Modality and terminology changes for behavioral health service delivery during the COVID-19 pandemic: a systematic review.

Introduction: The COVID-19 pandemic prompted healthcare professionals to implement service delivery adaptations to remain in compliance with safety regulations. Though many adaptations in service delivery were reported throughout the literature, a wide variety of terminology and definitions were used. Methods: To address this, we conducted a PRISMA review to identify service delivery adaptations across behavioral healthcare services in the United States from March 2020 to May 2022 and to identify variations in terminology used to describe these adaptations. We identified 445 initial articles for our review across eight databases using predetermined keywords. Using a two-round screening process, authors used a team approach to identify the most appropriate articles for this review. Results: Our results suggested that a total of 14 different terms were used to describe service modality changes, with the most frequent term being telehealth (63%). Each term found in our review and the frequency of use across identified articles is described in detail. Discussion: Implications of this review such as understanding modality changes during the COVID-19 pandemic and beyond are discussed. Our findings illustrate the importance of standardizing terminology to enhance communication and understanding among professionals.

#EEGManyLabs: Investigating the replicability of influential EEG experiments.

There is growing awareness across the neuroscience community that the replicability of findings about the relationship between brain activity and cognitive phenomena can be improved by conducting studies with high statistical power that adhere to well-defined and standardised analysis pipelines. Inspired by recent efforts from the psychological sciences, and with the desire to examine some of the foundational findings using electroencephalography (EEG), we have launched #EEGManyLabs, a large-scale international collaborative replication effort. Since its discovery in the early 20th century, EEG has had a profound influence on our understanding of human cognition, but there is limited evidence on the replicability of some of the most highly cited discoveries. After a systematic search and selection process, we have identified 27 of the most influential and continually cited studies in the field. We plan to directly test the replicability of key findings from 20 of these studies in teams of at least three independent laboratories. The design and protocol of each replication effort will be submitted as a Registered Report and peer-reviewed prior to data collection. Prediction markets, open to all EEG researchers, will be used as a forecasting tool to examine which findings the community expects to replicate. This project will update our confidence in some of the most influential EEG findings and generate a large open access database that can be used to inform future research practices. Finally, through this international effort, we hope to create a cultural shift towards inclusive, high-powered multi-laboratory collaborations.

Childhood abuse history and attention bias in adults.

Attention biases toward unpleasant information are evident among children and adults with a history of abuse and have been identified as a potential pathway through which abused children develop psychopathology. Identifying whether a history of childhood abuse affects the time course of attention biases in adults is critical, as this may provide intervention targets. The present study examined the time course of attention bias during an emotion-word Stroop task using event-related potentials (ERPs) in a sample of adults with a range of child abuse histories using a categorical approach (comparing adults with or without a history of moderate-to-severe childhood abuse) and a dimensional approach (analyzing the range from no abuse to severe abuse in a continuous manner). Although behavioral performance did not vary as a function of abuse history, adults with a history of moderate-to-severe childhood abuse showed ERP evidence of early reduced processing of emotional stimuli (smaller N200) and later reduced processing of emotional and nonemotional stimuli (smaller P300), followed by later increased processing of unpleasant stimuli (larger slow wave [SW]). Results suggest that early disengagement from emotional stimuli may help individuals with moderate-to-severe abuse histories to achieve normal behavioral performance on the emotion-word Stroop task. Additionally, regardless of analytic approach, adults with elevated levels of childhood abuse exhibited prolonged engagement (larger SW) specifically with unpleasant stimuli. Present results demonstrate attention bias patterns in adults with a history of childhood abuse and clarify the time course of attention bias. Results are discussed in the context of potential treatment implications.

Time Course of Brain Network Reconfiguration Supporting Inhibitory Control.

Hemodynamic research has recently clarified key nodes and links in brain networks implementing inhibitory control. Although fMRI methods are optimized for identifying the structure of brain networks, the relatively slow temporal course of fMRI limits the ability to characterize network operation. The latter is crucial for developing a mechanistic understanding of how brain networks shift dynamically to support inhibitory control. To address this critical gap, we applied spectrally resolved Granger causality (GC) and random forest machine learning tools to human EEG data in two large samples of adults (test sample n = 96, replication sample n = 237, total N = 333, both sexes) who performed a color-word Stroop task. Time-frequency analysis confirmed that recruitment of inhibitory control accompanied by slower behavioral responses was related to changes in theta and alpha/beta power. GC analyses revealed directionally asymmetric exchanges within frontal and between frontal and parietal brain areas: top-down influence of superior frontal gyrus (SFG) over both dorsal ACC (dACC) and inferior frontal gyrus (IFG), dACC control over middle frontal gyrus (MFG), and frontal-parietal exchanges (IFG, precuneus, MFG). Predictive analytics confirmed a combination of behavioral and brain-derived variables as the best set of predictors of inhibitory control demands, with SFG theta bearing higher classification importance than dACC theta and posterior beta tracking the onset of behavioral response. The present results provide mechanistic insight into the biological implementation of a psychological phenomenon: inhibitory control is implemented by dynamic routing processes during which the target response is upregulated via theta-mediated effective connectivity within key PFC nodes and via beta-mediated motor preparation.SIGNIFICANCE STATEMENT Hemodynamic neuroimaging research has recently clarified regional structures in brain networks supporting inhibitory control. However, due to inherent methodological constraints, much of this research has been unable to characterize the temporal dynamics of such networks (e.g., direction of information flow between nodes). Guided by fMRI research identifying the structure of brain networks supporting inhibitory control, results of EEG source analysis in a test sample (n = 96) and replication sample (n = 237) using effective connectivity and predictive analytics strategies advance a model of inhibitory control by characterizing the precise temporal dynamics by which this network operates and exemplify an approach by which mechanistic models can be developed for other key psychological processes.

