Interpretation Biases in Pain: Validation of Two New Stimulus Sets

Adults with chronic pain interpret ambiguous information in a pain and illness related fashion. However, limitations have been highlighted with traditional experimental paradigms used to measure interpretation biases. Whilst ambiguous scenarios have been developed to measure interpretation biases in adolescents with pain, no scenario sets exist for use with adults. Therefore, the present study: (i) sought to validate a range of ambiguous scenarios suitable for measuring interpretation biases in adults, whilst also allowing for two response formats (forced-choice and free response); and (ii) investigate paradigm efficacy, by assessing the effects of recent pain experiences on task responding. A novel ambiguous scenarios task was administered to adults (N = 241). Participants were presented with 62 ambiguous scenarios comprising 42 that could be interpreted in a pain/pain-illness or non-pain/non-pain illness manner: and 20 control scenarios. Participants generated their own solutions to each scenario (Word Generation Task), then rated how likely they would be to use two researcher-generated solutions to complete each scenario (Likelihood Ratings Task). Participants also rated their subjective experiences of pain in the last 3 months. Tests of reliability, including inter-rater agreement and internal consistency, produced two ambiguous scenario stimulus sets containing 18 and 20 scenarios, respectively. Further analyses revealed adults who reported more recent pain experiences were more likely to endorse the pain/pain-illness solutions in the Likelihood Ratings Task. This study provides two new stimulus sets for use with adults (including control items) in pain research and/or interventions. Results also provide evidence for a negative endorsement bias in adults.

Understanding mechanisms that may underlie the development and maintenance of anxiety in children and adolescents: Cognitive biases and parenting behaviours

<p>Anxiety is one of the most common forms of psychopathology in children and adolescents. Understanding the mechanisms that underlie the development and maintenance of this disorder is therefore critical. A variety of factors that interact with one another are likely to contribute to the risk and perpetuation of anxiety in young people. Moreover, risk and maintaining factors can occur at both an individual and environmental level. Cognitive biases are one such factor occurring at an individual level that are investigated in Study 1 and Study 2 of this thesis. Cognitive biases are also predicted to have associations with particular kinds of parenting behaviours, and Study 3 investigated these parenting behaviours. Study 3, therefore, provides a bridge between individual level cognitive mechanisms and possible environmental contexts that may contribute to the risk and maintenance of anxiety in young people. In Study 1, the relationships amongst anxiety, interpretation bias, and memory bias were investigated in children (M = 10.1 years, SD = 0.8). Children with higher levels of anxiety exhibit interpretation biases; a tendency to interpret ambiguous information in a negative manner. Moreover, interpretation biases are predicted to create negative memories for ambiguous information. In Study 1, 62 children heard ambiguous information about a novel animal and their interpretation and recall for this information was assessed. Interpretation bias was significantly associated with memory bias; children who interpreted the ambiguous information in a negative way also reported a greater number of negative memories for this information. Children with higher levels of anxiety also reported a greater number of negative memories. In Study 2 the relationship between interpretation bias and memory bias was investigated within an experimental paradigm, to understand whether there was evidence for a causal relationship between these cognitive biases. Children (M = 9.7 years, SD = 1.1) heard a series of ambiguous vignettes, and each vignette was followed by either a negative or a benign interpretation. Children were subsequently asked to recall the vignettes and children who had heard negative interpretations reported a greater number of negative memories. Children with higher levels of anxiety also reported a greater number of negative memories in their recall of the ambiguous vignettes. In Study 3, I investigated parental autonomy restriction and support in the context of parent-adolescent (M = 15.3 years, SD = 0.8) conversations, and their associations with anxiety, interpretation biases, and parental attributions. Higher levels of parental autonomy restriction may contribute to the risk and maintenance of anxiety in young people by signalling that the world is dangerous. Sixty-four mother-adolescent dyads were asked to discuss a recent conflict, and from this interaction maternal autonomy restriction and autonomy support were assessed. Adolescents with higher levels of anxiety and adolescents who exhibited interpretation biases to a greater extent, had mothers who demonstrated a greater amount of autonomy restriction within the conversations. Yet maternal variables were not significantly associated with either autonomy restriction or support. The results support predictions that these characteristics of young people may determine the extent of autonomy restriction parents engage in. In turn, autonomy restrictive parenting behaviours potentially play a role in the risk and maintenance of cognitive biases and anxiety. Overall this thesis contributes to an understanding of the complex and multiple relationships amongst factors that may be involved in the aetiology and perpetuation of anxiety in young people.</p>

