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Objective: Evidence points towards heightened anxiety and attention biases (AB) towards disorder‐specific (threatening) stimuli in patients with anorexia nervosa (AN). To date, it is unclear how anxiety and AB interact in eating disorders (ED). The present study tests the causal role of anxiety by inducing anxiety before a dot‐probe task with either ED‐specific stimuli or unspecific negative (threat‐related) information. We expected that anxiety would elicit AB for ED‐specific, but not for unspecific threat‐related stimuli. Methods: Adolescents with AN (AN, n = 32) or depression (DEP, n = 27) and healthy controls (HC, n = 29) underwent an anxiety induction or a low anxiety control task before a pictorial dot‐probe task with either under‐/overweight body‐related pictures or non‐disorder‐related threatening pictures (angry faces). BMI, level of ED symptoms, anxiety, stress, and depression were assessed at baseline. Results: The anxiety induction did not affect the observed attention pattern. AN showed an AB towards underweight body pictures compared to HC, whereas no disorder‐unspecific threat‐related AB emerged. Regression analyses revealed that only anxiety predicted the AB towards underweight body pictures. Discussion: Further experimental research may integrate eye tracking as an additional tool, or collect information on body dissatisfaction to obtain a better understanding of how anxiety biases attention. Highlights: Patients with AN show attention bias towards underweight body picturesAnxiety manipulation did not affect attention biasState anxiety predicted the strength of biased attention towards underweight body pictures [ABSTRACT FROM AUTHOR]

Background: Alcohol‐dependent individuals tend to selectively approach alcohol cues in the environment, demonstrating an alcohol approach bias. Because approach bias modification (ApBM) training can reduce the approach bias and decrease relapse rates in alcohol‐dependent patients when added to abstinence‐focused treatment, it has become a part of regular treatment. Moreover, in selective inhibition (SI) training, responses to one category of stimuli (i.e., alcohol stimuli) are selectively inhibited in an adapted Go/No‐Go task. SI‐Training has been found to effectively devalue the inhibited category and to reduce consumption of alcohol among social drinkers. This study investigated whether SI‐Training can further improve the effects of treatment as usual that includes ApBM, and if so, whether the effect is mediated by a devaluation of the inhibited alcohol stimuli. Methods: Abstinent alcohol‐dependent inpatients (N=434) were randomly assigned to receive 6 sessions of either active (n = 214, 32% female) or sham (n = 220, 38% female) SI‐Training, in addition to standard treatment that includes active ApBM. Ratings were used to assess changes in the evaluation of alcohol stimuli after the training. Relapse rates were assessed 3 and 12 months after treatment discharge. Results: Alcohol stimuli were rated negatively before and after the training, and the training did not influence these ratings. Evaluation of nonalcoholic drinks became more positive after active SI‐Training. Both ApBM and SI‐Training showed the expected training effects on reaction times. Contrary to expectations, SI‐Training conditions did not yield different abstinence rates 3 or 12 months after treatment. Conclusions: We found no evidence supporting the hypothesis that SI‐Training amplifies the relapse‐preventing effect of ApBM. Moreover, alcohol stimuli were rated negatively before and after treatment and were not influenced by SI‐Training. [ABSTRACT FROM AUTHOR]

Objectives: In terms of dual process models, behaviour can be conceived of as the outcome of an interplay between reflective, top‐down and impulsive, bottom‐up processes. Behaviour change interventions may benefit from targeting both types of processes in a coherent way. One approach to this, in the context of reducing hazardous drinking, is to combine imagery involving real‐life situations involving alcohol with the simple actions involved in Approach Bias Modification (ApBM), a form of Cognitive Bias Modification. Design: We developed and tested a version of this Imagery‐enhanced Approach Bias Modification (IApBM) in an experimental design, with two independent factors: imagery versus control and ApBM versus control training components (N = 139). Methods: An effect of integrating the training factors was hypothesized on the alcohol‐approach bias of an alcohol Approach‐Avoidance Task. Further exploratory analyses were performed for the bias on alcohol‐related Single Attribute Implicit Association Tests and on alcohol‐related questionnaires. Finally, the psychometric properties of an imagery interference effect during training were explored. Results: Results showed no benefit of the training and in fact suggested a negative interaction in which combining the training components appeared to block reductions in craving effected by each in isolation. The reliability of the imagery‐related interference effect was high and the effect was correlated with alcohol‐related scales. Conclusions: In conclusion, it appears that interference between training components decreases their individual effects when combining imagery and ApBM in the current way. The imagery‐related interference effects that could be measured during training conditions may be useful as an implicit measure of automatic processes underlying hazardous drinking. [ABSTRACT FROM AUTHOR]

