Transmission of Cognitive Bias and Fear From Parents to Children: An Experimental Study.

This study explored the role of parents in the development of a cognitive bias and subsequent fear levels in children. In Experiment 1, nonclinical children ages 8-13 (N = 122) underwent a training during which they worked together with their mothers on an information search task. Mothers received instructions to induce either a positive or negative information search bias in their children. Experiment 2 investigated to what extent mothers own cognitive bias predicted children's information search bias. Mothers of 49 nonclinical children ages 9-12 received no explicit training instructions before working together with their child on an information search task. Experiment 1 demonstrated that mothers had a significant impact on children's cognitive bias and fear. More precisely, children who had received a negative parental training displayed an increase in negative information search bias and fear, whereas children who had received a positive parental training showed an increase in positive information search bias and a decrease in fear. In Experiment 2, it was found that children's information search biases after working together with their mothers were predicted by their mothers' initial cognitive bias scores. These findings can be taken as support for the intergenerational transmission of cognitive biases from mothers to children.

Effectiveness and uptake of a transdiagnostic emotion regulation mobile intervention among university students: Protocol for a randomized controlled trial.

Background: Going to university is a major life event, which can be stressful and negatively affect mental health. However, it also presents an opportunity to establish a foundation for positive life trajectories. To support university students, a mobile transdiagnostic emotion regulation (ER) intervention has been developed, offering both broad-based (universal) and targeted (indicated) preventative support. ER, a transdiagnostic factor underlying various mental health problems, is a critical intervention target in students, a demographic particularly susceptible to mental health issues. Cultivating ER can help manage immediate stressors and foster long-term wellbeing. This paper describes the study protocol for a Randomized Controlled Trial (RCT) evaluating the effectiveness and uptake of such mobile transdiagnostic ER intervention. Method: The superiority parallel-group RCT involves 250 participants randomized to either the intervention condition (i.e., full access to the mobile intervention, (n = 125) or to a waitlist control condition (n = 125). Primary outcomes include ER skills and stress symptoms. Secondary outcomes include mental health parameters (anxiety, depression, resilience) and intervention uptake (i.e., objective engagement, subjective engagement, ER skills application in real life). Outcomes are assessed at baseline, week 3, 8 and 12, with continuous log-data collection for user engagement. Discussion: This study evaluates the effectiveness and uptake of a transdiagnostic ER mobile intervention for the student population addressing their ER developmental needs. If successful, the results will validate our approach to intervention development and whether focusing on learning transfer (i.e., application of the learnt skills in real-life) and personalization using a recommendation system, can boost the real-world application of skills and intervention impact.

Macro-engagement in mHealth: Exploring user engagement beyond the screen.

While digital technology holds great promise for health and well-being, some users feel sceptical about the time they spend online and how they use their mobile devices. This attitude could hamper uptake of digital health technologies and engagement with them. This study uses the concept of macro-engagement as a starting point to investigate how users of digital behaviour change interventions (DBCIs) engage with their behaviour change goals beyond the screens of their tools. Thirty semi-structured interviews were conducted with individuals who take part in behaviour change processes in different ways (i.e. mental health professionals, digital health experts and users of DBCIs). A qualitative analysis of their data through a grounded theory approach highlighted a wide array of offscreen behaviors and strategies that complement a behavior change process offscreen. Furthermore, implications for designing technology that encourages progressive non-reliance on DBCI usage are drawn out.

Optimization of a Transdiagnostic Mobile Emotion Regulation Intervention for University Students: Protocol for a Microrandomized Trial.

