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.

Boredom belief moderates the mental health impact of boredom among young people: Correlational and multi-wave longitudinal evidence gathered during the COVID-19 pandemic.

OBJECTIVES: Young people's experience of boredom and its psychological health sequelae have been exacerbated by the COVID-19 pandemic. The present study examined the moderating role of boredom beliefs-the extent to which one affectively dislikes boredom (boredom dislike) and cognitively accepts it (boredom normalcy)-on the association between boredom experience and mental well-being. We also validated a new measure of boredom beliefs in two different samples of young people. METHOD: We report data from a correlational study with British young people aged 12-25 (Study 1; N = 2495) and a 16-week eight-wave within-subject study with Israeli adolescents aged 12-18 (Study 2; N = 314). RESULTS: Across both studies, disliking boredom was associated with higher frequency and intensity of boredom. Boredom dislike moderated the negative association between boredom and mental well-being, such that the association was more salient among those who strongly disliked boredom. Normalizing boredom was positively associated with mental well-being. The measure of boredom beliefs demonstrated fair validity and reliability. CONCLUSION: Results provide novel insights into the potential buffering effect of boredom beliefs against the mental health impact of boredom, particularly at a time of reduced activity. These findings generalize across two different countries.

An early intervention for adolescent depression targeting emotional mental images and memory specificity: a process evaluation.

We have evaluated a novel early intervention for adolescent depression (age 16-18) in a feasibility randomised controlled trial. This nested process evaluation aimed to understand how this complex intervention worked. We sought to understand participants' views and experiences of receiving and interacting with the intervention to evaluate whether the underpinning theoretical basis of the intervention is justified and whether it contributes to valued outcomes for participants. Twelve participants were invited to take part in semi-structured interviews. Framework analysis was employed to identify important aspects of adolescents' experiences. The active ingredients identified by participants were consistent with and extended our understanding of the theoretical basis of the intervention. Four principle themes were identified: understanding how memory works and being able to remember memories in more detail; processing negative experiences and letting go; imagining positive future events; and understanding and being kinder to myself. The outcomes of the intervention were valued by participants. Six principle themes were identified: improving mood and well-being; reducing impact of negative memories; motivation and goal-directed behaviour; overcoming avoidance and rumination; relationships, communication and being open; and self-understanding and acceptance. A simplified logic model is also proposed to connect the intervention components, active ingredients, and valued outcomes. The findings provide an in-depth understanding of how participants interacted with the intervention and what they derived from it. For example, the findings establish processing negative experiences as a core intervention component, extend it to include letting go of these memories, and highlight that reducing the impact of negative memories is valued by participants. This richer understanding guides further intervention development and future implementation.

Behavioural approach-avoidance tendencies among individuals with elevated blood pressure.

Emotional dampening (blunted responses to affective stimuli or experiences) has been reported in individuals with clinical and subclinical levels of elevated blood pressure (BP). Our aim in the present study was to explore how the basic motivational systems of approach and avoidance to positively- and negatively-valenced stimuli are affected in elevated BP. High BP (n = 27) and Low BP (n = 29) participants completed an approach-avoidance task. In this task, participants pulled the joystick towards them when viewing a happy face (approach) and pushing it away when viewing an angry face (avoid) in the congruent condition, and reversed these action-to-emotion pairings in the incongruent condition. A mixed-design ANOVA revealed a significant main effect of condition, such that overall participants were faster across trials in the congruent than trials of the incongruent condition. There was also an emotion x BP interaction. Among the Low BP group, there were no RT differences to happy and angry expressions (across congruent and incongruent conditions) but those with High BP were quicker to respond to actions paired with angry than happy facial expressions (across conditions). Findings suggest that valence-specific motivational reactions are not dampened with an increase in BP, and are rather sensitized for the negative emotion of anger. Supplementary information: The online version contains supplementary material available at 10.1007/s12144-023-04337-2.

'C'mon, let's talk: a pilot study of mental health literacy program for Filipino migrant domestic workers in the United Kingdom.

