The Effectiveness of a Nonguided Mindfulness App on Perceived Stress in a Nonclinical Dutch Population: Randomized Controlled Trial.

BACKGROUND: Mindfulness has become increasingly popular, and positive outcomes have been reported for mindfulness-based interventions (MBIs) in reducing stress. These findings make room for innovative perspectives on how MBIs could be applied, for instance through mobile health (mHealth). OBJECTIVE: The aim of this study is to investigate whether a nonguided mindfulness mobile app can decrease perceived stress in a nonclinical Dutch population over the course of 8 weeks, with follow-up at 6 months. METHODS: A randomized controlled trial was performed to compare an experimental group that made use of a structured 8-week mHealth mindfulness program and a control group after 8 weeks, with follow-up after 6 months. Participants were recruited via a national television program. The primary outcome measure was perceived stress as measured by the Perceived Stress Scale, secondary outcomes were symptoms of burnout (measured using the visual analog scale [VAS]) and psychological symptoms (measured using the Four-Dimensional Symptom Questionnaire [4DSQ] at follow-up). Outcomes were analyzed using a multilevel regression model. RESULTS: At baseline, 587 respondents were included. Results showed no postintervention differences between groups for the level of perceived stress. With regard to the secondary outcome measures, the VAS for emotional exhaustion and physical exhaustion showed significantly lower scores for the experimental group after 8 weeks (P=.04 and P=.01, respectively), but not at follow-up. There were no differences between groups for psychological symptoms measured using the 4DSQ. CONCLUSIONS: These findings do not support our hypothesis that using the mindfulness app would reduce stress levels. However, our findings related to diminished exhaustion at 8 weeks are encouraging and require further investigation. TRIAL REGISTRATION: ClinicalTrials.gov NCT05246800; https://clinicaltrials.gov/show/NCT05246800.

CBM-I Training and Its Effect on Interpretations of Intent, Facial Expressions, Attention and Aggressive Behavior.

There is abundant evidence suggesting that attention and interpretation biases are powerful precursors of aggression. However, little is known how these biases may interact with one another in the development and maintenance of aggression. Using cognitive bias modification of interpretation (CBM-I), the present study examined whether training more pro-social or hostile intent attributions would affect attention bias, interpretation bias of facial expressions, aggression and mood. University students (17-48 years) were assigned to either a positive training (n = 40), negative training (n = 40), or control training (n = 40). Results showed that the positive training successfully changed measures of intent attributions in a pro-social direction compared to the control training. The negative training changed measures of intent attributions in a hostile direction but not more so than the control training. We found no generalization of the training effects to relevant other outcomes. Possible explanations underlying these findings are discussed.

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.

Skittish, shielded, and scared: relations among behavioral inhibition, overprotective parenting, and anxiety in native and non-native Dutch preschool children.

This study examined behavioral inhibition and overprotective parenting as correlates and predictors of anxiety disorder symptoms in preschoolers with a multi-cultural background (N=168). Parents of 3- to 6-year-old children completed a set of questionnaires twice, 12 months apart. Parents were also interviewed with the Anxiety Disorders Interview Schedule for DSM-IV at the 12-month point to assess the clinical severity of children's anxiety symptoms. Behavioral inhibition consistently emerged as a significant concurrent correlate of anxiety symptoms and this was particularly true for social anxiety symptoms. Overprotective parenting also emerged as a significant correlate of anxiety, but only in the case of non-social anxiety symptoms and mainly in non-native Dutch children. Prospective analyses revealed that behavioral inhibition was a significant predictor of social anxiety symptoms, while overprotective parenting did not explain significant variance in the development of children's anxiety over time. The support for an interactive effect of behavioral inhibition and overprotective parenting was unconvincing. Finally, it was found that children who exhibited stable high levels of behavioral inhibition throughout the study ran the greatest risk for developing an anxiety disorder.

Nonverbal and verbal transmission of disgust from mothers to offspring: effects on children's evaluation of a novel animal.

This study examined parent-offspring communication of disgust-related information and its effects on children's feelings of disgust and fear towards an animal. Mothers were instructed to provide information about a novel animal to their children (N=60) by studying in secrecy either disgusting or neutral attributes that were allegedly characteristic of this animal. First, mothers were instructed to do this in a nonverbal way; then they were also allowed to use verbal utterances. Results indicated that nonverbal communication of disgust by the mothers failed to produce any effects on offspring's subjective evaluations of the animal. However, verbal information transmission did have a differential impact on children's feelings of disgust and fear. That is, children to whom mothers had verbally communicated about a set of disgusting specimens not only displayed higher levels of disgust (Cohen's d=1.02) but also exhibited higher levels of fear (Cohen's d=.62) towards the novel animal as compared to children to whom mothers had verbally communicated about neutral specimens. The effect on fear was mainly due to the fact that children after the verbal neutral information exhibited a clear decline in fear, whereas children to whom mothers had provided verbal disgust information maintained a similar level of fear towards the animal. The implications of these results for the familial transmission of disgust and fear will be discussed.

