Depression is a global problem, causing disability and economic burden. Many people currently do not obtain treatment. Development of more accessible, cost-effective treatments is essential. An identified mechanism by which depression treatments work is through modifying underlying negative cognitive biases, which mediate changes in mood. A specific negative information-processing bias in depression is a tendency to interpret ambiguous facial expressions as sad rather than happy. The emotion recognition task is a treatment paradigm developed as a cognitive bias modification intervention to target this emotion recognition bias. Previous studies showed promising signs that this novel intervention could modify biases in people with low mood outside of laboratory conditions and potential to increase positive affect within laboratory conditions. The current study built on these developments, aiming to investigate, using a randomised controlled trial with follow-up at 2 and 6 weeks, whether a web-based version of the emotion recognition task could reduce depressive symptoms in addition to modifying emotion recognition biases. An analogue sample of 124 participants with low mood was recruited. Evidence was found that the intervention modified participants’ biases, compared to the control group but there was no evidence of improvement in mood. Study limitations included a high rate of attrition and non-adherence to the intervention. Future recommendations include modifying the intervention to increase acceptability, investigating generalizability of increased positive bias to different stimuli, and identifying consistent reductions in symptoms of depression before examining its efficacy with a clinical population.

The purpose of the present study was to determine whether computer-based cognitive bias modification (CBM) procedures could alter appraisal style toward viewing events from a big picture perspective and thereby influence emotional reactivity. Big picture appraisal entails viewing difficult situations and one's reactions to them in terms of a larger context. Appraisal training was implicit in that participants completed a series of vignettes, framed as a reading comprehension task, which trained either a big picture perspective or a personal/evaluative focus. When subsequently confronted with novel vignettes, participants produced interpretations that were consistent with assigned training condition. In addition, participants trained in big picture as compared to personal/evaluative appraisal subsequently demonstrated less emotional reactivity to a stressful task. / text

Objectives: This study sought to determine whether a computerised cognitive bias modification programme could be effective within a waiting-room setting for parents accompanying their children to CAMHS appointments. The primary objectives were to determine whether detectable changes to participants' emotion recognition could be observed in this setting, and whether this approach would be acceptable to the population. Secondary measures investigated whether the programme would lead to changes in participants' affect or changes in parents' appraisals of difficulties with children. Methods: A computerised emotion recognition training task was delivered to all participants during four weekly sessions. Participants in the experimental condition (n=17) received feedback aiming to shift their detection of positive facial emotions, while those in the control condition (n=14) received feedback which was not designed to elicit any shift in emotion detection. Results: Positive shifts in emotion recognition were observed in the experimental group, although no changes were observed in secondary measures in either control or experimental groups. Qualitative data indicated that the programme was acceptable and appropriately constructed. Conclusion: This study demonstrates that cognitive bias modification is possible within a waiting-room setting, although the extent to which this can lead to clinically significant improvements in mood or relationships remains uncertain. This work has implications for emotion recognition interventions for clinical populations known to present with negative emotional biases (e.g. anxiety and depression) and represents an important first research step towards developing interventions to improve parent-child relationships.