PURPOSE: This pilot study of a culturally adapted online mental health literacy (MHL) program called 'Tara, Usap Tayo!' (C'mon, Let's Talk) aims to assess the acceptability, appropriateness, feasibility, and potential effectiveness in improving the help-seeking behavior of Filipino migrant domestic workers in the United Kingdom (UK). METHODS: Using mixed methods, we conducted a non-randomized single-group study of the online MHL program with 21 participants. The development of this intervention was guided by the Medical Research Council Framework for developing complex interventions and utilized Heim & Kohrt's (2019) framework for cultural adaptation. Content materials from the WHO Mental Health Gap Action Program (mhGAP), WHO Problem Management Plus (PM +) and Adult Improving Access to Psychological Therapies (IAPT) were modified and translated into the Filipino language. The MHL program was delivered online in three sessions for two hours each session. Data were collected at three time points: (T1) pretest; (T2) posttest; and (3) follow-up test. Quantitative data on participants' attitudes towards help-seeking and level of mental health literacy as outcome measures of potential intervention effectiveness were collected at T1, T2 and T3, while focus group discussions (FGDs) to assess participants' feedback on the acceptability, feasibility, and appropriateness of the online MHL program were conducted immediately at T2. Data analysis was done using a thematic approach for qualitative data from the FGDs and descriptive statistics and repeated-measures ANOVA were used to assess the difference in the T1, T2, and T3 tests. Both quantitative and qualitative results were then integrated and triangulated to answer the research questions. RESULTS: The online MHL program is generally acceptable, appropriate, and feasible for use among Filipino migrant domestic workers. Preliminary findings lend support for its possible effectiveness in improving mental health literacy and help-seeking propensity. The cultural adaptation made in the content, form, and delivery methods of the intervention was acceptable and feasible for this target subcultural group. CONCLUSION: By improving their mental health literacy and help-seeking propensity, this online MHL program has the potential to provide support to the mental health and well-being of Filipino migrant domestic workers in the UK. Further feasibility study or large-scale randomized controlled trial is needed to confirm the preliminary findings of this study.

A network analysis of adolescent mental well-being during the coronavirus pandemic: Evidence for cross-cultural differences in central features.

The COVID-19 pandemic continues to pose unprecedented threat globally. Adolescents and youth may be especially susceptible to the long-term impact of these stressors, thus intervening early is an important priority. However, it is also crucial to understand how young people maintain psychological well-being in the face of adversity, particularly given that many nations are experiencing further waves of the pandemic. The understanding of such resilient outcomes could inform the development of programs to encourage positive mental health.We explored adolescents' resilience to the COVID-19 pandemic stress by examining core aspects of well-being across countries using network analysis. Using the short Warwick-Edinburgh Mental Wellbeing Scale, cross-sectional data was collected online from adolescents from India (N = 310; Males = 159, Females = 151, aged 12-18 years), Israel (N = 306; Males = 154, Females = 152, aged 12-18 years) and the United Kingdom (UK; N = 1666; Males = 598, Females = 1068, aged 12-25 years). Two highly similar network clusters were identified for UK and Israel, with three clusters emerging for India. UK and Israeli networks centred on "dealing with problems well" while the Indian network centred on "feeling useful". As central items highlight aspects of well-being that influence or are influenced by other aspects, these findings may inform interventions to safeguard adolescent mental health during future phases of the pandemic.

Promoting helpful attention and interpretation patterns to reduce anxiety and depression in young people: weaving scientific data with young peoples' lived experiences.

