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      Imagine the bright side of life: A randomized controlled trial of two types of interpretation bias modification procedure targeting adolescent anxiety and depression

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          Abstract

          Introduction

          Anxiety and depression are highly prevalent during adolescence and characterized by negative interpretation biases. Cognitive bias modification of interpretations (CBM-I) may reduce such biases and improve emotional functioning. However, as findings have been mixed and the traditional scenario training is experienced as relatively boring, a picture-based type of training might be more engaging and effective.

          Methods

          The current study investigated short- and long-term effects (up to 6 months) and users’ experience of two types of CBM-I procedure in adolescents with heightened symptoms of anxiety or depression (N = 119, aged 12–18 year). Participants were randomized to eight online sessions of text-based scenario training, picture-word imagery training, or neutral control training.

          Results

          No significant group differences were observed on primary or secondary emotional outcomes. A decrease in anxiety and depressive symptoms, and improvements in emotional resilience were observed, irrespective of condition. Scenario training marginally reduced negative interpretation bias on a closely matched assessment task, while no such effects were found on a different task, nor for the picture-word or control group. Subjective evaluations of all training paradigms were relatively negative and the imagery component appeared particularly difficult for adolescents with higher symptom levels.

          Conclusions

          The current results question the preventive efficacy and feasibility of both CBM-I procedures as implemented here in adolescents.

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          Most cited references 53

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          “The measurement of self-esteem,” in

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            Mental imagery in emotion and emotional disorders.

            Mental imagery has been considered relevant to psychopathology due to its supposed special relationship with emotion, although evidence for this assumption has been conspicuously lacking. The present review is divided into four main sections: (1) First, we review evidence that imagery can evoke emotion in at least three ways: a direct influence on emotional systems in the brain that are responsive to sensory signals; overlap between processes involved in mental imagery and perception which can lead to responding "as if" to real emotion-arousing events; and the capacity of images to make contact with memories for emotional episodes in the past. (2) Second, we describe new evidence confirming that imagery does indeed evoke greater emotional responses than verbal representation, although the extent of emotional response depends on the image perspective adopted. (3) Third, a heuristic model is presented that contrasts the generation of language-based representations with imagery and offers an account of their differing effects on emotion, beliefs and behavior. (4) Finally, based on the foregoing review, we discuss the role of imagery in maintaining emotional disorders, and its uses in psychological treatment. Copyright 2010 Elsevier Ltd. All rights reserved.
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              Induced emotional interpretation bias and anxiety.

              Five experiments are reported showing that the interpretation of personally relevant emotional information can be modified by systematic exposure to congruent exemplars. Participants were induced to interpret ambiguous information in a relatively threatening or a benign way. Comparison with a baseline condition suggested that negative and positive induction had similar but opposing effects. Induction of an interpretative bias did not require active generation of personally relevant meanings, but such active processing was necessary before state anxiety changed in parallel with the induced interpretative bias. These findings provide evidence consistent with a causal link between the deployment of interpretative bias and anxiety and reveal something of the processes underlying this association.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: Project administrationRole: ResourcesRole: SupervisionRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: InvestigationRole: MethodologyRole: ResourcesRole: SupervisionRole: VisualizationRole: Writing – review & editing
                Role: ConceptualizationRole: MethodologyRole: ResourcesRole: Writing – review & editing
                Role: ConceptualizationRole: MethodologyRole: ResourcesRole: Writing – review & editing
                Role: ConceptualizationRole: SupervisionRole: Writing – review & editing
                Role: ConceptualizationRole: Funding acquisitionRole: MethodologyRole: Project administrationRole: ResourcesRole: SupervisionRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                17 July 2017
                2017
                : 12
                : 7
                Affiliations
                [1 ] Department of Developmental Psychology, University of Amsterdam, Amsterdam, The Netherlands
                [2 ] Department of Psychology and Educational Sciences, Open University, Zwolle, The Netherlands
                [3 ] School of Psychology, University of Birmingham, Birmingham, United Kingdom
                [4 ] MRC Cognition & Brain Sciences Unit, Cambridge, United Kingdom
                [5 ] Mental Health Research and Treatment Center, Ruhr-Universität Bochum, Bochum, Germany
                TNO, NETHERLANDS
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                [¤]

                Current address: Department of Sociology, University of Amsterdam, Amsterdam, The Netherlands

                Article
                PONE-D-17-11401
                10.1371/journal.pone.0181147
                5513454
                28715495
                © 2017 de Voogd et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                Page count
                Figures: 2, Tables: 7, Pages: 24
                Product
                Funding
                Funded by: funder-id http://dx.doi.org/10.13039/501100001826, ZonMw;
                Award ID: 200210010
                Award Recipient : Leone de Voogd
                This study was funded by a grant from the Netherlands Organisation for Health Research and Development, ZonMW (grant number 200210010). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                Biology and Life Sciences
                Psychology
                Emotions
                Anxiety
                Social Sciences
                Psychology
                Emotions
                Anxiety
                People and Places
                Population Groupings
                Age Groups
                Adolescents
                Research and Analysis Methods
                Research Design
                Survey Research
                Questionnaires
                Biology and Life Sciences
                Psychology
                Psychometrics
                Social Sciences
                Psychology
                Psychometrics
                Medicine and Health Sciences
                Mental Health and Psychiatry
                Mood Disorders
                Depression
                Medicine and Health Sciences
                Mental Health and Psychiatry
                Psychological Stress
                Biology and Life Sciences
                Psychology
                Psychological Stress
                Social Sciences
                Psychology
                Psychological Stress
                Biology and Life Sciences
                Behavior
                Social Sciences
                Sociology
                Education
                Schools
                Custom metadata
                All relevant data files can be found at: https://osf.io/4gtmh/?view_only=383e5de7cbbe45828af120faea345359.

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