Assessment of disgust sensitivity in children with an age-downward version of the Disgust Emotion Scale.

The present study examined the psychometric properties of the Disgust Emotion Scale for Children (DES-C). Principal components analysis of the DES-C data revealed five factors reflecting disgust toward (a) rotting foods, (b) injection and blood, (c) odors, (d) mutilation and death, and (e) animals, which were largely in keeping with the intended subscales. The DES-C showed good reliability, excellent convergent validity (as established by correlations with an alternative self-report index of disgust), fairly good predictive validity (as assessed by correlations with measures of fear/anxiety and a behavioral index of disgust), and acceptable parent-child agreement (in particular with the mothers). Importantly, the DES-C proved to perform better on some psychometric indicators than an age-downward version of the Disgust Scale. These findings indicate that the DES-C should be regarded as the preferred scale for measuring disgust sensitivity and its role in the etiology and maintenance of anxiety problems in children.

The assessment of an inhibited, anxiety-prone temperament in a Dutch multi-ethnic population of preschool children.

The Behavioral Inhibition Questionnaire-Short Form (BIQ-SF) is a 14-item parent-rating scale for assessing an inhibited, anxiety-prone temperament in preschool children. This study examined the psychometric properties of the BIQ-SF scores in a multi-ethnic community population of Dutch boys and girls aged 2.5-6 years (total N = 2,343, from which various subsamples were derived). Results revealed that the factor structure of the BIQ-SF was as hypothesized: a model with six correlated factors representing children's inhibited behaviors in various social and non-social contexts provided a good fit for the data. The internal consistency of the BIQ-SF was generally satisfactory and scores on the scale were found to be fairly stable over a time period of up to 2 years. Parent-teacher agreement was acceptable, and relations between the BIQ-SF and observations of an inhibited temperament were moderate. Finally, BIQ-SF scores were positively associated with measures of anxiety and internalizing symptoms, whereas no significant links were found with externalizing symptoms. Altogether, these results provide support for the reliability and validity of the BIQ-SF as an economical method for assessing behavioral inhibition and anxiety proneness in young children.

Covariation bias for food-related control is associated with eating disorders symptoms in normal adolescents.

BACKGROUND AND OBJECTIVES: Covariation bias refers to the phenomenon of overestimating the contingency between certain stimuli and negative outcomes, which is considered as a heuristic playing a role in the maintenance of certain types of psychopathology. In the present study, covariation bias was investigated within the context of eating pathology. METHODS: In a sample of 148 adolescents (101 girls, 47 boys; mean age 15.3 years), a priori and a posteriori contingencies were measured between words referring to control and loss of control over eating behavior, on the one hand, and fear, disgust, positive and neutral outcomes, on the other hand. RESULTS: Results indicated that all adolescents displayed an a priori covariation bias reflecting an overestimation of the contingency of words referring to loss of control over eating behavior and fear- and disgust-relevant outcomes, while words referring to control over eating behavior were more often associated with positive and neutral outcomes. This bias was unrelated to level of eating disorder symptoms. In the case of a posteriori contingency estimates no overall bias could be observed, but some evidence was found indicating that girls with higher levels of eating disorder symptoms displayed a stronger covariation bias. CONCLUSION: These findings provide further support for the notion that covariation bias is involved in eating pathology, and also demonstrate that this type of cognitive distortion is already present in adolescents.

Does 'Yuck' mean 'Eek'? Fear responses in children after a disgust manipulation.

BACKGROUND AND OBJECTIVES: Disgust is a basic emotion that is thought to play a role in the development of animal phobias. This study was conducted to test whether experimentally induced disgust also results in higher levels of fear and interpretation bias. METHODS: Children aged 9-13 years (N=94) were asked to inspect a set of specimen characteristic of a novel animal and requested to form themselves an impression of it based on those characteristics. Half of the children were given a set of disgust-eliciting products in relation to the animal, whereas the other half received a set of neutral materials. RESULTS: The main results indicated that children in the disgust specimen group exhibited an increase in fear towards the novel animal and a stronger inclination to interpret ambiguous situations involving this animal in a more negative way as compared to children in the neutral specimen group. CONCLUSION: These findings confirm that disgust has a fear-promoting effect.