Attention training to pleasant stimuli in anxiety.

Attentional bias for threatening stimuli in anxiety is a common finding in the literature. The present study addressed whether attention training toward pleasant stimuli can reduce anxiety symptoms and induce a processing bias in favor of pleasant information in nonpatients who were selected to score similarly to individuals with generalized anxiety or panic disorder on a measure of worry or physiological arousal, respectively. Participants were randomly assigned to attention training to pleasant (ATP) stimuli or to a placebo control (PC) condition. All participants completed baseline and post-test dot-probe measures of attentional bias while event-related brain potentials were recorded. As expected, worry symptoms decreased in the ATP and not PC condition. ATP was also associated with early evidence (P100 amplitude) of greater attentional prioritization of probes replacing neutral stimuli within threat-neutral word pairs from pre-to-post intervention and later RT evidence of facilitated processing of probes replacing pleasant stimuli within pleasant-threat word pairs at post compared to PC. PC was associated with later evidence (P300 latency) of less efficient evaluation of probes following pleasant stimuli within pleasant-threat word pairs from pre-to-post and later RT evidence of facilitated processing of probes following threat stimuli within pleasant-threat word pairs at post compared to ATP. Results highlight early and later mechanisms of attention processing changes and underscore the potential of pleasant stimuli in optimizing attention-training interventions for anxiety.

Neural correlates of suspiciousness and interactions with anxiety during emotional and neutral word processing.

Suspiciousness is usually classified as a symptom of psychosis, but it also occurs in depression and anxiety disorders. Though how suspiciousness overlaps with depression is not obvious, suspiciousness does seem to overlap with anxious apprehension and anxious arousal (e.g., verbal iterative processes and vigilance about environmental threat). However, suspiciousness also has unique characteristics (e.g., concern about harm from others and vigilance about social threat). Given that both anxiety and suspiciousness have been associated with abnormalities in emotion processing, it is unclear whether it is the unique characteristics of suspiciousness or the overlap with anxiety that drive abnormalities in emotion processing. Event-related brain potentials were obtained during an emotion-word Stroop task. Results indicated that suspiciousness interacts with anxious apprehension to modulate initial stimulus perception processes. Suspiciousness is associated with attention to all stimuli regardless of emotion content. In contrast, anxious arousal is associated with a later response to emotion stimuli only. These results suggest that suspiciousness and anxious apprehension share overlapping processes, but suspiciousness alone is associated with a hyperactive early vigilance response. Depression did not interact with suspiciousness to predict response to emotion stimuli. These findings suggest that it may be informative to assess suspiciousness in conjunction with anxiety in order to better understand how these symptoms interact and contribute to dysfunctional emotion processing.

Electrophysiological evidence of the time course of attentional bias in non-patients reporting symptoms of depression with and without co-occurring anxiety.

Anxiety is characterized by attentional biases to threat, but findings are inconsistent for depression. To address this inconsistency, the present study systematically assessed the role of co-occurring anxiety in attentional bias in depression. In addition, the role of emotional valence, arousal, and gender was explored. Ninety-two non-patients completed the Penn State Worry Questionnaire (Meyer et al., 1990; Molina and Borkovec, 1994) and portions of the Mood and Anxiety Symptom Questionnaire (Watson et al., 1995a,1995b). Individuals reporting high levels of depression and low levels of anxiety (depression only), high levels of depression and anxiety (combined), or low levels of both (control) completed an emotion-word Stroop task during event-related brain potential recording. Pleasant and unpleasant words were matched on emotional arousal level. An attentional bias was not evident in the depression-only group. Women in the combined group had larger N200 amplitude for pleasant than unpleasant stimuli, and the combined group as a whole had larger right-lateralized P300 amplitude for pleasant than unpleasant stimuli, consistent with an early and later attentional bias that is specific to unpleasant valence in the combined group. Men in the control group had larger N200 amplitude for pleasant than unpleasant stimuli, consistent with an early attentional bias that is specific to pleasant valence. The present study indicates that the nature and time course of attention prompted by emotional valence and not arousal differentiates depression with and without anxiety, with some evidence of gender moderating early effects. Overall, results suggest that co-occurring anxiety is more important than previously acknowledged in demonstrating evidence of attentional biases in depression.