BACKGROUND: Anxiety and depression are common, disabling and frequently start in youth, underscoring the need for effective, accessible early interventions. Empirical data and consultations with lived experience youth representatives suggest that maladaptive cognitive patterns contribute to and maintain anxiety and depression in daily life. Promoting adaptive cognitive patterns could therefore reflect "active ingredients" in the treatment and/or prevention of youth anxiety and depression. Here, we described and compared different therapeutic techniques that equipped young people with a more flexible capacity to use attention and/or promoted a tendency to positive/benign (over threatening/negative) interpretations of uncertain situations. METHODS: We searched electronic databases (PubMed, PsycINFO, EMBASE, and PsycARTICLES) for studies containing words relating to: intervention; youth; anxiety and/or depression and attention and/or interpretation, and selected studies which sought to reduce self-reported anxiety/depression in youth by explicitly altering attention and/or interpretation patterns. Ten young people with lived experiences of anxiety and depression and from diverse backgrounds were consulted on the relevance of these strategies in managing emotions in their daily lives and also whether there were additional strategies that could be targeted to promote adaptive thinking styles. RESULTS: Two sets of techniques, each targeting different levels of responding with different strengths and weaknesses were identified. Cognitive bias modification training (CBM) tasks were largely able to alter attention and interpretation biases but the effects of training on clinical symptoms was more mixed. In contrast, guided instructions that teach young people to regulate their attention or to evaluate alternative explanations of personally-salient events, reduced symptoms but there was little experimental data establishing the intervention mechanism. Lived experience representatives suggested that strategies such as deliberately recalling positive past experiences or positive aspects of oneself to counteract negative thinking. DISCUSSION: CBM techniques target clear hypothesised mechanisms but require further co-design with young people to make them more engaging and augment their clinical effects. Guided instructions benefit from being embedded in clinical interventions, but lack empirical data to support their intervention mechanism, underscoring the need for more experimental work. Feedback from young people suggest that combining complimentary techniques within multi-pronged "toolboxes" to develop resilient thinking patterns in youth is empowering.

Acceptability of a brief training programme targeting attention and interpretation biases for threat in youth with a history of maltreatment.

BACKGROUND: Tendencies to attend to threatening cues in the environment and to interpret ambiguous situations with negative/hostile intent maintain and may even precipitate internalizing and externalizing problems in young people with a history of maltreatment. Challenging maladaptive information-processing styles using cognitive bias modification (CBM) training may reduce symptoms. AIMS: To investigate the acceptability of CBM training in nine young people attending alternate education provision units in the UK, and 10 young people living in out-of-home care institutions in Nepal with a history of maltreatment. METHOD: CBM training consisted of five sessions of training over a 2-week period; each training session consisted of one module targeting attention biases and one module targeting interpretation biases for threat. A feedback form administered after training measured acceptability. Pre- and post-intervention measures of internalizing and externalizing symptoms were also taken. RESULTS: Most young people (89%) found the training helpful and 84% found the training materials realistic. There were reductions in many symptom domains, but with individual variation. Although limited by the lack of a control condition, we established generalizability of acceptability across participants from two cultural settings. CONCLUSIONS: Replication of these findings in larger feasibility randomized controlled trials with measures of attention and interpretation bias before and after intervention, are needed to assess the potential of CBM in reducing anxiety symptoms and its capacity to engage targeted mechanisms.

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.

Dimensionality of Early Adversity and Associated Behavioral and Emotional Symptoms: Data from a Sample of Japanese Institutionalized Children and Adolescents.

Recent approaches have begun to identify common variance across co-occurring childhood adversities (CAs) and their associations with symptoms of psychopathology. However, few studies have investigated these questions in high-risk samples, and in different cultural contexts. This study examined common variance amongst 18 types of CAs and associated symptomatology in 457 children and adolescents living in 24 residential homes in Japan. Principal component analysis identified four significant components that explained 35.1% of the variance: parental abuse, parental psychosocial risks, parental absence, and parental neglect. Path analysis revealed general as well as differential associations with negative outcomes: parental abuse, parental neglect, and parental psychosocial risks significantly associated with conduct problems, whereas parental abuse uniquely associated with peer problems, and parental neglect with hyperactivity/inattention. As well as confirming prior knowledge, these findings also extended understanding of these associations to a new cultural context. Future studies should take into account the multidimensional nature when assessing CAs.

Assessing emotional processing difficulties in normotensive individuals with high and isolated blood pressure elevations.

