The Impact of Modifying Interpretive Bias on Contamination-Related Obsessive–Compulsive Symptoms

Cognitive-behavioural models of obsessive–compulsive disorder (OCD) propose that a tendency to negatively interpret ambiguous thoughts and situations plays a key role in maintaining the disorder. Moreover, some researchers have proposed that negative interpretive biases may share a common processing mechanism with attentional biases, with changes in one predicted to lead to changes in the other. The current study examined whether training positive (i.e., adaptive) interpretive bias of contamination-related OCD concerns using a cognitive bias modification paradigm (CBM-I) would lead to reductions in contamination concerns, as well as changes in contamination-related attentional bias. Undergraduate students with high levels of contamination-related OCD symptoms were randomly assigned to receive either positive (n?=?31) or neutral (n?=?33) CBM-I training. Participants in the positive training condition, relative to the neutral training condition, showed a significantly greater increase in positive interpretive bias, significantly less within-session behavioural avoidance of contaminants, and significantly reduced contamination-related cognitions (at one-week follow-up). Contrary to expectations, CBM-I training did not differentially impact attentional bias nor self-reported contamination-related OCD symptoms. We discuss future directions in applying CBM-I to contamination-related OCD.

     

Interpretation Bias Training in Depressed Adolescents: Near- and Far-Transfer Effects

Depressed adolescents are characterized by negative interpretation biases. Although investigators have used cognitive bias modification for interpretation (CBM-I) to experimentally manipulate interpretation biases in depressed adults, the near- and far-transfer effects are not well understood in adolescents diagnosed with Major Depressive Disorder (MDD). In this study, we extend previous research by investigating the near- and far-transfer effects of 6 sessions of Positive versus Neutral CBM-I on independent measures of interpretation bias (near-transfer effects) and on attention biases and clinical symptoms (far-transfer effects) in a sample of adolescents with MDD (n = 46). At post-training, adolescents who received Positive CBM-I interpreted ambiguous scenarios more positively than did participants who received Neutral CBM-I, providing evidence of training effectiveness. There was no evidence, however, of near- or far-transfer effects. These findings raise concerns about the malleability of interpretation biases in adolescent depression and suggest that further work is needed to establish the clinical utility of CBM-I for adolescents with MDD.     

Adolescent threat-related interpretive bias and its modification: the moderating role of regulatory control

Dual process models describe psychopathology as the consequence of an imbalance between a fast, impulsive system and a regulatory control system and have recently been applied to anxiety disorders. The aim of the current study was to specifically examine the role of a regulatory control system in regulating 1) threat-related interpretive bias and 2) the effectiveness of interpretive bias training in adolescents. In total, 67 adolescents participated and followed either a positive Cognitive Bias Modification of Interpretation (CBM-I) training or a placebo-control condition. Results revealed that interpretive bias and the effectiveness of its modification depended on individual differences in regulatory control. That is, low levels of regulatory control in combination with high levels of state anxiety were associated with the strongest threat-related interpretive bias and those individuals benefited the most of the positive interpretation training. The current study provided empirical support for the role of dual processes in adolescent threat-related interpretive bias.     

Attention Biases to Threat Link Behavioral Inhibition to Social Withdrawal over Time in Very Young Children

Behaviorally inhibited children display a temperamental profile characterized by social withdrawal and anxious behaviors. Previous research, focused largely on adolescents, suggests that attention biases to threat may sustain high levels of behavioral inhibition (BI) over time, helping link early temperament to social outcomes. However, no prior studies examine the association between attention bias and BI before adolescence. The current study examined the interrelations among BI, attention biases to threat, and social withdrawal already manifest in early childhood. Children (N = 187, 83 Male, M _age  = 61.96 months) were characterized for BI in toddlerhood (24 & 36 months). At 5 years, they completed an attention bias task and concurrent social withdrawal was measured. As expected, BI in toddlerhood predicted high levels of social withdrawal in early childhood. However, this relation was moderated by attention bias. The BI-withdrawal association was only evident for children who displayed an attention bias toward threat. The data provide further support for models associating attention with socioemotional development and the later emergence of clinical anxiety.     