Stress may potentiate the chronification of nicotine addiction, but the exact mechanisms remain elusive. We performed an explorative pilot study examining the effects of psychological stress, administered via the socially evaluated cold pressor task (SECPT), on implicit approach bias for smoking‐related cues in smokers in the approach–avoidance task (AAT). Smokers (N = 24) were subjected to the stress or control condition of the SECPT by using a within‐subject design. Consistent with previous findings, a strong approach bias for smoking‐related cues in the AAT was found in smokers. Exposure to stress did not affect the general bias for smoking‐related cues in the AAT relative to the control condition of the SECPT. In additional explorative analyses, an interaction among carbon monoxide (CO) levels in expired air, cortisol levels, and stress on approach bias for smoking‐related cues was found. Higher CO levels, possibly due to recent smoking, prior to stress exposure were associated with an approach bias for smoking‐related cues. Our results suggest that CO levels in interaction with stress can modulate implicit, automatic processing in the context of nicotine addiction. Our findings might provide novel cues to how stress influences cigarette craving and smoking behavior. [ABSTRACT FROM AUTHOR]

Objective: Body and food‐related information are thought to activate cognitive biases and contribute to the maintenance of eating disorders (ED). Approach‐avoidance biases may play an important role in the maintenance of dietary restriction and excessive food intake. Therefore, the present study aimed to examine approach‐avoidance biases toward food and body stimuli in individuals with anorexia nervosa (AN), bulimia nervosa (BN), and healthy controls (HC). Methods: The study included 42 individuals with AN, 24 individuals with BN, and 38 HCs. We used two implicit Approach‐Avoidance Tasks (AAT) to assess approach‐avoidance biases: participants completed a Food‐AAT (high‐calorie vs. low‐calorie food) and a Body‐AAT (thin vs. normal weight bodies). Additionally, explicit ratings of food and body stimuli were assessed. Results: There were no significant Group × Stimulus × Direction interactions in the implicit Food‐AAT or implicit Body‐AAT. In explicit ratings, individuals with AN and BN reported less urge to eat and more regret if they ate high‐calorie and low‐calorie food; individuals with AN and BN rated normal weight bodies as less normal weight, less attractive and less desirable than HCs. There were no group differences in explicit ratings of the thin body. Discussion: We did not find evidence for biased approach‐avoidance tendencies toward food or body stimuli in individuals with AN or BN. Future studies are necessary to understand conflicting findings regarding approach‐avoidance biases toward food and body stimuli in individuals with ED. [ABSTRACT FROM AUTHOR]

The current study aimed to investigate the discrepancy between self‐reported and peer‐reported likeability among children, and the relation with social anxiety, depression, and social support. In total, 532 children between 7 and 12 years completed questionnaires about social anxiety symptoms, depressive symptoms, and social support, estimated their own likeability, and indicated how much they liked their classmates. Children with higher levels of social anxiety or depression overestimated their likeability less or even underestimated their likeability. Social anxiety symptoms, but not depressive symptoms, were significant predictors of the discrepancy. Social support was positively related to likeability and negatively related to social anxiety, but did not moderate the association between social anxiety symptoms and perception accuracy of likeability. These results are in line with cognitive theories of childhood social anxiety, and they stress the importance of using multi‐informant measures when studying the relation between social anxiety and social functioning in children. [ABSTRACT FROM AUTHOR]

