Cognitive bias modification: Induced interpretive biases affect memory.

Previous research has shown that it is possible to experimentally induce interpretive biases using ambiguous scenarios. This study extends past findings by examining the effects of cognitive bias modification for interpretation on subsequent scenario recall. Participants were trained to interpret emotionally ambiguous passages in either a positive or negative direction. Transfer of the training to novel scenarios was tested. After training, participants were also asked to recall details from these novel scenarios. The results indicate that the training was effective in inducing the intended group differences in interpretive bias. Importantly, participants exhibited memory biases that corresponded to their training condition. These results suggest that manipulating interpretive biases can result in corresponding changes in memory. Findings from this study highlight the importance of future research on the relation among cognitive biases and on the possibility of modifying cognitive biases in emotional disorders. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

The reduction of anxiety vulnerability through the modification of attentional bias: A real-world study using a home-based cognitive bias modification procedure.

Recent laboratory work suggests that biased attentional responding to negative information causally impacts anxiety reactivity to a contrived laboratory stressor. However, it remains unknown whether such attentional bias contributes to real-world anxiety vulnerability. In the present study, the authors addressed this issue by experimentally inducing biased attentional response to emotionally negative stimuli, using a home-based attentional training program and then examining the influence of this attentional manipulation on trait anxiety scores and on state anxiety responses to a subsequent stressful life event. The attentional bias modification procedure was effective in inducing attentional avoidance of negative information. Furthermore, this attentional manipulation served to reduce trait anxiety scores and to attenuate state anxiety responses to the subsequent naturalistic stressor. These findings support the hypotheses that biased attentional responding to emotionally negative information contributes causally to real-world anxiety vulnerability. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A meta-analysis of the effect of cognitive bias modification on anxiety and depression.

Cognitive biases have been theorized to play a critical role in the onset and maintenance of anxiety and depression. Cognitive bias modification (CBM), an experimental paradigm that uses training to induce maladaptive or adaptive cognitive biases, was developed to test these causal models. Although CBM has generated considerable interest in the past decade, both as an experimental paradigm and as a form of treatment, there have been no quantitative reviews of the effect of CBM on anxiety and depression. This meta-analysis of 45 studies (2,591 participants) assessed the effect of CBM on cognitive biases and on anxiety and depression. CBM had a medium effect on biases (g = 0.49) that was stronger for interpretation (g = 0.81) than for attention (g = 0.29) biases. CBM further had a small effect on anxiety and depression (g = 0.13), although this effect was reliable only when symptoms were assessed after participants experienced a stressor (g = 0.23). When anxiety and depression were examined separately, CBM significantly modified anxiety but not depression. There was a nonsignificant trend toward a larger effect for studies including multiple training sessions. These findings are broadly consistent with cognitive theories of anxiety and depression that propose an interactive effect of cognitive biases and stressors on these symptoms. However, the small effect sizes observed here suggest that this effect may be more modest than previously believed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Effect of a positive emotional state on interpretation bias for threat in children with anxiety disorders.

The authors examined the effect of a positive emotional state on interpretation bias for threat in children with anxiety disorders. Participants were 34 children with anxiety disorders and 34 children without any psychological disorders who were randomly assigned to either a positive or neutral emotion induction condition. Consistent with the broaden-and-build theory, children with anxiety disorders exhibited an interpretation bias for threat, but not when they were in a positive emotional state. Furthermore, results indicated that positive emotional state made a unique prediction of interpretation bias score, whereas state anxiety did not. Findings are discussed with reference to theory, clinical implications, and suggestions for future research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Recollection is impaired by the modification of interpretation bias.

The interpretation paradigm of cognitive-bias modification (CBM-I) was modified with instructions used in process-dissociation procedures for the purpose of investigating processes contributing to performance on the transfer task. In Experiment 1, nonanxious students were trained to interpret ambiguous situations in either a negative or benign way (or they read nonambiguous scenarios). They were then asked to respond to new ambiguous situations, in the same way as contextually similar analogues during training, or to respond differently. Benign training proactively impaired memory for negative outcomes. This effect was replicated by anxious students in Experiment 2 and discussed with respect to the assumptions underlying process-dissociation procedures and directions for future research. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Interpretation bias in social anxiety as detected by event-related brain potentials.

