Eni S. Becker

Retraining Automatic Action Tendencies Changes Alcoholic Patients’ Approach Bias for Alcohol and Improves Treatment Outcome

This study tested the effects of a new cognitive-bias modification (CBM) intervention that targeted an approach bias for alcohol in 214 alcoholic inpatients. Patients were assigned to one of two experimental conditions, in which they were explicitly or implicitly trained to make avoidance movements (pushing a joystick) in response to alcohol pictures, or to one of two control conditions, in which they received no training or sham training. Four brief sessions of experimental CBM preceded regular inpatient treatment. In the experimental conditions only, patients’ approach bias changed into an avoidance bias for alcohol. This effect generalized to untrained pictures in the task used in the CBM and to an Implicit Association Test, in which alcohol and soft-drink words were categorized with approach and avoidance words. Patients in the experimental conditions showed better treatment outcomes a year later. These findings indicate that a short intervention can change alcoholics’ automatic approach bias for alcohol and may improve treatment outcome.

Spider fearful individuals attend to threat, then quickly avoid it: Evidence from eye movements

According to cognitive models of anxiety, anxiety patients exhibit an early reflexive attentional bias toward threat stimuli, which may be followed by intentional avoidance of these stimuli. To determine the time course of attentional vigilance and avoidance, the authors conducted an eye-tracking study in which 22 highly spider fearful participants (SFs) and 23 nonanxious control participants (NACs) studied groups of 4 pictures (spider, butterfly, dog, and cat). The authors found that the very first fixation was on a spider picture more often in SFs than in NACs. However, SFs quickly moved their eyes away from the spider they had fixated first, yielding shorter gaze durations than NACs. Afterward, SFs exhibited shorter gaze durations on spiders than NACs for the rest of the 1-min presentation time. This early reflexive attentional bias toward threat followed by avoidance of threat may explain earlier failures to find attentional biases in anxiety.

The emotional Stroop effect in anxiety disorders: General emotionality or disorder specificity?

Selective attentional biases, often documented with a modified Stroop task, are considered to play an important role in the etiology and maintenance of anxiety. Two competing explanations for these effects are selectivity for highly emotional words in general vs. selectivity for disorder-specific words. We tested these explanations in 32 patients with generalized anxiety disorder (GAD), 29 patients with social phobia (SP), and 31 non-anxious controls. Stimuli were of four kinds: GAD-related words, SP-related words, words with a neutral valence, and words with a positive valence. Different attentional biases were observed: GAD patients were slowed by all types of emotional words, while SP patients were distracted specifically by speech-related words.

The Epidemiology of Generalized Anxiety Disorder in Europe

The objective of this paper is to provide a review on available data to date on the epidemiology of GAD in Europe, and to highlight areas for future research. MEDLINE searches were performed and supplemented by consultations with experts across Europe to identify non-published reports. Despite variations in the design of studies, available data suggest that (a) about 2% of the adult population in the community is affected (12-month prevalence), (b) GAD is one of the most frequent (up to 10%) of all mental disorders seen in primary care, (c) GAD is a highly impairing condition often comorbid with other mental disorders, (d) GAD patients are high utilizers of healthcare resources, and (e) despite the high prevalence of GAD in primary care, its recognition in general practice is relatively low. Marked data deficits are: lack of data from eastern European countries, lack of information about the natural course of GAD in unselected samples, the vulnerability and risk factors involved in the aetiology of GAD and lack of data about adequate and inappropriate treatments in GAD patients as well as the associated and societal costs of GAD.

Approach bias modification in alcohol dependence: Do clinical effects replicate and for whom does it work best?

BACKGROUND Alcoholism is a progressive neurocognitive developmental disorder. Recent evidence shows that computerized training interventions (Cognitive Bias Modification, CBM) can reverse some of these maladaptively changed neurocognitive processes. A first clinical study of a CBM, called alcohol-avoidance training, found that trained alcoholic patients showed less relapse at one-year follow-up than control patients. The present study tested the replication of this result, and questions about mediation and moderation. METHODS 509 alcohol-dependent patients received treatment as usual (primarily Cognitive Behavior Therapy) inpatient treatment. Before and after treatment, the implicit approach bias was measured with the Alcohol Approach-Avoidance Task. Half of the patients were randomly assigned to CBM, the other half received treatment as usual only. Background variables, psychopathology and executive control were tested as possible moderating variables of CBM. One year after treatment, follow-up data about relapse were collected. RESULTS The group receiving CBM developed alcohol-avoidance behavior and reported significantly lower relapse rates at one-year follow-up. Change in alcohol-approach bias mediated this effect. Moderation analyses demonstrated that older patients and patients with a strong approach-bias at pretest profited most from CBM. CONCLUSIONS CBM is a promising treatment add-on in alcohol addiction and may counter some of the maladaptive neurocognitive effects of long-term alcoholism.