The overarching aim of this thesis was to contribute towards the translation of a laboratory paradigm into a clinical intervention: that is, to develop a positive Cognitive Bias Modification (CBM) technique using mental imagery into an internet-based computerized intervention for people with clinical depression. Preliminary studies using an imagery-based CBM to modify interpretation bias in depression have shown significant effects of the CBM in alleviating depressive symptoms. We know very little, however, about the mechanisms underlying the beneficial effect of imagery-based CBM in depression. A particular focus of the current thesis was to explore the effects of imagery-based CBM on variables that were thought to contribute to symptom improvement: mental imagery, emotion and behaviour. Experiment 1 explored these effects in a sample of mildly depressed individuals, using a CBM paradigm in which participants were required to generate mental imagery in response to positive, negative or mixed (control) combinations of picture and word cues. Participants assigned to the positive imagery condition showed mood improvements as well as enhanced behavioural performance (fishing game task) and reduced cognitive bias compared to participants in the two other conditions. Further, positive imagery was rated as increasingly vivid as they went along with the training. Study 2 explored the possibility that the behavioural task (i.e. a fishing game) used in mildly depressed individuals to detect CBM-induced differences in behaviour could be associated with behavioural differences between individuals with various and clinical levels of depressive symptoms. The hypothesis was tested that in a sample of individuals with minimal to severe symptoms of depression, behavioural performance on the fishing game would be inversely related to the severity of their depressive symptoms. As predicted, participants with higher depression scores performed less well on the fishing game task than those with lower scores, and this association remained when controlling for other variables such as state mood. Experiment 3a and 3b constituted the first two pilot studies exploring the feasibility of delivering imagery-based CBM over the internet to individuals with clinical depression. In Experiment 3a, the imagery-based CBM was developed into an internet-based intervention involving 6 sessions of CBM that participants completed in their own home over a week. The Oxford Imagery Generation (OxIGen) program was piloted in a small sample (N = 6) of clinically depressed individuals, and qualitative data were collected to assess experience of the intervention. As a result, refinements were made to improve the intervention and enhance engagement. In Experiment 3b, the finalised version of the OxIGen program, which involved 12 sessions of online CBM completed over a month, was piloted in a small sample (N = 8) of individuals with clinical depression. Results showed high levels of acceptability and adherence. Three of the four participants allocated to the positive imagery version of OxIGen showed reliable levels of symptom improvement. The exploration of the effects of OxIGen on mental imagery, bias and behaviour provided a mixed picture. For example, the predicted change in vividness for positive future imagery and negative interpretative bias was only found in two of the four participants from the positive imagery group. Finally in Experiment 4, the effects of OxIGen on positive future imagery and behaviour were examined as part of a wider clinical trial involving a large sample (N = 150) of individuals with clinical depression. The larger scale of this study allowed a sufficiently powered test of the prediction that the intervention would lead to changes in specific features of imagery (i.e. vividness and likelihood of positive future imagery) and increases in behavioural activation. Further, the hypothesised link between positive future imagery and optimism was tested. The results examined whether the OxIGen intervention can induce changes at different levels of psychological functioning (i.e. emotional, cognitive and behavioural). It is discussed that the combined action of these changes may reinstate a positive feedback cycle that ultimately leads to symptom improvements. Existing resources are largely insufficient to combat the major health problem of depression. The development of a promising laboratory paradigm towards a clinical intervention is an important step towards the development of short and inexpensive forms of treatment that can be delivered to the hands of the many people who need help.

There is a growing interest in brief, low-cost workplace health promotion interventions for wellbeing, which target increasing resilience, mindfulness and positive appraisal. One such health promotion intervention is Positive Mental Training. Three linked studies set out to investigate the efficacy of Positive Mental Training in the workplace. Study 1 used a double blind, randomised control trial design, with healthy volunteer employees randomised to intervention or control conditions. Validated questionnaires measured wellbeing, resilience, mindfulness, burnout and emotional distress at 4 time intervals, over a 6 month period. Multi-level linear modelling showed significant effects of the intervention on wellbeing and depression. ANCOVA analysis revealed these benefits were not sustained at follow up (26 weeks). Study 2 expanded on study 1, with qualitative interviews of purposefully selected participants of study 1. A grounded theory approach was used to explore individual motivations, benefits and limitations of the programme. Study 3 adopted a component research design to investigate one possible underlying aspect of this multi-component health promotion intervention (positive appraisal suggestion) in a student population and examined whether relaxation increased this effect. Positive appraisal suggestions given with or without relaxation were both able to significantly increase levels of positive affect and self-esteem compared to a control. Positive cognitive bias was found to increase in both the active conditions and the control suggesting differential cognitive and emotional processes, in that an increase in positive CB was not associated with an increase in mood. Overall these studies indicated evidence for the efficacy of Positive Mental Training in workplace health promotion, explored experience of participants undertaking the study and investigated the underlying mechanisms of an active component of Positive Mental Training. Theoretical and clinical implications are discussed.

