The Emerging Literature on Exposure-Based Writing Therapies for Subthreshold and Clinical Posttraumatic Stress Disorder: A Response to Thompson-Hollands et al.'s (2020) Commentary on Dawson et al. (2020).

Thompson-Hollands et al.'s (2020) commentary on our systematic review of exposure-based writing therapies for subthreshold and clinical posttraumatic stress symptoms (Dawson et al., 2020) emphasizes important questions about the impact of heterogeneity in drawing inferences from evidence reviews. In this reply, we discuss (a) our rationale for undertaking a systematic review that was broad rather than narrow in scope and (b) provide clarifications on how heterogeneity was considered in the meta-analyses that were conducted. We also strongly agree with Thompson-Hollands et al.'s recommendation that future research should focus on better understanding the mechanisms by which exposure-based writing therapies help reduce posttraumatic stress symptoms.

Exposure-Based Writing Therapies for Subthreshold and Clinical Posttraumatic Stress Disorder: A Systematic Review and Meta-Analysis.

We undertook a systematic review to assess the efficacy of exposure-based writing therapies (WTs) for trauma-exposed adults with subthreshold or clinical levels of posttraumatic stress disorder. Four databases (PsycINFO, Medline, Wiley Online, PILOTS) were searched for randomized controlled trials (RCTs) of exposure-based WTs. A total of 13 RCTs that reported on results from 17 WT versus control comparisons were included. The primary outcomes were posttraumatic stress symptom severity at posttreatment and/or clinical response. An overall unclear or high risk of bias was identified in 84.6% of studies. In comparison to both waitlist k = 3, Hedges' g = -0.97, 95% CI [-1.20, -0.73], and placebo writing conditions, k = 9, Hedges' g = -0.48, 95% CI [-0.87, -0.08], WTs were more beneficial to participants. There was no evidence of a difference between WTs that were longer in duration compared to other psychotherapy, k = 2; pooled OR = 1.42; 95% CI [0.83, 2.43]. These findings indicate that exposure-based WTs are effective when compared to waitlist and placebo writing control conditions. The evidence needs to be considered in the context of the modest number of studies conducted to date, the high methodological heterogeneity between the studies, and the high or unclear risk of bias across many studies. Further research is needed to increase the evidence base regarding the efficacy of WTs for posttraumatic stress. Future research should also measure the mediators and predictors of outcomes to further develop protocols and understand which variants of WTs work for different populations or individuals.

Callous-Unemotional Features are Associated with Emotion Recognition Impairments in Young ODD Children with Low but not High Affective Arousal.

Despite increasing support for the distinction between primary and secondary variants of callous-unemotional features in children with disruptive behavioural disorders, evidence about whether emotion recognition deficits are only characteristic of primary CU is inconclusive. We tested whether, in young children with Oppositional Defiant Disorder (ODD; N = 74), level of affective arousal moderated the association between CU and performance on behavioural measures of emotional abilities. The association between CU and emotion recognition abilities was dependent on the child's level of affective arousal with higher CU associated with poorer emotion recognition abilities for ODD children with lower affective arousal (r = - 0.49; p = .007) but not for those with higher levels (r = 0.03; p = .838). Our results replicate recent findings and give support to the notion that the primary CU variant is characterised emotionally by under arousal of affect, low affect dysregulation and impaired emotion recognition abilities.

Maternal Elaborative Language in Shared Emotion Talk with ODD Children: Relationship to Child Emotion Competencies.

While maternal elaborative reminiscing has been found to be positively connected to children's emotion competencies, little is known about how the quality of maternal talk during mother-child talk about shared emotion events relates to emotional competencies in children with disruptive behavioural disorders. In this study of 68 four to eight year-olds with oppositional defiant disorder and 34 children without a diagnosis there was no evidence of differences between mothers of oppositional defiant disorder (ODD) children and mothers of non-ODD children in their use of emotion descriptors and open-ended questions when discussing emotion events with their child. After controlling for child age, gender, expressive verbal abilities and number of conversational turns, the more the mothers used these devices the poorer child's ability to generate causes for emotions and the lower the child's emotion regulation ability. The association for child emotion regulation was moderated by child's diagnostic status with a notable relationship for ODD mother-child dyads but not for the other group. The implications of the findings for the conceptualisation of mother-child talk and its relationship to the development of emotion competencies in children with disruptive behavioural problems are discussed.

