Sustaining attention in affective contexts during adolescence: age-related differences and association with elevated symptoms of depression and anxiety.

Sustained attention, a key cognitive skill that improves during childhood and adolescence, tends to be worse in some emotional and behavioural disorders. Sustained attention is typically studied in non-affective task contexts; here, we used a novel task to index performance in affective versus neutral contexts across adolescence (N = 465; ages 11-18). We asked whether: (i) performance would be worse in negative versus neutral task contexts; (ii) performance would improve with age; (iii) affective interference would be greater in younger adolescents; (iv) adolescents at risk for depression and higher in anxiety would show overall worse performance; and (v) would show differential performance in negative contexts. Results indicated that participants performed more poorly in negative contexts and showed age-related performance improvements. Those at risk of depression performed more poorly than those at lower risk. However, there was no difference between groups as a result of affective context. For anxiety there was no difference in performance as a function of severity. However, those with higher anxiety showed less variance in their reaction times to negative stimuli than those with lower anxiety. One interpretation is that moderate levels of emotional arousal associated with anxiety make individuals less susceptible to the distracting effects of negative stimuli.

Susceptibility to prosocial and antisocial influence in adolescence.

INTRODUCTION: Adolescents are particularly susceptible to social influence and previous studies have shown that this susceptibility decreases with age. The current study used a cross-sectional experimental paradigm to investigate the effect of age and puberty on susceptibility to both prosocial and antisocial influence. METHODS: Participants (N = 520) aged 11-18 from London and Cambridge (United Kingdom) rated how likely they would be to engage in a prosocial (e.g. "help a classmate with their work") or antisocial (e.g. "make fun of a classmate") act. They were then shown the average rating (in fact fictitious) that other adolescents had given to the same question, and were then asked to rate the same behaviour again. RESULTS: Both prosocial and antisocial influence decreased linearly with age, with younger adolescents being more socially influenced when other adolescents' ratings were more prosocial and less antisocial than their own initial rating. Both antisocial and prosocial influence significantly decreased across puberty for boys but not girls (independent of age). CONCLUSIONS: These findings suggest that social influence declines with increasing maturity across adolescence. However, the exact relationship between social influence and maturity is dependent on the nature of the social influence and gender. Understanding when adolescents are most susceptible to different types of social influence, and how this might influence their social behaviour, has important implications for understanding adolescent social development.

Asymmetrical transfer effects of cognitive bias modification: Modifying attention to threat influences interpretation of emotional ambiguity, but not vice versa.

BACKGROUND AND OBJECTIVES: It is well established that attention bias and interpretation bias each have a key role in the development and continuation of anxiety. How the biases may interact with one another in anxiety is, however, poorly understood. Using cognitive bias modification techniques, the present study examined whether training a more positive interpretation bias or attention bias resulted in transfer of effects to the untrained cognitive domain. Differences in anxiety reactivity to a real-world stressor were also assessed. METHODS: Ninety-seven first year undergraduates who had self-reported anxiety were allocated to one of four groups: attention bias training (n = 24), interpretation bias training (n = 26), control task training (n = 25) and no training (n = 22). Training was computer-based and comprised eight sessions over four weeks. Baseline and follow-up measures of attention and interpretation bias, anxiety and depression were taken. RESULTS: A significant reduction in threat-related attention bias and an increase in positive interpretation bias occurred in the attention bias training group. The interpretation bias training group did not exhibit a significant change in attention bias, only interpretation bias. The effect of attention bias training on interpretation bias was significant as compared with the two control groups. There were no effects on self-report measures. LIMITATIONS: The extent to which interpretive training can modify attentional processing remains unclear. CONCLUSIONS: Findings support the idea that attentional training might have broad cognitive consequences, impacting downstream on interpretive bias. However, they do not fully support a common mechanism hypothesis, as interpretive training did not impact on attentional bias.

The nature of trauma memories in acute stress disorder in children and adolescents.