BACKGROUND: Many university students experience mental health problems such as anxiety and depression. To support their mental health, a transdiagnostic mobile app intervention has been developed. The intervention provides short exercises rooted in various approaches (eg, positive psychology, mindfulness, self-compassion, and acceptance and commitment therapy) that aim to facilitate adaptive emotion regulation (ER) to help students cope with the various stressors they encounter during their time at university. OBJECTIVE: The goals of this study are to investigate whether the intervention and its components function as intended and how participants engage with them. In addition, this study aims to monitor changes in distress symptoms and ER skills and identify relevant contextual factors that may moderate the intervention's impact. METHODS: A sequential explanatory mixed methods design combining a microrandomized trial and semistructured interviews will be used. During the microrandomized trial, students (N=200) will be prompted via the mobile app twice a day for 3 weeks to evaluate their emotional states and complete a randomly assigned intervention (ie, an exercise supporting ER) or a control intervention (ie, a health information snippet). A subsample of participants (21/200, 10.5%) will participate in interviews exploring their user experience with the app and the completed exercises. The primary outcomes will be changes in emotional states and engagement with the intervention (ie, objective and subjective engagement). Objective engagement will be evaluated through log data (eg, exercise completion time). Subjective engagement will be evaluated through exercise likability and helpfulness ratings as well as user experience interviews. The secondary outcomes will include the distal outcomes of the intervention (ie, ER skills and distress symptoms). Finally, the contextual moderators of intervention effectiveness will be explored (eg, the time of day and momentary emotional states). RESULTS: The study commenced on February 9, 2023, and the data collection was concluded on June 13, 2023. Of the 172 eligible participants, 161 (93.6%) decided to participate. Of these 161 participants, 137 (85.1%) completed the first phase of the study. A subsample of participants (18/172, 10.5%) participated in the user experience interviews. Currently, the data processing and analyses are being conducted. CONCLUSIONS: This study will provide insight into the functioning of the intervention and identify areas for improvement. Furthermore, the findings will shed light on potential changes in the distal outcomes of the intervention (ie, ER skills and distress symptoms), which will be considered when designing a follow-up randomized controlled trial evaluating the full-scale effectiveness of this intervention. Finally, the results and data gathered will be used to design and train a recommendation algorithm that will be integrated into the app linking students to relevant content. TRIAL REGISTRATION: ClinicalTrials.gov NCT05576883; https://www.clinicaltrials.gov/study/NCT05576883. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/46603.

Mood and emotional reactivity of adolescents during the COVID-19 pandemic: short-term and long-term effects and the impact of social and socioeconomic stressors.

Adolescence is a formative period for socio-emotional development which is threatened by the COVID-19 pandemic. The current longitudinal study examined two aims: (1) the short- and long-term effects of the pandemic on young people's mood (i.e. vigor, tension, and depression levels) and emotional reactivity (i.e. fluctuations in daily mood), and (2) the impact of stressors on mood, emotional reactivity, self-oriented (i.e. maladaptive behavior towards COVID-19 rules) and other-benefitting behaviors (i.e. behavior aimed at helping and comforting others). We conducted an online two-week daily diary study among 462 Dutch adolescents (Mage = 15.27 years, 64% females) and 371 young adults (Mage = 21.49 years, 81% females) in May 2020, with a follow-up in November 2020 (N = 238 and 231, respectively adolescents and young adults). In May 2020, young adults and older relative to younger adolescents showed higher levels and more fluctuations in tension and depression and lower levels of vigor. Vigor levels decreased and tension and depression levels increased between May 2020 and November 2020, especially for younger adolescents. There were positive associations between instability of negative emotions (i.e. tension and depression fluctuations) and the exposure to stressors (i.e. family stress and inequality of online homeschooling) in the adolescent sample. Together, this study demonstrates vulnerability regarding young people's mood and emotional reactivity during the COVID-19 pandemic, especially for adolescents who experience more stressors.

Long-term tDCS effects on neurophysiological measures of cognitive control in tobacco smokers.

INTRODUCTION: In this study we assessed the effects of transcranial Direct Current Stimulation (tDCS) on inhibitory control and error processing as measures of cognitive control to better understand tDCS modulation of smoking behaviour. METHODS: Smokers were allocated to six sessions of either active tDCS (n = 34) or sham tDCS (n = 35) (https://clinicaltrials.gov/ct2/show/NCT03027687). Immediately before, one day after, and three months after all tDCS sessions, participants performed the Go-NoGo task while we measured behavioural and neurophysiological responses. RESULTS: One day after the intervention no significant effect was found of active tDCS on behavioural and neurophysiological measures of cognitive control in tobacco smokers. However, a significant improvement in reaction times, and a decrease in No-Go P3 amplitudes for smoking cues was found three months after active tDCS. CONCLUSION: Given the direction of the effect, we speculate that tDCS has a long-term modulatory learning effect on selective attention and motor inhibition.

Multi-session electrical neuromodulation effects on craving, relapse and cognitive functions in cocaine use disorder: A randomized, sham-controlled tDCS study.