In this study we investigated the effects of seeking versus avoiding proximity to mother on children's emotional recovery from a stressor. Sixty children 9–12 years underwent a moodinduction procedure and were randomly assigned to seek proximity from or avoid an image of their mothers. The effect of this manipulation on children's self‐reported negative emotions, skin conductance and heart rate variability (respiratory sinus arhythmia) was assessed. Higher levels of attachment anxiety were linked to more self‐reported sadness when children had to avoid mother, but no evidence for such an effect was found on a physiological level. For avoidant attachment, a similar pattern of results emerged, but both for self‐reported sadness and skin conductance. [ABSTRACT FROM AUTHOR]

Summary: This study evaluated the efficacy of approach–avoidance training as an additional treatment for children and adolescents with obesity seeking inpatient treatment. Two hundred thirty‐two participants (8–16 years, 53.9% girls) were randomly assigned either to multisession approach–avoidance (IG) or to placebo training (CG). As outcomes, cognitive biases post intervention, body mass index, eating behaviour, food intake, self‐regulation, and weight‐related quality of life were assessed, also at 6‐ and 12‐month follow‐up. Modification of approach–avoidance bias was observed, but lacked in transfer over sessions and in generalization to attention and association bias. After 6 months, the IG reported less “problematic” food consumption, higher self‐regulation, and higher quality of life; effects did not persist until the 12‐month follow‐up; no significant interaction effects were observed regarding weight course. Despite there was no direct effect on weight course, approach–avoidance training seems to be associated with promising effects on important pillars for weight loss. Further research concerning clinical effectiveness is warranted. [ABSTRACT FROM AUTHOR]

Background To examine the applicability of an alcohol-avoidance training procedure in patients with alcohol dependence and alcohol-induced neurocognitive disorders (NDs), we trained 2 groups that differed in the degree of cognitive impairment: One group fulfilled the DSM-5 criteria for alcohol-induced mild ND, and 1 group was diagnosed with Korsakoff's syndrome (KS) (alcohol-induced major ND, confabulatory/amnesic subtype; DSM-5). The intervention is assumed to match the preserved cognitive capacity for implicit learning in both groups. Methods Fifty-one inpatients with a mild ND and 54 inpatients with KS were trained. Six training sessions (including pre- and posttests) of a computerized implicit alcohol approach-avoidance task were applied. Neurocognitive variables were available from the standard assessment procedure of the clinic. Results Training of alcohol-avoidance tendencies is feasible in a population with alcohol-related NDs. The alcohol-approach bias decreased for both groups in each session. Better learning results over time were obtained in participants with a larger baseline alcohol-approach tendency. Learning effects were positively related to age and implicit (nondeclarative) memory functioning. No relation between training effects and executive or explicit memory functions was found. Conclusions Training of an alcohol-avoidance tendency can be successfully applied in patients with alcohol dependence including those with alcohol-induced NDs. [ABSTRACT FROM AUTHOR]

Two studies showed an improvement in clinical outcomes after alcohol approach bias retraining, a form of Cognitive Bias Modification (CBM). We investigated whether transcranial direct current stimulation (tDCS) could enhance effects of CBM. TDCS is a neuromodulation technique that can increase neuroplasticity and has previously been found to reduce craving. One hundred alcohol-dependent inpatients (91 used for analysis) were randomized into three experimental groups in a double-blind parallel design. The experimental group received four sessions of CBM while receiving 2 mA of anodal tDCS over the dorsolateral prefrontal cortex (DLPFC). There were two control groups: One received sham stimulation during training and one received active stimulation at a different moment. Treatment outcomes were abstinence duration (primary) and relapse after 3 and 12 months, craving and approach bias (secondary). Craving and approach bias scores decreased over time; there were no significant interactions with experimental condition. There was no effect on abstinence duration after three months (χ2(2) = 3.53, p = 0.77). However, a logistic regression on relapse rates after one year (standard outcome in the clinic, but not-preregistered) showed a trend when relevant predictors were included; relapse was lower in the condition receiving active stimulation during CBM only when comparing to sham stimulation (B = 1.52, S.E. = .836, p = .07, without predictors: p = .19). No strong evidence for a specific enhancement effect of tDCS on CBM was found. However, in a post-hoc analysis, tDCS combined with CBM showed a promising trend on treatment outcome. Important limitations are discussed, and replication is necessary to find more reliable effects. [ABSTRACT FROM AUTHOR]