Are claims of non-inferiority of Internet and computer-based cognitive-behavioural therapy compared with in-person cognitive-behavioural therapy for adults with anxiety disorders supported by the evidence from head-to-head randomised controlled trials? A systematic review.

OBJECTIVE: This review examines the evidence from head-to-head randomised controlled trials addressing whether the efficacy of cognitive-behavioural therapy for anxiety disorders, obsessive-compulsive disorder and post-traumatic stress disorders in adults delivered by computer or online (computer- and Internet-delivered cognitive-behavioural therapy) is not inferior to in-person cognitive-behavioural therapy for reducing levels of symptoms and producing clinically significant gains at post-treatment and at follow-up. A supplementary aim is to examine the evidence for severity as a moderator of the relative efficacy of computer- and Internet-delivered cognitive-behavioural therapy and in-person cognitive-behavioural therapy. METHOD: PubMed, PsycINFO, Embase and Cochrane database of randomised trials were searched for randomised controlled trials of cognitive-behavioural therapy for these disorders with at least an in-person cognitive-behavioural therapy and Internet or computer cognitive-behavioural therapy arm. RESULTS: A total of 14 randomised controlled trials (9 Internet, 5 computer) of cognitive-behavioural therapy for social anxiety disorder, panic disorder and specific phobia and 3 reports of effect moderators were included. One study showed a low risk of bias when assessed against risk of bias criteria for non-inferiority trials. The remaining studies were assessed as high or unclear risk of bias. One study found that Internet-delivered cognitive-behavioural therapy was superior and non-inferior at post-treatment and follow-up to group in-person cognitive-behavioural therapy for social anxiety disorder. One study of Internet-delivered cognitive-behavioural therapy for panic disorder showed non-inferiority to individual in-person cognitive-behavioural therapy for responder status at post-treatment and one of Internet cognitive-behavioural therapy for panic disorder for symptom severity at follow-up. Other comparisons (22 Internet, 13 computer) and for estimates pooled for Internet cognitive-behavioural therapy for social anxiety disorder, Internet cognitive-behavioural therapy for panic disorder and computer-delivered cognitive-behavioural therapy studies did not support non-inferiority. Evidence of effect moderation by severity and co-morbidity was mixed. CONCLUSION: There is limited evidence from randomised controlled trials which supports claims that computer- or Internet-delivered cognitive-behavioural therapy for anxiety disorders is not inferior to in-person delivery. Randomised controlled trials properly designed to test non-inferiority are needed before conclusions about the relative benefits of in-person and Internet- and computer-delivered cognitive-behavioural therapy can be made. PROSPERO: CRD420180961655-6.

Reduced willingness to approach genuine smilers in social anxiety explained by potential for social evaluation, not misperception of smile authenticity.

We investigate perception of, and responses to, facial expression authenticity for the first time in social anxiety, testing genuine and polite smiles. Experiment 1 (N = 141) found perception of smile authenticity was unaffected, but that approach ratings, which are known to be reduced in social anxiety for happy faces, are more strongly reduced for genuine than polite smiles. Moreover, we found an independent contribution of social anxiety to approach ratings, over and above general negative affect (state/trait anxiety, depression), only for genuine smiles, and not for polite ones. We argue this pattern of results can be explained by genuine smilers signalling greater potential for interaction - and thus greater potential for the scrutiny that is feared in social anxiety - than polite smiles. Experiment 2 established that, relative to polite smilers, genuine smilers are indeed perceived as friendlier and likely to want to talk for longer if approached. Critically, the degree to which individual face items were perceived as wanting to interact correlated strongly with the amount that social anxiety reduced willingness to approach in Experiment 1. We conclude it is the potential for social evaluation and scrutiny signalled by happy expressions, rather than their positive valence, that is important in social anxiety.

Emotional Abilities in Children with Oppositional Defiant Disorder (ODD): Impairments in Perspective-Taking and Understanding Mixed Emotions are Associated with High Callous-Unemotional Traits.