BACKGROUND: The use of transcranial Direct Current Stimulation (tDCS) has previously shown promising results for reducing craving in cocaine use disorder. In this study we further explored the potential of tDCS as add-on intervention in the treatment of cocaine use disorder. METHODS: In a randomized, placebo-controlled, between subject study, we applied tDCS bilaterally with the anodal electrode targeting the right dorsolateral prefrontal cortex (DLPFC; https://clinicaltrials.gov/ct2/show/NCT03025321). Patients with cocaine use disorder were allocated to ten sessions of either active tDCS (n = 29) or sham (n = 30) on five consecutive days. Inhibitory control and risky decision-making were measured via a Go-NoGo task and a two-choice gambling task, respectively, each at baseline, one day after all tDCS sessions and after three months. Relapse at follow-up and craving were also assessed. RESULTS: There was no significant effect of active tDCS on the number of cocaine use days and craving. Relapse was frequent among patients who had received either active or sham tDCS (48.0 % and 69.2 %, respectively), despite an overall decrease in craving during the first two weeks of treatment. No effects were found on cognitive functions. An exploratory analysis for crack cocaine use only revealed that relapse rates were significantly reduced after active tDCS (n = 17) as compared to sham (n = 19). CONCLUSIONS: No beneficial effects of tDCS on number of cocaine use days, craving and cognitive functions were found in the present study, but somewhat promising results were obtained regarding relapse rates among crack-cocaine users specifically. Further research is required to determine the efficacy of tDCS as a complementary treatment in cocaine use disorder.

No effect of repetitive tDCS on daily smoking behaviour in light smokers: A placebo controlled EMA study.

INTRODUCTION: The effectiveness of repetitive transcranial Direct Current Stimulation (tDCS) on reducing smoking behaviour has been studied with mixed results. Smoking behaviour is influenced by affect and context, therefore we choose to use mobile ecological momentary assessments (EMA) to measure changes in smoking behaviour after tDCS. METHODS: In a randomized, placebo-controlled, between subject study, we applied tDCS bilaterally with the anodal electrode targeting the right DLPFC (https://clinicaltrials.gov/ct2/show/NCT03027687). Smokers were allocated to six sessions of either active tDCS (n = 35) or sham tDCS (n = 36) and received two sessions on three different days in one week. They were asked to keep track of their daily cigarette consumption, craving and affect in an application on their mobile phones for three months starting one week before the first tDCS session. RESULTS: Number of smoked cigarettes a day progressively decreased up to one week after the last tDCS session in both conditions. Active treatment had no additional effect on cigarette consumption, craving and affect. CONCLUSIONS: In this exploratory study, repetitive bilateral tDCS over the DLPFC had no effect on daily smoking behaviour. Future research needs to investigate how motivation to quit smoking and the number of tDCS sessions affect the efficacy of repetitive tDCS.

Mindfulness, Interpretation Bias, and Levels of Anxiety and Depression: Two Mediation Studies.

In two studies, a possible mediation effect was tested of cognitive interpretation bias in the relation between respectively dispositional mindfulness and acceptance, on the one hand, and symptoms of depression and anxiety, on the other hand. An undergraduate student sample (N = 133; 86% female, M age = 19.8) and a convenience community sample (N = 186; 66% female, M age = 36.5) were examined by means of an online questionnaire measuring dispositional mindfulness (FFMQ-SF; Study 1) and acceptance (AAQ-II; Study 2), anxiety (STAI-trait) and depressive (BDI-II) symptoms, and interpretation bias (with the interpretation bias task, IBT). Considering both studies, results showed consistently the expected relations of larger mindfulness skills going together with a smaller cognitive interpretation bias and lower levels of depression and anxiety symptoms. More interestingly, it was found that interpretation bias served as a mediator in the relations between respectively dispositional mindfulness and acceptance, and symptoms of depression and anxiety. With these findings, some more insight in the working mechanisms of mindfulness-based treatments on internalizing psychopathology has been obtained.

Impaired subjective self-control in alcohol use: An ecological momentary assessment study.

