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.     

Body Modification Sites and Abuse History

Self-reported experience of physical, sexual, and mental abuse and general emotional abandonment was significantly associated with a variety of piercings, tattoos, and scarifications in a sample of 4,700 members of an online body-modification site. More significant associations were found for the women in the sample than for the men. Possible clinical implications of the results are discussed.     

NAVIGATING THE FUTURE IN A SEA OF CRISPR UNCERTAINTY

Humanity's toolkit for altering the world we live in now includes CRISPR. Through an evolutionary process, bacteria acquired a way to protect themselves from an invading virus, making their immediate future more secure. In human hands, this powerful genome-editing tool offers the potential to impact, at a breathtaking rate, not only our own evolutionary future, but the future of other life on this planet. Ethical concerns about altering genomes are not new, but the birth of two CRISPR gene-edited babies last year created a renewed urgency around navigating the future and the lack of an agreed-upon map to guide us is distressing. The goal of this article is not to provide that map but to suggest two essential questions, drawn from the context of events surrounding CRISPR to date, that should guide its drafting—“Who do we trust?” and “When is it time to act?”—and to consider what Unitarian Universalism might contribute to answering those questions.     

Prevalence and correlates of tattooing in Norway: A large‐scale cross‐sectional study

To our knowledge, no previous large‐scale study has examined the prevalences and correlates of having only easily concealed tattoos, or readily visible tattoos. We conducted an exploratory online survey in Norway asking 15,654 (6,151 females) persons aged 16–91 (m = 33.65 ± 12.27) about various demographic, sports, substance use, mental health, personality, and tattooing questions. The estimated prevalence of tattooing was 20.8% (females: 23.8%, males: 17.9%), of which 13.3% had readily visible tattoos. Results of multivariate logistic regression analysis indicated that females, being older than 19 years, higher body mass index, lifetime anabolic‐androgenic steroid use (AAS), and higher scores on extraversion were associated with higher odds of having a tattoo. Factors associated with higher odds of having only easily concealed tattoos were being 40–49 (versus those ≤ 19) years old, being only high school or tertiary (versus being only primary school) educated, often or not (versus always) exercising in a gymnasium, and high scores on agreeableness. Females, and higher scores on extraversion and neuroticism were associated with higher odds of having at least one readily visible tattoo. Our findings delineate the significance of demographic variables, gymnasium exercise, AAS, and personality in the practice of tattooing.     

The Love equation for the normal loading of a rigid cone on an elastic half-space: no need for a modification

A new schematic diagram is presented which shows the displacement paths of surface particles within the contact circle when a rigid cone is loaded normally on an elastic half-space. With the help of this diagram and the information available in the literature, it is argued here that a modification made to the Love equation in 1999 is unnecessary and incorrect. It is also shown that the modification results in an incorrect expression for the surface radial displacement outside the contact circle. Therefore, it is suggested that the modification be dropped forthwith.     

Developing a measure of interpretation bias for depressed mood: An ambiguous scenarios test

The tendency to interpret ambiguous everyday situations in a relatively negative manner (negative interpretation bias) is central to cognitive models of depression. Limited tools are available to measure this bias, either experimentally or in the clinic. This study aimed to develop a pragmatic interpretation bias measure using an ambiguous scenarios test relevant to depressed mood (the AST-D).¹ In Study 1, after a pilot phase (N = 53), the AST-D was presented via a web-based survey (N = 208). Participants imagined and rated each AST-D ambiguous scenario. As predicted, higher dysphoric mood was associated with lower pleasantness ratings (more negative bias), independent of mental imagery measures. In Study 2, self-report ratings were compared with objective ratings of participants’ imagined outcomes of the ambiguous scenarios (N = 41). Data were collected in the experimental context of a functional Magnetic Resonance Imaging scanner. Consistent with subjective bias scores, independent judges rated more sentences as negatively valenced for the high versus low dysphoric group. Overall, results suggest the potential utility of the AST-D in assessing interpretation bias associated with depressed mood.     