Attributional style is hypothesised to causally contribute to depression vulnerability through influencing both emotional response and rumination following life events. Consistent with this hypothesis, Peters et al. (2011) found that training individuals towards a pessimistic attributional style, characterised by internal-stable attributions for negative events and external-unstable attributions for positive events, resulted in greater negative mood and emotional reactivity to perceived failure, relative to training a resilient attributional style characterized by the reverse pattern of attributions. To date, however, the relative contribution of the internal-external and stable-unstable dimensions, their interaction, and their application to positive or negative events upon influencing emotional response and, by theoretical extension, risk for depression, remains unresolved. To resolve this question, 80 participants received training manipulating attributional style along four dimensions (i.e., internal versus external attributions for negative events; internal versus external attributions for positive events; stable versus unstable attributions for negative events; stable versus unstable attributions for positive events) in a 24 orthogonal factorial design. Participants then completed a perceived failure induction task. Measures of emotion and state rumination were completed pre-manipulation, post- manipulation, and post-induction. The internality dimension for positive and, separately, negative events influenced both immediate emotional response and emotional reactivity. Stable attributions for negative events increased negative emotional response and moderated the effect of internal attributions for negative events: internal attributions to negative resulted in greater emotional reactivity relative to external attributions, but only in the context of stable attributions for negative events. Both internal and stable dimensions also had independent effects. These findings identifying the active components driving the effect of attributional style upon emotional reactivity suggest slight revisions and refinements to attribution models of depression vulnerability. Furthermore, it provides further evidence that attributional style can be modified and furthers understanding of how CBM-attribution training could be developed as a potential intervention for the treatment of depression.

No description available.

No description available.

Heavy/at-risk alcohol use among young adults is an important public health problem given its association with health risk behavior and negative consequences. Dual process models of self-control characterize heavy/at-risk alcohol use as a function of (1) automatic appetitive processes and (2) conscious control processes. While existing interventions typically focus on individuals’ conscious control processes, recent research has focused on targeting automatic appetitive processes directly through strategies such as Cognitive Bias Modification (CBM). Although there is some evidence that CBM may improve outcomes for patients in treatment for alcohol use disorder, there is less evidence for its efficacy among young adults. This has been attributed to utilizing CBM as a stand-alone intervention and recruiting samples with low motivation to change drinking in prior studies. To address these limitations, this study examined the efficacy of CBM as an adjunct to brief web-based motivational intervention among young adults interested in changing their drinking. Heavy drinkers, ages 18-34, were recruited through social media platforms and completed an online screener. Eligible participants (N = 81) completed baseline assessment and a web-based motivational intervention (NIAAA- Rethinking Drinking). Participants were randomized to one of two adjunct intervention conditions—CBM or SHAM (control)—that was completed following the motivational intervention and over 4 sessions in the ensuing week. Weekly number of drinks, weekend drinking, alcohol-related consequences, readiness to change, and implicit biases toward alcohol were measured at baseline, 1-week and 1-month follow-up. Intervention condition did not significantly predict the primary outcomes of weekly drinking or consequences at 1-month, controlling for sex. In addition, intervention condition was not associated with implicit bias toward alcohol at 1-week or 1-month follow-up, controlling for sex. Post-hoc analyses revealed the intervention may be differentially efficacious for individuals high, versus low, in readiness to change. Overall, this web based CBM intervention did not reduce drinking behavior, consequences, or implicit biases compared to SHAM. Future work should focus on alternative strategies to modify automatic processes to enhance motivational web-based interventions, particularly among individuals highly motivated to change their behavior.