Fragile early visual percepts mark genetic liability specific to schizophrenia.

Disruption of visual percepts by a subsequent stimulus (ie, backward masking) has been consistently noted in schizophrenia, with some evidence that this fragility in early perception is present in people with genetic liability for the disorder. Given the potential of backward masking paradigms to mark neural processes that confer risk for schizophrenia, it is important to test the diagnostic specificity of abnormalities in visual perception. To more fully assess whether masking visual stimuli reveals a marker of genetic liability (ie, endophenotype) specific to schizophrenia, we tested 44 people with the disorder, 29 people with bipolar disorder, 56 first-degree biological relatives of people with schizophrenia, 26 first-degree biological relatives of people with bipolar disorder, and 43 nonpsychiatric control participants using a magnocellular-biased visual backward masking procedure that included target-to-mask onset asynchronies ranging from 0 to 80 ms. Relatives of people with schizophrenia who were without schizophrenia spectrum disorders exhibited impaired performance compared with nonpsychiatric control participants and relatives of people with bipolar disorder when a visual mask interrupted early perception (eg, 27 ms). A similar vulnerability of early processes was noted in people with schizophrenia, yet they also had impaired performance when masks occurred at later time points (ie, 80 ms). Performance deficits were not attributable to intellectual function, measures of attention and memory, symptomatology, or medication dosage. Bipolar patients and their relatives failed to exhibit deficits on the backward masking task. Fragility of early visual percepts appears to mark genetic liability specific to schizophrenia and may serve as an endophenotype for the disorder.

Depression and anxious apprehension distinguish frontocingulate cortical activity during top-down attentional control.

A network consisting of left dorsolateral prefrontal cortex (LDLPFC) and dorsal anterior cingulate cortex (dACC) has been implicated in top-down attentional control. Few studies have systematically investigated how this network is altered in psychopathology, despite evidence that depression and anxiety are associated with attentional control impairments. Functional MRI and dense-array event-related brain potential (ERP) data were collected in separate sessions from 100 participants during a color-word Stroop task. Functional MRI results guided ERP source modeling to characterize the time course of activity in LDLPFC (300-440 ms) and dACC (520-680 ms). At low levels of depression, LDLPFC activity was indirectly related to Stroop interference and only via dACC activity. In contrast, at high levels of depression, dACC did not play an intervening role, and increased LDLPFC activity was directly related to decreased Stroop interference. Specific to high levels of anxious apprehension, higher dACC activity was related to more Stroop interference. Results indicate that depression and anxious apprehension modulate temporally and functionally distinct aspects of the frontocingulate network involved in top-down attention control.

Time course of processing emotional stimuli as a function of perceived emotional intelligence, anxiety, and depression.

An individual's self-reported abilities to attend to, understand, and reinterpret emotional situations or events have been associated with anxiety and depression, but it is unclear how these abilities affect the processing of emotional stimuli, especially in individuals with these symptoms. The present study recorded event-related brain potentials while individuals reporting features of anxiety and depression completed an emotion-word Stroop task. Results indicated that anxious apprehension, anxious arousal, and depression were associated with self-reported emotion abilities, consistent with prior literature. In addition, lower anxious apprehension and greater reported emotional clarity were related to slower processing of negative stimuli indexed by event-related potentials (ERPs). Higher anxious arousal and reported attention to emotion were associated with ERP evidence of early attention to all stimuli regardless of emotional content. Reduced later engagement with stimuli was also associated with anxious arousal and with clarity of emotions. Depression was not differentially associated with any emotion processing stage indexed by ERPs. Research in this area may lead to the development of therapies that focus on minimization of anxiety to foster successful emotion regulation.

Attentional bias to negative emotion as a function of approach and withdrawal anger styles: an ERP investigation.

Although models of emotion have focused on the relationship between anger and approach motivation associated with aggression, anger is also related to withdrawal motivation. Anger-out and anger-in styles are associated with psychopathology and may disrupt the control of attention within the context of negatively valenced information. The present study used event-related brain potentials (ERPs) to examine whether anger styles uniquely predict attentional bias to negative stimuli during an emotion-word Stroop task. High anger-out predicted larger N200, P300, and N400 to negative words, suggesting that aggressive individuals exert more effort to override attention to negative information. In contrast, high anger-in predicted smaller N400 amplitude to negative words, indicating that negative information may be readily available (primed) for anger suppressors, requiring fewer resources. Individuals with an anger-out style might benefit from being directed away from provocative stimuli that might otherwise consume their attention and foster overt aggression. Findings indicating that anger-out and anger-in were associated with divergent patterns of brain activity provide support for distinguishing approach- and withdrawal-related anger styles.