BACKGROUND: There is increasing theoretical, clinical and research evidence for the role of trauma memory in the aetiology of acute pathological stress responses in adults. However, research into the phenomenology of trauma memories in young people is currently scarce. METHODS: This study compared the nature of trauma narratives to narratives of unpleasant non-traumatic events in young people (aged 8-17) who sought emergency medical attention following an assault or road traffic accident. Data were collected within 2-4 weeks of the index event. Symptom severity was assessed by child self-report and face-to-face diagnostic interviews. Comparisons of narrative indices were made between those children with acute stress disorder (ASD) and those without ASD. RESULTS: Among participants (n = 50), those with ASD (38%) had significantly elevated levels of disorganisation in their trauma narrative, compared both to trauma-exposed controls and to their unpleasant comparative narrative. This effect was not accounted for by age. Regardless of ASD diagnostic status, trauma narratives had significantly higher sensory content and significantly lower positive emotion content compared to the unpleasant comparative narrative. These effects were not significant when age was included as a covariate. Acute symptom severity was significantly predicted by the level of disorganisation in the trauma narrative and the child's cognitive appraisals of the event. CONCLUSIONS: These data provide the first empirical evidence that disorganisation is not only directly linked to symptom severity, but also specific to the trauma memory. In addition, it provides support for the adaptation of adult cognitive models to acute pathological stress reactions in children and adolescents.

Differential predictions about future negative events in seasonal and non-seasonal depression.

BACKGROUND: Previous research indicates that individuals with seasonal depression (SD) do not exhibit the memory biases for negative self-referent information that characterize non-seasonal depression (NSD). The current study extended this work by examining processing of self-referent emotional information concerning potential future events in SD. METHOD: SD and NSD patients, along with never-depressed controls, completed a scenario-based measure of likelihood estimation for future positive and negative events happening either to the self or to another person. RESULTS: SD patients estimated future negative events as more likely to happen to both the self and others, relative to controls. In contrast, in the NSD sample this bias was specific to self-referred material. There were no group differences for positive events. CONCLUSIONS: These data provide further evidence that the self-referent bias for processing negative information that characterizes NSD can be absent in SD, this time in the domain of future event processing.

What might not have been: an investigation of the nature of counterfactual thinking in survivors of trauma.

BACKGROUND: Counterfactual thinking (CFT) refers to the process of reflecting on an event and changing aspects of it so as to alter the eventual outcome. Such thinking appears frequent in survivors of trauma (e.g. 'If only I had stayed at home then I wouldn't have had the accident'), but has received little systematic empirical investigation. Four studies examined the nature of CFT in both trauma survivors and non-traumatized controls. METHOD: Participants generated CFT to their own trauma or to written scenarios. RESULTS: Three key findings emerged. Firstly, trauma survivors overwhelmingly produced CFT that mutated aspects of their own behaviour during the traumatic event (self-referent CFT) and that improved the event's outcome (upward CFT; Studies 1 and 2). Secondly, self-referent CFT style in trauma survivors was generalized to non-autobiographical scenarios and was independent of how much control the protagonist in the scenarios had over the outcome. In contrast, never-traumatized controls tended to generate more self-referent CFT to scenarios where the protagonists had some control than to scenarios where the protagonist had little control (Study 3). Thirdly, this self-referent, upward CFT style of trauma survivors was not related to frequency of post-traumatic stress symptoms (Studies 1 and 3) or Posttraumatic Stress Disorder (PTSD) caseness (Study 2). CONCLUSIONS: These results are interpreted in terms of a self-referent, upward CFT style that is normative following trauma for all survivors, regardless of levels of trauma-related distress, and that is applied to any negative events that are encountered.

An experimental investigation of hypervigilance for threat in children and adolescents with post-traumatic stress disorder.

