The world dangerous it is

The Scrambled Sentences Task (SST) is a robust measure of interpretational processes in psychopathology. However, there is little evidence of its utility in measuring dysfunctional appraisals (DAs) of potentially traumatic events. We developed a novel SST for trauma-related DAs and examined its psychometric properties including convergent validity (correlations with PTSD-related symptoms and self-reported DAs), divergent validity (e.g., symptoms of depression and eating disorders), and retest reliability via an online study. Our sample (T1: $\it N$ = 214, T2: $\it N$ = 145) included participants who reported a potentially traumatic life event still eliciting distress. We found high correlations between the SST, PTSD-related symptoms ($\it r$ = .37-.51), and self-report measures of DAs ($\it r$ = .41-.58), indicating good convergent validity. Internal consistency (split-half = .78-.90) and retest reliability (ICC(3,1) = .73-.81) were also good. However, moderate to large correlations with symptoms of other disorders ($\it r$ = .17-.58) indicated limited divergent validity. Finally, the SST explained unique variance in PTSD-related symptoms above self-report measures of DAs. The results demonstrate the promise of the SST as a valid and reliable tool to assess DAs in the context of potentially traumatic life events. Further research should investigate the transdiagnostic role of trauma-related DAs in psychopathology and the relationship between the SST and self-report measures of DAs

The good, the bad, and the ugly

Avoidance behaviors are shaped by associative learning processes in response to fear of impending threats, particularly physical harm. As part of a defensive repertoire, avoidance is highly adaptive in case of acute danger, serving a potent protective function. However, persistent or excessive fear and maladaptive avoidance are considered key factors in the etiology and pathophysiology of anxiety- and stress-related psychosomatic disorders. In these overlapping conditions, avoidance can increase the risk of mental comorbidities and interfere with the efficacy of cognitive behavioral treatment approaches built on fear extinction. Despite resurging interest in avoidance research also in the context of psychosomatic medicine, especially in conditions associated with pain, disturbed interoception, and disorders of the gut-brain axis, current study designs and their translation into the clinical context face significant challenges limiting both, the investigation of mechanisms involved in avoidance and the development of novel targeted treatment options. We herein selectively review the conceptual framework of learning and memory processes, emphasizing how classical and operant conditioning, fear extinction, and return of fear shape avoidance behaviors. We further discuss pathological avoidance and safety behaviors as hallmark features in psychosomatic diseases, with a focus on anxiety- and stress-related disorders. Aiming to emphasize chances of improved translational knowledge across clinical conditions, we further point out limitations in current experimental avoidance research. Based on these considerations, we propose means to improve existing avoidance paradigms to broaden our understanding of underlying mechanisms, moderators and mediators of avoidance, and to inspire tailored treatments for patients suffering from psychosomatic disorders

Reduced belief updating in the context of depressive symptoms

$\bf Background$ Depressive symptoms are associated with negative expectations and reduced belief updating by positive information. Cognitive immunization, the devaluation of positive information, has been argued to be central in this relationship and predictive processing models suggest that more positive information is associated with greater cognitive immunization. $\bf Methods$ In an online experiment, $\it N$ = 347 healthy participants took part in a performance task with standardized feedback of varying levels of positivity (mild, moderate, extreme). Effects of feedback positivity on cognitive immunization were investigated. Further, depressive symptoms, interpretation bias and participant’s self-evaluation were examined as potential correlates of belief updating. $\bf Results$ As expected, participants receiving mildly positive feedback reported a greater amount of cognitive immunization than those receiving moderately positive feedback. However, neither group differed from those receiving extremely positive feedback. Although depressive symptoms did not show the hypothesized association with cognitive immunization, they were associated with a weaker increase in positive expectations following feedback. Exploratory analyses showed associations between self-evaluation and belief updating. $\bf Conclusions$ The results suggest that healthy participants engaged in cognitive immunization when feedback was less positive than expected. Depressive symptoms were associated with reduced belief updating, but not with cognitive immunization. Self-evaluation may be a promising factor for future research

Investigating the effect of proactive interference control training on intrusive memories