Understanding mechanisms that may underlie the development and maintenance of anxiety in children and adolescents: Cognitive biases and parenting behaviours

<p>Anxiety is one of the most common forms of psychopathology in children and adolescents. Understanding the mechanisms that underlie the development and maintenance of this disorder is therefore critical. A variety of factors that interact with one another are likely to contribute to the risk and perpetuation of anxiety in young people. Moreover, risk and maintaining factors can occur at both an individual and environmental level. Cognitive biases are one such factor occurring at an individual level that are investigated in Study 1 and Study 2 of this thesis. Cognitive biases are also predicted to have associations with particular kinds of parenting behaviours, and Study 3 investigated these parenting behaviours. Study 3, therefore, provides a bridge between individual level cognitive mechanisms and possible environmental contexts that may contribute to the risk and maintenance of anxiety in young people. In Study 1, the relationships amongst anxiety, interpretation bias, and memory bias were investigated in children (M = 10.1 years, SD = 0.8). Children with higher levels of anxiety exhibit interpretation biases; a tendency to interpret ambiguous information in a negative manner. Moreover, interpretation biases are predicted to create negative memories for ambiguous information. In Study 1, 62 children heard ambiguous information about a novel animal and their interpretation and recall for this information was assessed. Interpretation bias was significantly associated with memory bias; children who interpreted the ambiguous information in a negative way also reported a greater number of negative memories for this information. Children with higher levels of anxiety also reported a greater number of negative memories. In Study 2 the relationship between interpretation bias and memory bias was investigated within an experimental paradigm, to understand whether there was evidence for a causal relationship between these cognitive biases. Children (M = 9.7 years, SD = 1.1) heard a series of ambiguous vignettes, and each vignette was followed by either a negative or a benign interpretation. Children were subsequently asked to recall the vignettes and children who had heard negative interpretations reported a greater number of negative memories. Children with higher levels of anxiety also reported a greater number of negative memories in their recall of the ambiguous vignettes. In Study 3, I investigated parental autonomy restriction and support in the context of parent-adolescent (M = 15.3 years, SD = 0.8) conversations, and their associations with anxiety, interpretation biases, and parental attributions. Higher levels of parental autonomy restriction may contribute to the risk and maintenance of anxiety in young people by signalling that the world is dangerous. Sixty-four mother-adolescent dyads were asked to discuss a recent conflict, and from this interaction maternal autonomy restriction and autonomy support were assessed. Adolescents with higher levels of anxiety and adolescents who exhibited interpretation biases to a greater extent, had mothers who demonstrated a greater amount of autonomy restriction within the conversations. Yet maternal variables were not significantly associated with either autonomy restriction or support. The results support predictions that these characteristics of young people may determine the extent of autonomy restriction parents engage in. In turn, autonomy restrictive parenting behaviours potentially play a role in the risk and maintenance of cognitive biases and anxiety. Overall this thesis contributes to an understanding of the complex and multiple relationships amongst factors that may be involved in the aetiology and perpetuation of anxiety in young people.</p>

Assessing the CogBIAS hypothesis: A multilevel and network approach

The Cognitive Bias (CogBIAS) hypothesis posits that cognitive biases develop as a function of environmental influences (that determine the valence of the biases) as well as the differential susceptibility to those influences (that determine the potency of the biases). The current study employed data from the CogBIAS Longitudinal Study (CogBIAS-L-S) to assess, for the first time, the CogBIAS hypothesis. In particular, measures of life experiences and polygenic scores for depression were employed to assess the longitudinal development of two cognitive biases (namely, memory and interpretation biases) in a three-wave sample of adolescents aging 12-16 years. A series of multilevel linear probability models revealed that positive life experiences promote wellbeing by enhancing positive and diminishing negative cognition; and negative life experiences can, under some circumstances, promote positive cognition through a form of ‘steeling’ effect. Although the depression polygenic scores (MDD PRS) were unable to directly predict the cognitive outcomes, the interaction between them and positive life experiences was shown to lead to a stronger positive social interpretation bias. Exploratory network techniques supported the notion that cognitive biases and dependent life events form complex systems that collectively exert influences onto psychological wellbeing/illness. The current results provide the first line of polygenic evidence in support of the CogBIAS and extend the theory by revealing additional patterns that can be incorporated into the CogBIAS model.