This study examined the effect of sense modality (auditory/visual) on emotional dampening (reduced responsiveness to emotions with elevation in blood pressure). Fifty-six normotensive participants were assessed on tasks requiring labelling and matching of emotions in faces and voices. Based on median split of systolic and diastolic blood pressures (SBP and DBP, respectively), participants were divided into low BP, high BP and isolated BP groups. On emotion-labelling tasks, analysis revealed reduced emotion recognition in the high BP than the low BP group. On emotion-matching tasks, reduced emotion recognition was noted in high and also isolated BP group as compared to low BP group for the task that required matching a visual target with one of the four auditory distractors. Our findings show for the first time that even isolated elevations in either SBP or DBP may result in emotional dampening. Furthermore, the study highlights that the emotional dampening effect generalises to explicit processing (labelling) of emotional information in both faces and voices-and that these effects tentatively occur during more pragmatic and covert (matching) emotion recognition processes too. These findings require replication in clinical hypertensives.

Research Review: Cognitive bias modification of interpretations in youth and its effect on anxiety: a meta-analysis.

BACKGROUND: Emerging evidence suggests that cognitive bias modification of interpretations (CBM-I) is effective in altering interpretation biases and reducing anxiety in adults. Less is known about the impact of CBM-I in young people, but some recent findings, including a meta-analysis of combined cognitive bias modification of interpretation and attention techniques, have cast doubt on its clinical utility. Given the current debate, this meta-analysis sought to establish the independent effects of CBM-I on interpretations biases and anxiety in youth. METHODS: Studies were identified through a systematic literature search of PsycINFO, Ovid MEDLINE, PsycARTICLES, Web of Science and EMBASE between January 1992 and March 2017. Eligible studies aimed to target interpretation biases; did not combine CBM-I with another intervention; included a control condition; randomly allocated participants to conditions; assessed interpretation bias and/or anxiety as an outcome; included individuals up to age 18; and did not present previously reported data. Reference lists of included articles were checked for further eligible studies, and authors were contacted for unpublished data. RESULTS: We identified 26 studies meeting eligibility criteria that included in the meta-analysis. CBM-I had moderate effects on negative and positive interpretations (g = -0.70 and g = -0.52, respectively) and a small but significant effect on anxiety assessed after training (g = -0.17) and after a stressor (g = -0.34). No significant moderators were identified. CONCLUSIONS: In contrast to previous meta-analytic findings, our results indicate that CBM-I has potential but weak anxiolytic effects in youth. Our findings suggest that it may be premature to disregard the potential value of CBM-I research and further research in this field is warranted.

Reduced specificity of autobiographical memories in young people with tic disorders.

OBJECTIVE: Depression is common in Tourette syndrome and Chronic Tic Disorders (TS/CTD) and contributes to significant impairment. The specificity of autobiographical memories is implicated in an individual's sense of self and their daily functioning but also in the onset and development of depression in the general population. Here, we examined whether memory specificity is reduced in young people with TS/CTD, relative to control participants, and whether memory specificity is associated with depression. METHOD: Thirty young people with TS/CTD (14 females; age: x̅ = 11.31; SD = 1.66; 87% White British) and twenty-six (12 females; age: x̅ = 11.23; SD = 2.43; 77% White British) control participants completed the study. Participants completed the Autobiographical Memory Task, which asks participants to respond with a specific memory to cue words, and a questionnaire measure of depressive symptoms. RESULTS: There was no significant difference between the two groups in terms of age, gender, ethnicity, IQ and depressive symptomatology. Young people with TS/CTD had less specific autobiographical memories than their peers (p < 0.001, r = 0.49). Across both groups, increased memory specificity for positive cue words was associated with reduced depressive symptomatology (p < 0.001, R2 = 0.51). CONCLUSIONS: Our findings indicate that autobiographical memory in young people with TS is characterised by a lack of specificity and, as with neurotypical peers, reduced memory specificity for positive words is associated with depressive symptoms. Autobiographical memory specificity could be an important factor in understanding mood symptoms that characterise young people with TS/CTD and may be an important cognitive target to reduce the development of depression in young people with TS/CTD.

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.

Annual Research Review: An expanded account of information-processing mechanisms in risk for child and adolescent anxiety and depression.