Intrusive re-experiencing is a hallmark symptom of posttraumatic Stress Disorder (PTSD). According to prominent models of intrusive phenomena, intrusive memories may result from impairments in the efficiency of working memory capacity (WMC), more specifically proactive interference control. Yet, experimental research is scarce. Therefore, the present study aimed to investigate experimentally the role of proactive interference control in intrusive memories. We randomly assigned 57 healthy participants to either receive a high interference control training or a low interference control training. Participants were then exposed to highly distressing film clips. WMC was assessed before and after the training. Intrusion symptoms were assessed directly post-training and after one week using an Intrusion Provocation Task (IPT), a one-week intrusions diary, and the retrospective intrusion subscale of the Impact of Event Sale – Revised (IES-R). Results indicated that both groups reported improvements in WMC and fewer intrusions on the second IPT post-training, with no differences between groups. Similarly, no group differences on intrusions were found at one-week follow-up (i.e., intrusion diary and IES-R). To conclude, these data are not consistent with the hypothesis that WMC plays a role in intrusive re-experiencing. Implications for future research are discussed.(TEPT). De acuerdo con los prominentes modelos de fenómenos intrusivos, las memorias intrusivas pueden resultar en deterioros en la eficiencia de la capacidad de memoria de trabajo (CMT), más específicamente del control proactivo de interferencias. Sin embargo, la investigación experimental a este respecto es escasa. Por lo tanto, el presente estudio tuvo como objetivo investigar experimentalmente el papel del control proactivo de interferencias en las memorias intrusivas. Asignamos aleatoriamente 57 participantes sanos a recibir, ya sea, un entrenamiento de control de alta interferencia o un entrenamiento de control de baja interferencia. Luego, los participantes fueron expuestos a videoclips de películas altamente angustiantes. La CMT fue evaluada antes y después del entrenamiento. Los síntomas de intrusión se evaluaron directamente después del entrenamiento y después de una semana utilizando una Tarea de Provocación de Intrusión (IPT), registro diario de intrusiones (por una semana), y la subescala de intrusión retrospectiva de la Escala del Impacto del Evento - Revisada (IES-R). Los resultados indicaron que ambos grupos experimentaron mejoras en la CMT y reducción de intrusiones en la segunda IPT posterior al entrenamiento, sin diferencias entre los grupos. De manera similar, no se encontraron diferencias de grupo en las intrusiones en el seguimiento de una semana (es decir, en el diario de intrusiones y la IES-R). Para concluir, estos datos no son consistentes con la hipótesis de que la CMT desempeña un papel en la re-experiencia intrusiva. Se discuten las implicaciones para futuras investigaciones

Using cognitive bias modification-appraisal training to manipulate appraisals about the self and the world in analog trauma

$\bf Background$ Dysfunctional appraisals are a key mechanism in posttraumatic stress disorder (PTSD). Experimental manipulations of appraisals via Cognitive Bias Modification-Appraisal (CBM-App) training targeting cognitions related to the ‘self’ has shown to affect analog trauma symptoms. The present study aimed to conceptually replicate and extend previous findings by comparing a newly developed 'world' to the original 'self' training, and investigate the moderating role of locus of control (LOC) on intrusions. $\bf Methods$ Healthy participants ($\it N$ = 173) were exposed to distressing films as an analog trauma induction. Next, participants received positive or negative CBM-App, targeting either self- or world-relevant appraisals. Dysfunctional appraisals and LOC were assessed pre- and post-training. During the week after the laboratory session, participants recorded their intrusions and associated distress in a diary. One week later, trauma-relevant symptomatology was assessed. $\bf Results$ Positive compared to negative CBM-App induced training-congruent appraisals, independent of the trained cognition (self vs. world). However, there was no effect on analog trauma symptoms and LOC did not moderate the training’s effect. $\bf Conclusions$ Our results underline the validity of CBM-App as a method to experimentally manipulate appraisals. However, since we did not fully replicate previous findings further research on mechanisms associated with transfer effects is warranted

Demonstration of a "leapfrog" randomized controlled trial as a method to accelerate the development and optimization of psychological interventions

$\bf Background$ The scale of the global mental health burden indicates the inadequacy not only of current treatment options, but also the pace of the standard treatment development process. The "leapfrog" trial design is a newly-developed simple Bayesian adaptive trial design with potential to accelerate treatment development. A first leapfrog trial was conducted to provide a demonstration and test feasibility, applying the method to a low-intensity internet-delivered intervention targeting anhedonia. $\bf Methods$ At the start of this online, single-blind leapfrog trial, participants self-reporting depression were randomized to an initial control arm comprising four weeks of weekly questionnaires, or one of two versions of a four-week cognitive training intervention, imagery cognitive bias modification (imagery CBM). Intervention arms were compared to control on an ongoing basis via sequential Bayesian analyses, based on a primary outcome of anhedonia at post-intervention. Results were used to eliminate and replace arms, or to promote them to become the control condition based on pre-specified Bayes factor and sample size thresholds. Two further intervention arms (variants of imagery CBM) were added into the trial as it progressed. $\bf Results$ $\it N$ = 188 participants were randomized across the five trial arms. The leapfrog methodology was successfully implemented to identify a "winning" version of the imagery CBM, i.e. the version most successful in reducing anhedonia, following sequential elimination of the other arms. $\bf Conclusions$ The study demonstrates feasibility of the leapfrog design and provides a foundation for its adoption as a method to accelerate treatment development in mental health. Registration: clinicaltrials.gov, NCT04791137