Most studies of emotion abilities in disruptive children focus on emotion expression recognition. This study compared 74 children aged 4-8 years with ODD to 45 comparison children (33 healthy; 12 with an anxiety disorder) on behaviourally assessed measures of emotion perception, emotion perspective-taking, knowledge of emotions causes and understanding ambivalent emotions and on parent-reported cognitive and affective empathy. Adjusting for child's sex, age and expressive language ODD children showed a paucity in attributing causes to emotions but no other deficits relative to the comparison groups. ODD boys with high levels of callous-unemotional traits (CU) (n = 22) showed deficits relative to low CU ODD boys (n = 25) in emotion perspective-taking and in understanding ambivalent emotions. Low CU ODD boys did not differ from the healthy typically developing boys (n = 12). Impairments in emotion perceptive-taking and understanding mixed emotions in ODD boys are associated with the presence of a high level of CU.

Perceived emotion genuineness: normative ratings for popular facial expression stimuli and the development of perceived-as-genuine and perceived-as-fake sets.

In everyday social interactions, people's facial expressions sometimes reflect genuine emotion (e.g., anger in response to a misbehaving child) and sometimes do not (e.g., smiling for a school photo). There is increasing theoretical interest in this distinction, but little is known about perceived emotion genuineness for existing facial expression databases. We present a new method for rating perceived genuineness using a neutral-midpoint scale (-7 = completely fake; 0 = don't know; +7 = completely genuine) that, unlike previous methods, provides data on both relative and absolute perceptions. Normative ratings from typically developing adults for five emotions (anger, disgust, fear, sadness, and happiness) provide three key contributions. First, the widely used Pictures of Facial Affect (PoFA; i.e., "the Ekman faces") and the Radboud Faces Database (RaFD) are typically perceived as not showing genuine emotion. Also, in the only published set for which the actual emotional states of the displayers are known (via self-report; the McLellan faces), percepts of emotion genuineness often do not match actual emotion genuineness. Second, we provide genuine/fake norms for 558 faces from several sources (PoFA, RaFD, KDEF, Gur, FacePlace, McLellan, News media), including a list of 143 stimuli that are event-elicited (rather than posed) and, congruently, perceived as reflecting genuine emotion. Third, using the norms we develop sets of perceived-as-genuine (from event-elicited sources) and perceived-as-fake (from posed sources) stimuli, matched on sex, viewpoint, eye-gaze direction, and rated intensity. We also outline the many types of research questions that these norms and stimulus sets could be used to answer.

Standards of care for obsessive-compulsive disorder centres.

In recent years, many assessment and care units for obsessive-compulsive disorder (OCD) have been set up in order to detect, diagnose and to properly manage this complex disorder, but there is no consensus regarding the key functions that these units should perform. The International College of Obsessive-Compulsive Spectrum Disorders (ICOCS) together with the Obsessive Compulsive and Related Disorders Network (OCRN) of the European College of Neuropsychopharmacology (ECNP) and the Anxiety and Obsessive Compulsive Disorders Section of the World Psychiaric Association (WPA) has developed a standards of care programme for OCD centres. The goals of this collaborative initiative are promoting basic standards, improving the quality of clinical care and enhance the validity and reliability of research results provided by different facilities and countries.

Fearful faces drive gaze-cueing and threat bias effects in children on the lookout for danger.

Most developmental studies of face emotion processing show faces in isolation, in the absence of any broader context. Here we investigate two types of interactions between expression and threat contexts. First, in adults, following of another person's direction of social attention is increased when that person shows fear and the context requires vigilance for danger. We investigate whether this also occurs in children. Using a Posner-style eye-gaze cueing paradigm, we tested whether children would show greater gaze-cueing from fearful than happy expressions when the task was to be vigilant for possible dangerous animals. Testing across the 8-12-year-old age range, we found this fear priority effect was absent in the youngest children but developed to reach adult levels in the oldest children. However, even the oldest children were unable to sustain fear-prioritization when the onset of the target was delayed. Second, we addressed the development of 'threat bias' - namely faster identification of dangerous animals than safe animals - in the social context provided by expressive faces. In our non-anxious samples (i.e. with typical-population levels of anxiety), adults showed a threat bias regardless of the expression or looking direction of the just-seen cue face whereas 8-12-year-olds only showed a threat bias when the just-seen cue face displayed fear. Overall, the results argue that some, but not all, aspects of expression-context interactions are mature by 12 years of age.

Early language impairments and developmental pathways of emotional problems across childhood.