A Comparison of attentional biases and memory biases in social phobia and major depression

Cognitive processes play an important role in the etiology and maintenance of anxiety and depression. Current theories differ, however, in their predictions regarding the occurrence of attentional biases and memory biases in depression and anxiety. To allow for a systematic comparison of disorders and cognitive processes, 117 women (35 with generalized social phobia, 27 with major depression, and 55 healthy controls) participated in a test of visual attention (visual search), an explicit memory test (free recall), and an implicit memory test (anagram solving). Both clinical groups exhibited attentional biases for disorder-related words, whereas only depressed participants showed clear evidence of explicit and implicit memory biases. The implications of these results for competing theories are discussed.

Speeded detection and increased distraction in fear of spiders: evidence from eye movements.

Anxiety patients exhibit attentional biases toward threat, which have often been demonstrated as increased distractibility by threatening stimuli. In contrast, speeded detection of threat has rarely been shown. Therefore, the authors studied both phenomena in 3 versions of a visual search task while eye movements were recorded continuously. Spider-fearful individuals and nonanxious control participants participated in a target search task, an odd-one-out search task, and a category search task. Evidence for disorder-specific increased distraction by threat was found in all tasks, whereas speeded threat detection did not occur in the target search task. The implications of these findings for cognitive theories of anxiety are discussed, particularly in relation to the concept of disengagement from threat.

Obesity and mental illness in a representative sample of young women

OBJECTIVE: To investigate the relation between mental disorders and weight, especially obesity.DESIGN: Epidemiological study of mental disorders with a representative sample of young women.SUBJECTS: A total of 2064 women, age 18–25 y, living in Dresden, Germany.MEASUREMENTS: Verbal reports of body mass index, structured clinical interview for psychological disorders.RESULTS: We found an association between psychological disorders and weight. Obese women had the highest rate of mental disorders overall, and they had higher rates of all subgroups of mental disorders, although many differences were not statistically significant. Most importantly, obese women suffered from an anxiety disorder significantly more often than women who were not obese. The observed differences were independent of socioeconomic status.CONCLUSIONS: In young women, obesity is related to increased rates of mental disorders, most notably anxiety disorders. Future longitudinal research will have to determine the causal relationships behind this correlation.

Explicit Memory in Anxiety Disorders

Two experiments were conducted to study selective memory bias favoring anxiety-relevant materials in patients with anxiety disorders. In the 1st experiment, 32 patients with generalized anxiety disorder (GAD), 30 with social phobia (speaking anxiety), and 31 control participants incidentally learned GAD-relevant words, speech anxiety-relevant words, strongly pleasant words, and words with a neutral valence. Participants did not show any explicit memory bias for threatening materials. Thirty patients suffering from panic disorder (PD) with agoraphobia and 30 controls took part in the 2nd experiment. The design was similar to the 1st experiment. This time a highly specific selective memory bias for threatening words was found. Words describing symptoms of anxiety were better recalled by PD patients. Results are consistent with previous findings but are inexplicable by existing theories.

Reliabilität und Validität dreier Instrumente zur Messung von Angst vor Spinnen

Zusammenfassung. Es wird uber die Gutekriterien und Faktorenstrukturen dreier Instrumente zur Messung von Angst vor Spinnen berichtet. Der “Spinnenphobie-Fragebogen (SPF)“ und der “Fragebogen zur Angst vor Spinnen (FAS)“ sind Ubersetzungen englischsprachiger, mehrfaktorieller Fragebogen. Beim “Spinnenangst-Screening (SAS)“ handelt es sich um eine Neuentwicklung mit nur vier Items zum moglichst okonomischen Screening groser Stichproben. Alle drei Instrumente zeigten gute bis sehr gute Reliabilitatswerte, sowohl bezuglich der internen Konsistenz als auch der Retest-Reliabilitat. Auch die Konstruktvaliditaten und die Kriteriumsvaliditaten erwiesen sich als sehr gut. Verwendungsempfehlungen fur das Screening und die beiden Fragebogen werden gegeben.