Internet-based interpretation bias modification for body dissatisfaction: A three-armed randomized controlled trial.

OBJECTIVE: Appearance-related interpretation bias is postulated to play a role in the maintenance of body dissatisfaction (BD), a risk factor for body dysmorphic disorder (BDD), and eating disorders (ED). Cognitive bias modification for interpretation (CBM-I) has been shown to reduce maladaptive interpretation bias and symptoms in various emotional disorders. This study investigated the acceptability and efficacy of an easily disseminable, web-based CBM-I program for BD. METHODS: Individuals with high BD (N = 318) were randomized to a multi-session CBM-I (Sentence Word Association Paradigm [SWAP] with feedback) vs. control (SWAP without feedback) versus waitlist condition. Interpretation bias, BD and associated symptoms were assessed at baseline and post-intervention. Symptoms were monitored up to 1-week and 4-week follow-up. We further investigated transference effects to stress reactivity, as predicted by cognitive-behavioral models, at post-intervention. RESULTS: Appearance-related CBM-I led to a differential pre-post increase in adaptive interpretation patterns, particularly for appearance-related and social situations (d = 0.65-1.18). Both CBM-I and control training reduced BD, BDD symptom severity, and depression. However, CBM-I (vs. control and waitlist) improved appearance-related quality of life (d = 0.51), self-esteem (d = 0.52), and maladaptive appearance-related beliefs (d = 0.47). State stress reactivity was overall reduced in the CBM-I condition (vs. waitlist). Intervention effects largely held stable up to follow-ups. Treatment satisfaction was comparable to other CBM-I studies, with low rates of adverse reactions. DISCUSSION: These findings support assumptions of cognitive-behavioral models for BD, BDD, and ED, and suggest that web-based CBM-I is an efficacious and acceptable intervention option.

Threat-induced impulsivity in Go/Nogo tasks: Relationships to task-relevance of emotional stimuli and virtual proximity.

Threatening stimuli are thought to induce impulsive responses, but Emotional Go/Nogo task results are not in line with this. We extend previous research by testing effects of task-relevance of emotional stimuli and virtual proximity. Four studies were performed to test this in healthy college students. When emotional stimuli were task-relevant, threat both increased commission errors and decreased RT, but this was not found when emotional stimuli were task-irrelevant. This was found in both between-subject and within-subject designs. These effects were found using a task version with equal go and nogo rates, but not with 90-10% go-nogo rates. Proximity was found to increase threat-induced speeding, with task-relevant stimuli only, although effects on accuracy were less clear. Threat stimuli can thus induce impulsive responding, but effects depend on features of the task design. The results may be of use in understanding theoretically unexpected results involving threat and impulsivity and designing future studies.

Predictive Attentional Bias Modification Induces Stimulus-Evoked Attentional Bias for Threat.

Attentional Bias Modification (ABM) aims to modulate attentional biases, but questions remain about its efficacy and there may be new variants yet to explore. The current study tested effects of a novel version of ABM, predictive ABM (predABM), using visually neutral cues predicting the locations of future threatening and neutral stimuli that had a chance of appearing after a delay. Such effects could also help understand anticipatory attentional biases measured using cued Visual Probe Tasks. One hundred and two participants completed the experiment online. We tested whether training Towards Threat versus Away from Threat contingencies on the predABM would cause subsequent attentional biases towards versus away from threat versus neutral stimuli, respectively. Participants were randomly assigned and compared on attentional bias measured via a post-training Dot-Probe task. A significant difference was found between the attentional bias in the Towards Threat versus Away from Threat group. The training contingencies induced effects on bias in the expected direction, although the bias in each group separately did not reach significance. Stronger effects may require multiple training sessions. Nevertheless, the primary test confirmed the hypothesis, showing that the predABM is a potentially interesting variant of ABM. Theoretically, the results show that automatization may involve the process of selecting the outcome of a cognitive response, rather than a simple stimulus-response association. Training based on contingencies involving predicted stimuli affect subsequent attentional measures and could be of interest in future clinical studies.

Anticipatory versus reactive spatial attentional bias to threat.

Dot-probe or visual probe tasks (VPTs) are used extensively to measure attentional biases. A novel variant termed the cued VPT (cVPT) was developed to focus on the anticipatory component of attentional bias. This study aimed to establish an anticipatory attentional bias to threat using the cVPT and compare its split-half reliability with a typical dot-probe task. A total of 120 students performed the cVPT task and dot-probe tasks. Essentially, the cVPT uses cues that predict the location of pictorial threatening stimuli, but on trials on which probe stimuli are presented the pictures do not appear. Hence, actual presentation of emotional stimuli did not affect responses. The reliability of the cVPT was higher at most cue-stimulus intervals and was .56 overall. A clear anticipatory attentional bias was found. In conclusion, the cVPT may be of methodological and theoretical interest. Using visually neutral predictive cues may remove sources of noise that negatively impact reliability. Predictive cues are able to bias response selection, suggesting a role of predicted outcomes in automatic processes.

Combining attentional bias modification with dorsolateral prefrontal rTMS does not attenuate maladaptive attentional processing.