Negatively biased interpretation has been hypothesized as an important factor in the aetiology and maintenance of depression. Recently developed cognitive bias modification paradigms, intending to change these biases towards a more optimistic interpretation tendency (CBM-I), seem to offer new promising implications for cognitive therapy innovation. Surprisingly, the increasing interest in the modifiability of interpretation bias is contrasted by a severe lack of methodological and measurement development studies. A review of current research revealed 1) a severe lack of psychometrically evaluated measures for depressionrelated interpretation bias and its modification, 2) inconsistent findings for the existence of depression-related interpretation bias depending on the (direct or indirect) assessment paradigm, 3) a demand for profound knowledge about the underlying work mechanisms and best ingredients for CBM-I procedures, and 4) a lack of measures and CBM-I training materials in the German language. With these considerations in mind, the objectives of this dissertation were 1) to develop and evaluate an internally consistent and valid measure for the assessment of depression-related interpretation bias and its modification, 2) to validate an indirect priming task to assess interpretation bias and to further examine the interrelations of four different direct and indirect assessment paradigms, 3) to evaluate a new and more active CBM-I variant and test its effectiveness in comparison with guided CBM-I and a control group, and 4) to provide valid test and CBM-I training materials in German. The aim of study 1 was to develop and evaluate a pragmatic assessment instrument, consisting of a 30-item questionnaire (long version) and two 15-item parallel short versions (A and B). Items were generated as ambiguous sentences, reflecting three relevant content areas based on Beck’s cognitive triad (Beck et al., 1979). All three versions of the instrument were found to be structurally stable, internally consistent and valid. In line with Beck’s cognitive triad (Beck et al., 1979) in depression, confirmatory factor analyses determined a three factor solution (self, experiences, future). Significant correlations were found between all scales and depressive mood. The two short versions represent the same underlying constructs, share identical psychometric properties and possess high parallel-test reliability. The study was the first to evaluate and confirm the factorial validity as well as the parallel-test reliability, and therefore suitability to measure modification of interpretation bias measure in the context of depressed mood. The aim of study 2 was to evaluate an indirect affective priming task using homophones as ambiguous material and to compare this task to three different already established interpretation bias paradigms, namely an ambiguous scenarios test, a scrambled sentences test under cognitive load, as well as a homophone paradigm. No empirical support for mood-related interpretation bias was found for the newly developed affective priming task as well as the homophone task, which both did not differentiate between dysphoric and non-dysphoric individuals. The ambiguous scenarios test and the scrambled sentences test under cognitive load were shown to be internally consistent and valid instruments that were also highly intercorrelated. These findings emphasize the challenge to create valid ambiguous test stimuli for the measure of depression-related interpretation bias as well as the inequality of different assessment paradigms. Study 2 was the first study to examine the relatedness of four different direct and indirect assessment paradigms for the measure of depression-related interpretation bias in one sample. The aim of study 3 was to compare the efficacy of CBM-I requiring participants to imagine standardized positive resolutions to a novel, more active training version that required participants to generate the positive interpretations themselves. Participants were randomly allocated to (1) standardized CBM-I, (2) self-generation CBM-I or (3) a control group. Outcome measures included self-report mood measures and a depression-related interpretation bias measure. Both positive training variants significantly increased the tendency to interpret fresh ambiguous material in an optimistic manner. However, only the standardized imagery CBM-I paradigm positively influenced mood. Study 3 successfully evaluated a new CBM-I variant, gained insights about the role of self-generation and added further support