Face Emotion Processing in Depressed Children and Adolescents with and without Comorbid Conduct Disorder

Studies of adults with depression point to characteristic neurocognitive deficits, including differences in processing facial expressions. Few studies have examined face processing in juvenile depression, or taken account of other comorbid disorders. Three groups were compared: depressed children and adolescents with conduct disorder (n = 23), depressed children and adolescents without conduct disorder (n = 29) and children and adolescents without disorder (n = 37). A novel face emotion processing experiment presented faces with ‘happy’, ‘sad’, ‘angry’, or ‘fearful’ expressions of varying emotional intensity using morphed stimuli. Those with depression showed no overall or specific deficits in facial expression recognition accuracy. Instead, they showed biases affecting processing of low-intensity expressions, more often perceiving these as sad. In contrast, non-depressed controls more often misperceived low intensity negative emotions as happy. There were no differences between depressed children and adolescents with and without conduct disorder, or between children with comorbid depression/conduct disorder and controls. Face emotion processing biases rather than deficits appear to distinguish depressed from non-depressed children and adolescents.     

The Association Between Elevated Maternal Panic-Like and Depression Symptoms and Separation-Related Interpretive Biases in Offspring

We explored the association between maternal panic-like and depression symptoms with the offspring’s separation-related interpretive bias in a community sample. Separation anxiety has been found to be a precursor of panic disorders; therefore we focused on children and adolescents’ (aged 7–14 years) interpretive bias tapping into separation concerns using a story-based task. We collected self-reports and maternal reports of the levels of separation anxiety in the offspring. To assess maternal panic-like symptoms, we measured interoceptive and agoraphobic fears; as they have been found to increase the likelihood of experiencing panic disorders. The results showed that elevated levels of maternal interoceptive fears and agoraphobia co-occurring with depression were associated with an interpretive bias that related to separation anxiety concerns in children and adolescents. Offspring whose mothers experienced elevated panic-like symptoms together with depression did not show an interpretive bias linked to generalized anxiety concerns, suggesting the bias is content specific. The clinical significance of these findings stems from giving insight as to what extent separation interpretive biases would be influenced by maternal mental health variables, as these biases could constitute a vulnerability factor for later psychopathology. Further research is merited to address the findings with a longitudinal approach.     

The causal role of interpretive bias in anxiety reactivity

Elevated anxiety vulnerability is associated with a tendency to interpret ambiguous stimuli as threatening, but the causal basis of this relationship has not been established. Recently, procedures have been developed to systematically manipulate interpretive bias, but the impact of such manipulation on anxiety reactivity to a subsequent stressor has not yet been examined. In the present study, training procedures were used to induce interpretive biases favoring the threatening or nonthreatening meanings of ambiguous information in a sample of 48 undergraduate students. Following this interpretive training, participants' emotional reactions to a stressful video were assessed. The finding that the manipulation of interpretive bias modified emotional reactivity supports the hypothesis that interpretive bias can indeed play a causal role in anxiety vulnerability.     

A Single-Session Online Cognitive Bias Modification of Interpretations Modified for Adults With Anxiety and Depressive Symptoms

Anxiety and depression are common, co-occurring, and costly mental health disorders. Cognitive bias modification aims to modify biases to reduce associated symptoms. Few studies have targeted multiple biases associated with both anxiety and depression, and those that have lacked a control condition. This study piloted a single-session online cognitive bias modification (known as CBM-IA) designed to target two biases associated with anxiety and depression—interpretation bias and attribution style—in adults with varying levels of anxiety and depressive symptoms. Participants (18–26 years) with at least mild levels of anxiety/stress and depressive symptoms on the DASS-21 were randomly allocated to an intervention (n = 23) or a control (n = 22) condition. The training consisted of a single-session online CBM-IA to encourage positive interpretations and a positive attribution style.Interpretation bias, attribution style, anxious and depressive mood states, and anxiety, stress and depressive symptoms improved at posttraining and at follow-up, irrespective of condition. Changes in interpretation bias from pre- to posttraining were significantly associated with changes in anxious mood state. CBM-IA, as implemented in this single-session pilot study, did not significantly reduce targeted biases and symptoms compared to a control condition. This adds to the mixed evidence on the efficacy of single-session CBM-I for altering biases and symptoms.     