Individuals with aggression regulation disorders tend to attribute hostility to others in socially ambiguous situations. Previous research suggests that this "hostile attribution bias" is a powerful cause of aggression. Facial expressions form important cues in the appreciation of others' intentions. Furthermore, accurate processing of facial expressions is fundamental to normal socialization. However, research on interpretation biases in facial affect is limited. It is asserted that a hostile interpretation bias (HIB) is likely to be displayed by individuals with an antisocial (ASPD) and borderline personality disorder (BPD) and probably also with an intermittent explosive disorder (IED). However, there is little knowledge to what extent this bias is displayed by each of these patient groups. The present study investigated whether a HIB regarding emotional facial expressions was displayed by forensic psychiatric outpatients (FPOs) and whether it was associated with ASPD and BPD in general or, more specifically, with a disposition to react with pathological aggression. Participants of five different groups were recruited: FPOs with ASPD, BPD, or IED, non-forensic patients with BPD (nFPOs-BPD), and healthy, non-aggressive controls (HCs). Results suggest that solely FPOs with ASPD, BPD, or IED exhibit a HIB regarding emotional facial expressions. Moreover, this bias was associated with type and severity of aggression, trait aggression, and cognitive distortions. The results suggest that a HIB regarding facial expressions is an important characteristic of pathological aggressive behavior. Interventions that modify the HIB might help to reduce the recurrence of aggression. Aggr. Behav. 43:386-397, 2017. © 2017 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Alcohol-dependent patients have been shown to faster approach than avoid alcohol stimuli on the Approach Avoidance Task ( AAT). This so-called alcohol approach bias has been associated with increased brain activation in the medial prefrontal cortex and nucleus accumbens. Cognitive bias modification ( CBM) has been used to retrain the approach bias with the clinically relevant effect of decreasing relapse rates one year later. The effects of CBM on neural signatures of approach/avoidance tendencies remain hitherto unknown. In a double-blind placebo-controlled design, 26 alcohol-dependent in-patients were assigned to a CBM or a placebo training group. Both groups performed the AAT for three weeks: in CBM training, patients pushed away 90 percent of alcohol cues; this rate was 50 percent in placebo training. Before and after training, patients performed the AAT offline, and in a 3 T magnetic resonance imaging scanner. The relevant neuroimaging contrast for the alcohol approach bias was the difference between approaching versus avoiding alcohol cues relative to soft drink cues: [(alcohol pull > alcohol push) > (soft drink pull > soft drink push)]. Before training, both groups showed significant alcohol approach bias-related activation in the medial prefrontal cortex. After training, patients in the CBM group showed stronger reductions in medial prefrontal cortex activation compared with the placebo group. Moreover, these reductions correlated with reductions in approach bias scores in the CBM group only. This suggests that CBM affects neural mechanisms involved in the automatic alcohol approach bias, which may be important for the clinical effectiveness of CBM. [ABSTRACT FROM AUTHOR]