BACKGROUND: Anxiety and depression occurring during childhood and adolescence are common and costly. While early-emerging anxiety and depression can arise through a complex interplay of 'distal' factors such as genetic and environmental influences, temperamental characteristics and brain circuitry, the more proximal mechanisms that transfer risks on symptoms are poorly delineated. Information-processing biases, which differentiate youth with and without anxiety and/or depression, could act as proximal mechanisms that mediate more distal risks on symptoms. This article reviews the literature on information-processing biases, their associations with anxiety and depression symptoms in youth and with other distal risk factors, to provide direction for further research. METHODS: Based on strategic searches of the literature, we consider how youth with and without anxiety and/or depression vary in how they deploy attention to social-affective stimuli, discriminate between threat and safety cues, retain memories of negative events and appraise ambiguous information. We discuss how these information-processing biases are similarly or differentially expressed on anxiety and depression and whether these biases are linked to genetic and environmental factors, temperamental characteristics and patterns of brain circuitry functioning implicated in anxiety and depression. FINDINGS: Biases in attention and appraisal characterise both youth anxiety and depression but with some differences in how these are expressed for each symptom type. Difficulties in threat-safety cue discrimination characterise anxiety and are understudied in depression, while biases in the retrieval of negative and overgeneral memories have been observed in depression but are understudied in anxiety. Information-processing biases have been studied in relation to some distal factors but not systematically, so relationships remain inconclusive. CONCLUSIONS: Biases in attention, threat-safety cue discrimination, memory and appraisal may characterise anxiety and/or depression risk. We discuss future research directions that can more systematically test whether these biases act as proximal mechanisms that mediate other distal risk factors.

Investigating the effectiveness of brief cognitive reappraisal training to reduce fear in adolescents.

As adolescent anxiety is common and costly, identifying effective strategies to reduce symptoms is a priority. This study tested whether adolescents could learn to use cognitive reappraisal strategies to attenuate fear during extinction learning. Fifty-seven participants (12-15 years) viewed images of two neutral faces, one which was paired with a fearful expression and shrieking scream (conditioned threat stimulus) and the other that was never paired with the aversive outcome (conditioned safety stimulus) during fear acquisition. Before extinction, participants either received cognitive appraisal training, which explored alternative, benign meanings associated with the scream or a control activity. Self-reported fear ratings in the cognitive reappraisal group were significantly lower to both the conditioned threat and safety stimuli after extinction than the control group. These findings did not characterise fear-potentiated startle data. Potential reasons for the lack of consistency between measures are considered.

Using real-time fMRI to influence effective connectivity in the developing emotion regulation network.

For most people, adolescence is synonymous with emotional turmoil and it has been shown that early difficulties with emotion regulation can lead to persistent problems for some people. This suggests that intervention during development might reduce long-term negative consequences for those individuals. Recent research has highlighted the suitability of real-time fMRI-based neurofeedback (NF) in training emotion regulation (ER) networks in adults. However, its usefulness in directly influencing plasticity in the maturing ER networks remains unclear. Here, we used NF to teach a group of 17 7-16 year-olds to up-regulate the bilateral insula, a key ER region. We found that all participants learned to increase activation during the up-regulation trials in comparison to the down-regulation trials. Importantly, a subsequent Granger causality analysis of Granger information flow within the wider ER network found that during up-regulation trials, bottom-up driven Granger information flow increased from the amygdala to the bilateral insula and from the left insula to the mid-cingulate cortex, supplementary motor area and the inferior parietal lobe. This was reversed during the down-regulation trials, where we observed an increase in top-down driven Granger information flow to the bilateral insula from mid-cingulate cortex, pre-central gyrus and inferior parietal lobule. This suggests that: 1) NF training had a differential effect on up-regulation vs down-regulation network connections, and that 2) our training was not only superficially concentrated on surface effects but also relevant with regards to the underlying neurocognitive bases. Together these findings highlight the feasibility of using NF in children and adolescents and its possible use for shaping key social cognitive networks during development.

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.