“Why Am I so Anxious?” A Study of Attention Bias in Obsessive Compulsive Disorder

Previous research investigating attentional bias has produced intriguingly equivocal results. The present large-scale study explored attentional bias in subjects diagnosed with obsessive-compulsive disorder (OCD) and in a control group (n = 80) using the Emotional Stroop Test. Results clearly indicated poorer performances across the board amongst patients diagnosed with OCD compared to the control group, particularly in the case of anxiety-related stimuli. This paper discusses, in the light of current models of attentional bias towards threat in anxiety disorders, the processes whereby attentional bias towards anxiety stimuli might play a vital role in the causation and maintenance of OCD.     

Cascading effects: the influence of attention bias to threat on the interpretation of ambiguous information

Both attention bias to threat and negative interpretive bias have been implicated in the emergence and maintenance of anxiety disorders. However, relations between attention and interpretive biases remain poorly understood. The current study experimentally manipulated attention bias to threat and examined the effects of attention training on the way ambiguous information was interpreted. Results suggest that the preferential allocation of attention towards threat affects the manner in which ambiguous information is interpreted. Individuals trained to attend to threat were more likely than individuals in a placebo training group to interpret ambiguous information in a threat-related manner. These data suggest that perturbations in the initial stages of information processing associated with anxiety may lead to a cascade of subsequent processing biases.     

Enhancing the Efficacy of Cognitive Bias Modification for Social Anxiety

Cognitive bias modification for interpretation (CBM-I) is a promising treatment modality for social anxiety disorder, but effect sizes are relatively small across investigations (Hallion & Ruscio, 2011). Additionally, the extent to which CBM-I impacts other cognitive, emotional, and behavioral outcomes is unclear. This study investigated whether two empirically supported treatment components for anxiety disorders, imaginal exposure (IE) and relaxation, augment the effects of CBM-I and increase the extent to which the effects of CBM-I generalize to behavioral and affective outcomes. We randomly assigned 111 undergraduate students with social anxiety to undergo IE, relaxation, or neutral thinking prior to CBM-I, then measured their interpretation biases, as well as their speaking time, anxiety, and subjective evaluations of performance during a speech task. Results indicated that individuals who received IE prior to CBM-I evidenced more adaptive interpretation biases and less behavioral avoidance during the speech task than did individuals who engaged in relaxation or neutral thinking. However, they did not report differential anxiety, habituation, or evaluations of their performance on the speech task. These findings suggest that the combination of CBM-I with adjunct components that target behavioral, rather than cognitive, mechanisms can facilitate transfer of the effects of CBM-I to reducing behavioral avoidance.     

Cognitive bias modification of interpretations: A viable treatment for child and adolescent anxiety?

Anxiety disorders in children and adolescents are common and impairing. As many patients do not benefit from – or have difficulties accessing – frontline treatments, novel, effective and easy-to-deliver interventions are needed. Cognitive Bias Modification of Interpretations (CBM-I) training has been used to treat adult anxiety disorders. CBM-I methods train individuals to endorse benign rather than negative resolutions of ambiguous cues. Developmental extensions of CBM-I are important for several reasons. First, implementing CBM-I in symptomatic children and adolescents may facilitate early preventative gains. Second, as training uses simple learning mechanisms, CBM-I may reflect a developmentally-suitable strategy for shaping adaptive processing styles. Third, as this age range involves protracted neurocognitive maturation and associated plasticity, administering CBM-I early could drive powerful, long-lasting benefits for emotional development. Finally, data from CBM-I studies could inform the cognitive mechanisms involved in the genesis of early-emerging anxiety. This paper provides the first organised review of CBM-I studies conducted in children and adolescents, and contains suggestions for future research that may help realise the therapeutic potential of early CBM-I interventions.     