BACKGROUND: The present study examined biases in visual attention for emotional material in children and adolescents with post-traumatic stress disorder (PTSD) and healthy controls. METHODS: The participants carried out an attentional deployment task in which probe detection latency data were used to determine the distribution of visual attention for threat-related and depression-related material. RESULTS: The results showed that children and adolescents with PTSD, relative to controls, selectively allocated processing resources towards socially threatening stimuli and away from depression-related stimuli. This attentional avoidance of depression-related information in the PTSD participants declined with age. CONCLUSIONS: The results of the study are interpreted as a consolidation and extension of previous research on attentional bias and emotional disorder in younger participants.

Attentional processing and levels of symptomatology in Seasonal Affective Disorder (SAD): a preliminary longitudinal study.

DESIGN: The ability of performance on the emotional Stroop task to predict subsequent levels of symptomatology was examined within a longitudinal design in a group of individuals with SAD. Participants were tested in the winter when depressed and again in the summer when remitted. RESULTS: There was no change in emotional Stroop performance across the two time points. However, winter performance on the emotional Stroop task predicted symptom levels in the summer, even with winter symptom levels partialled out. The nature of this relationship was that a greater emotional Stroop effect for threat words in the winter was related to more improved mood in the summer. Furthermore, the strength of the relationship between lower winter emotional Stroop performance and more negative winter mood was associated with poorer mood in the summer.

Anxiety and cognitive inhibition.

In 3 experiments, the authors investigated whether anxiety proneness is associated with impaired inhibitory processing. Participants made speeded decisions requiring inhibition of threatening or neutral meanings of ambiguous words, which were inappropriate in their current context. In Experiment 1 there were no differences found in inhibitory processing associated with anxiety. However, in Experiment 2, when the capacity for controlled processing was reduced by imposition of a mental load, anxious individuals showed a response pattern consistent with a general impairment of inhibitory processing. In Experiment 3, a group who had experienced a traumatic event also showed evidence of impaired inhibition, despite the absence of additional load. Thus anxiety proneness is associated with a general deficit of inhibitory processing, but this may be revealed only under conditions that limit the availability of controlled processing resources.

Judgements about emotional events in children and adolescents with post-traumatic stress disorder and controls.

Research with clinically anxious adults has revealed that they estimate future negative events as far more likely to occur, relative to healthy controls. In addition, anxious adults estimate that such events are more likely to happen to themselves than to others. Previous research with anxious children and adolescents, in contrast, has revealed no increased probability estimates for negative events, relative to controls, and the events were rated as more likely to happen to others than to the self. The present study followed up these discrepant findings by investigating probability judgements concerning future negative events generated by children and adolescents who had actually experienced an extreme negative event and who met criteria for a diagnosis of Post-traumatic Stress Disorder (PTSD). Control groups comprised a group of healthy participants, and a group of healthy participants whose parents had experienced a trauma and who met criteria for PTSD. The results revealed no overall differences between the clinical group and the controls. However, children and adolescents with PTSD estimated all negative events as significantly more likely to happen to others than to themselves, with this other-referent bias being strongest for events matched to their trauma. In contrast, the two control groups exhibited an other-referent bias for physically threatening events but not for socially threatening ones. Developmental analyses indicated that the strength of the relationship between anxiety and elevated judgements about future negative events declined with age in the control participants but that there was no significant relationship in the groups who had been exposed to trauma. The findings are discussed in the context of the literature on information processing biases and PTSD.

Memory bias for emotional information in children and adolescents with posttraumatic stress disorder: a preliminary study.

Studies with adult participants with emotional disorders have revealed an explicit memory bias in favor of recalling negative emotional information, particularly if the information is related to the participants' emotional concerns. This process was investigated in a preliminary study with children and adolescents with posttraumatic stress disorder and control participants. Participants were presented with sets of negative, neutral, and positive words and asked to recall them after a short retention interval. Posttraumatic stress disorder participants showed poorer overall memory performance compared with control participants. They also showed a bias in favor of recalling negative information, but there was no evidence of any specificity beyond this for threat-related material. Regression analyses revealed no relationship between mood, memory bias, and age. Results are discussed in terms of the adult literature and with respect to issues of the developmental continuity of posttraumatic stress disorder.