Psychopathology symptoms in a sample of female cosmetic surgery patients.

OBJECTIVE: During the past decades, cosmetic surgery has become increasingly popular. People with certain psychopathology disorders, for example, body dysmorphic disorder (BDD), are dissatisfied with their physical appearance, and a significant number try to receive cosmetic medical treatment for their complaints. It seems relatively easy for them to receive this type of surgery, despite the fact that it has no or even adverse effects on the symptoms. The present study aimed to investigate the psychological condition and especially the presence of psychopathological symptoms such as BDD in cosmetic surgery patients. METHODS: Questionnaires about body image dissatisfaction, symptoms of BDD and psychopathology in general and satisfaction about surgery were sent to patients who had been treated in a large cosmetic surgery clinic. RESULTS: Of the patients who replied, 86% were pleased with the outcome of the cosmetic procedure. Further, 21-59% of these former patients scored higher on questionnaires of body image dissatisfaction and psychopathological symptoms than a norm group from the general population. When differentiating the group on the basis of BDD symptomatology, it appeared that the high BDD symptomatic group displayed significantly worse outcome on all measurements. That is, high BDD symptomatic patients were more dissatisfied about the result of surgery, exhibited higher levels of psychopathology, and had lower self-esteem than the low symptomatic BDD patients. CONCLUSION: These findings clearly suggest that the evaluation of the psychological condition and motivation of the candidate patient might be a valuable addition to the standard procedure in cosmetic medical treatment settings.

To look or not to look: an eye movement study of hypervigilance during change detection in high and low spider fearful students.

Previous eye movement studies of attentional bias in spider fear reported inconsistent results with respect to early attentional capture, suggesting that overt attentional capture only reliably occurs under specific circumstances. In addition, none of these studies explored covert attention. The present study examined attentional bias in spider phobia using a change detection paradigm that was expected to provide good conditions for documenting attentional capture. In contrast to our expectations, eye movement data showed that all participants' first fixations were fastest on general negative targets, whereas participants' first fixations on spider targets were slower in the spider fearful than in the nonfearful group. In addition, spider fearful participants made more nontarget fixations before fixating on a spider target than did nonfearful participants. Thus, we found that participants' overt attention was more quickly focused on general negative targets, whereas covert attentional processes enabled initial avoidance of fear-relevant (i.e. spider) stimuli. The present findings have important implications for research on attention and fear as they indicate that fearful individuals are not characterized by static attentional orienting toward threat but, under certain conditions, may avert attention from threat automatically.

Reduction of verbally learned fear in children: a comparison between positive information, imagery, and a control condition.

This study explored the effects of positive information and imagery as ways of reducing a verbally installed fear in children. Seventy-two primary school children aged 9-13 years were first exposed to negative information to induce fear of a novel animal, and were then randomly assigned to three interventions: positive information, imagery, or a control condition. Outcome of various interventions was assessed by means of a standardized scale of fear beliefs and an index of confirmation bias (defined as the tendency to search for threat information in relation to the feared stimulus). Results indicated that both positive information and imagery were more effective in reducing fear than the control condition. Some evidence was also obtained showing that positive information was more effective than imagery, which suggests that this intervention represents the most optimal treatment approach when dealing with verbally acquired fears in children.

Fear- and disgust-related covariation bias and eating disorders symptoms in healthy young women.

Covariation bias refers to the phenomenon of overestimating the contingency between certain stimuli and negative outcomes, which is considered as a heuristic playing a role in the maintenance of certain types of psychopathology. In the present study, an attempt was made to investigate covariation bias within the context of eating pathology. In a sample of 61 female undergraduates, a priori and a posteriori contingencies were measured between pictures of obese and slim bodies, on the one hand, and fear- or disgust-relevant outcomes, on the other hand. Results indicated that participants in general displayed an a priori and an a posteriori covariation bias reflecting an overestimation of the link between obese bodies and disgust-relevant outcomes. However, this bias was not related to eating disorder symptomatology. Meanwhile, eating pathology was positively associated with a priori covariation biases referring to the associations between obese bodies and fear-relevant outcomes, and between slim bodies and disgust-relevant outcomes. All in all, these findings suggest that covariation bias plays a role in eating pathology.

Person-related protective and vulnerability factors of psychopathology symptoms in non-clinical adolescents.

