To Go or Not to Go: A Proof of Concept Study Testing Food-Specific Inhibition Training for Women with Eating and Weight Disorders

This is the author accepted manuscript. The final version is available from Wiley via the DOI in this record.Inefficient food-specific inhibitory control is a potential mechanism that underlies binge eating in bulimia nervosa and binge eating disorder. Go/no-go training tools have been developed to increase inhibitory control over eating impulses. Using a within-subjects design, this study examined whether one session of food-specific go/no-go training, versus general inhibitory control training, modifies eating behaviour. The primary outcome measure was food consumption on a taste test following each training session. Women with bulimia nervosa and binge eating disorder had small non-significant reductions in high-calorie food consumption on the taste test following the food-specific compared with the general training. There were no effects on eating disorder symptomatic behaviour (i.e. binge eating/purging) in the 24 h post-training. The training task was found to be acceptable by the clinical groups. More research is needed with larger sample sizes to determine the effectiveness of this training approach for clinical populations.Robert Turton receives funding from the Medical Research Council (MRC) and the Psychiatry Research Trust (PRT) (Grant PCPTAAR). Dr. Bruno Palazzo Nazar has received funding from Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) and from the Federal University of Rio de Janeiro (UFRJ). Dr. Emilee Burgess received funding from the University of Alabama at Birmingham and Nova Scotia Health Authority. Dr. Colette Hirsch, Professor Janet Treasure OBE and Dr. Valentina Cardi, receive salary support from the National Institute for Health Research (NIHR), Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London

Development and psychometric evaluation of a scrambled sentences test specifically for worry in individuals with generalised anxiety disorder

The tendency to draw negative conclusions from ambiguous information (interpretation bias) is prevalent across emotional disorders and plays a key role in the development and maintenance of pathological worry and anxious mood. Assessing interpretation bias using valid and reliable measures is central to empirical research. A commonly used measure of interpretation bias is the scrambled sentences test (SST), originally relating to depression. Given the association between interpretation bias and worry, we aimed to develop and psychometrically evaluate a new version of the SST with items pertaining to common worry domains for use in worry and anxiety research. In Studies 1–3 (analogue samples, combined N = 288), the new worry SST showed excellent construct validity (moderate-to-strong associations with worry and anxiety-related measures), and reliability (split-half and test-retest reliability). We confirmed construct validity in Study 4 (N = 215 individuals with generalised anxiety disorder). Furthermore, we demonstrated version specificity in analogue and clinical samples: the worry SST was associated with trait worry but not trait rumination, while the original depression SST largely showed the opposite pattern. Overall, the new worry SST is a psychometrically robust measure that may be especiall

Cognitive bias modification for interpretation with and without prior repetitive negative thinking to reduce worry and rumination in generalised anxiety disorder and depression: Protocol for a multisession experimental study with an active control condition

Introduction Worry and rumination are two forms of repetitive thinking characterised by their negative content and apparently uncontrollable nature. Although worry and rumination share common features and have been conceptualised as part of a transdiagnostic repetitive negative thinking (RNT) process, it remains unclear whether they share the same underlying cognitive mechanisms. This multisession experimental study investigates the tendency to make negative interpretations regarding ambiguous information as a cognitive mechanism underlying RNT. We compare multisession cognitive bias modification for interpretations (CBM-I) with an active control condition to examine whether repeatedly training positive interpretations reduces worry and rumination in individuals with generalised anxiety disorder or depression, respectively. Further, we examine the potential modulatory effects of engaging in RNT immediately prior to CBM-I. Design, methods and analysis A community sample of individuals meeting diagnostic criteria for either generalised anxiety disorder (n=60) or current major depressive episode (n=60) will be randomly allocated to CBM-I with prior RNT, CBM-I without prior RNT (ie, standard CBM-I), or an active control (no resolution of ambiguity) condition. All conditions receive a 3-week internet-based intervention consisting of one initial session at the first study visit and nine home-based sessions of CBM-I training (or active control). We will assess and compare the effects of CBM-I with and without prior RNT on 'near-transfer' measures of interpretation bias closely related to the training as well as 'far-transfer' outcomes related to RNT and emotional distress. Impact on questionnaire measures will additionally be assessed at 1-month follow-up. Multigroup analyses will be conducted to assess the impact of CBM-I on near-transfer and far-transfer outcome measures

Are Different Forms of Repetitive Negative Thinking Associated With Interpretation Bias in Generalized Anxiety Disorder and Depression?

