive-behavioural treatments (CBT) for anxiety disorders leading to the hypothesis that adolescents may respond more poorly to CBT than adults. METHODS: We use meta-regression to explore whether variability in the mean age of participants in trials of CBT for anxiety predicted variability between studies in symptom change effect sizes. PsycARTICLES, PsycINFO, MEDLINE and Embase databases were searched with the terms exposure and each of anxiety, phobia, or panic disorder diagnostic terms and cognitive behav* therapy with each of the diagnostic terms. Data were pooled from CBT trials for anxiety disorders (excluding anxiety-related disorders - obsessive compulsive disorder and posttraumatic stress disorder) where participants' mean age was 11 years or older. 149 studies were selected and data on change in symptoms from pre-treatment to post-treatment (k = 195), pre-treatment to follow-up (k = 108) and post-treatment to follow-up (k = 107) were extracted. RESULTS: Several possible confounding variables were also accounted for (e.g., proportion of females, number of sessions). Younger age was associated with smaller improvement in anxious symptoms from pre-to post-treatment. However, younger age was also associated with greater improvement in symptoms from post-treatment to follow-up. CONCLUSIONS: CBT is effective at reducing anxious symptoms, however, younger people may respond more slowly to treatment than older people.

Commentary: Predicting outcomes of treatment for anxiety disorders - using data from fear learning paradigms. A commentary on Waters and Pine (2016).

Despite the apparent effectiveness of cognitive-behavioral therapy (CBT) in the treatment of anxiety disorders, more can be done to predict individual variability in the effectiveness of CBT. One potentially useful predictor involves individual differences in fear inhibition and extinction as similar learning processes are thought to be involved in CBT. Waters and Pine (this issue) present an investigation of the relationship between pretreatment indices of fear extinction and responsiveness to CBT among children with anxiety disorders. We discuss these findings and place them within the context of supporting evidence from neurobiological and genetic research. Various novel ways in which different elements of fear inhibition and extinction can be quantified are then outlined, and the potential utility of this approach for clinicians and researchers particularly in developmental samples is discussed.

DEFICITS IN DISENGAGING ATTENTION FROM THREAT PREDICT IMPROVED RESPONSE TO COGNITIVE BEHAVIORAL THERAPY FOR ANXIETY.

BACKGROUND: Pretreatment biases in attending toward threat have been shown to predict greater symptom reduction following cognitive behavioral therapy (CBT) for anxiety. Findings to date do not extend to clinical severity of diagnoses and they assess treatment response immediately posttreatment and not at follow-up. Research in this area has also not examined components of vigilance (e.g., engagement, disengagement) or whether these effects are confined to external attention and not attention to internal symptoms of anxiety. METHODS: In the present investigation, 96 adults with a range of anxiety disorders completed a dot probe task to assess threat-related attention biases before and after 12 sessions of CBT. RESULTS: Pretreatment deficits in disengaging attention from external and internal threats, and not the speed of engagement with threat, predicted reductions in clinical severity of diagnoses that were maintained 2 years later. The presence of posttreatment attention biases was not associated with increased clinical severity after treatment. CONCLUSIONS: Pretreatment deficits in disengaging attention from threat may promote better and more durable response to CBT for a range anxiety disorders.