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  • 1.
    Adams, Sally
    et al.
    Univ Bristol, Sch Expt Psychol, Bristol BS8 1TU, Avon, England.
    Penton-Voak, Ian S.
    Univ Bristol, Sch Expt Psychol, Bristol BS8 1TU, Avon, England.
    Harmer, Catherine J.
    Univ Oxford, Warneford Hosp, Dept Psychiat, Oxford OX3 7JX, England.
    Holmes, Emily A.
    MRC Cognit & Brain Sci Unit, Cambridge CB2 7EF, England.
    Munafo, Marcus R.
    Univ Bristol, Sch Expt Psychol, Bristol BS8 1TU, Avon, England.
    Effects of emotion recognition training on mood among individuals with high levels of depressive symptoms: study protocol for a randomised controlled trial2013In: Trials, ISSN 1745-6215, E-ISSN 1745-6215, Vol. 14, article id 161Article in journal (Refereed)
    Abstract [en]

    Background: We have developed a new paradigm that targets the recognition of facial expression of emotions. Here we report the protocol of a randomised controlled trial of the effects of emotion recognition training on mood in a sample of individuals with depressive symptoms over a 6-week follow-up period. Methods/Design: We will recruit 190 adults from the general population who report high levels of depressive symptoms (defined as a score >= 14 on the Beck Depression Inventory-II). Participants will attend a screening session and will be randomised to intervention or control procedures, repeated five times over consecutive days (Monday to Friday). A follow-up session will take place at end-of -treatment, 2-weeks and 6-weeks after training. Our primary study outcome will be depressive symptoms, Beck Depression Inventory- II (rated over the past two weeks). Our secondary outcomes are: depressive symptoms, Hamilton Rating Scale for Depression; anxiety symptoms, Beck Anxiety Inventory (rated over the past month); positive affect, Positive and Negative Affect Schedule (rated as 'how you feel right now'); negative affect, Positive and Negative Affect Schedule (rated as 'how you feel right now'); emotion sensitivity, Emotion Recognition Task (test phase); approach motivation and persistence, the Fishing Game; and depressive interpretation bias, Scrambled Sentences Test. Discussion: This study is of a novel cognitive bias modification technique that targets biases in emotional processing characteristic of depression, and can be delivered automatically via computer, Internet or Smartphone. It therefore has potential to be a valuable cost-effective adjunctive treatment for depression which may be used together with more traditional psychotherapy, cognitive-behavioural therapy and pharmacotherapy.

  • 2.
    Browning, Michael
    et al.
    Univ Oxford, Dept Psychiat, Oxford OX3 7JX, England.
    Grol, Maud
    Univ Oxford, Dept Psychiat, Oxford OX3 7JX, England.
    Ly, Verena
    Univ Oxford, Dept Psychiat, Oxford OX3 7JX, England.
    Goodwin, Guy M.
    Univ Oxford, Dept Psychiat, Oxford OX3 7JX, England.
    Holmes, Emily A.
    Univ Oxford, Dept Psychiat, Oxford OX3 7JX, England.
    Harmer, Catherine J.
    Univ Oxford, Dept Psychiat, Oxford OX3 7JX, England.
    Using an Experimental Medicine Model to Explore Combination Effects of Pharmacological and Cognitive Interventions for Depression and Anxiety2011In: Neuropsychopharmacology, ISSN 0893-133X, E-ISSN 1740-634X, Vol. 36, no 13, p. 2689-2697Article in journal (Refereed)
    Abstract [en]

    Selective serotonergic reuptake inhibitors (SSRIs) and cognitive therapies are effective in the treatment of anxiety and depression. Previous research suggests that both forms of treatments may work by altering cognitive biases in the processing of affective information. The current study assessed the effects of combining an SSRI with a cognitive intervention on measures of affective processing bias and resilience to external challenge. A total of 62 healthy participants were randomly assigned to receive either 7 days of citalopram (20 mg) or placebo capsules while also completing either an active or a control version of a computerized cognitive bias training task. After treatment, standard measures of affective processing bias were collected. Participants' resilience to external stress was also tested by measuring the increase in negative symptoms induced by a negative mood induction. Participants who received both citalopram and the active cognitive bias training task showed a smaller alteration in emotional memory and categorization bias than did those who received either active intervention singly. The degree to which memory for negative information was altered by citalopram predicted participants' resistance to the negative mood induction. These results suggest that co-administration of an SSRI and a cognitive training intervention can reduce the effectiveness of either treatment alone in terms of anxiety-and depression-relevant emotional processing. More generally, the findings suggest that pinpointing the cognitive actions of treatments may inform future development of combination strategies in mental health. Neuropsychopharmacology (2011) 36, 2689-2697; doi: 10.1038/npp.2011.159; published online 10 August 2011