Worry and rumination, two forms of repetitive negative thinking (RNT), are prevalent in generalized anxiety disorder (GAD) and depression. Cognitive processing biases, especially the tendency to draw negative conclusions from ambiguous information (interpretation bias), may maintain worry and rumination. Yet the relationship between interpretation bias and both forms of RNT has not been explored in clinical versus nonclinical samples. In this cross-sectional study, participants with GAD (n = 72), depression (n = 79), or neither disorder (n = 71) completed two tasks assessing interpretation bias, measures of worry and rumination, and reported negative thought intrusions during a behavioral task. Interpretation bias was associated with higher levels of worry, rumination, and negative thought intrusions. Both clinical groups generated significantly more negative interpretations than healthy comparison participants. These findings link interpretation bias to worry and rumination and establish the need for research investigating the causal role of interpretation bias in maintaining RNT

Using event-related potential and behavioural evidence to understand interpretation bias in relation to worry

Worry is a common experience, thought to be maintained by the tendency of interpreting ambiguous information in a consistent (e.g. negative) manner, termed “interpretation bias”. This study explored whether high worriers (Penn State Worry Questionnaire score, PSWQ ≧ 56) and low worriers (PSWQ score ≦ 39) show different interpretation biases, and examined at which stages of information processing these interpretation biases occur. Participants with high and low worry levels completed interpretation assessment tasks yielding behavioural and event-related potential indices. We focused on the N400 component, reflecting whether given interpretations were in line with or violated participants' own interpretations. We found that high worriers lack the benign interpretation bias found in low worriers from the early "online" interpretative stage, reflected by the reaction time in a relatedness judgment task and the N400 in a lexical decision task, to the later "offline" stage at which participants had time for reflection. Our results suggest that a benign interpretation bias may be a protective factor in relation to worry and is likely to remain active across online and offline stages of interpretation processing

Cognitive processes predict worry and anxiety under different stressful situations

Worry, a stream of negative thoughts about the future, is maintained by poor attentional control, and the tendency to attend to negative information (attention bias) and interpret ambiguity negatively (interpretation bias). Memories that integrate negative interpretations (interpretation-memory) may also contribute to worry, but this remains unexplored. We aimed to investigate how these cognitive processes are associated with worry and anxiety cross-sectionally (Phase 1), and then explore which cognitive processes from Phase 1 would predict worry and anxiety during times of high stress, namely prior to examinations (Phase 2), and after the initial onset of the COVID-19 pandemic (Phase 3). Worry, anxiety, and cognitive processes were assessed in an undergraduate sample (N = 64). We found that whilst greater benign interpretation bias and benign interpretation-memory bias were associated with lower levels of concurrent worry and anxiety, only interpretation bias explained unique variance in worry and anxiety. No cognitive predictor significantly explained unique variance in prospective worry and anxiety prior to examinations. In relation to anxiety and worry during the stress of the COVID-19 pandemic, both benign attention bias and benign interpretation-memory bias predicted decreased worry; only benign attention bias predicted decreased anxiety. Findings suggest that cognitive processes can predict changes in worry and anxiety during future stressful contexts

Using event-related potential and behavioural evidence to understand interpretation bias in relation to worry

The tendency to interpret ambiguous information in a consistent (e.g., negative) manner (interpretation bias) may maintain worry. This study explored whether high and low worriers generate different interpretations and examined at which stages of information processing these interpretations can occur. Participants completed interpretation assessment tasks yielding behavioural and N400 event-related potential indices, which index whether a given interpretation was generated. High worriers lacked the benign interpretation bias found in low worriers. This was evident for early “online” interpretations (reflected in reaction times to relatedness judgments and lexical decisions, as well as at a neurophysiological level, N400, for lexical decisions only), to later “offline” interpretations (observed at a behavioural level on the scenario task and recognition task) when participants had time for reflection. Results suggest that a benign interpretation bias may be a protective factor for low worriers, and that these interpretations remain active across online and offline stages of processing

Impact of imagery-enhanced interpretation training on offline and online interpretations in worry