Little is known about psychophysiological correlates of interpretation bias in social anxiety. To address this issue, the authors measured event-related brain potentials (ERPs) in high and low socially anxious individuals during a task wherein ambiguous scenarios were resolved with either a positive or negative ending. Specifically, the authors examined modulations of the P600, an ERP that peaks approximately 600 ms following stimulus onset and indexes violations of expectancy. Low-anxious individuals were characterized by an increased P600 to negative in comparison with positive sentence endings, suggesting a positive interpretation bias. In contrast, the high-anxious group evidenced equivalent P600 magnitude for negative and positive sentence endings, suggesting a lack of positive interpretation bias. Similar, but less reliable results emerged in earlier time windows, that is, 200-500 ms poststimulus. Reaction time, occurring around 900 ms poststimulus, failed to show a reliable interpretation bias. Results suggest that ERPs can detect interpretation biases in social anxiety before the emission of behavioral responses. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Introduction to the special section on cognitive bias modification in emotional disorders.

Cognitive models of anxiety disorders and unipolar depression have postulated that selective information processing plays an important role in the development and maintenance of emotional psychopathology. Cognitive bias modification (CBM) procedures have recently been developed to test this theoretical claim. The purpose of this special section is to introduce the central ideas underlying CBM and to bring together the research that exemplifies the theoretical and clinical potential of the CBM approach. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Memory bias for threatening information in anxiety and anxiety disorders: A meta-analytic review.

Although some theories suggest that anxious individuals selectively remember threatening stimuli, findings remain contradictory despite a considerable amount of research. A quantitative integration of 165 studies with 9,046 participants (clinical and nonclinical samples) examined whether a memory bias exists and which moderator variables influence its magnitude. Implicit memory bias was investigated in lexical decision/stimulus identification and word-stem completion paradigms; explicit memory bias was investigated in recognition and recall paradigms. Overall, effect sizes showed no significant impact of anxiety on implicit memory and recognition. Analyses indicated a memory bias for recall, whose magnitude depended on experimental study procedures like the encoding procedure or retention interval. Anxiety influenced recollection of previous experiences; anxious individuals favored threat-related information. Across all paradigms, clinical status was not significantly linked to effect sizes, indicating no qualitative difference in information processing between anxiety patients and high-anxious persons. The large discrepancy between study effects in recall and recognition indicates that future research is needed to identify moderator variables for avoidant and preferred remembering. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Exploring the role of parent training in the treatment of childhood anxiety.

Data from a randomized clinical trial comparing the relative efficacy of individual cognitive–behavioral therapy (ICBT), family CBT (FCBT), and a family-based education/support/attention control (FESA) condition were used to examine associations between in-session therapeutic techniques related to parent training (PT) and treatment outcomes. This study explored the extent to which therapists’ use of PT techniques, specifically (a) parental anxiety management, (b) transfer of control from therapist to parent to child over child’s coping, (c) communication skills training, and (d) contingency management training, contributed to treatment outcome in family-based CBT. Children (N = 53; 31 males; 7.8–13.8 years of age; M = 10.1 years, SD = 2.3; 85% Caucasian, 9% African American, 4% Asian, 2% “other” background) with a principal anxiety disorder completed 16 sessions of CBT with their parents. The relative contributions of PT components on treatment outcome were evaluated. As hypothesized, both transfer-of-control and parental anxiety management techniques significantly contributed to improvement on clinician and parent ratings of child global functioning within FCBT. PT did not significantly contribute to improvement on measures of child anxiety. These preliminary findings suggest that when FCBT is conducted for child anxiety, PT (i.e., transfer-of-control and parental anxiety management techniques) may contribute to improvements in the child’s global functioning. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Malleability of attentional bias for positive emotional information and anxiety vulnerability.