The KOALA-study: study protocol for a comprehensive study of cognitive biases in adolescent anorexia nervosa patients compared to healthy and clinical controls

Background Anorexia nervosa (AN) is characterized by dysfunctional cognitions including cognitive biases at various levels of information processing. However, less is known about the specificity of these biases, i.e., if they occur for eating-disorder-related information alone or also for non-eating-disorder-related emotional information in AN patients (content-specificity) and if they are unique to individuals with AN or are also shown by individuals with other mental disorders (disorder-specificity). Methods The present study systematically assesses cognitive biases in 12–18-year-old female adolescents with AN on three levels of information processing (attention, interpretation, and memory) and with regard to two types of information content (eating-disorder-related, i.e., stimuli related to body weight and shape, and non-eating-disorder-related). To address not only content- but also disorder-specificity, adolescents with AN will be compared not only to a healthy control group but also to a clinical control group (adolescents with major depression or particular anxiety disorders). Cognitive biases are assessed within a single experimental paradigm based on the Scrambled Sentences Task. During the task eye movements are recorded in order to assess attention biases while interpretation biases are derived from the behavioural outcome. An incidental free recall test afterwards assesses memory biases. We expect adolescents with AN to show more pronounced negative cognitive biases on all three levels of information processing and for both types of content compared to healthy adolescents. In addition, we expect the specificity of biases to translate into differential results for the two types of content: AN patients are expected to show stronger biases for disorder-related stimuli but similar or less pronounced biases for non-disorder-related stimuli compared to the clinical control group. Discussion This is the first study to comprehensively assess cognitive biases in adolescents with AN. It will have essential implications not only for cognitive-behavioural models of AN but also for subsequent studies aiming to modify cognitive biases in this population, thereby addressing important maintaining factors already at an early stage of the disorder.

Evaluation of film stimuli for the assessment of social-emotional processing

Background: Social-emotional difficulties have been proposed to play a key role in the progression of psychiatric disorders, including anorexia nervosa. The aim of the current study was to build on existing work and develop more ecologically valid measures of interpretation biases and evoked emotional responses. Methodology: 124 healthy female participants aged 18 – 25 took part in the study. We evaluated two sets of 18 brief film clips to be used in two tasks assessing interpretation of ambiguous scenarios and reactions to emotionally provoking scenes. Written interpretations were coded, the valence of the interpretations was analysed, and an ambiguity check was conducted. Evoked facial affect and mood ratings in response to each film clip during the second, evoked emotions task were analysed using exploratory factor analyses. Results: Most of the film clips were interpreted in the expected neutral, positive, and negative manner while still retaining some ambiguity. However, participants were more attuned to the negative cues in the ambiguous film clips and three film clips were identified as unambiguous. The exploratory factor analyses showed that the positive and negative film clips used in the evoked emotions task formed their own factors as expected. However, there was substantial cross-loading of the neutral film clips when participants’ facial expression data was analysed.Discussion: A subset of the film clips evaluated here could be used to assess interpretation biases and evoked emotional responses among people with anorexia nervosa. Ambiguous negatively valenced film clips should have more subtle negative cues to ensure there is enough room for interpretation. Additionally, care should be taken to ensure optimal recording conditions if evoked facial expressions are to be assessed.

Cognitive Biases in Blood-Injection-Injury Phobia: A Review

Blood-injection-injury (BII) phobia can lead to avoidance of crucial medical procedures and to detrimental health consequences, even among health workers. Yet unlike other specific phobias, BII phobia has been understudied. Specifically, while cognitive biases have been extensively investigated in other anxiety disorders, little is known about the same biases in BII phobia. The current article reviews cognitive biases in BII phobia and suggest future directions for further study and treatment. The reviewed biases include attention, expectancy, memory, perception, and interpretation biases. The investigation of these biases is highly relevant, as cognitive biases have been found to interact with anxiety symptoms. Results showed that attention, expectancy, and memory biases are involved in BII phobia, while no studies were found on interpretation nor perception biases. Mixed results were found for attention bias, as different studies found different components of attention bias, while others found no attention bias at all. Similarly, some studies found a-priori/a-posteriori expectancy biases, while other studies found only one type of bias. A better understanding of the cognitive particularities of BII phobia may lead to better treatments and ultimately reduce avoidance of needles and blood-related situations, thereby enabling individuals with BII phobia to undergo potentially life-saving medical procedures.