Publications by authors named "Patrick Clarke"

55 Publications

Validation of a new rat model of urethral sphincter injury and leak point pressure measurements.

Scand J Urol 2021 Aug 9:1-7. Epub 2021 Aug 9.

Department of Clinical Research, Biomedical Laboratory and Research Unit of Urology, University of Southern Denmark, Odense, Denmark.

Aims: experiments were performed to establish and validate a rat model of urethral sphincter injury and to develop a method for leak point pressure (LPP) measurements performed repeatedly in the same animal.

Methods: Twenty-four Sprague-Dawley female rats underwent bladder and epidural catheter implantation. Five days later, cystometry was performed using continuous infusion. Anesthesia with isoflurane, ketamine-xylazine (KX) or fentanyl-fluanisone-midazolam (FFM) was used. After three micturition cycles, intrathecal bupivacaine was administered leading to the suppression of reflex bladder contractions. LPP measurements were performed using vertical tilt. After the initial LPP measurement, animals underwent partial resection of the striated urethral sphincter. The effect was evaluated 6 weeks after surgery, by repeating the LPP measurement in the same animal.

Results: Ten out of 19 animals showed full micturition cycles under isoflurane, and all 9 animals under KX anesthesia. No significant difference in micturition pressures (Mean ± SEM; 30.1 ± 2.3 vs. 26.8 ± 1.6 mmHg) and LPP (31.0 ± 2.4 vs. 28.0 ± 0.9 mmHg) was observed between isoflurane and KX groups, respectively. Reflex micturition was suppressed with FFM. Bupivacaine led to overflow incontinence in all cases. Sphincter injury caused fibrotic changes and a significant increase in LPP (26.4 ± 2.3 before vs. 46.9 ± 4.6 mmHg after injury,  < 0.05).

Conclusions: KX anesthesia preserves bladder contractions. Intrathecal bupivacaine eliminates reflex micturition, allowing for repeated LPP measurements in the same animal. Resection of striated sphincter resulted in increased LPP 6 weeks post injury. The site of urethral sphincter resection healed with fibrosis.
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http://dx.doi.org/10.1080/21681805.2021.1960598DOI Listing
August 2021

Accelerated theta burst stimulation for the treatment of depression: A randomised controlled trial.

Brain Stimul 2021 Sep-Oct;14(5):1095-1105. Epub 2021 Jul 29.

Epworth Centre for Innovation in Mental Health, Epworth Healthcare and Department of Psychiatry, Monash University, Camberwell, Victoria, Australia.

Introduction: Theta burst pattern repetitive transcranial magnetic stimulation (TBS) is increasingly applied to treat depression. TBS's brevity is well-suited to application in accelerated schedules. Sizeable trials of accelerated TBS are lacking; and optimal TBS parameters such as stimulation intensity are not established.

Methods: We conducted a three arm, single blind, randomised, controlled, multi-site trial comparing accelerated bilateral TBS applied at 80 % or 120 % of the resting motor threshold and left unilateral 10 Hz rTMS. 300 patients with treatment-resistant depression (TRD) were recruited. TBS arms applied 20 bilateral prefrontal TBS sessions over 10 days, while the rTMS arm applied 20 daily sessions of 10 Hz rTMS to the left prefrontal cortex over 4 weeks. Primary outcome was depression treatment response at week 4.

Results: The overall treatment response rate was 43.7 % and the remission rate was 28.2 %. There were no significant differences for response (p = 0.180) or remission (p = 0.316) across the three groups. Response rates between accelerated bilateral TBS applied at sub- and supra-threshold intensities were not significantly different (p = 0.319). Linear mixed model analysis showed a significant effect of time (p < 0.01), but not rTMS type (p = 0.680).