Background Cognitive bias modification ( CBM) studies have provided evidence that cognitive biases play a causal role in alcohol use disorders. In this study, data from a CBM experiment in alcoholic patients were re-analyzed. In the original study, no mediation by associations measured with an Implicit Association Test (IAT) was found. In this study, we explored the possibility that relevant alcohol-related automatic processes may be cue-specific. Methods Data from a previous clinical study in a sample of 214 alcohol-addicted patients were re-analyzed. Patients were assigned to a CBM intervention or control condition, performed an alcohol-approach IAT, and were followed up for relapse data a year after training. In this study, bias scores measured via the IAT were calculated and analyzed separately for different stimulus categories: Alcohol, Soft drink, Approach, and Avoid. Results Training reversed the alcohol-approach bias for all categories. This reversal of bias also predicted reduced relapse, but involved a complex stimulus category-dependent pattern in which an avoidance bias for Alcohol stimuli was most predictive of reduced relapse. Conclusions The results contribute to evidence that CBM indeed affects relapse probability via changes in automatic processes, although future study is needed to determine the precise nature of mediating processes. Automatic processes underlying alcohol-related associations may be stimulus-specific, which may be important for the methods of future studies involving implicit measures. [ABSTRACT FROM AUTHOR]

Background Models of addictive behaviors postulate that implicit alcohol-related memory associations and biased interpretation processes contribute to the development and maintenance of alcohol misuse and abuse. The present study examined whether alcohol-dependent patients ( AP) show an alcohol-related interpretation bias. Second, the relationship between the interpretation bias and levels of harmful drinking was investigated. Methods The sample included 125 clinically diagnosed AP and 69 clinically diagnosed control patients (CP) who had either a mood or an anxiety disorder. Participants completed a booklet containing 12 open-ended ambiguous scenarios. Seven scenarios were alcohol-relevant, and 5 were emotionally relevant, that is, panic- or depression-relevant. Participants were asked to read each scenario and to generate a continuation. In addition, the Alcohol Use Disorder Identification Test ( AUDIT) and Beck Depression Inventory were administered. Results Logistic multivariate multilevel analyses revealed that AP' probability of generating an alcohol-related continuation on all 3 scenario types was higher than that of CP. Moreover, alcohol-related interpretation biases were positively associated with levels of harmful drinking (i.e., AUDIT scores). Conclusions These findings are the first to show that AP show an alcohol-related interpretation bias, which generalizes to other ambiguous emotionally relevant contexts, and therefore advance our understanding of the role of implicit biased alcohol-related memory associations and interpretation processes. [ABSTRACT FROM AUTHOR]

Background Computerized cognitive bias modification ( CBM) programs have generated promising results regarding the treatment of alcohol dependence and anxiety disorders. However, there is hardly any research yet on the implementation of alcohol- CBM into clinical practice. This article addresses the question of the optimal number of training sessions for a specific form of CBM: approach bias re-training in alcohol-dependent patients. Methods Participants were 111 alcohol-dependent patients of an inpatient rehabilitation clinic. In addition to treatment as usual, they took part in a 12-session CBM protocol, aimed at re-training alcohol approach tendencies, with an adapted Alcohol Approach-Avoidance Task. Learning curves and 2-level fitted mean trends were analyzed. Furthermore, parameters of the fitted mean trend and information on the most effective number of training sessions were used to predict 1-year follow-up data. Results Two-level analyses revealed 6 training sessions to be the mean optimum, yet many patients improve further after that. Prediction of the individual optimum (speed of response) and parameters of the fitted mean trends failed. The linear term of the graph describing the mean trend of training effects, but not the speed of response, predicted 1-year follow-up data. Conclusions Suggestions for practical implementations of CBM are discussed. [ABSTRACT FROM AUTHOR]