BACKGROUND: While both theory and empirical findings have supported impaired self-control as a crucial factor in understanding problem drinking, little is known about the relationship of self-control and drinking in naturalistic settings. The present study uses Ecological Momentary Assessment (EMA) to examine the predictive relationships between impaired subjective self-control, craving and alcohol use in everyday life. METHODS: A sample of 172 regular drinkers responded on their smartphone to three random prompts each day for seven days in which amount of perceived self-control and craving were measured with self-report. In the meantime, participants were instructed to initiate an EMA report when they started drinking alcohol. RESULTS: Findings supported the hypotheses that impaired self-control and higher craving levels were prospectively related to the likelihood that people will drink. That is, on random assessments that preceded drinking (i.e., were within two hours of drinking), perceived self-control was lower and craving was higher compared to random assessments that were not followed by drinking. Additionally, during drink consumption, impaired self-control and craving were associated with a higher amount of expected alcohol consumption. Findings further indicated that subjective self-control acted as a moderator of the relationship between craving and alcohol consumption during drinking occasions. CONCLUSIONS: By using a smartphone mobile application, this study showed that impaired subjective self-control and craving are prospectively related to alcohol use in the real-world. Furthermore, findings are consistent with theories of addiction that substance use might be associated with the interplay of control processes and increased motivation.

Compliance with ecological momentary assessment protocols in substance users: a meta-analysis.

BACKGROUND AND AIMS: While there are considerable benefits to Ecological Momentary Assessment (EMA), poor compliance with assessment protocols has been identified as a limitation, particularly in substance users. Our aim was to identify the pooled compliance rate of EMA studies in substance users and examine variables that may influence compliance with EMA protocols, such as the length and frequency of assessments. DESIGN: A meta-analysis and meta-regression of all possible studies (randomized controlled trials and longitudinal) which incorporated EMA protocols, examining substance use. SETTING: Studies took place from 1998 to 2017, in numerous countries world-wide. PARTICIPANTS: One hundred and twenty-six studies were identified, contributing a total of 19 431 participants (52.32% male, mean age = 28.86). MEASUREMENTS: Compliance data, the proportion of responses to the study protocol, were extracted from each study alongside prompt frequency, total length of assessment period, substance use population and device used to administer EMA prompts. FINDINGS: The pooled compliance rate across all studies was 75.06% [95% confidence interval (CI) = 72.37%, 77.65%]. There was no evidence that compliance rates were significantly associated with prompt frequency [Q(3) = 7.35, P = 0.061], length of assessment period [Q(2) = 2.40, P = 0.301], substance type [Q(3) = 6.30, P = 0.098] or device administration [Q(4) = 4.28, P = 0.369]. However, dependent samples (69.80%) had lower compliance rates than non-dependent samples [76.02%; Q(1) = 4.13, P = 0.042]. CONCLUSIONS: The pooled compliance rate for Ecological Momentary Assessment studies in substance-using populations from 1998 to 2017 was lower than the recommended rate of 80%, and was not associated with frequency or duration of assessments.

Cognitive bias in action: evidence for a reciprocal relation between confirmation bias and fear in children.

BACKGROUND AND OBJECTIVES: Some cognitive models propose that information processing biases and fear are reciprocally related. This idea has never been formally tested. Therefore, this study investigated the existence of a vicious circle by which confirmation bias and fear exacerbate each other. METHODS: One-hundred-and-seventy-one school children (8-13 years) were first provided with threatening, ambiguous, or positive information about an unknown animal. Then they completed a computerized information search task during which they could collect additional (negative, positive, or neutral) information about the novel animal. Because fear levels were repeatedly assessed during the task, it was possible to examine the reciprocal relationship between confirmation bias and fear. RESULTS: A reciprocal relation of mutual reinforcement was found between confirmation bias and fear over the course of the experiment: increases in fear predicted subsequent increases in the search for negative information, and increases in the search for negative information further enhanced fear on a later point-in-time. In addition, the initial information given about the animals successfully induced diverging fear levels in the children, and determined their first inclination to search for additional information. LIMITATIONS: As this study employed a community sample of primary school children, future research should test whether these results can be generalized to clinically anxious youth. CONCLUSIONS: These findings provide first support for the notion that fearful individuals may become trapped in a vicious circle in which fear and a fear-related confirmation bias mutually strengthen each other, thereby maintaining the anxiety pathology.

"Watch out for the gerbils, my child!" the role of maternal information on children's fear in an experimental setting using real animals.