The Herald of Free Enterprise disaster. Lessons from the first 6 years.

A substantial body of data has been collected on survivors of the Herald of Free Enterprise disaster over the first 6 years. These data show the psychological effects to be considerable, and although they appear to decrease over time, 6 years later there remains a substantial minority that remains highly distressed. Our research has also pointed to those factors that appear to be important in determining the severity and chronicity of symptoms. Levels of crisis support early on seem to be protective. Not everyone has access to supportive others, and these people would seem to be at increased risk of disturbance. But even if crisis support is potentially available from family and friends, not everyone is in a position to draw on these resources. Those individuals who possess negative attitudes toward emotional expression might be less likely to seek out support. Evidence would suggest that modifying such attitudes might be an important component of intervention. A further target for intervention would seem to be the causal attributions made by survivors. It was found that those who perceived the causes of events during the disaster as internal and controllable were at greatest risk of psychological disturbance. The data gathered in the wake of this disaster suggest that intervening early with respect to these three components (crisis support, attitude to emotional expression, and attributional style) is highly likely to mitigate against long-term distress.

Lack of attentional bias for emotional information in clinically depressed children and adolescents on the dot probe task.

The present study utilised a cognitive paradigm to investigate attentional biases in clinically depressed children and adolescents. Two groups of children and adolescents--clinically depressed (N = 19) and normal controls (N = 26)--were asked to complete a computerised version of the attentional dot probe paradigm similar to that used by MacLeod, Mathews, and Tata (1986). Results provided no support for an attentional bias, either toward depression-related words or threat words, in the depressed group. This finding is discussed in the context of cognitive theories of anxiety and depression.

The directed forgetting task: application to emotionally valent material.

Three experiments are reported which investigate the application of the directed forgetting task to emotionally valent material and to different mood states. In this task, some subjects are told when halfway through an intentional or incidental learning task that the trials presented so far are to be forgotten because they were merely practice. However, at the end of the subsequent list, the subjects are then asked to recall all of the previous items including those that they were instructed to forget. The results typically show that significantly fewer directed forgetting items are recalled whether the task is an intentional or incidental learning one. In the first experiment, normal and 'depressed' students rated positive and negative material for pleasantness; although directed forgetting effects were obtained, there were no differential effects of mood state nor of valence of the material. In order to investigate this effect further, a variant of this task was used in Experiment 2 in which the positive and negative material had to be processed in relation to the self. The results showed that differential forgetting now occurred; healthy students recalled more positive than negative information, but this positive bias was not obtained for 'depressed' students who showed an even-handed level of recall. In Experiment 3, groups of clinically depressed, clinically anxious, and normal controls were presented with the directed forgetting task. The key finding showed that the depressed subjects showed a retrieval facilitation for to-be-forgotten negative adjectives, an effect that was not present for the other two groups. It is concluded therefore, that the directed forgetting task could be usefully extended to investigate cognition-emotion interactions in clinical populations.

Biases in visual attention in children and adolescents with clinical anxiety and mixed anxiety-depression.

Recent research has indicated that anxious adult and child patients and high trait-anxious adults selectively shift attention toward threatening stimuli. The present study extends this research and investigates the content-specificity of the effects in clinically anxious and mixed anxious-depressed children and adolescents. Twenty four generally anxious patients, aged 9 to 18, 19 mixed anxious-depressed patients, and 24 normal controls were comparable with respect to age, sex, verbal IQ, and vocabulary level. The participants carried out an attentional deployment task in which probe detection latency data were used to determine the distribution of visual attention for threat-related and depression-related material. The results showed that clinically anxious children, relative to controls, selectively allocated processing resources toward threat stimuli. However, mixed anxious-depressed children, relative to controls, did not show any attentional bias towards either threat- or depression-related stimuli. Preliminary data on age and gender differences are also presented. The results of this study are discussed in the light of previous research.