Cognitive bias modification (CBM) studies suggest a causal role of interpretation biases in the aetiology and maintenance of Social Anxiety Disorder. However, it is unknown if the effects of induced biases transfer to behaviour. In two analogue studies, behavioural changes in response to aversive and positive stimuli were measured after the induction of positive and negative interpretation biases in ‘averagely anxious’ participants. Responses to emotional multi-facial displays (‘crowds’) were measured using an indirect Approach–Avoidance Task (AAT). The crowds comprised different ratios of either neutral and angry faces or happy and angry faces. In Experiment 1, negatively trained participants (NETs) showed a faster avoidance response for the neutral–angry crowds when the number of angry pictures in the crowd increased. This response pattern resembles the one previously found in socially anxious individuals. Experiment 2 replicated the effect of the cognitive bias manipulation on conceptually comparable material, but did not show transfer to the behavioural task. These studies add to the body of knowledge regarding successful modification of interpretive bias and generalizability to a behavioural task. Copyright © 2010 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Aims The main aim of this study was to test whether automatic action-tendencies to approach alcohol can be modified, and whether this affects drinking behaviour. Design and participants Forty-two hazardous drinkers were assigned randomly to a condition in which they were implicitly trained to avoid or to approach alcohol, using a training variety of the alcohol Approach Avoidance Test (AAT). Participants pushed or pulled a joystick in response to picture-format (landscape or portrait). The pictures depicted alcoholic or non-alcoholic drinks. Participants in the avoid-alcohol condition pushed most alcoholic and pulled most non-alcoholic drinks. For participants in the approach-alcohol condition these contingencies were reversed. After the implicit training, participants performed a taste test, including beers and soft drinks. Automatic action tendencies at post-test were assessed with the AAT, including both trained and untrained pictures, and with a different test (Implicit Association Test, IAT). We further tested effects on subjective craving. Results Action tendencies for alcohol changed in accordance with training condition, with the largest effects in the clinically relevant avoid-alcohol condition. These effects occurred outside subjective awareness and generalized to new pictures in the AAT and to an entirely different test using words, rather than pictures (IAT). In relatively heavy drinking participants who demonstrated changed action tendencies in accordance with their training condition, effects were found on drinking behaviour, with participants in the approach-alcohol condition drinking more alcohol than participants in the avoid-alcohol condition. No effect was found on subjective craving. Conclusions Retraining automatic processes may help to regain control over addictive impulses, which points to new treatment possibilities. [ABSTRACT FROM AUTHOR]

Memory for the layout of the ten digits 0 to 9 on the keypads of push-button telephones and calculators was investigated in five experiments. Experiments 1 and 2 revealed that, despite frequent usage of these devices, free recall of the numerical layouts is quite poor; and that the layout on calculators is even harder to recall than the telephone layout. Experiment 4 showed that the same is true for recognition of the layouts. Experiment 3 revealed that part of the recall advantage of the telephone layout can be attributed to its being more plausible and more similar to a schematic or prototypical layout of digits. Experiment 5 indicated that a single case of directing attention to the layouts can enhance recall significantly. The results are integrated into earlier research on memory for everyday objects, and concepts used in laboratory memory research such as interference, inference, and attention are used to explain memory for these everyday objects. Copyright © 1999 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Two studies showed an improvement in clinical outcomes after alcohol approach bias retraining, a form of Cognitive Bias Modification (CBM). We investigated whether transcranial direct current stimulation (tDCS) could enhance effects of CBM. TDCS is a neuromodulation technique that can increase neuroplasticity and has previously been found to reduce craving. One hundred alcohol-dependent inpatients (91 used for analysis) were randomized into three experimental groups in a double-blind parallel design. The experimental group received four sessions of CBM while receiving 2 mA of anodal tDCS over the dorsolateral prefrontal cortex (DLPFC). There were two control groups: One received sham stimulation during training and one received active stimulation at a different moment. Treatment outcomes were abstinence duration (primary) and relapse after 3 and 12 months, craving and approach bias (secondary). Craving and approach bias scores decreased over time; there were no significant interactions with experimental condition. There was no effect on abstinence duration after three months (χ2(2) = 3.53, p = 0.77). However, a logistic regression on relapse rates after one year (standard outcome in the clinic, but not-preregistered) showed a trend when relevant predictors were included; relapse was lower in the condition receiving active stimulation during CBM only when comparing to sham stimulation (B = 1.52, S.E. = .836, p = .07, without predictors: p = .19). No strong evidence for a specific enhancement effect of tDCS on CBM was found. However, in a post-hoc analysis, tDCS combined with CBM showed a promising trend on treatment outcome. Important limitations are discussed, and replication is necessary to find more reliable effects., (© 2016 Society for the Study of Addiction.)