High frequency repetitive Transcranial Magnetic Stimulation (rTMS) over the left dorsolateral prefrontal cortex (DLPFC) has been shown to reduce depressive symptoms and improve cognitive biases such as attentional bias. One promising technique that may complement rTMS treatment is attentional bias modification (ABM) training, given the similarity in modulating attentional bias and affecting neuronal activity. We tested whether the combination of rTMS treatment and ABM training in a single session would attenuate maladaptive attentional processing and improve mood in participants with subclinical depressive symptoms. To this end, 122 healthy participants were randomly assigned to one of four groups, receiving either a single rTMS treatment, a single ABM treatment, a combination of rTMS and ABM or a sham treatment. Of these 122 participants, 72 showed a heightened BDI-II score (between 9 and 25) and were included in our main analyses. In our subclinical (≥9 and ≤25 BDI-II) sample, a single combination treatment of rTMS and ABM training induced no significant changes in attentional bias, attentional control or mood, nor did rTMS alone affect attentional bias systematically. We discuss these null findings in light of the task specifics and relate them to the ongoing discussion on ABM training in depression.

Effects of induced appearance-related interpretation bias: A test of the cognitive-behavioral model of body dysmorphic disorder.

BACKGROUND AND OBJECTIVES: Interpretation biases are hypothesized to maintain body dysmorphic disorder (BDD). Although their existence and malleability have been investigated in clinical studies, their causal status in the maintenance of BDD remains unclear. This study examined the effects of a single-session appearance-related interpretation bias training (CBM-I) on bias indices and stress reactivity (i.e., distress, appearance dissatisfaction, self-esteem, perceived physical attractiveness), exploring the causality predicted in cognitive-behavioral models. METHODS: We used a modified version of the Word Sentence Association Paradigm (WSAP), assessing explicit (i.e., decision rates) and more implicit interpretation bias components (i.e., reaction times). Mentally healthy students (N = 112) were randomized to training conditions enhancing positive interpretation patterns (PT) vs. negative interpretation patterns (NT) vs. a no-feedback control condition (CC). Stress reactivity was assessed during the Cyberball Paradigm. RESULTS: The PT showed a pre-post increase in adaptive bias patterns regarding decision and a differential pre-post decrease in reaction times for the rejection of negative interpretations, compared to the other groups. There were no condition-congruent post-training differences in stress reactivity. However, residual interpretation bias change was significantly correlated with state distress, self-esteem and appearance dissatisfaction during stressor exposure. LIMITATIONS: Limitations pertaining to sample characteristics, training and assessment overlap, and stressor task design are discussed. CONCLUSIONS: Findings suggest that appearance-related interpretation bias is modifiable both explicitly and more implicitly via CBM-I in a mentally healthy sample. The causal status of interpretation bias in BDD maintenance warrants further investigation.

Working mechanisms of a general positivity approach-avoidance training: Effects on action tendencies as well as on subjective and physiological stress responses.

BACKGROUND AND OBJECTIVES: The general positivity training, a Cognitive Bias Modification procedure modifying individuals' approach-avoidance tendencies to positively and negatively valenced pictures by means of a joystick task, has been proven effective in attenuating stress reactivity in dysphoric students. The present study explored which training component (pull positive pictures, push negative pictures, or both) is the active one in changing action tendencies and stress responses. METHODS: Two-hundred-and-thirteen students completed one of four approach-avoidance trainings before being exposed to a stressful speech-task: The general positivity training (pull positive and push negative pictures), a training to approach positive pictures and avoid empty pictures (ApP), a training to avoid negative pictures and approach empty pictures (AvN), or a sham-training. RESULTS: The pattern of results suggests that the groups trained to avoid negative pictures showed a stronger increase in positive approach-avoidance tendencies than the other two groups. However, only the positivity training induced significant within-group changes in positive bias. The groups further did not differ in self-report or cardiovascular measures of anxiety in response to the stress-task. Instead, the training affected mood directly: Exposure to negative pictures during the training increased state anxiety. LIMITATIONS: Generalizability of the findings is limited by using an unselected student sample. Also, the use of empty pictures as neutral stimuli in the ApP and AvN could have weakened training effects in these groups. CONCLUSIONS: Although our results hint at the importance of avoiding negative pictures for modifying an approach-avoidance bias, only the positivity training with both components may effectively induce a positive bias. Remarkably, we failed to replicate and extend previously reported effects of the training on stress-responses. Hence, it remains questionable whether the changes in bias reflect changes in underlying cognitive processing tendencies or task-specific learning effects.

Eye-Tracking Based Attention Bias Modification (ET-ABM) Facilitates Disengagement from Negative Stimuli in Dysphoric Individuals.

