Elske Salemink

Cognitive Bias Modification and Cognitive Control Training in Addiction and Related Psychopathology Mechanisms, Clinical Perspectives, and Ways Forward

The past decade has witnessed a surge in research on training paradigms aimed at directly influencing cognitive processes in addiction and other psychopathology. Broadly, two avenues have been explored: In the first, the aim was to change maladaptive cognitive motivational biases (cognitive bias modification); in the second, the aim was to increase general control processes (e.g., working memory capacity). These approaches are consistent with a dual-process perspective in which psychopathology is related to a combination of disorder-specific impulsive processes and weak general abilities to control these impulses in view of reflective longer-term considerations. After reviewing the evidence for dual-process models in addiction, we discuss a number of critical issues, along with suggestions for further research. We argue that theoretical advancement, along with a better understanding of the underlying neurocognitive processes, is crucial for adequately responding to recent criticisms on dual-process models and for optimizing training paradigms for use in clinical practice.

Autobiographical memories become less vivid and emotional after eye movements.

OBJECTIVES To test (1) whether eye movements during retrieval of emotional memories are followed by less vividness and less emotionality of future recollections, (2) whether this effect, if present, is stronger than the effects of a control activity (finger tapping), (3) whether the alleged effects of tapping and eye movements are stronger than a no-movement, control condition (mere imagery), (4) whether reductions in vividness and emotionality after eye movements (and finger tapping) are specific to negative memories or also occur in the case of positive memories. METHOD Sixty healthy volunteers recalled either positive or negative memories and scored the vividness and emotionality of the recollections. Next, memories were recalled whilst the participant was performing rapid eye movements, finger tapping, or not performing a dual task. Then participants were asked to recall the event again and to rate its vividness and emotionality. RESULTS Compared to finger tapping and the no-dual-task condition, recollections after eye movements made future recollections less vivid. After eye movements, but not after the other interventions, negative memories became less negative, and positive memories became less positive. CONCLUSION The findings show that eye movements not only reduce vividness and emotionality of memories during the eye moving, but also affect future recollections, during which no eye movements are made. Some theoretical explanations are discussed. As to clinical implications, it is suggested that if there is a role for eye-movement-based treatments, it is very limited.

Effects of positive interpretive bias modification in highly anxious individuals

Over the past 20 years evidence has accumulated that individuals suffering from anxiety tend to interpret ambiguous information as threatening. Considering the causal role of this interpretive bias in anxiety, it was recently established that modifying interpretive biases influences anxiety. This suggests that anxiety can be clinically treated by directly targeting this interpretive bias. The present study was designed to modify a negative interpretive bias in highly anxious individuals, and subsequently assess the hypothesized beneficial effects on clinical measures. High trait-anxious participants were randomly assigned to one of two conditions: a positive interpretational Cognitive Bias Modification (CBM-I) or a control condition (n=2 x 17). The program was offered online for eight consecutive days. Upon completing the program, participants who had followed positive CBM-I were less state and trait-anxious compared to the control group. Additionally, positively trained participants scored lower on a measure of general psychopathology (SCL-90). No effects were observed on social anxiety and stress vulnerability. The mixed pattern of findings renders them rather inconclusive, leaving interpretations of the potential therapeutic merits of CBM-I open for future research.

Ruminative coping as avoidance: a reinterpretation of its function in adjustment to bereavement

The paper argues for a reconceptualization of ruminative coping with the death of a loved one as an avoidant rather than a confrontational strategy. Ruminative coping has been characterized within the bereavement field as persistent, repetitive and passive focus on negative emotions and symptoms. It has been theoretically described and empirically shown to be a maladaptive process, being conceptually related to complicated/chronic/prolonged grief. Furthermore, it has been contrasted with denial and suppression processes—which, too, have been understood to be maladaptive and associated with major complications following bereavement. Here evidence is reviewed and the case made that rumination is not an opposite form of coping from suppression or denial, but that it is a similar phenomenon to these, and different from the types of confrontation that take place in so-called “grief work”. Implications with respect to intervention for complicated grief are discussed.

Modifying Threat-related Interpretive Bias in Adolescents

Socially anxious feelings sharply increase during adolescence and such feelings have been associated with interpretive biases. Studies in adults have shown that interpretive biases can be modified using Cognitive Bias Modification procedures (CBM-I) and subsequent effects on anxiety have been observed. The current study was designed to examine whether the CBM-I procedure has similar effects in adolescents. Unselected adolescents were randomly allocated to either a positive interpretation training (n = 88) or a placebo-control condition (n = 82). Results revealed that the training was successful in modifying interpretations and effects generalized to a new task. The interpretive bias effects were most pronounced in individuals with a threat-related interpretive bias at pre-test. No effects on state anxiety were observed. The current findings are promising with regard to applying bias modification procedures to adolescents, while further research is warranted regarding emotional effects.