  • 3.
    Browning, Michael
    et al.
    Univ Oxford, Dept Psychiat, Oxford OX1 2JD, England.
    Holmes, Emily A.
    Univ Oxford, Dept Psychiat, Oxford OX1 2JD, England.
    Charles, Matthew
    UCL, Res Dept Clin Educ & Hlth Psychol, London WC1E 6BT, England.
    Cowen, Philip J.
    Univ Oxford, Dept Psychiat, Oxford OX1 2JD, England.
    Harmer, Catherine J.
    Univ Oxford, Dept Psychiat, Oxford OX1 2JD, England.
    Using Attentional Bias Modification as a Cognitive Vaccine Against Depression2012In: Biological Psychiatry, ISSN 0006-3223, E-ISSN 1873-2402, Vol. 72, no 7, p. 572-579Article in journal (Refereed)
    Abstract [en]

    Background: Negative attentional biases are thought to increase the risk of recurrence in depression, suggesting that reduction of such biases may be a plausible strategy in the secondary prevention of the illness. However, no previous study has tested whether reducing negative attentional bias causally affects risk factors for depressive recurrence. The current experimental medicine study reports the effects of a computerized attentional bias modification (ABM) procedure on intermediate measures of the risk of depressive recurrence (residual depressive symptoms and the cortisol awakening response) in patients with recurrent depression. Methods: Sixty-one patients with at least two previous episodes of depression who were currently in remission were randomized to receive either an active (positive) or placebo computer-based ABM regime. The ABM regime presented either pictures of faces or words. Residual depressive symptoms, measured using the Beck Depression Inventory and the cortisol awakening response were measured immediately before and after completion of the bias modification and then again after 4 weeks' follow-up. Results: Positive, face-based ABM reduced both measures of recurrence risk (Beck Depression Inventory and cortisol awakening response). This effect occurred during the month following completion of bias modification. Word-based modification did not influence the outcome measures. Conclusions: Positive face-based ABM was able to reduce intermediate measures of recurrence risk in previously depressed patients. These results suggest that ABM may provide a "cognitive vaccine" against depression and offer a useful strategy in the secondary prevention of the illness.

  • 4.
    Browning, Michael
    et al.
    Univ Oxford, Oxford OX3 7JX, England.
    Holmes, Emily A.
    Univ Oxford, Oxford OX3 7JX, England.
    Harmer, Catherine J.
    Univ Oxford, Oxford OX3 7JX, England.
    The modification of attentional bias to emotional information: A review of the techniques, mechanisms, and relevance to emotional disorders2010In: Cognitive, Affective, & Behavioral Neuroscience, ISSN 1530-7026, E-ISSN 1531-135X, Vol. 10, no 1, p. 8-20Article in journal (Refereed)
    Abstract [en]

    A negative bias in the deployment of attention to emotional stimuli is commonly found in both anxiety and depression. Recent work has highlighted that such biases are causally related to emotional vulnerability, suggesting that interventions that ameliorate them may be therapeutic. Here, we review the evidence that attentional bias can be modified using both pharmacological and psychological interventions. We highlight the behavioral and neuroimaging studies that suggest that these interventions impact upon attention via alteration of distinct neural mechanisms. Specifically, pharmacological interventions appear to influence the initial deployment of attention via an effect on the amygdala-based stimulus appraisal system, whereas psychological interventions influence attention at later time points and may alter activity in the lateral prefrontal cortex. Finally, we suggest a conceptual framework that embraces both pharmacological and psychological approaches and consider the possible implications of this work for future research and treatment development.

  • 5.
    Browning, Michael
    et al.
    Univ Oxford, Warneford Hosp, Dept Psychiat, Oxford OX3 7JX, England.
    Holmes, Emily A.
    Univ Oxford, Warneford Hosp, Dept Psychiat, Oxford OX3 7JX, England.
    Murphy, Susannah E.
    Univ Oxford, Warneford Hosp, Dept Psychiat, Oxford OX3 7JX, England.
    Goodwin, Guy M.
    Univ Oxford, Warneford Hosp, Dept Psychiat, Oxford OX3 7JX, England.
    Harmer, Catherine J.
    Univ Oxford, Warneford Hosp, Dept Psychiat, Oxford OX3 7JX, England.
    Lateral Prefrontal Cortex Mediates the Cognitive Modification of Attentional Bias2010In: Biological Psychiatry, ISSN 0006-3223, E-ISSN 1873-2402, Vol. 67, no 10, p. 919-925Article in journal (Refereed)
    Abstract [en]

    Background: A tendency to orient attention toward threatening stimuli may be involved in the etiology of anxiety disorders. In keeping with this, both psychological and pharmacological treatments of anxiety reduce this negative attentional bias. It has been hypothesized, but not proved, that psychological interventions may alter the function of prefrontal regions supervising the allocation of attentional resources. Methods: The current study examined the effects of a cognitive training regime on attention. Participants were randomly assigned to one of two training conditions: "attend-threat" training, which increases negative attentional bias, or "avoid-threat" training, which reduces it. The behavioral effects of training were assessed using a sample of 24 healthy participants. Functional magnetic resonance imaging data were collected in a further 29 healthy volunteers using a protocol that allowed the influence of both stimuli valence and attention to be discriminated. Results: Cognitive training induced the expected attentional biases in healthy volunteers. Further, the training altered lateral frontal activation to emotional stimuli, with these areas responding specifically to violations of the behavioral rules learned during training. Connectivity analysis confirmed that the identified lateral frontal regions were influencing attention as indexed by activity in visual association cortex. Conclusions: Our results indicate that frontal control over the processing of emotional stimuli may be tuned by psychological interventions in a manner predicted to regulate levels of anxiety. This directly supports the proposal that psychological interventions may influence attention via an effect on the prefrontal cortex.