Self-help and long-term behavior therapy for obesity

The Trevose Behavior Modification Program, a self-help group offering continuing care for obesity, has recently been shown to produce large long-term weight losses. The present study aimed to replicate this finding across different settings and participants, assessing the weight losses and attrition rates of 128 participants in three Trevose program satellite groups that used the same treatment procedures and manual as the central Trevose group. The satellite groups' results closely paralleled those of the Central Group. Mean intent-to-treat weight loss, or final losses recorded for all participants regardless of their treatment termination date, was 13.7 +/- 0.7% of initial body weight (1.8 +/- 0.7 kg). At two years, 43.8% of participants remained in treatment, having lost a mean of 19.0 +/- 0.8% of their body weight (16.2 +/- 1.0 kg); at five years, 23.4% remained, having lost 18.4 +/- 1.1% of body weight (15.6 +/- 1.5 kg). These results demonstrate that the Trevose model of weight control, combining self-help and continuing care, can be extended and disseminated to other settings, with potentially significant public health consequences.     

Cognitive bias modification as a strategy to reduce children's fears and concerns about the secondary school transition

Background and objectives: Cognitive Bias Modification of Interpretations (CBM-I) has emerged as an anxiety-reducing tool for children and adolescents, targeting maladaptive interpretations of everyday situations. This literature falls short of addressing whether the effects of CBM-I extend to worries about a real-life stressor, such as a school transition. Design: The study comprised a between-groups design comparing the effects of CBM-I to an active control (AC) intervention in children. Method: We recruited 38 children within two months of their primary–secondary school transition and investigated the capacity for multi-session, parent-administered CBM-I, compared to an AC condition, to modify cognitive style and reduce anxiety symptoms and school concerns. Results: While benign interpretations increased significantly and negative interpretations tended to decrease following CBM-I, both interventions significantly reduced anxiety symptoms and school concerns. Conclusions: These findings indicate that anxiety-reducing effects of CBM-I in children extend to a real life stressful event, but that equivalent anxiety reduction may be achieved through exposure to potentially worrying situations and parent–child interaction in the absence of bias modification.     

Practice makes perfect: Training the interpretation of emotional ambiguity

The interpretation of emotionally ambiguous words, sentences, or scenarios can be altered through training procedures that are collectively called cognitive bias modification for interpretation (CBM-I). In three experiments, we systematically manipulated the nature of the training in order to discriminate between emotional priming and ambiguity resolution accounts of training effects. In Experiment 1 participants completed word fragments that were consistently related to either a negative or benign interpretation of an ambiguous sentence. In a subsequent semantic priming task they demonstrated an interpretation bias, in that they were faster to identify relatedness of targets that were associated with the training-congruent meaning of an emotionally ambiguous homograph. We then manipulated the training sentences to show that interpretation bias was eliminated when participants simply completed valenced word fragments following unrelated sentences (Experiment 2), or completed fragments that were related to emotional but unambiguous sentences (Experiment 3). Only when participants were required to actively resolve emotionally ambiguous sentences during training did changes in interpretation emerge at test. Findings suggest that CBM-I achieves its effects by altering a production rule that aids the selection of meaning from emotionally ambiguous alternatives, in line with an ambiguity resolution account.     

Longevity of attentional bias modification effects for food cues in overweight and obese individuals

Accumulating evidence shows that overweight individuals exhibit an attentional bias for food and that this bias can be modified. This study investigated the longevity of such modification effects. Using a dot probe paradigm, a community sample of overweight and obese women (N = 104) was trained to direct attention towards (‘attend’) or away from (‘avoid’) food pictures. Participants completed five weekly training sessions. Attentional bias was measured before and after training, at 24 h and one-week follow-up. To increase generalisability, at each of the post-training and follow-up assessments, participants were shown a mix of old and new food pictures. They also completed another implicit bias measure, i.e. a word stem task. Attentional bias for food increased in the ‘attend’ group and decreased in the ‘avoid’ group. These retraining effects were maintained at 24 h and one-week follow-up, and extended to new food pictures. Participants in the ‘avoid’ group also produced relatively fewer food words on the word stem task than those in the ‘attend’ group. Results are consistent with predictions of cognitive-motivational models that attentional biases are malleable. They further suggest that attentional bias modification, which targets the implicit processes that underlie the heightened food responsivity in overweight individuals, could help combat pathological (over)eating.