Recent research supports a causal link between attentional bias for negative emotional information and anxiety vulnerability. However, little is known about the role of positive emotional processing in modulating anxiety reactivity to stress. In the current study, we used an attentional training paradigm designed to experimentally manipulate the processing of positive emotional cues. Participants were randomly assigned to complete a computerized probe detection task designed to induce selective processing of positive stimuli or to a sham condition. Following training, participants were exposed to a laboratory stressor (i.e., videotaped speech), and state anxiety and positive affect in response to the stressor were assessed. Results revealed that individual variability in the capacity to develop an attentional bias for positive information following training predicted subsequent emotional responses to the stressor. Moreover, individual differences in social anxiety, but not depression, moderated the effects of the attentional manipulation, such that, higher levels of social anxiety were associated with diminished attentional allocation toward positive cues. The current findings point to the potential value of considering the role of positive emotional processing in anxiety vulnerability. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Facilitating a benign attentional bias reduces negative thought intrusions.

The causal role of biased attention in worry was investigated in an experiment in which high worriers were assigned either to a condition requiring attention to nonthreatening words and text while ignoring worry-related material or to a mixed-attention control condition. The former procedure led to fewer negative thought intrusions in a worry test (as rated by both participants and an assessor) than did the control condition. These findings suggest that attentional bias plays a causal role in worry and that its modification can reduce excessive worry. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clinical implications of attentional bias in anxiety disorders: An integrative literature review.

Research on information processing biases has been motivated by the hope that it would lead to new and more efficient psychotherapeutic interventions. The literature is abundant with empirical data of attentional biases toward threat stimuli in anxiety disorders. This article aims to review the existing literature on the topic of attentional bias in anxiety disorders and discuss important implications for clinical practice. We adopted an integrative approach to link research data on attentional bias, information processing, and cognitive accounts (automaticity and controllability) with clinical practice in cognitive-behavioral therapy. It is important to develop and apply therapeutic interventions that can effectively reduce negative attentional biases while treating the main problems associated with anxiety disorders. However, it remains to be seen whether cognitive therapy interventions targeting more voluntary, strategic information processing can have a positive impact on automatic, involuntary processing involved in attentional biases. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Attention modification program in individuals with generalized anxiety disorder.

Research suggests that individuals with generalized anxiety disorder (GAD) show an attention bias for threat-relevant information. However, few studies have examined the causal role of attention bias in the maintenance of anxiety and whether modification of such biases may reduce pathological anxiety symptoms. In the present article, the authors tested the hypothesis that an 8-session attention modification program would (a) decrease attention bias to threat and (b) reduce symptoms of GAD. Participants completed a probe detection task by identifying letters (E or F) replacing one member of a pair of words. The authors trained attention by including a contingency between the location of the probe and the nonthreat word in one group (Attention Modification Program; AMP) and not in the other (attention control condition; ACC). Participants in the AMP showed change in attention bias and a decrease in anxiety, as indicated by both self-report and interviewer measures. These effects were not present in the ACC group. These results are consistent with the hypothesis that attention plays a causal role in the maintenance of GAD and suggest that altering attention mechanisms may effectively reduce anxiety. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The role of self-statements as a mediator in treatment for youth with anxiety disorders.

The authors investigated features of self-statements as predictors of anxiety in children with and without anxiety disorder (AD) and as a mediator of treatment of ADs in children. Children (N = 145) between the ages of 9 and 13 years participated (71 AD youth, 84 controls). Self-statements were classified by valence and content. Results indicated that children's anxious, but not positive or depressed, self-statements significantly predicted anxiety in children with and without AD. For children with AD, changes in anxious self-statements mediated treatment gains, replicating a previously reported finding. A states of mind ratio mediated only 1 outcome measure, and positive and depressive cognitions served no mediating role. The impact of anxious self-talk on children's adjustment and implications for cognitive theory of anxiety in children are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Attentional bias for threat in older adults: Moderation of the positivity bias by trait anxiety and stimulus modality.