  • 6.
    Lang, Tamara J.
    et al.
    Univ Oxford, Dept Psychiat, Oxford OX3 7JX, England.
    Blackwell, Simon E.
    Univ Oxford, Dept Psychiat, Oxford OX3 7JX, England.
    Harmer, Catherine J.
    Univ Oxford, Dept Psychiat, Oxford OX3 7JX, England.
    Davison, Phil
    Univ Oxford, Dept Psychiat, Oxford OX3 7JX, England.
    Holmes, Emily A.
    Univ Oxford, Dept Psychiat, Oxford OX3 7JX, England.
    Cognitive Bias Modification Using Mental Imagery for Depression: Developing a Novel Computerized Intervention to Change Negative Thinking Styles2012In: European Journal of Personality, ISSN 0890-2070, E-ISSN 1099-0984, Vol. 26, no 2, p. 145-157Article in journal (Refereed)
    Abstract [en]

    Why do some people see their glass as half-empty rather than half-full or even imagine that the glass will be filled in the future? Experimental methods can illuminate how individual differences in information processing style can profoundly impact mood or even result in disorders such as depression. A computerized cognitive bias modification intervention targeting interpretation bias in depression via positive mental imagery (CBM-I) was evaluated by investigating its impact on mental health and cognitive bias compared with a control condition. Twenty-six depressed individuals completed either positive imagery-focussed CBM-I or a control condition daily at home over one week. Outcome measures were collected pre-treatment and post-treatment and at two-week follow-up. Individuals in the positive condition demonstrated significant improvements from pre-treatment to post-treatment in depressive symptoms, cognitive bias and intrusive symptoms compared with the control condition. Improvements in depressive symptoms at two-week follow-up were at trend level. The results of this first controlled comparison of positive imagery-focussed CBM-I for depression further support the clinical potential of CBM-I and the development of a novel computerized treatment that could help patients imagine a more positive future. Broader implications concern the modification of individual differences in personality variables via their interaction with key information processing targets. Copyright (C) 2011 John Wiley & Sons, Ltd.

  • 7.
    Woud, Marcella L.
    et al.
    Ruhr Univ Bochum, Dept Psychol, Bochum, Germany.
    Blackwell, Simon E.
    Ruhr Univ Bochum, Dept Psychol, Bochum, Germany.
    Steudte-Schmiedgen, Susann
    Tech Univ Dresden, Dept Psychol, Dresden, Germany.
    Browning, Michael
    Univ Oxford, Dept Psychiat, Oxford, England.
    Holmes, Emily A.
    Karolinska Inst, Div Psychol, Dept Clin Neurosci, Stockholm, Sweden.
    Harmer, Catherine J.
    Univ Oxford, Dept Psychiat, Oxford, England.
    Margraf, Juergen
    Ruhr Univ Bochum, Dept Psychol, Bochum, Germany.
    Reinecke, Andrea
    Univ Oxford, Dept Psychiat, Oxford, England.
    Investigating d-cycloserine as a potential pharmacological enhancer of an emotional bias learning procedure2018In: Journal of Psychopharmacology, ISSN 0269-8811, E-ISSN 1461-7285, Vol. 32, no 5, p. 569-577Article in journal (Refereed)
    Abstract [en]

    The partial N-methyl-D-aspartate receptor agonist d-cycloserine may enhance psychological therapies. However, its exact mechanism of action is still being investigated. Cognitive bias modification techniques allow isolation of cognitive processes and thus investigation of how they may be affected by d-cycloserine. We used a cognitive bias modification paradigm targeting appraisals of a stressful event, Cognitive Bias Modification-Appraisal, to investigate whether d-cycloserine enhanced the modification of appraisal, and whether it caused greater reduction in indices of psychopathology. Participants received either 250 mg of d-cycloserine (n=19) or placebo (n=19). As a stressor task, participants recalled a negative life event, followed by positive Cognitive Bias Modification-Appraisal training. Before and after Cognitive Bias Modification-Appraisal, appraisals and indices of psychopathology related to the stressor were assessed. Cognitive Bias Modification-Appraisal successfully modified appraisals, but d-cycloserine did not affect appraisals post-training. There were no post-training group differences in frequency of intrusions. Interestingly, d-cycloserine led to a greater reduction in distress and impact on state mood from recalling the event, and lower distress post-training was associated with fewer intrusions. Therefore, d-cycloserine may affect emotional reactivity to recalling a negative event when combined with induction of a positive appraisal style, but via a mechanism other than enhanced learning of the appraisal style.

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