Simone P.W. Haller

How to boost positive interpretations? A meta-analysis of the effectiveness of cognitive bias modification for interpretation.

The current meta-analysis explores the strength of effects of cognitive bias modification training for interpretation bias (CBM-I) on positive (i.e., adaptive) interpretations and mood as well as the training and sample characteristics influencing these effects. Data-bases were searched with the key words “interpret* bias AND training” and “interpret* bias AND modif*”. Reference lists of identified articles were checked and authors of identified articles were contacted for further relevant articles and unpublished data. Studies were reviewed for inclusion with eligibility criteria being that the study (a) aimed to target interpretation biases through any kind of training, (b) assessed mood and/or interpretation bias as outcome measures, (c) allocated individuals to training conditions at random, and (d) recruited adult samples. A meta-analytic multilevel mixed-effects model was employed to assess standardized mean changes in interpretation bias, negative mood, and emotional reactivity. In addition, several training and sample characteristics were explored for their potential to enhance benign training effectiveness. On average, benign CBM-I resulted in an increase in positive interpretation bias (p<.01) and a decrease in negative mood state (p<.001), but did not affect emotional reactivity. These effects were not consistently different from control conditions with no or neutral training. However, within benign training conditions imagery instructions and more training sessions were related to larger cognitive and mood effects, whereas feedback about training performance and inclusion of non-benign training items (instead of including benign items only) boosted cognitive effects only. Finally, training was more effective in women (cognitive and mood effects) and presumably samples with symptomatic emotional dysregulation (cognitive effects). Although the effects of emotional dysregulation and number of training sessions could not well be distinguished, there is an indication that when used with imagery instructions and more training sessions, benign CBM-I can be employed as a useful complementary treatment to usual psychotherapies.

Social anxiety disorder in adolescence: How developmental cognitive neuroscience findings may shape understanding and interventions for psychopathology.

Highlights • Late childhood and adolescence are a sensitive juncture for social anxiety onset.• Cognitive biases linked to social anxiety manifest in differences in functional brain response.• Normative socio-affective developments may exacerbate biased processing.• Increased plasticity/learning may make adolescence an ideal time to intervene.• Modifying processing biases through cognitive training and neurofeedback represent two possible age-appropriate interventions.

A developmental angle to understanding the mechanisms of biased cognitions in social anxiety

Social anxiety disorder (SAD) is debilitating and common, affecting 7.3–12.1% of the population (e.g., Wittchen et al., 1999; Kessler et al., 2005). Age-of-onset data show that SAD symptoms are often first experienced in late childhood or adolescence (Kessler et al., 2005). While adolescence is a period when many typical social fears and worries emerge, major questions remain as to why some youths are more vulnerable to experiencing persistent and impairing social anxiety. A key gap in current theoretical models of SAD etiology is an understanding of the mechanisms by which risk factors are expressed during development. In this opinion paper, we address this gap by first discussing the nature of age-typical increases in social fears and worries in the transition to adolescence and outlining possible brain-based developmental mechanisms by which these arise. Next, we discuss how these age-typical changes in neurocognitive functioning might, in a subset of adolescents, enable maladaptive processing biases in relation to social cues to emerge or be exacerbated. These processing biases may, in turn, contribute to the onset of persistent social anxiety.

Measuring online interpretations and attributions of social situations: Links with adolescent social anxiety

OBJECTIVE We evaluated the utility of a novel, picture-based tool to measure how adolescents interpret and attribute cause to social exchanges and whether biases in these processes relate to social anxiety. Briefly presented ambiguous visual social scenes, each containing a photograph of the adolescent as the protagonist, were followed by three possible interpretations (positive, negative, neutral/unrelated) and two possible causal attributions (internal, external) to which participants responded. METHOD Ninety-five adolescents aged 14 to 17 recruited from mainstream schools, with varying levels of social anxiety rated the likelihood of positive, negative and unrelated interpretations before selecting the single interpretation they deemed as most likely. This was followed by a question prompting them to decide between an internal or external causal attribution for the interpreted event. RESULTS Across scenarios, adolescents with higher levels of social anxiety rated negative interpretations as more likely and positive interpretations as less likely compared to lower socially anxious adolescents. Higher socially anxious adolescents were also more likely to select internal attributions to negative and less likely to select internal attributions for positive events than adolescents with lower levels of social anxiety. CONCLUSIONS Adolescents with higher social anxiety display cognitive biases in interpretation and attribution. This tool is suitable for measuring cognitive biases of complex visual-social cues in youth populations with social anxiety and simulates the demands of daily social experiences more closely. LIMITATIONS As we did not measure depressive symptoms, we cannot be sure that biases linked to social anxiety are not due to concurrent low mood.

Attention allocation and social worries predict interpretations of peer-related social cues in adolescents

Highlights • Across scenes, increasing social anxiety was associated with greater endorsement of negative interpretations.• Greater attentional deployment to peers predicted increased endorsements of negative interpretations.• Self-relevant scenes yielded more negative interpretations.• Older adolescents selected more benign interpretations.

