Experimental Modification of Interpretation Bias about Animal Fear in Young Children: Effects on Cognition, Avoidance Behavior, Anxiety Vulnerability, and Physiological Responding

Experimental Modification ofInterpretation Bias about Animal Fear in Young Children: Effects on Cognition,Avoidance Behavior, Anxiety Vulnerability, and Physiological Responding

Lester, Field, & Muris, 2011

Research Question

•       How does experimental modification of children’s interpretation bias affect cognition, behavioral avoidance, anxiety vulnerability, and physiological responding?

Introduction and Literature Review

•         Child anxiety is associated with the tendency to interpret ambiguous information in a threatening manner
•       Adult studies using feedback-learning paradigms (CBM-I) have demonstrated that it is possible to induce positive and negative interpretation biases, and that negative biases are causally linked with anxiety vulnerability

o   Participants are reinforced for consistently disambiguating scenarios in a positive or negative way

•        CBM-I procedures have been developed that are more suitable for use with children

o   Important because childhood represents a “hot” developmental period when negative cognitions (presumably) and anxiety develop

o   Successful in changing cognition, behavior, and anxiety vulnerability, but not state anxiety

•        Children who had been given negative information about an ambiguous animal showed higher heart rates when asked to approach a box they thought contained the animal, compared to a control animal

Hypotheses

•         Children in the negative modification condition will interpret future ambiguous information in a negative manner, and vice versa for the positive condition
•         Negative modification will lead to an increase in anxiety across the training, positive modification will lead to a decrease in anxiety
•         Compared to those in the negative training, kids in the positive training condition will demonstrate less avoidance behavior, anxiety vulnerability, and physiological responding

Method

·         Participants

o   67 children, 6-11 years of age (29 girls, 38 boys)

o   Randomized to positive animal modification (34) or negative animal modification (33)

·         Procedure

o   Mean heart rate measured

o   Completed STAI-C and FSSC-R

o   Ambiguous vignettes

§  18 vignettes counterbalanced so that 9 are administered pre-modification and the other 9 post-modification (to test the effects of the modification)

§  5 sentences long and children indicate at the end of each sentence how scary they thought the ending of the story would be (1 to 7 Likert scale)

§  Ex. “It is night time and you are in your bedroom. You hear a noise coming from outside. The noise gets louder. You open your curtains to take a look outside. You see a cuscus outside your window.”

o   Visual analogue mood scales

§  Children were asked to rate from 0 to 100 how nervous they felt immediately pre- and post-modification

o   Bias modification

§  Programmed in E-Prime

§  30 ambiguous scenarios involving 3 novel Australian marsupials

§  Children are asked to imagine themselves in each situation and decide how each story might continue (by choosing either a positive or negative option)

§  After choosing, kids were provided with feedback contingent on their condition (either “Good” or “Wrong”)

§  Ex. “You are in a field when you spot a quoll looking around for something to eat. There are lots of little baby mice scurrying around the field. You also notice some bushes full of juicy berries. You wonder what the quoll will like to eat.”

·         “Oh no!! They quoll is gobbling up the baby mice. You can hear his sharp teeth crunching their bones” or “ The hungry quoll runs over to the buses and starts munching on the tasty berries and leaves”

o   Visual analogue mood scales

o   Ambiguous vignettes

o   Behavioral Approach Task (BAT)

§  Anxiety rating

§  Covered pet carrier with a slit on one end, soft toy, hay, and rustling sounds – asked to approach and pet the animal

§  Anxiety rating

o   Debriefing and optional positive bias modification

Results

•         Groups were comparable on trait anxiety, fear scores, and gender
•         The training worked: kids in the positive condition learned to pick the positive outcomes and kids in the negative condition learned to pick the negative outcomes
•         Threat biases decreased significantly after the positive modification, but increased significantly after the negative modification

o   But the negative group was more anxious pre-modification

•         Increase in anxiety across the negative modification, no change in anxiety across the positive modification
•       BAT results may have been affected by the fact that kids in the negative training condition were more anxious pre-BAT

o   Children in the negative group took longer to approach the pet carrier than children in the positive group

o   Odds of not putting their hand in the box was 3.52 times higher for those in the negative condition

o   Training did not have an effect on anxiety vulnerability or physiological responding to the task

Discussion

•         Interpretation biases can be successfully modified in young children – the training worked and had associated effects on interpretation bias, state anxiety, and behavioral avoidance, but no effects on anxiety vulnerability or physiological responding
•         Effects of positive modification stronger than negative modification
•         No way to entirely tease out if induced biases caused by changes in state anxiety or the training itself, but past research suggests the latter

o   Inconsistent literature on modification affecting state anxiety

•         Mood differences pre-BAT may help to explain group differences in behavioral avoidance
•          Active generation of interpretations, longer training, or assessment of measures post-BAT may be required to see group effects on anxiety vulnerability and physiological responding

o   Or a more emotionally salient task may be necessary to evoke responses in all three components of anxiety

•          Limitations: nonclinical sample, wide age range, different methods from those used with adults
•          Future clinical applications highlighted

Questions

•          Mean heart rate was calculated over a 15-second period during the BAT and the task was stopped if kids didn’t put their hand inside in that amount of time. Is reaction time the best way to measure behavioral avoidance? Any problems with this approach to measuring heart rate? Any ideas on how to measure behavioral avoidance or physiological responding differently?
•          Anxiety significantly increased across the negative training, but non-significantly decreased across the positive training. Any thoughts on why this might be?
•          How might you design the study differently so that you could tease apart the effects of cognition and emotion on behavioral avoidance during the BAT?
•         The authors argue that they might have been more likely to find group differences on anxiety vulnerability and physiological responding if they had assessed these measures post-BAT. Do you agree? What about a prolonged pre-BAT period to assess anticipatory anxiety?
•          Interpretation training was effective in changing behavioral avoidance, but not physiological responding or subjective ratings of anxiety. How can we make sense of this given what we know about CBT for child anxiety?
•         What do you think about using trainings such as these as an adjunct to CBT for child anxiety? Are there childhood anxiety disorders you think might be particularly amenable?
•          What differences, if any, might you expect in a sample of clinically anxious children?