BACKGROUND: Language impairments are associated with an increased likelihood of emotional difficulties later in childhood or adolescence, but little is known about the impact of LI on the growth of emotional problems. AIMS: To examine the link between early language status (language impaired (LI), typical language (TL)) and the pattern and predictors of growth in emotional difficulties from school entry to the start of high school in a large cohort of Australian children. METHODS & PROCEDURES: Unconditional latent growth curves of emotional difficulties were modelled across four waves (ages 4-5, 6-7, 8-9 and 10-11) using data from 1627 boys (280 LI, 1347 TL) and 1609 girls (159 LI, 1450 TL). Conditional latent growth curves estimated the main effects of LI on the severity and slope of growth in emotional problems. Simultaneous multiple regression tested the interaction between language status and the other predictors of the development of emotional symptoms. OUTCOMES & RESULTS: LI predicted a significant persistent elevation in severity of emotional difficulties across childhood among boys (d = 0.33-0.57) and girls (d = 0.25-0.39) but was not associated with their growth. LI moderated the association between hostile parenting and the severity of emotional symptoms for boys and the effect of socioeconomic status (SES) and temperamental sociability on the linear and quadratic growth of emotional problems for girls but had no impact on the influence of other predictors. CONCLUSIONS & IMPLICATIONS: There is no effect of LI on the characteristic rate and shape of growth in emotional symptoms across childhood although LI children maintain elevated severities of emotional difficulties. The associations between child reactivity, peer problems, prosocial behaviours, maternal distress and parental warmth and the development of emotional difficulties were the same for LI and TL children. LI enhanced the influence of hostile parenting on a higher severity of emotional symptoms for boys and of lower SES on a faster rate of development of emotional symptoms for girls. LI offset the usual protective effect of higher sociability and the usual vulnerability of higher social avoidance to a faster increase in emotional symptoms with age.

A comparison of the quality of intrusive memories in post-traumatic stress disorder and depression.

As in post-traumatic stress disorder (PTSD), intrusive memories (IMs) also play an important role in depression. Evidence about the comparative quality of IMs in PTSD and depression is limited and inconsistent. A total of 28 adults with PTSD, 29 with depression, and 30 controls identified intrusive and voluntary segments of narrative memories of key events. Self-report and language measures of memory quality were obtained. Depressed and PTSD participants reported higher frequency of IMs and higher IM-related interference than controls. IMs in PTSD participants were distinguished from depressed and control participants by higher self-rated distress, higher self-rated sensory quality, and a higher proportion of sensory words in the narrative. The depressed and control groups did not differ on IM quality. PTSD IM segments had more sensory content than voluntary segments and fewer temporal markers. The IM segments of the depressed and control groups had fewer temporal markers than the voluntary segments. Depression severity predicted fewer sensory words in the IM after considering peri-event dissociation and arousal but did not add to the prediction of other IM qualities. A strong sensory quality is a distinctive feature of IMs in PTSD but not in depression. Basic sensory processes contribute to the intrusiveness of remembering in PTSD but not in depression.

A randomized controlled trial of therapist-facilitated brief online behavioral parent training for reducing child disruptive behavior.

Background: Addressing child disruptive behavior in low and middle-income countries (LMICs) is challenging. Therapist-facilitated, multisession, brief, online group parent training offers hope for mitigating this issue. However, trials, particularly in Asia, are limited. Objective: This study primarily assessed the effectiveness of Brief Behavior Parent Training Vietnam (BBPTV) in reducing child disruptive behavior. Method: This study was a randomized controlled trial involving 109 Vietnamese parents (mean age = 34.1, 96 % were mothers) of preschool children displaying ongoing disruptive behaviors. Interventions included the BBPTV group (n = 56) receiving a therapist-facilitated, four-session program conducted through online group meetings and the care-as-usual (CAU) group (n = 53) having a 15 min individual online consultation. Primary outcomes, assessed online at two and six months postintervention, encompassed the intensity and frequency of children's disruptive problems. Secondary outcomes involved parenting practices, coercive interactions, marital conflicts, parenting self-efficacy, and parental mental health. Results: In contrast to CAU, the BBPTV group showed lower child disruptive intensity, reduced parent-child coercive interactions, and diminished marital conflicts, with a higher score in involving parenting two months post-intervention. Six months postintervention, BBPTV also exhibited significantly lower scores in child disruptive intensity and problems, harsh parenting, and coercive processes compared to CAU. Conclusions: The therapist-facilitated, four-session, internet-delivered group parent intervention resulted in superior and sustained improvements in child disruptive behavior, parenting practices, and parent-child coercive interaction compared to usual care, highlighting the potential for online BBPT to extend mental health care in Vietnam and other LMICs.

