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Friday, August 19, 2011
Dr. Jamie Micco is a clinical research psychologist within the Child Cognitive Behavioral Therapy program at MGH. Her research has focused on information-processing biases in children and adolescents with or at risk for mood or anxiety disorders and novel treatment paradigms to remediate these biases. Common information-processing biases among youth with anxiety and depression include: 1) “attention bias,” which is the tendency to preferentially attend to threat stimuli versus positive or neutral stimuli, and 2) “interpretation bias,” which is the inclination to select negative or threatening interpretations of ambiguous situations, pictures, or words. An example of interpretation bias would be a depressed adolescent who assumes her friend no longer likes her when the friend does not immediately call her back.
Dr. Micco is currently in the process of completing an NIMH-funded pilot study of a computerized interpretation bias modification program for adolescents (ages 14-21) with symptoms of depression. Previous studies with anxious adults have found that repeated training in positive interpretations of potentially threatening situations reduces interpretation bias and symptoms of anxiety (e.g., Teachman & Addison, 2008). Based on prior work, Dr. Micco developed a four-session computerized bias modification program and is comparing its efficacy to that of four sessions of a sham intervention. To date, 35 adolescents have completed the study, with preliminary results supporting the efficacy of the bias modification program in adolescents who start off with strong negative interpretation biases, as measured by responses to completely ambiguous scenarios. Thus far, among adolescents with worse initial bias, those in the intervention group have shown greater improvement in interpretation bias at mid- and post-intervention assessments than those in the control group (see Figure).
In collaboration with Dr. Dina Hirshfeld-Becker, Co-Director of the Child Cognitive Behavioral Therapy Program at MGH, Dr. Micco is continuing her work in information-processing biases by examining if such biases are a risk factor for development of anxiety disorders. Although attention and interpretation biases are associated with anxiety disorders, it remains unclear whether these biases are precursors or consequences of anxiety disorders. If they are precursors, then bias modification programs may be efficacious in preventing anxiety disorders in children. Dr. Micco was recently awarded the MassGeneral Hospital for Children Pilot Research Award, which will fund a pilot study of attention and interpretation biases in young offspring (ages 4-7) of parents with anxiety disorders in comparison to offspring of parents without anxiety or mood disorders. The study will also examine factors that increase risk for having information-processing biases, such as behavioral inhibition (the temperamental tendency to react to novel or unfamiliar stimuli with fear or restraint), parental information-processing biases, and family environment (including family conflict and parental criticism).
The study will recruit 20 children with at least one parent with a lifetime history of generalized anxiety disorder, social phobia, or panic disorder and 20 children of healthy comparison parents. All children and their parents will receive structured diagnostic interviews to assess for anxiety and mood disorders, and children will take part in a laboratory assessment of behavioral inhibition. Attention bias in children and parents will be measured using a dot-probe task, which is a computerized assessment that measures reaction time to very brief displays of negative, positive, and neutral stimuli. Interpretation bias will be measured through open-ended interpretations of ambiguous threat-relevant scenarios and quantitative threat ratings (see Micco & Ehrenreich, 2008); to increase developmental sensitivity, dolls will be used for the youngest children so they can “act out” the interpretations. Family environment will be assessed via parental questionnaires. Data gathered from this pilot project will lay the groundwork for larger studies of cognitive biases in children at risk for anxiety, and will represent a first step toward examining whether cognitive biases represent a fruitful target for preventive intervention among young children at risk for anxiety.
Micco, J.A. and J.T. Ehrenreich, Children's interpretation and avoidant response biases in response to non-salient and salient situations: relationships with mothers' threat perception and coping expectations. J Anxiety Disord, 2008. 22(3): p. 371-85.
Teachman, B.A. and L.M. Addison, Training non-threatening interpretations in spider fear. Cognitive Therapy and Research, 2008. 32(3): p. 448- 459.
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