Performance of children and adolescents with PTSD on the Stroop colour-naming task.

BACKGROUND: Investigators have used various experimental paradigms such as the Stroop colour naming test to study how adults with different emotional disorders process emotional information. However, to date, little research has been carried out on younger subjects. METHOD: In the current experiment, children and adolescents with post-traumatic stress disorder (PTSD) and control subjects aged 9-17 years, participated in a modified Stroop colour naming task. RESULTS: The results indicated that the children and adolescents with PTSD showed increased Stroop interference for trauma-related material relative to neutral words and to the performance of the controls. CONCLUSIONS: These findings indicate that attentional bias to trauma-congruent information is a function of PTSD in young age groups. The results are discussed with respect to the literature on information processing in PTSD.

Everyday memory deficits in children and adolescents with PTSD: performance on the Rivermead Behavioural Memory Test.

Adult post-traumatic stress disorder (PTSD) patients often report a wide range of cognitive problems in memory, concentration, attention, planning, and judgement. Evaluation of these cognitive aspects of PTSD in adults has helped to define the nature of the disorder. However, there is a paucity of such work in younger subjects. This study has employed the Rivermead Behavioural Memory Test (RBMT) to examine cognitive factors in children and adolescents with PTSD. Eighteen child and adolescent patients with PTSD and 22 control subjects completed the test. PTSD subjects showed poorer overall memory performance compared with controls. Specifically, they were worse on the prospective and orientation items of the RBMT. The results are discussed in the light of research on everyday memory in adults with PTSD.

Performance of children of adults with PTSD on the stroop color-naming task: a preliminary study.

Investigators have used various experimental paradigms to study how individuals with different emotional disorders process emotional information. However, little research has been done on relatives of individuals with emotional disorders, despite developments in the area of emotional contagion. In the current experiment, children of adults with posttraumatic stress disorder (PTSD) (n = 18) and control participants (n = 21), ages 9-17 years, participated in a modified Stroop color-naming task. The results indicated that the children of adults with PTSD showed increased Stroop interference for threat-related relative to neutral words and to the performance of the controls. These findings are discussed with respect to the literature on information processing in PTSD and emotional contagion in families.

Memory for emotional trait adjectives in clinically depressed youth.

An experiment was conducted to examine memory for emotional trait adjectives in depressed children and adolescents. Two groups of children and adolescents, clinically depressed participants and non-clinical controls, were compared on computerized versions of recall and recognition memory tasks. Three groups of words (positive trait adjectives, negative trait adjectives, and categorized neutral words) were used in the experiment. Results showed that the depressed group recalled significantly more negative adjectives than positive adjectives, whereas the control group recalled the same number of positive and negative adjectives. This effect was predicted by the association between age and level of depression, with the depression-related bias becoming stronger with age. Signal detection analysis revealed that the depressed group did not show any bias in the recognition task. The findings are discussed with respect to cognitive theories of depression with consideration of the developmental implications.

Information processing in recovered depressed children and adolescents.

Previous research into subjective probability estimates for negative events revealed that depressed children estimated events as equally likely to happen to themselves as to other children. In contrast, both controls and anxious children estimated that negative events were more likely to happen to others than to themselves. The present study followed up this finding by investigating the subjective probability judgements concerning future negative events generated by children and adolescents who have recovered from depression. Subjects generated probability estimates either for themselves or for other children for a range of negative events on a visual analogue scale. The results revealed that both recovered depressed and matched control groups estimated negative events as significantly more likely to happen to others than to themselves. It was also found that the recovered depressed subjects estimated that negative events were less likely overall, compared to the controls. These results are discussed in the context of the adult literature.