Implicit associations tied to psychopathology

Implicit associations reflect relatively uncontrollable automatic associations between concepts in memory. Our lab has demonstrated that anxiety and many other forms of psychopathology are characterized by biases in these associations. For instance, we have shown that phobic individuals are more likely than non-phobic individuals to associate their feared object with danger. Moreover, persons with panic disorder associate themselves with panic (vs. calm) relatively more than do non-anxious individuals, and importantly, these associations change following successful treatment and even predict the extent someone will experience a reduction in symptoms.

To allow the public to learn about implicit mental health associations, we direct a public web site called Project Implicit Health that allows visitors to try an Implicit Association Test and receive feedback on their score. More than 500,000 tests have been completed!

Cognitive bias modification

A primary focus of our work has been to examine the causal link between change in cognitive biases and symptom (e.g., anxiety) reduction using cognitive bias modification paradigms. These computer-based training programs are designed to directly alter biased ways of thinking, such as the tendency to make threat interpretations. For instance, we have trained interpretations to be more benign to decrease anxious responding among obsessional, contamination fearful, socially anxious, trait anxious, spider fearful, and anxiety sensitive samples, and even found that symptom changes following interpretation training for acrophobia (height fear) were as large as those achieved by a group receiving the gold-standard exposure therapy. We have also shifted negative future thinking in people with negative expectations about the future.

These demonstrations are significant because they permit evaluation of the causal, rather than simply correlational, claims that underlie cognitive models, and because they offer promise for new interventions that are easy to disseminate given they are computer-based and do not require a therapist. In 2015, we launched MindTrails, a public website for people to try different online interpretation training programs. The latest iteration of MindTrails, Calm Thinking, launched in January 2019.

Through our research on the MindTrails site, we also explore how to increase user engagement and reduce dropout, which are both common challenges within online interventions. We are currently investigating the use of telecoaching to increase user engagement among individuals at high risk for attrition, and have future plans to personalize and gamify elements of MindTrails.

Dynamic monitoring of thoughts, feelings, and behaviors

Rather than rely on a static snapshot of biased processing, we seek new ways to more dynamically track anxious and other disorder-related thoughts, feelings, and behaviors. For instance, in collaboration with colleagues in engineering we use active (e.g., ecological momentary assessment) and passive (e.g., GPS, accelerometer, psychophysiology) mobile sensing via smartphones to learn how social anxiety and depressive symptoms tie to communication patterns and emotion regulation efforts in natural environments.

In addition, we are developing new paradigms that enable more fine-grained, continuous assessment of biased processing of emotional information (e.g., tracking moment-to-moment changes in responding as positive and negative information is encountered, tracking computer mouse movements in response to feared stimuli to capture avoidance motivation; tracking sensitivity to reward and punishment cues as they shift over time).

Change in cognitive processing over treatment and across time

To evaluate whether change in cognitive biases predicts later symptom change, we have used repeated measures designs and dynamic modeling approaches. For instance, we have shown that change in the tendency to negatively (mis)interpret ambiguous stimuli tied to panic-related bodily cues predicts later reductions in maladaptive avoidance behaviors, and a myriad of other panic responses.

Additionally, given that most cognitive bias measures are not process pure, we have started to look more in depth at just what is changing during treatment (e.g., to what extent changes reflect relatively more automatic vs. strategic components). We also collaborate with Dr. Kristen Lindgren to investigate change in alcohol associations across time.

Intrusive, unwanted thoughts

Intrusive unwanted thinking is tied to numerous forms of psychopathology. We have been investigating individual differences in the nature of intrusive thoughts and methods to control unwanted thinking, such as thought suppression. For example, we have conducted a series of studies to better understand how age-related changes in cognitive processing and emotion regulation alter the ability to suppress the recurrence of intrusive unwanted thoughts, and mitigate the thoughts’ potentially negative affective consequences.

Relatedly, we completed a meta-analysis of thought suppression outcomes tied to psychopathology, finding that, while psychopathology is associated with greater rates of intrusive thinking, contrary to many theoretical predictions, there were no overall differences in the recurrence of thoughts following thought suppression between groups with and without psychopathology.

Attitudes about mental illness and its treatment

Building from the social cognition literature and our understanding of how to modify negative beliefs and attitudes about stigmatized groups, we are examining how automatic biases affect clinical populations. We seek to better understand stigma toward persons with mental illness and treatment seeking, as well as what factors motivate people to seek care (e.g., beliefs about the value of science in determining a treatment plan, role of biases at the state level).