Socioemotional selectivity theory suggests that emotion regulation goals motivate older adults to preferentially allocate attention to positive stimuli and away from negative stimuli. This study examined whether anxiety moderates the effect of the positivity bias on attention for threat. The authors employed the dot probe task to compare subliminal and supraliminal attention for threat in 103 young and 44 older adults. Regardless of anxiety, older but not young adults demonstrated a vigilant–avoidant response to angry faces. Anxiety influenced older adults’ attention such that anxious individuals demonstrated a vigilant–avoidant reaction to sad faces but an avoidant–vigilant reaction to negative words. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Demonstrations of implicit anti-fat bias: The impact of providing causal information and evoking empathy.

Three studies investigated implicit biases, and their modifiability, against overweight persons. In Study 1 (N=144), the authors demonstrated strong implicit anti-fat attitudes and stereotypes using the Implicit Association Test, despite no explicit anti-fat bias. When participants were informed that obesity is caused predominantly by overeating and lack of exercise, higher implicit bias relative to controls was produced; informing participants that obesity is mainly due to genetic factors did not result in lower bias. In Studies 2A (N=90) and 2B (N=63), participants read stories of discrimination against obese persons to evoke empathy. This did not lead to lower bias compared with controls but did produce diminished implicit bias among overweight participants, suggesting an in-group bias. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A self-agency bias in preschoolers' causal inferences.

Preschoolers' causal learning from intentional actions—causal interventions—is subject to a self-agency bias. The authors propose that this bias is evidence-based, in other words, that it is responsive to causal uncertainty. In the current studies, two causes (one child controlled, one experimenter controlled) were associated with one or two effects, first independently, then simultaneously. When initial independent effects were probabilistic, and thus subsequent simultaneous actions were causally ambiguous, children showed a self-agency bias. Children showed no bias when initial effects were deterministic. Further controls established that children's self-agency bias is not a wholesale preference but rather is influenced by uncertainty in causal evidence. These results demonstrate that children's own experience of action influences their causal learning, and the findings suggest possible benefits in uncertain and ambiguous everyday learning contexts. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Evidence-based psychological treatments for late-life anxiety.

This project identified evidence-based psychotherapy treatments for anxiety disorders in older adults. The authors conducted a review of the geriatric anxiety treatment outcome literature by using specific coding criteria and identified 17 studies that met criteria for evidence-based treatments (EBTs). These studies reflected samples of adults with generalized anxiety disorder (GAD) or samples with mixed anxiety disorders or symptoms. Evidence was found for efficacy for 4 types of EBTs. Relaxation training, cognitive-behavioral therapy (CBT), and, to a lesser extent, supportive therapy and cognitive therapy have support for treating subjective anxiety symptoms and disorders. CBT for late-life GAD has garnered the most consistent support, and relaxation training represents an efficacious, relatively low-cost intervention. The authors provide a review of the strengths and limitations of this research literature, including a discussion of common assessment instruments. Continued investigation of EBTs is needed in clinical geriatric anxiety samples, given the small number of available studies. Future research should examine other therapy models and investigate the effects of psychotherapy on other anxiety disorders, such as phobias and posttraumatic stress disorder in older adults. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Prepared for the worst: Readiness to acquire threat bias and susceptibility to elevate trait anxiety.

Although people differ in their susceptibility to elevate trait anxiety in response to extended stress, little is known about the cognitive substrate of this particular individual difference. We report three studies designed to evaluate the hypothesis that individual differences in readiness to acquire an attentional bias toward threat cues, in response to a contingency that makes the acquisition of such a bias adaptive, underlie individual differences in susceptibility to elevate trait anxiety in response to extended stress. Our findings confirm that the ease with which such a threat bias can be transiently evoked by experimental conditions that encourage its acquisition predicts the degree to which trait anxiety later becomes elevated by extended exposure to a mild stressor. Furthermore, this reflects the fact that such early measures of attentional bias plasticity predict the later naturalistic acquisition of attentional bias in response to subsequent stress, which in turn is associated with a consequent increase in trait anxiety level. These findings are consistent with our proposed account of individual differences in susceptibility to elevate trait anxiety in response to stress. (PsycINFO Database Record (c) 2010 APA, all rights reserved)