Test of a Factor Mixture-Based Taxonic-Dimensional Model of Anxiety Sensitivity and Panic Attack Vulnerability among University and Clinical Samples in Mexico City

The aim of the present study was to evaluate a factor mixture-based taxonic-dimensional model of anxiety sensitivity (AS) (Bernstein et al. Behavior Therapy 41:515-521, 2010), as measured by the ASI-3 (Taylor et al. Psychological Assessment 19:176-188, 2007), in regard to panic attacks, anxiety symptoms, and behavioral impairment among a university sample (N = 150, n _females  = 107, M _age = 21.3 years, SD = 4.3) and a clinical sample (N = 150, n _females  = 102, M _age = 39.0 years, SD = 12.0) from Mexico City, Mexico. Findings demonstrated cross-national support for the conceptual and operational utility of the AS taxonic-dimensional hypothesis (Bernstein et al. Journal of Anxiety Disorders 20:1-22, 2007b). Specifically, (1) the FMM-based AS taxon class base rate was significantly greater among the clinical relative to the university sample; (2) risk for panic attacks was significantly greater among the AS taxon class relative to the AS normative class; and (3) continuous individual differences in AS physical and psychological concerns, within the AS taxon class, were associated with level of risk for panic attacks, as well as panic attack severity and anxiety symptom levels. Similar AS taxonic-dimensional effects were observed in relation to degree of behavioral impairment across domains of functioning. The study results are discussed with respect to their implications for better understanding the nature of AS-related cognitive vulnerability for panic and related anxiety psychopathology.     

Behavioral and Socio-emotional Functioning in Children with Selective Mutism: A Comparison with Anxious and Typically Developing Children Across Multiple Informants

We examined differences among 158 children, 44 with selective mutism (SM; M = 8.2 years, SD = 3.4 years), 65 with mixed anxiety (MA; M = 8.9 years, SD = 3.2 years), and 49 community controls (M = 7.7 years, SD = 2.6 years) on primary caregiver, teacher, and child reports of behavioral and socio-emotional functioning. Children with SM were rated lower than controls on a range of social skills, but the SM and MA groups did not significantly differ on many of the social skills and anxiety measures. However, children with SM were rated higher than children with MA and controls on social anxiety. Findings suggest that SM may be conceptualized as an anxiety disorder, with primary deficits in social functioning and social anxiety. This interpretation supports a more specific classification of SM as an anxiety disorder for future diagnostic manuals than is currently described in the literature. The present findings also have implications for clinical practice, whereby social skills training merits inclusion in intervention for children with anxiety disorders as well as children with SM.     

Effects of Exposure to Community Violence on Internalizing Symptoms: Does Desensitization to Violence Occur in African American Youth?

The purpose of the current study was to examine the linear and curvilinear associations of exposure to community violence to internalizing symptoms in 251 African American adolescents (mean age = 12.86, SD = 1.28). Participants reported on exposure to community violence, anxiety symptoms, and depressive symptoms. Regression analyses were used to test the hypotheses and, consistent with predictions, the results indicated that the association between violence and depression was curvilinear; whereas the association to anxiety was linear and positive. The results highlight the importance of considering more complex models of the impact of exposure to community violence on psychological functioning in African American youth from economically- disadvantaged communities.     

An Ecological Risk Model for Early Childhood Anxiety: The Importance of Early Child Symptoms and Temperament

Childhood anxiety is impairing and associated with later emotional disorders. Studying risk factors for child anxiety may allow earlier identification of at-risk children for prevention efforts. This study applied an ecological risk model to address how early childhood anxiety symptoms, child temperament, maternal anxiety and depression symptoms, violence exposure, and sociodemographic risk factors predict school-aged anxiety symptoms. This longitudinal, prospective study was conducted in a representative birth cohort (n = 1109). Structural equation modeling was used to examine hypothesized associations between risk factors measured in toddlerhood/preschool (age = 3.0 years) and anxiety symptoms measured in kindergarten (age = 6.0 years) and second grade (age = 8.0 years). Early child risk factors (anxiety symptoms and temperament) emerged as the most robust predictor for both parent-and child-reported anxiety outcomes and mediated the effects of maternal and family risk factors. Implications for early intervention and prevention studies are discussed.     