Psychopathology in youths is thought to originate from a dynamic interplay of a variety of protective and vulnerability factors. In this study, a large multi-ethnic sample of non-clinical adolescents (N = 376) completed questionnaires for measuring a wide range of person-related protective and vulnerability factors as well as psychopathology symptoms, in order to explore (a) the relations among various protective and vulnerability factors, and (b) the unique contributions of these protective and vulnerability factors to different types of psychological problems. Results indicated that the overlap among protective and vulnerability factors was quite modest. Further, it was found that factors clustered in theoretically meaningful components reflecting protection, vulnerability, and more specific aspects of coping and social support. Finally, data indicated that each type of psychopathology symptoms was associated with a typical set of protective and vulnerability factors. Although these results should be interpreted with caution because of the cross-sectional nature of the study, they may nevertheless guide future research exploring multifactorial models of psychopathology in youths.

Children's internal attributions of anxiety-related physical symptoms: age-related patterns and the role of cognitive development and anxiety sensitivity.

The present study examined age-related patterns in children's anxiety-related interpretations and internal attributions of physical symptoms. A large sample of 388 children aged between 4 and 13 years completed a vignette paradigm during which they had to explain the emotional response of the main character who experienced anxiety-related physical symptoms in a variety of daily situations. In addition, children completed measures of cognitive development and anxiety sensitivity. Results demonstrated that age, cognitive development, and anxiety sensitivity were all positively related to children's ability to perceive physical symptoms as a signal of anxiety and making internal attributions. Further, while a substantial proportion of the younger children (i.e., <7 years) were able to make a valid anxiety-related interpretation of a physical symptom, very few were capable of making an internal attribution, which means that children of this age lack the developmental prerequisites for applying physical symptoms-based theories of childhood anxiety.

Listen to your heart beat and shiver! An experimental study of anxiety-related emotional reasoning in children.

The present study investigated anxiety-related emotional reasoning in 9-13-year-old children using an experimental approach. Eighty-one children completed a computerized ambiguous situations test for assessing their perception of threat under two conditions. In the experimental condition, children were attached to an apparatus that allegedly recorded their heart beat, the sound of which was presented to them via headphones. In the control condition, children listened to the sound of an African djembe drum while completing the ambiguous situations test. It was found that children in the experimental condition generally provided higher threat ratings than children in the control condition, and this difference remained significant when controlling for levels of anxiety sensitivity, panic and other anxiety symptoms. These results are in keeping with the idea that children may partially rely on internal physical sensations when evaluating the dangerousness of ambiguous events.

"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.

"You might belong in Gryffindor": children's courage and its relationships to anxiety symptoms, big five personality traits, and sex roles.

This study describes a first exploration of the construct of courage in youths. Children aged 8-13 years were invited to report on the most courageous action that they had ever performed during their life. In addition, the Courage Measure for Children (CM-C) was construed as an index of children's level of personal courage, and this scale was administered in two samples of school children (Ns being 168 and 159) along with a number of other questionnaires. Results indicated that children were familiar with the concept of courage as more than 70% reported to have carried out a courageous action during their life. In addition, self-reported courage as indexed by the CM-C was positively correlated with scores on a vignette measure of courage, parent ratings of children's courage, extraversion, openness/intellect, and a masculine sex role, whereas a negative correlation was observed with anxiety symptoms. The implications of these findings and potential directions for future research are briefly discussed.

Mom told me scary things about this animal: parents installing fear beliefs in their children via the verbal information pathway.

This study investigated whether fear beliefs can be installed in children after parents had received negatively tinted information about a novel stimulus. Parents of children aged 8-13 years (N = 88) were presented with negative, positive, or ambiguous information about an unknown animal and then given a number of open-ended vignettes describing confrontations with the animal with the instruction to tell their children what would happen in these situations. Results indicated that children's fear beliefs were influenced by the information that was provided to the parent. That is, parents who had received negative information provided more threatening narratives about the animal and hence installed higher levels of fear beliefs in their children than parents who had received positive information. In the case of ambiguous information, the transmission of fear was dependent on parents' trait anxiety levels. More precisely, high trait anxious parents told more negative stories about the unknown animal, which produced higher fear levels in children.

Mental illness stigma and disclosure: consequences of coming out of the closet.

The present study investigated disclosure patterns among mental health consumers (N = 500) and examined the relationships among disclosure, perceived stigmatization, perceived social support, and self-esteem. Results suggest that selective disclosure optimizes social support and limits stigmatization. Perceived stigmatization has a detrimental impact on self-esteem, especially for those who are relatively open about their mental disorder.