Using an experimental approach, we examined the effects of verbal information as provided by the mothers on children's fear of real novel animals. Mothers of children aged 8 to 12 years (N=47) were shown a cage containing a pair of exotic rodents (i.e., Mongolian gerbils) and then received either positive or negative information about these animals. Mothers were told that their child would have to approach the animals and had the opportunity to prepare their children for this confrontation. Results showed that mothers spontaneously passed over the information they had received to their children. Most importantly, this information to some extent determined children's fear reactions towards the animals. That is, whereas no clear effects of information were found on subjective fear ratings, the data did indicate that children of mothers in the negative information condition were more reluctant to approach the animals as compared to children of mothers who had received positive information. The findings provide further support for the idea that verbal information as provided by parents may induce fear in their offspring.

Children's fear reactions to the 2009 Swine Flu pandemic: the role of threat information as provided by parents.

The purpose of the present study was to investigate the contribution of threat information as provided by the parents to the development of children's fear within the context of the 2009 Swine Flu pandemic. Normal school children aged 7-12 years (N = 223) and their parents completed questionnaires to measure fear of the Swine Flu and general fearfulness for medical affairs. Children and parents were also asked to indicate to what extent parents had provided children with threat-related information about this disease. Results indicated that children's fear of the Swine Flu was significantly related to parents' fear of this disease. Further, it was found that parent's transmission of threat information was positively associated with children's fear and that this link remained significant when controlling for other sources of information (i.e., media, friends, and school) or direct experience with the disease. Most importantly, results showed that threat information as provided by the parents played a role in the association between parents' and children's fear. More precisely, support was found for a partial mediation model in which parents' fear of the Swine Flu was related with parents' threat information transmission, which in turn was associated with children's fear of the disease.

"Will a Cuscus bite you, if he shows his teeth?" Inducing a fear-related confirmation bias in children by providing verbal threat information to their mothers.

Confirmation bias refers to the inclination to selectively search for information that confirms the view that one holds. Research has shown that fearful individuals mainly seek information that confirms dangerousness of the dreaded stimulus or situation (i.e., verification), whereas they have less an eye for information that invalidates threat (i.e., falsification). It has been demonstrated that fear-related reasoning biases also occur in children, but little is known about where these biases originate from. The present study examined the role of mothers in the development of a fear-related confirmation bias in children. More precisely, it was tested whether mothers install such a reasoning bias in their children via verbal threat information. For this purpose, mothers of 52 children aged 9-12 years were provided with either threatening or positive information about a novel animal and then instructed to describe the animal to their child on the basis of a number of open-ended vignettes. Results indicated that mothers who received threat information about the novel animal displayed a fear-related confirmation bias: that is, they relied less on a falsification strategy than mothers who had heard the positive information. Most importantly, mothers passed the bias on to their children. More precisely, after the vignettes task, children of mothers who had received threat information also sought less information to invalidate the dangerousness of the animal than children of mothers who had received positive information.

Ground control to Major Tom: experimental manipulation of anxiety-related interpretation bias by means of the "space odyssey" paradigm and effects on avoidance tendencies in children.

The "space odyssey" paradigm refers to an experimental method that can be used to manipulate interpretation bias in youths. In this study, the "space odyssey" paradigm was employed to induce either a negative or a positive interpretation bias in a sample of 120 non-clinical children aged 9-13 years. The results indicated that children's interpretation bias and avoidance tendencies scores were successfully manipulated during the experiment. That is, children in the negative training group showed an increase in negative interpretation bias and avoidance tendencies, whereas children in the positive training group exhibited a decrease in interpretation bias and avoidance tendencies, although it should be admitted that these effects in general were rather weak. Further, no support was found for the idea that high-anxious children were more affected by the experimental manipulation than low-anxious children.

Effects of verbal information on fear-related reasoning biases in children.

The present study made an attempt to induce fear-related reasoning biases by providing children with negative information about a novel stimulus. For this purpose, non-clinical children aged 9-12 years (N=318) were shown a picture of an unknown animal for which they received either negative, ambiguous, positive, or no information. Then children completed a series of tests for measuring various types of reasoning biases (i.e., confirmation bias and covariation bias) in relation to this animal. Results indicated that children in the negative and, to a lesser extent, the ambiguous information groups displayed higher scores on tests of fear-related reasoning biases than children in the positive and no information groups. Altogether, these results support the idea that learning via negatively tinted information plays a role in the development of fear-related cognitive distortions in youths.