Emotional and behavioural outcomes later in childhood and adolescence for children with specific language impairments: meta-analyses of controlled prospective studies.

BACKGROUND: Prospective evidence on psychological outcomes for children with specific language impairments (SLI) is accumulating. To date, there has been no attempt to summarise what this evidence says about the strength of link between SLI and later child and adolescent emotional and behavioural (EB) outcomes. METHODS: We undertook a systematic review and meta-analysis (following PRISMA guidelines and involving a literature search to June 2012 of seven databases, including MEDLINE and PsychAPA) of prospective, cohort studies of children with SLI and typical language development (TLD) reporting on the incidence and severity of EB problems later in childhood or adolescence. RESULTS: Nineteen follow-up reports of eight cohorts with 553 SLI children and 1533 TLD controls were identified. Initial assessment was at 3-8.8 years of age and follow-up duration from 2 to 12 years. Pooled across comparable studies, SLI children were about two times more likely to show disorder levels of overall internalising problems, overall externalising and ADHD problems than TLD children. Compared with the average TLD child (50 percentile), at follow-up, the symptom severity of the average SLI child was at the 72 percentile (95% CI 65-79 percentile) on internalising symptoms, the 69 percentile (95% CI 63-74 percentile) on externalising symptoms and the 60 percentile (95% CI 52-68 percentile) on AHDH severity. The findings about risk to specific mental disorders and the severity of specific problems were inconclusive. CONCLUSIONS: Relative to typical children, SLI children experience clinically important increases in the severity of diverse emotional, behavioural and ADHD symptoms and more frequently show a clinical level of these problems. The small number of studies included in pooled analysis and methodological heterogeneity reduce the precision and generalisability of the findings. Most studies do not account for initial levels of EB problems.

Attachment- and Emotion-Focused Parenting Interventions for Child and Adolescent Externalizing and Internalizing Behaviors: A Meta-Analysis.

Attachment- and emotion-focused parenting interventions (AE) have grown in popularity as an alternative to behavioral parent training (BPT) for children and adolescents. AE go beneath behavior by helping parents understand and respond to their child's underlying attachment and emotional needs. Past reviews have examined their effects on attachment security and caregiver sensitivity, though less is known regarding their effects on child mental health symptoms. Reported here is the first systematic review and meta-analysis of individual and group AE on externalizing behavior (EXT) and internalizing behavior (INT) for children aged 0-18 years. A search of four databases prior to July 2021 elicited 43 studies that met eligibility criteria. Meta-analysis revealed that AE were superior to waitlist controls for EXT (SMD = - 0.17) and INT (SMD = - 0.34). Effects were sustained at follow-up periods of 6 months and greater, and AE considered to target child mental health were significantly more effective than those that did not in reducing EXT and INT. Two studies retrieved directly compared AE to BPT, which showed no evidence of a difference for follow-up measures of EXT. No studies compared AE to BPT on INT. AE demonstrated no evidence of superiority compared to controls for parent mental health. Findings support the potential for AE to reduce EXT and INT in children and adolescents; however, future research should consider the relative effectiveness of AE.

Advance agreements for mental health care: an examination of process and outcomes.

OBJECTIVE: Despite high demand for anticipatory planning tools in mental health there is little Australian research about their implementation. This study examines the processes and outcomes of the introduction of structured mental health advanced agreements in the Australian Capital Territory. METHOD: Thirty-three patients with serious mental illness collaborated with a key clinician to develop an advanced agreement. Patients and clinicians were provided with appropriate education, workbooks and materials. The process and outcomes associated with developing and completing an agreement were evaluated with patient and clinician interviews and self-report measures. RESULTS: The process was strongly accepted by the patients with only 16% discontinuing for reasons related to the advanced agreement. Participants strongly endorsed benefits both to themselves and to the management of patients' illnesses. Service level impediments, particularly clinician acceptance, limited treatment options, and the lack of legal force of the agreement were identified. CONCLUSIONS: When supported, mental health patients can work collaboratively with clinicians to produce anticipatory treatment requests which are beneficial, feasible and consistent with good care. Implementation of anticipatory planning in mental health will require service-level changes to promote clinician acceptance and to embed practices which facilitate these tools as part of routine care.

