Year of Zoom in a Year of Doom: Lessons Learned Delivering ERP Remotely During the COVID-19 Pandemic.

In response to the COVID-19 pandemic and consequential shutdown measures, many mental health professionals started providing therapy to patients exclusively via telehealth. Our research center, which specializes in studying and treating obsessive-compulsive disorder (OCD), historically has provided in-person exposure and response prevention (ERP) to adults with OCD, but shifted to telehealth during the pandemic. Unlike in other modes of talk therapy, ERP's emphasis on therapist-supervised exposures presented unique opportunities and challenges to delivering treatment entirely via a virtual platform. This paper provides case examples to illustrate lessons we learned delivering ERP exclusively via telehealth in New York from March 2020 through June 2021 and offers recommendations for future study and practice. Though we observed a number of drawbacks to fully remote ERP, we also discovered advantages to delivering ERP this way, meriting additional research attention.

Knowledge of Threat Biases Perceptual Decision Making in Anxiety: Evidence From Signal Detection Theory and Drift Diffusion Modeling.

Background: Threat biases are considered key factors in the development and maintenance of anxiety. However, these biases are poorly operationalized and remain unquantified. Furthermore, it is unclear whether and how prior knowledge of threat and its uncertainty induce these biases and how they manifest in anxiety. Method: Participants (n = 55) used prestimulus cues to decide whether the subsequently presented stimuli were threatening or neutral. The cues either provided no information about the probability (high uncertainty) or indicated high probability (low uncertainty) of encountering threatening or neutral targets. We used signal detection theory and hierarchical drift diffusion modeling to quantify bias. Results: High-uncertainty threat cues improved discrimination of subsequent threatening and neutral stimuli more than neutral cues. However, anxiety was associated with worse discrimination of threatening versus neutral stimuli following high-uncertainty threat cues. Using hierarchical drift diffusion modeling, we found that threat cues biased decision making not only by shifting the starting point of evidence accumulation toward the threat decision but also by increasing the efficiency with which sensory evidence was accumulated for both threat-related and neutral decisions. However, higher anxiety was associated with a greater shift of starting point toward the threat decision but not with the efficiency of evidence accumulation. Conclusions: Using computational modeling, these results highlight the biases by which knowledge regarding uncertain threat improves perceptual decision making but impairs it in case of anxiety.

Is threat detection Black and White? Race effects in threat-related perceptual decision-making.

There is a vast literature base indicating that people respond differently to Black and White individuals based on differential perceptions of threat. As facial affect is a fundamental way that individuals communicate their emotional state, studies have examined differences in how Black and White threatening facial expressions are perceived. However, perceptual decisions regarding threatening and neutral stimuli often occur in familiar contexts or in environments where explicit cues indicate the presence or absence of threat. Furthermore, these decisions often occur in "noisy" (i.e., ambiguous) environments where the quality of sensory evidence is poor, requiring us to rely on perceptual "sets" or expectations to interpret such evidence. Therefore, in the present study we used a two-alternative perceptual decision-making task in which participants used threatening and neutral cue-elicited perceptual sets to discriminate between subsequently presented threatening and neutral Black and White faces. Threatening cues led to a greater tendency to decide that both Black and White faces were threatening, as well as faster and greater discriminability between threatening and neutral Black and White faces. However, race-related differences revealed that, following both cue types, discriminability between threatening and neutral Black faces was worse compared to White faces. Therefore, using a paradigm that is ecologically valid, our findings highlight the importance of examining basic aspects of visual perception to understand race-related differences in threat-related perceptual decision-making. Furthermore, these findings emphasize the importance of anticipatory top-down factors when making perceptual decisions about the presence or absence of threat in faces of different races. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Threat and uncertainty in the face of perceptual decision-making in anxiety.

Anxiety is defined as an anticipatory response to uncertain, future threats. It is unknown how anticipatory information regarding uncertainty about upcoming threatening and neutral stimuli impacts attention and perception in anxiety. Individuals with and without anxiety disorders performed two perceptual decision-making tasks in which they used threat or neutral prestimulus cues to discriminate between subsequent threatening and neutral faces. In one task, cues provided no probability information (high uncertainty). In the other, cues indicated a high probability of encountering threatening or neutral faces (low uncertainty). Under high uncertainty only, anxious apprehension was associated with worse discrimination between threatening versus neutral faces after threat cues. Additionally, anxious arousal was associated with worse discrimination after neutral cues in individuals with anxiety disorders. These findings will advance the field by spurring the development of more comprehensive and ecologically valid models in which anticipatory top-down factors influence threat perception in anxiety. (PsycInfo Database Record (c) 2022 APA, all rights reserved).