To address shortcomings of purely reaction-time based attention bias modification (ABM) paradigms, a novel eye-tracking based ABM training (ET-ABM) was developed. This training targets the late disengagement from negative stimuli and the lack of attention for positive information, which are characteristics of depression. In the present study, 75 dysphoric students (BDI ≥ 9) were randomly assigned to either this positive training (PT), or a sham-training (ST) that did not train any valence-specific gaze pattern (positive and negative pictures had to be disengaged from and attended to equally often). Results showed that the PT induced a positive attentional bias (longer fixations of positive than negative pictures). Although the ST group showed an increase in positive attentional bias as well, this increase was not as strong as in the PT group. Compared to the ST, the PT specifically induced faster disengagement from negative pictures. No differential training effects were found on stress responses or state rumination. These results show that the ET-ABM successfully modifies attentional processes, specifically late disengagement from negative stimuli, in dysphoric students, and hence might be a promising alternative to existing ABM paradigms.

Repetitive transcranial magnetic stimulation modulates the impact of a negative mood induction.

High frequency repetitive Transcranial Magnetic Stimulation (rTMS) over the left dorsolateral prefrontal cortex (DLPFC) has been found to alleviate depressive symptoms. However, the mechanisms driving these effects are still poorly understood. In the current study, we tested the idea that this intervention protects against negative mood shifts following emotional provocation. We furthermore explored changes in EEG activity (frontal alpha asymmetry) and effects on attentional processing (emotional Stroop). To this end, 23 healthy individuals participated in two sessions separated by one week, whereby they once received 15 min of 10Hz rTMS stimulation (1500 pulses) at 110% of the individual motor threshold, and once sham stimulation. Then, negative mood was induced using sad movie clips. The results revealed a significantly stronger mood decline following rTMS compared to sham stimulation. No changes were observed in frontal alpha asymmetry and attentional processing. Our findings are at odds with the view that high frequency rTMS over the left DLPFC directly protects against the induction of negative mood, but rather suggest that it enhances the effects of emotional provocation. Possibly, in healthy young individuals, this stimulation protocol heightens susceptibility to mood induction procedures in general.

Can't Look Away: An Eye-Tracking Based Attentional Disengagement Training for Depression.

To address shortcomings of purely reaction-time based attentional bias modification (ABM) paradigms, we developed an ABM task that is controlled by eye-tracking. This task allows to assess and train both disengagement from negative pictures and maintained attention to positive pictures. As a proof-of-principle study with an unselected student sample, this positive training (PT; N = 44) was compared to a negative training (NT; N = 42), which reinforced the opposite attentional pattern. Importantly, training trials were completed only if participants performed the correct gaze patterns. Results showed that higher depression levels were associated with slower disengagement from negative stimuli at baseline. As expected, the PT induced longer fixations on positive pictures and faster disengagement from negative pictures. The NT showed no changes in attentional processes. The groups did not differ in mood reactivity and recovery from a stressor. Advantages of using eye-tracking in ABM and potential applications of the training are discussed.

Always Approach the Bright Side of Life: A General Positivity Training Reduces Stress Reactions in Vulnerable Individuals.

Emotional disorders are characterized by cognitive biases towards negative stimuli, and a lack of biases towards positive ones. Therefore, we developed a cognitive bias modification training, modifying approach-avoidance tendencies to diverse emotional pictures. In Study 1, a negative training (pull negative, push positive pictures) was compared to a positive training (vice versa) in 141 students. The pre-existing positivity bias remained after positive training, but reversed into a negativity bias after negative training. This effect transferred to an attentional bias. The training affected neither mood nor emotional vulnerability to stress. In Study 2, we investigated the effects of the positive training in 102 dysphoric and non-dysphoric students, all in a sad mood state. Compared to placebo training, the positive training strengthened a positivity bias, and it reduced emotional vulnerability in dysphoric students. This suggests potential therapeutic value of the training, but further studies are needed.

Refilling the half-empty glass--Investigating the potential role of the Interpretation Modification Paradigm for Depression (IMP-D).

BACKGROUND AND OBJECTIVES: Cognitive biases are known to cause and maintain depression. However, little research has been done on techniques targeting interpretation tendencies found in depression, despite the promising findings of anxiety studies. This paper presents two experiments, investigating the suitability of an Interpretation Modification Paradigm for Depression (IMP-D) in healthy individuals, which has already proven its effectiveness in anxiety (Beard & Amir, 2008). Different from other paradigms, the IMP-D aims at modifying an interpretation bias on response- and on a more implicit reaction time-level, making this task less susceptible to demand effects. METHODS: The Word-Sentence Association Paradigm for Depression (Hindash & Amir, 2011) was modified and administered in healthy volunteers (experiment I: N = 81; experiment II: N = 105). To enhance a positive interpretation bias, endorsing benign and rejecting negative interpretations of ambiguous scenarios was reinforced through feedback. This intervention was compared to the opposite training (both experiments) and a control training (experiment II only). RESULTS: Both experiments revealed a significant increase in bias towards benign interpretations on the level of overt decisions, while only in the first experiment a change was found on a reaction time level. These modifications are not reflected in group-differences in emotional vulnerability. LIMITATIONS: Possible limitations regarding the reliability of inter-dependent response and reaction time measures are discussed. CONCLUSIONS: The IMP-D is able to modify interpretation biases, but adaptations are required to maximize its beneficial effects.