Integration and organization of trauma memories and posttraumatic symptoms.

To examine the connection between trauma memory integration in personal memory, memory organization, and posttraumatic symptom severity, 47 trauma-exposed adults undertook an event-cuing task for their trauma memory and for a memorable nontraumatic negative event. Measures of integration provided by self-endorsement, rated by naïve judges, or calculated from the language of the memories, did not significantly predict posttraumatic stress disorder symptom severity after adjusting for age, time since the event, anxiety when disclosing, familiarity of the memory, and integration of nontrauma memory. Less use of casual connectives in the trauma memory narrative was associated with higher trauma-related avoidance (r = .33; p = .03), whereas self-rating of the trauma memory as disorganized was associated with higher overall symptom severity (r = .42; p = .006).

Gaining a new perspective on the quality of parent-adolescent relationships from adolescent speech samples.

Although the quality of the parent-teen relationship is key to understanding both psychopathology and well-being in adolescence, there are limited assessments of adolescents' underlying attitudes regarding their parents. This study aimed to evaluate a novel and brief method of coding adolescents' 3-min speech samples regarding their affective attitudes (e.g., thoughts and feelings) toward their parent. A community sample of 72 adolescents (M age = 16 years) completed a 3-min speech sample and several questionnaire measures of the quality of the parent-teen relationship and adolescents' psychosocial outcomes. Speech samples were coded for critical and warm affective attitudes toward the parent using the Family Affective Attitude Rating Scale (FAARS). Results showed that FAARS negative relational schemas (NRS) and positive relational schemas (PRS) scales were reliable and converged with questionnaire assessments of attachment and relationship quality, antisocial outcomes, and pro-social behavior. When included in the same model, adolescents' NRS, but not the questionnaire measures, was uniquely associated with externalizing behavior and prosocial behavior. Furthermore, adolescents' PRS, but not the questionnaires, was uniquely associated with callous-unemotional traits. Results suggest that the FAARS coding scheme can reliably assess adolescents' affective attitudes toward their parents and that this information is relevant to understanding adolescents' psychosocial outcomes. The implications of these findings for multimethod clinical assessments, large cohort research, and adolescents' therapeutic outcomes are discussed. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

What is top-down about seeing enemies? Social anxiety and attention to threat.

An attentional bias to threat is an important maintaining and possibly aetiological factor for social anxiety. Despite this, little is known about the underlying mechanisms of threat biases, such as the relative contributions of top-down and bottom-up attention. In order to measure attentional bias toward threat, the current study employed a variation of the dot-probe task in which participants' attention was initially cued to the left or right side of the screen before an angry face paired with a neutral face was displayed, and subsequently participants responded to a probe in the locus of one of the faces. This design provides separate measures of engagement with and disengagement from threat. In addition, in order to manipulate the availability of top-down attentional resources, participants completed this task under no, low (simple arithmetic task), and high (difficult arithmetic task) working memory load. Higher levels of social anxiety were found to be associated with increased engagement with threat under no-load, whereas this effect was eliminated under low-load and high-load conditions. Moreover, social anxiety was not associated with delayed disengagement from threat. These results highlight the critical role of top-down attention for engaging attention with threat.

Searching for emotion: A top-down set governs attentional orienting to facial expressions.

Research indicates that humans orient attention toward facial expressions of emotion. Orienting to facial expressions has typically been conceptualised as due to bottom-up attentional capture. However, this overlooks the contributions of top-down attention and selection history. In the present study, across four experiments, these three attentional processes were differentiated using a variation of the dot-probe task, in which participants were cued to attend to a happy or angry face on each trial. Results show that attention toward facial expressions was not exclusively driven by bottom-up attentional capture; instead, participants could shift their attention toward both happy and angry faces in a top-down manner. This effect was not found when the faces were inverted, indicating that top-down attention relies on holistic processing of the face. In addition, no evidence of selection history was found (i.e., no improvement on repeated trials or blocks of trials in which the task was to orient to the same expression). Altogether, these results suggest that humans can use top-down attentional control to rapidly orient attention to emotional faces.