Worry and rumination are forms of repetitive negative thinking (RNT) that are maintained by negative interpretations and a predominance of abstract, verbal thinking. Hence, facilitating more positive interpretations and imagery-based thinking in combination may reduce RNT. Study 1 administered interpretation training with and without enhanced imagery, and an active control condition (designed not to change interpretations), in individuals with high levels of RNT (worry and/or rumination). Combining interpretation training with sustained imagery resulted in the highest levels of positive interpretation bias using an offline test of interpretation bias (when individuals have time to reflect). Study 2 investigated whether imagery-enhanced interpretation training influences online interpretations when ambiguous information is first encountered, indexed by reaction times and amplitude of the N400 event-related potential, as well as enhances offline positive interpretations in high worriers. It also examined whether imagery-enhanced interpretation training reduces negative thought intrusions associated with worry. Both online (reaction time) and offline interpretations were more positive following imagery-enhanced interpretation training, and negative thoughts were reduced, compared to the active control. However, no differences emerged on neurophysiological markers during the online task. Hence, brief interpretation training encompassing sustained imagery modifies online and offline interpretations, but further training may be required to impact upon neurophysiological measures

Internet-Delivered Interpretation Training Reduces Worry and Anxiety in Individuals With Generalized Anxiety Disorder: A Randomized Controlled Experiment

Objective: Generalized anxiety disorder (GAD) is a debilitating condition, characterized by negative interpretations about ambiguous situations. This study tested whether entirely internet-delivered interpretation training [cognitive bias modification (CBM)] versus control promotes positive interpretations and reduces worry and anxiety in individuals with GAD, with or without depression. Method: A two-arm (CBM; control) parallel-group randomized controlled experiment. Assessments were preintervention (T0), postintervention (T1), 1-month (T2) postintervention, and 3-month (T3) postintervention. Participants with GAD (with or without comorbid depression) were randomly allocated to either CBM (n = 115) or control (n = 115). Participants, but not researchers, were blind to allocated condition. Participants completed up to 10 online CBM or control sessions across 1 month. Interpretation bias [coprimary outcomes: scrambled sentence test (SST), recognition test (RT)], and number of negative thought intrusions during a breathing focus task were measured at T0 and T1. Self-reported levels of worry [Penn State Worry Questionnaire-trait (PSWQ trait); Penn State Worry Questionnaire-past week (PSWQ weekly)], anxiety [Generalized Anxiety Disorder scale (GAD-7)], depression [Patient Health Questionnaire (PHQ-9)], rumination [Ruminative Response Scale (RRS)], and repetitive negative thinking [RNT; Repetitive Thinking Questionnaire-trait (RTQ-trait)] were assessed at T0–T3. Results: The per-protocol analyses included N = 186 participants (CBM n = 94; control n = 92). As predicted, we found moderate-to-large training effects on the primary outcome of interpretation bias at T1. Secondary outcomes of negative thought intrusions at T1 and selfreported symptoms at T2 were all significantly lower in the CBM versus control condition. All but one effect (trait RNT) were sustained at T3. Conclusions: In this randomized controlled study, we found that fully online interpretation training ameliorated core features of GAD in individuals with or without comorbid depression up to 3 months posttraining

Interpretation training to target repetitive negative thinking in generalized anxiety disorder and depression

Objective: Repetitive negative thinking (RNT) e.g., worry in generalized anxiety disorder (GAD) and rumination in depression, is often targeted during psychological treatments. To test the hypothesis that negative interpretation bias contributes to worry and rumination, we assessed the effects of inducing more positive interpretations in reducing RNT. Method: Volunteers diagnosed with GAD (66) or Depression (65) were randomly allocated to one of two versions of Cognitive Bias Modification (CBM-I), either with or without RNT priming prior to training), or a control condition, each involving 10 internet-delivered sessions. Outcome measures of interpretation bias, a behavioral RNT task and self-reported worry, rumination, anxiety and depression were obtained at baseline, after home-based training and at 1-month follow up (self-report questionnaires only). Results: CBM-I training, across diagnostic groups, promoted a more positive interpretation bias and led to reductions in worry, rumination, and depressive symptoms, which were maintained at follow up. Anxiety symptoms were reduced only in the GAD group at follow up. There were no differences between CBM-I versions; brief priming of RNT did not influence CBM-I effectiveness. Level of interpretation bias post training partially mediated the effects of CBM-I on follow-up questionnaire scores. Conclusions: In contrast to some recent failures to demonstrate improvements following internet-delivered CBM, we found that self-reported RNT and negative mood were reduced by CBM-I. This is consistent with a causal role for negative interpretation bias in both worry and rumination, suggesting a useful role for CBM-I within treatments for anxiety and depression