Modification of information processing biases in emotional disorders: Clinically relevant developments in experimental psychopathology
Baert, S., Koster, E. H. W., De Raedt, R. (2011)
International Journal of Cognitive Therapy, 4, 208-222

Abstract

Experimental psychopathology has provided abundant evidence to suggest information-processing biases in anxiety and depression.

Cognitive bias modification (CBM) procedures are specifically designed to modify dysfunctional processing for those circumstances where patients are depleted form intentional control to override the bias. Through repeated practice, CBM intends to alter former biases and automate new, more adaptive cognitive processes. It holds potential in the treatment of anxiety and depression.

Cognitive theories on information processing

Research on information-processing in emotional disorders has predominantly been guided by the cognitive schema theory proposed by Beck and Bower’s associative network theory.

Beck’s cognitive schema theory.
Information-processing is guided by schema’s, defined as memory structures which, based on previous experiences, contain and organize information about the self, the world, and the future These schema’s are thought to bias encoding of information. Specific information processing biases at the level of attention, interpretation, and memory mediate incoming information and subjective experience. Eventual experience is considered to be the product of both bottom-up processing of the environment as well as top-down processing involving selection, abstraction, interpretation and elaboration. In the case of anxiety and depression, emotional information-processing will influence experience in a negative way, causing maladaptive emotional responses. These negative experiences further reinforce the maladaptive schemas.

It is thought that the active ingredients of cognitive behavioural therapy (CBT) act through modification of maladaptive cognition. Mostly, these techniques work by identifying maladaptive beliefs and negative thoughts and substituting these more adaptive ideas. CBT emphasizes the presence and content of schema-incongruent information that disconfirms former beliefs, which subsequently leads to new experiences that evoke or strengthen more adaptive schema’s.

The reciprocal influence between CBT and information processing bias has received scare attention. Information-processing biases may act as a barrier in CBT.

Information processing biases often act involuntarily and occur outside of conscious awareness. Although a change in controlled processing can lead to a change in automatic processing, this would require fulfilment of a least two crucial conditions. These are: 1) Using effortful control in situations of stress and negative mood. But, cognitive resources might not be sufficiently available. And 2) The individual must be motivated to do so. One possible direction is to include procedures modifying biases that are out of the patient’s voluntary control.

Attentional biases in depression and anxiety

Depression and anxiety are characterized by a very similar uncontrollability of intrusive thoughts with specific anxiety- or depression-related concerns and emotional consequences. There is a attentional bias for threat in clinically anxious individuals and individuals with heightened anxiety bias. At early, automatic stages of information processing, anxious individuals allocate more attention to threat and have difficulty disengaging from threat. With longer stimulus presentations, anxious individuals avert their attention from threat. The pattern of early vigilance has been related to enhanced detection of threat. Attentional avoidance at later stages is associated with impaired habituation and emotional processing.

The attentional bias in depression may be predominantly due to disengagement difficulties. Once negative information becomes the focus of attention, depressive patients may have difficulty diverting their attention and focusing on something else.

On the causal status of information processing biases

In order to establish a causal relationship between cognitive bias and the development or maintenance of a psychopathological state, several requirements must be met. These are: 1) There must be temporal link indicating that the cognitive biases precede psychopathology. 2) It must be demonstrated that manipulation of cognitive biases lead to changes in psychopathology

Attentional bias is associated with emotional reactivity and the development of anxiety and depression, but no causal conclusion can be drawn.

Introducing cognitive bias modification of attentional bias

Attentional training is successful in modifying attentional bias. The effects if CBM on emotional reactivity have been demonstrated in healthy populations as well as in (sub) clinical populations.

Effect of CBM in healthy populations

CBM has proved to be capable of influencing stress reactivity in healthy populations to both induced as well as naturalistic stressors.

Effects of CBM in clinical populations

CBM has also proven to be effective in clinical populations.

Toward a clinical application

Because processing biases can be seen as a barrier to schema change, psychotherapy might profit from direct manipulation of fast-acting maladaptive processing. The most effective way to change automatic processes is training of the opposite process.

CBM exposes the patient to a large amount of negative stimuli and trains the patient over several hundred trials evoking repeated practice to shift attention away from the negative information. This directly target information-processing biases.

Three areas at which clinical intervention targeted at emotional disorders might benefit from the development of experimental procedures aimed at reducing information-processing biases. These are: 1) Clinical treatment of emotional disorders. Directly modifying the maladaptive information processing might make schema content more easy to address and change. 2) Primary prevention of emotional disorders. 3) Relapse prevention after treatment