Time course of attentional bias in anxiety: emotion and gender specificity.

Anxiety is characterized by cognitive biases, including attentional bias to emotional (especially threatening) stimuli. Accounts differ on the time course of attention to threat, but the literature generally confounds emotional valence and arousal and overlooks gender effects, both addressed in the present study. Nonpatients high in self-reported anxious apprehension, anxious arousal, or neither completed an emotion-word Stroop task during event-related potential (ERP) recording. Hypotheses differentiated time course of preferential attention to emotional stimuli. Individuals high in anxious apprehension and anxious arousal showed distinct early ERP evidence of preferential processing of emotionally arousing stimuli along with some evidence for gender differences in processing. Healthy controls showed gender differences at both early and later processing stages. The conjunction of valence, arousal, and gender is critical in the time course of attentional bias.

The time course of activity in dorsolateral prefrontal cortex and anterior cingulate cortex during top-down attentional control.

A network of brain regions has been implicated in top-down attentional control, including left dorsolateral prefrontal cortex (LDLPFC) and dorsal anterior cingulate cortex (dACC). The present experiment evaluated predictions of the cascade-of-control model (Banich, 2009), which predicts that during attentionally-demanding tasks, LDLPFC imposes a top-down attentional set which precedes late-stage selection performed by dACC. Furthermore, the cascade-of-control model argues that dACC must increase its activity to compensate when top-down control by LDLPFC is poor. The present study tested these hypotheses using fMRI and dense-array ERP data collected from the same 80 participants in separate sessions. fMRI results guided ERP source modeling to characterize the time course of activity in LDLPFC and dACC. As predicted, dACC activity subsequent to LDLPFC activity distinguished congruent and incongruent conditions on the Stroop task. Furthermore, when LDLPFC activity was low, the level of dACC activity was related to performance outcome. These results demonstrate that dACC responds to attentional demand in a flexible manner that is dependent on the level of LDLPFC activity earlier in a trial. Overall, results were consistent with the temporal course of regional brain function proposed by the cascade-of-control model.

Anger style, psychopathology, and regional brain activity.

Depression and anxiety often involve high levels of trait anger and disturbances in anger expression. Reported anger experience and outward anger expression have recently been associated with left-biased asymmetry of frontal cortical activity, assumed to reflect approach motivation. However, different styles of anger expression could presumably involve different brain mechanisms and/or interact with psychopathology to produce various patterns of brain asymmetry. The present study explored these issues by comparing resting regional electroencephalographic activity in participants high in trait anger who differed in anger expression style (high anger-in, high anger-out, both) and participants low in trait anger, with depression and anxiety systematically assessed. Trait anger, not anger-in or anger-out, predicted left-biased asymmetry at medial frontal EEG sites. The anger-in group reported higher levels of anxious apprehension than did the anger-out group. Furthermore, anxious apprehension moderated the relationship between trait anger, anger-in, and asymmetry in favor of the left hemisphere. Results suggest that motivational direction is not always the driving force behind the relationship of anger and left frontal asymmetry. Findings also support a distinction between anxious apprehension and anxious arousal.

Low-vision reading speed: influences of linguistic inference and aging.

PURPOSE: Reading is a dynamic task involving both linguistic and visual analysis. In this study, we asked how two types of linguistic information--characters used in segmenting words from one another, and sentence context--differ in their usefulness for people with normal and low vision. Given evidence for age-related differences in some forms of cognitive processing, we also investigated the effect of age. METHODS: There were four groups of 10 participants: vision status (normal, low) crossed with age (young, <35 years; old, >65 years). Reading speeds were compared for regularly spaced text and text in which the spaces were removed, a manipulation intended to eliminate local cues for text segmentation and force attention to clusters of letters or whole words. We also evaluated the effect of sentence context by comparing reading speeds for regular sentences and sentences in which word order was scrambled. RESULTS: Removal of spaces had a greater impact on low vision than normal vision, reducing average speeds to 45% and 66% of speeds for regularly spaced text, respectively. We interpret this to mean that people with low vision have less access to spatially distributed linguistic regularities of text such as prefixes, suffixes, or word length. Removal of sentence context through scrambling had a greater impact on normal vision than low vision, reducing mean reading speed to 53% and 66%, respectively. Finally, comparison of our young and old readers showed no major differences in the use of sentence context or in the impact of removing spaces between words. CONCLUSIONS: People with low vision appear to rely more on spacing information in sentences, whereas people with normal vision appear to make better use of sentence context, irrespective of age.