to the potential therapeutic significance of imagery-based cognitive bias modification strategies. Altogether, this dissertation significantly contributed to the research field of depressionrelated interpretation bias by 1) filling a gap in measure development studies, 2) increasing the knowledge of the relatedness of different assessment paradigms, 3) increasing the knowledge about the working mechanisms and optimal ingredients of successful CBM-I, and 4) evaluating and providing assessment as well as CBM-I training materials for the German language context. / Ein negativer Interpretationsbias bezieht sich auf die Tendenz, mehrdeutige Reize (z.B. Situationen, Gesichtsausdrücke, Rückmeldung von anderen Personen) in einer pessimistischen Art und Weise zu interpretieren. Diese kognitive Verzerrung im Rahmen der Informationsverarbeitung wird als wichtiger Faktor für die Entstehung und Aufrechterhaltung von depressiven Störungen diskutiert. Insbesondere die Modifikation dieser Tendenz zu einem positiveren Interpretationsstil (Cognitive bias modification targeting interpretation; CBM-I) erweckte in den vergangenen Jahren großes Forschungsinteresse, da diese innovativen, computergestützten Techniken wirkungsvolle Behandlungsansätze für die Therapie von Depressionen bedeuten könnten. Nach aktuellem Forschungsstand besteht jedoch 1.) ein Mangel an hinreichend evaluierten Instrumenten für die Erhebung von depressionsbedingten Interpretationsverzerrungen und insbesondere deren Veränderbarkeit, 2.) eine inkonsistente Befundlage für die Existenz von depressionsbedingten Interpretationsverzerrungen in Abhängigkeit von der (direkten oder indirekten) Erhebungsmethode, 3.) ein Bedarf an genaueren Erkenntnissen über die zugrunde liegenden Wirkmechanismen und effektivsten Komponenten von CBM-I und 4.) ein Fehlen von CBM-I Materialien und Erhebungsmethoden in deutscher Sprache. Vor diesem Hintergrund wurden die Ziele dieser Dissertation formuliert, die neben einer kurzen Einführung in das Themengebiet und einer abschließenden Diskussion aus drei Studien besteht. Das Ziel der ersten Studie war die Entwicklung und Validierung eines pragmatischen Erhebungsinstrumentes zur Messung von depressionsbedingten Interpretationsverzerrungen, bestehend aus einem Fragebogen (Langfassung, 30 Items) und zwei Kurz- bzw. Parallelversionen (A und B, jeweils 15 Items). In den Items werden emotional mehrdeutig interpretierbare Szenarien beschrieben, deren Inhalte Beck‘s kognitive Triade (Beck et al., 1979) widerspiegeln. Den Ergebnissen zufolge können alle drei Versionen des Instruments als strukturell stabil, internal konsistent und valide bewertet werden. In Übereinstimmung mit der Theorie der kognitiven Triade (Beck et al., 1979) wurde mittels konfirmatorischer Faktorenanalyse eine Dreifaktorenlösung (Selbst, Erfahrungen, Zukunft) festgestellt. Signifikante Korrelationen wurden zwischen allen Skalenwerten und depressiver Symptomatik gefunden. Die beiden Parallelversionen weisen ähnliche psychometrische Eigenschaften sowie eine hohe Paralleltest-Konsistenz auf. Das Ziel der zweiten Studie war die Validierung eines indirekten, affektiven Priming- Verfahrens, in dem homophone Wörter als emotional zweideutige Stimuli eingesetzt wurden. Dieser Test wurde zusätzlich mit drei bereits etablierten Erhebungsparadigmen (Ambiguous Scenarios Test; Scrambled Sentences Test, Homophone-Test) verglichen. Hinsichtlich der Ergebnisse konnte keine empirische Unterstützung für den affektiven Priming-Test sowie für den Homophone-Test gefunden werden; beide Tests zeigten keinen Zusammenhang mit depressiven Symptomen. Der Ambiguous Scenarios Test und der Scrambled Sentences Test erwiesen sich als internal konsistent und valide und wiesen außerdem eine hohe Interkorrelation auf. Die Ergebnisse geben Aufschluss über die Vergleichbarkeit der unterschiedlichen Erhebungsparadigmen. Das Ziel der dritten Studie war die Entwicklung und Evaluation einer neuen, aktiveren CBM-I Variante, in der die Teilnehmer mittels eines computergestützten Trainings aufgefordert wurden, positive Interpretationen auf emotional mehrdeutige Szenarien eigenständig zu generieren. Die Ergebnisse der neuen CBM-I-Variante wurden mit den Ergebnissen einer herkömmlichen CBM-I-Variante (Standard-CBM-I) sowie den Ergebnissen einer Kontrollgruppe verglichen. Es zeigte sich, dass sowohl die neue CBM-I-Variante als auch Standard-CBM-I die Interpretationstendenz signifikant in eine positive Richtung verbesserten. Darüber hinaus konnte durch Standard-CBM-I eine stimmungsaufhellende Wirkung erzielt werden.