Multisession Cognitive Bias Modification targeting multiple biases in adolescents with elevated social anxiety

Research studies applying cognitive bias modification of attention (CBM-A) and interpretations (CBM-I) training to reduce adolescent anxiety by targeting associated cognitive biases have found mixed results. This study presents a new multi-session, combined bias CBM package, which uses a mix of training techniques and stimuli to enhance user-engagement. We present preliminary data on its viability, acceptability and effectiveness on reducing symptoms and biases using an A–B case series design. 19 adolescents with elevated social anxiety reported on their social anxiety, real-life social behaviours, general anxiety, depression, and cognitive biases at pre/post time-points during a 2-week baseline phase and a 2-week intervention phase. Retention rate was high. Adolescents also reported finding the CBM training helpful, particularly CBM-I. Greater reductions in social anxiety, negative social behaviour, and general anxiety and depression, characterised the intervention but not baseline phase. There was a significant correlation between interpretation bias change and social anxiety symptom change. Our enhanced multi-session CBM programme delivered in a school-setting appeared viable and acceptable. Training-associated improvements in social anxiety will require further verification in a study with an active control condition/group.

Modulatory effects of dynamic fMRI-based neurofeedback on emotion regulation networks during adolescence

This study used real-time fMRI-based neurofeedback (NF) to modulate functional connectivity patterns in the emotional regulation networks in a sample of adolescent girls. Adolescence is a developmental period which brings along changes at multiple levels, such as hormonal changes, improvements in socio-emotional processing, as well as ongoing brain maturation and functioning. It has been suggested that these changes increase the risk for the individual. For example, early, difficulties with emotion regulation have been linked to a range of mental health problems, such as anxiety. Here we successfully trained participants to modulate the functional coupling of the prefrontal cortex and the amygdala towards a more negative connectivity pattern, which resembles the connectivity pattern found in the mature brain. These brain-based changes were related to changes at the behavioural level. We also found that the modulation largely depends on the specific neurofeedback implementation, which provides important insights for future NF training approaches.

Group decision-making is optimal in adolescence

Group decision-making is required in early life in educational settings and central to a well-functioning society. However, there is little research on group decision-making in adolescence, despite the significant neuro-cognitive changes during this period. Researchers have studied adolescent decision-making in ‘static’ social contexts, such as risk-taking in the presence of peers, and largely deemed adolescent decision-making ‘sub-optimal’. It is not clear whether these findings generalise to more dynamic social contexts, such as the discussions required to reach a group decision. Here we test the optimality of group decision-making at different stages of adolescence. Pairs of male pre-to-early adolescents (8 to 13 years of age) and mid-to-late adolescents (14 to 17 years of age) together performed a low-level, perceptual decision-making task. Whenever their individual decisions differed, they were required to negotiate a joint decision. While there were developmental differences in individual performance, the joint performance of both adolescent groups was at adult levels (data obtained from a previous study). Both adolescent groups achieved a level of joint performance expected under optimal integration of their individual information into a joint decision. Young adolescents’ joint, but not individual, performance deteriorated over time. The results are consistent with recent findings attesting to the competencies, rather than the shortcomings, of adolescent social behaviour.

Subclinically Anxious Adolescents Do Not Display Attention Biases When Processing Emotional Faces – An Eye-Tracking Study

Recent research suggests that early difficulties with emotion regulation go along with an increased risk for developing psychiatric disorders, such as anxiety disorders for example. Adolescent anxiety is often referred to as a gateway disorder, due to its high predictability for lifelong persistent mental health problems. It has been shown that clinically anxious adolescents exhibit attention biases toward negative stimuli, yet whether these biases can also be found in the subclinical range of subclinically anxious adolescents is currently unclear. In this study, we set out to investigate this question by combining an emotional Go-Nogo task with eye-tracking techniques to assess attention biases for emotional faces in a subclinical sample of 23 subclinically anxious adolescent girls. This combined approach allowed us to look at both, behavioral and covert attention biases. Using both traditional and Bayesian hypothesis testing, we found no evidence for a bias toward negative, threat-relevant stimuli in the behavioral level or eye-tracking data. We believe that the results can help close a gap in the current literature by showing that like low-anxious adolescents, subclinically anxious adolescents do not exhibit attention biases when viewing de-contextualized emotional stimuli in the Overlap task. Together with previous research findings in clinically anxious participants which have reported high levels of attention biases, our results seem to suggest that attention biases do no increase linearly as a function of individual anxiety level. Future research is now needed to explore the contribution of additional factors, such as depression for example.

When change is the only constant: The promise of longitudinal neuroimaging in understanding social anxiety disorder

Highlights • The human brain has a protracted developmental trajectory and is inherently adaptive.• A dynamic, developmental aspect is largely missing from neurobiological models of psychopathology.• Longitudinal data are key to progress in our understanding of social anxiety disorder.• Analytical recommendations for longitudinal imaging studies are made.