Efficacy and safety of high-dose baclofen for the treatment of alcohol dependence : A multicentre, randomised, double-blind controlled trial

Previous randomised placebo-controlled trials with low-to-medium doses of baclofen (30-60mg) showed inconsistent results, but case studies suggested a dose-response effect and positive outcomes in patients on high doses of baclofen (up to 270mg). Its prescription was temporary permitted for the treatment of alcohol dependence (AD) in France, and baclofen is now widely prescribed. Recently, a small RCT found a strong effect of a mean dose of 180mg baclofen. In the present study the efficacy and safety of high doses of baclofen was examined in a multicentre, double-blind, placebo-controlled trial. 151 patients were randomly assigned to either six weeks titration and ten weeks high-dose baclofen (N=58; up to 150mg), low-dose baclofen (N=31; 30mg), or placebo (N=62). The primary outcome measure was time to first relapse. Nine of the 58 patients (15.5%) in the high-dose group reached 150mg and the mean baclofen dose in this group was 93.6mg (SD=40.3). No differences between the survival distributions for the three groups were found in the time to first relapse during the ten-weeks high-dose phase (χ2=0.41; p=0.813) or the 16-weeks complete medication period (χ2=0.04; p=0.982). There were frequent dose-related adverse events in terms of fatigue, sleepiness, and dry mouth. One medication related serious adverse event occurred in the high-dose baclofen group. Neither low nor high doses of baclofen were effective in the treatment of AD. Adverse events were frequent, although generally mild and transient. Therefore, large-scale prescription of baclofen for the treatment of AD seems premature and should be reconsidered.

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.

Visual search attentional bias modification reduced social phobia in adolescents

BACKGROUND AND OBJECTIVES An attentional bias for negative information plays an important role in the development and maintenance of (social) anxiety and depression, which are highly prevalent in adolescence. Attention Bias Modification (ABM) might be an interesting tool in the prevention of emotional disorders. The current study investigated whether visual search ABM might affect attentional bias and emotional functioning in adolescents. METHODS A visual search task was used as a training paradigm; participants (n = 16 adolescents, aged 13-16) had to repeatedly identify the only smiling face in a 4 × 4 matrix of negative emotional faces, while participants in the control condition (n = 16) were randomly allocated to one of three placebo training versions. An assessment version of the task was developed to directly test whether attentional bias changed due to the training. Self-reported anxiety and depressive symptoms and self-esteem were measured pre- and post-training. RESULTS After two sessions of training, the ABM group showed a significant decrease in attentional bias for negative information and self-reported social phobia, while the control group did not. There were no effects of training on depressive mood or self-esteem. LIMITATIONS No correlation between attentional bias and social phobia was found, which raises questions about the validity of the attentional bias assessment task. Also, the small sample size precludes strong conclusions. CONCLUSIONS Visual search ABM might be beneficial in changing attentional bias and social phobia in adolescents, but further research with larger sample sizes and longer follow-up is needed.

Validation of the "recognition task" used in the training of interpretation biases

It was recently established that interpretive bias plays a causal role in anxiety. The vast majority of studies examining this causal relationship have used a social script interpretive bias training and have tested whether interpretations were indeed changed. Typically, a recognition task is used as the manipulation check. However, despite its widespread use, this task has not been validated. The aim of the present study was to examine the validity of the recognition task. It was hypothesised that the recognition task should reflect differences in interpretive bias between high and low levels of neuroticism, while it should not be affected by temporarily mood states that result from the interpretive bias modification. Participants scoring high (n = 35) and low (n = 54) on neuroticism followed either a positive or a negative mood induction procedure and subsequently completed the recognition task. Results showed that the recognition task differentiated between individuals scoring high and low on neuroticism. In addition, the task was insensitive to mood state. The data argue in favour of the validity of this measure of trained interpretive bias following the modification of that bias.

Interpretation training influences memory for prior interpretations.

Anxiety is associated with memory biases when the initial interpretation of the event is taken into account. This experiment examined whether modification of interpretive bias retroactively affects memory for prior events and their initial interpretation. Before training, participants imagined themselves in emotionally ambiguous scenarios to which they provided endings that often revealed their interpretations. Then they were trained to resolve the ambiguity in other situations in a consistently positive (n = 37) or negative way (n = 38) before they tried to recall the initial scenarios and endings. Results indicated that memory for the endings was imbued with the emotional tone of the training, whereas memory for the scenarios was unaffected.