Using three indirect measures to assess the role of sexuality-related associations and interpretations for women's sexual desire

Theoretical models emphasize the role of both automatic appraisals (i.e., associations) and conscious appraisals (i.e., interpretations) for sexual desire. Studies on sexuality-related appraisals have not combined self-report measures and experimental paradigms in order to compare the relevance of associations or interpretations. The aim of this study was to assess the relative contribution of both associations and interpretations to the explanation of low sexual desire in women. Toward this goal, indirect measures assessing associations (via a Single Target Implicit Association Test [STIAT]) and interpretations (via a Scrambled Sentences Test [SST] and a scenario task) were administered in a sample of 263 women ($M_{age}$ = 27.90, SD 8.27) with varying levels of sexual desire and different sexual orientations (exclusively heterosexual women: 54.6%). Negative sexuality-related interpretations as assessed with two variants of the SST as well as the scenario task added to the explanation of lower sexual desire in women. Negative associations as measured with the STIAT were predictive of lower sexual desire only in women who did not indicate an exclusively heterosexual orientation. In this study, sexuality-related interpretations were more relevant to women’s sexual desire than automatic associations. Future studies should assess the causal mechanism underlying sexuality-related interpretations (e.g., by evaluating whether these can be changed via cognitive bias modification techniques or psychological treatments)

Does napping enhance the effects of Cognitive Bias Modification-Appraisal training?

Posttraumatic Stress Disorder (PTSD) is characterised by dysfunctional appraisals of the trauma and its consequences including one’s own symptoms. Experimental studies have shown that Cognitive Bias Modification-Appraisal (CBM-App) training can reduce dysfunctional interpretations and analog trauma symptoms. One important question is how to enhance the effects of CBM-App. Following work suggesting that sleep has beneficial effects on consolidation processes and can thus improve learning, the present study investigated whether a brief period of sleep (i.e., a nap) enhances the effects of CBM-App. All participants watched a stressful movie as an analogue trauma induction. After that, participants received either positive or negative CBM-App training. Within each training, half of the participants then had a 90-minute nap or watched a neutral movie. Results showed that the CBM training induced training-congruent appraisals. Sleep did not enhance this effect. Participants who slept, however, experienced fewer intrusive memories of the analogue trauma, but this effect was independent of the CBM condition. These results provide valuable information about the effects of sleep during a 90-minute nap period on encoding of analogue trauma and emotional learning in the context of appraisal, and highlight the importance of sleep as a focus for continued research

The effects of modifying dysfunctional appraisals in posttraumatic stress disorder using a form of cognitive bias modification

$\bf Introduction:$ Dysfunctional appraisals about traumatic events and their sequelae are a key mechanism in posttraumatic stress disorder (PTSD). Experimental studies have shown that a computerized cognitive training, cognitive bias modification for appraisals (CBM-APP), can modify dysfunctional appraisals and reduce analogue trauma symptoms amongst healthy and subclinical volunteers. $\bf Objective:$ We aimed to test whether CBM-APP could reduce dysfunctional appraisals related to trauma reactions in PTSD patients, and whether this would lead to improvements in PTSD symptoms. $\bf Methods:$ We compared CBM-APP to sham training in a parallel-arm proof-of-principle double-blind randomized controlled trial amongst 80 PTSD patients admitted to an inpatient clinic. Both arms comprised a training schedule of 8 sessions over a 2-week period and were completed as an adjunct to the standard treatment programme. $\bf Results:$ In intention-to-treat analyses, participants receiving CBM-APP showed a greater reduction in dysfunctional appraisals on a scenario task from pre- to posttraining (primary outcome) assessments, compared to those receiving sham training ($\it d$= 1.30, 95% CI 0.82–1.80), with between-group differences also found on the Posttraumatic Cognitions Inventory (PTCI; $\it d$ = 0.85, 95% CI 0.39–1.32) and the PTSD Checklist for DSM-5 (PCL-5; $\it d$ = 0.68, 95% CI 0.23–1.14), but not for long-term cortisol concentrations ($\it d$ = 0.25, 95% CI –0.28 to 0.78). Reductions in dysfunctional appraisals assessed via the scenario task correlated with reductions on the PTCI, PCL-5, and hair cortisol concentrations from pre- to posttraining time points. $\bf Conclusions:$ Results support dysfunctional appraisals as a modifiable cognitive mechanism, and that their proximal modification transfers to downstream PTSD symptoms. These findings could open new avenues for improving present therapeutic approaches