The Relation of Severity and Comorbidity to Treatment Outcome with Cognitive Behavioral Therapy for Childhood Anxiety Disorders

The present study investigated the impact of comorbidity over and above the impact of symptom severity on treatment outcome of Cognitive Behavioral Therapy for children with anxiety disorders. Children (aged 8–12, n = 124) diagnosed with an anxiety disorder were treated with a short-term CBT protocol. Severity was assessed with a composite measure of parent-reported behavior problems. Two approaches to comorbidity were examined; “total comorbidity” which differentiated anxiety disordered children with (n = 69) or without (n = 55) a co-occurring disorder and “non-anxiety comorbidity’ which differentiated anxious children with (n = 22) or without a non-anxiety comorbid disorder (n = 102). Treatment outcome was assessed in terms of Recovery, represented by post-treatment diagnostic status, and Reliable Change, a score reflecting changes in pre- to post-treatment symptom levels. Severity contributed to the prediction of (no) Recovery and (more) Reliable Change in parent-reported internalizing and externalizing symptoms and self-reported depressive symptoms. Total and non-anxiety comorbidity added to the prediction of diagnostic recovery. Non-anxiety comorbidity added to the prediction of Reliable Change in parent reported measures by acting as a suppressor variable. Non-anxiety comorbidity operated as a strong predictor that explained all of the variance associated with severity for self-reported depressive symptoms. The results support the need for further research on mechanisms by which treatment gains in children with higher symptom severity and non-anxiety comorbidity can be achieved.     

Autism Spectrum Symptomatology in Children: The Impact of Family and Peer Relationships

This study examines the potential impact of family conflict and cohesion, and peer support/bullying on children with autism spectrum disorder (ASD). While such impacts have been established for a range of non-ASD childhood disorders, these findings may not generalize to children with ASD because of unique problems in perspective-taking, understanding others’ emotion, cognitive rigidity, and social reasoning. A structural model-building approach was used to test the extent to which family and peer variables directly or indirectly affected ASD via child anxiety/depression. The sample (N = 322) consisted of parents of children with ASD referred to two specialist clinics. The sample contained parents of children with Autistic Disorder (n = 76), Asperger Disorder (n = 188), Pervasive Disorder Not Otherwise Specified (n = 21), and children with a non-ASD or no diagnosis (n = 37). Parents completed questionnaires on-line via a secure website. The key findings were that anxiety/depression and ASD symptomatology were significantly related, and family conflict was more predictive of ASD symptomatology than positive family/peer influences. The results point to the utility of expanding interventions to include conflict management for couples, even when conflict and family distress is low. Further research is needed on the potentially different meanings of family cohesion and conflict for children with ASD relative to children without ASD.     

A Meta-analytic Review of the Role of Child Anxiety Sensitivity in Child Anxiety

Conflicting findings exist regarding (1) whether anxiety sensitivity (AS) is a construct distinct from anxiety in children and (2) the specific nature of the role of AS in child anxiety. This study uses meta-analytic techniques to (1) determine whether youth (ages 6–18 years) have been reported to experience AS, (2) examine whether AS differentiates anxiety disordered youth from youth without diagnoses, and (3) ascertain whether AS distinguishes youth with panic disorder from those with other anxiety disorders. The weighted mean effect size analyses included 15 studies and 6,579 participants. Results suggested positive correlational relationships between AS and anxiety for children (r = 0.26) and adolescents (r = 0.36) and higher levels of AS for anxiety disordered youth than non-clinical youth (d = 0.64). Findings tentatively suggested higher levels of AS for youth with panic disorder than youth diagnosed with other anxiety disorders. Implications and future directions in the research of child AS are discussed.     

Blushing-Fearful Individuals’ Judgmental Biases and Conditional Cognitions: An Internet Inquiry

The present study examines two mechanisms that might explain why blushing-fearful individuals fear blushing: Judgmental biases for blushing in ordinary social situations that usually do not elicit a blush, and negative conditional cognitions about blushing irrespective of situation. A web-based self-report measure, linked to a German internet forum for people with fear of blushing, was completed by a group of high blushing-fearful participants (n = 155) and a low fear group (n = 61). Supporting the idea that cognitive biases are involved in fear of blushing, blushing-fearful participants showed inflated estimates of both the probability and the costs of blushing in these situations. In addition, blushing-fearful individuals were characterized by relatively negative conditional cognitions about blushing.