Conclusion: This is the largest accelerated bilateral TBS study to date and provides evidence that it is effective and safe in treating TRD. The accelerated application of TBS was not associated with more rapid antidepressant effects. Bilateral sequential TBS did not have superior antidepressant effect to unilateral 10 Hz rTMS. There was no significant difference in antidepressant efficacy between sub- and supra-threshold accelerated bilateral TBS.
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http://dx.doi.org/10.1016/j.brs.2021.07.018DOI Listing
July 2021

Cognitive Biases in Type 2 Diabetes and Chronic Pain.

J Pain 2021 Jul 17. Epub 2021 Jul 17.

School of Psychology, University of Sydney, Sydney, Australia.

The aim of the present study was to investigate the role of cognitive processing biases in Type 2 diabetes (T2D) and chronic pain, 2 conditions that are highly co-morbid. The final sample comprised 333 individuals (86 with T2D and chronic pain, 65 with chronic pain, 76 with T2D, 106 without any form of diabetes or pain). Participants completed questionnaires assessing pain and diabetes-related outcomes, as well as measures of interpretation bias, attentional bias, and attentional bias variability. In a 2 (pain status) x 2 (T2D status) x 3 (bias valence) ANOVA design, interpretation biases were found to be stronger in individuals with chronic pain than individuals without pain, although there were no differences according to T2D status. No group differences in attentional biases were found. Among individuals with T2D, greater interpretation bias was associated with better blood glucose control, but also greater fear of hypoglycemia. For individuals with chronic pain, greater interpretation bias and attentional bias variability was associated with worse pain outcomes. Whilst interpretation bias may be present in chronic pain, it also appears to indicate better glycemic control in individuals with T2D. These findings suggest a more dynamic approach to understanding cognitive bias is needed, to consider when these biases are more or less adaptive, so that they can be better harnessed to improve outcomes for individuals with T2D who experience chronic pain. PERSPECTIVE: These findings suggest that cognitive biases can be associated with psychopathology in chronic pain and in T2D, but can also potentially be adaptive in those with T2D. Diabetes management interventions may require a careful balance between promoting sufficient concern to motivate engagement in adaptive diabetes self-management, whilst also minimizing fear of hypoglycemia.
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http://dx.doi.org/10.1016/j.jpain.2021.06.016DOI Listing
July 2021

A comparison of 15 minute vs 30 minute repetitive transcranial magnetic stimulation sessions for treatment resistant depression - are longer treatment sessions more effective?

J Affect Disord 2021 03 7;282:974-978. Epub 2021 Jan 7.

The Adelaide Clinic, Ramsay Health Care (SA) Mental Health Services; Discipline of Psychiatry, University of Adelaide; Northern Adelaide Local Health Network, Adelaide, SA, Australia. Electronic address:

Background: Repetitive Transcranial Magnetic Stimulation (rTMS) is a safe and effective treatment for treatment resistant depression (TRD). The number of patients able to be treated with rTMS is determined by the availability of the machine and staff. If treatment delivered in a shorter time were just as effective as longer treatments, then more patients could be treated with the same resources.

Method: This naturalistic study investigated 145 first-time patients treated with 15 minute (900 pulses) or 30 minute (1800 pulses) RLF rTMS for TRD 3 days/week for 6 weeks. Response and remission rates for the two groups were compared. We investigated whether longer right unilateral low (1Hz) frequency (RLF) repetitive transcranial magnetic stimulation (rTMS) treatment sessions are more effective than shorter sessions in achieving response and remission for treatment resistant depression (TRD).

Results: The duration of rTMS treatment sessions had no effect on treatment outcomes over the course of 6 weeks. The group treated with 15 minute rTMS sessions showed a partial response rate of 28.2%, a response rate of 11.5% and remission rate of 21.8%, which did not differ significantly from patients receiving 30 minute sessions who had a partial response rate of 25.4%, response rate of 17.9% and remission rate of 22.4%.

Limitations: Participants were not randomized and the inclusion criteria were broad and reflected the nature of patients seen in routine practice.

Conclusions: Fifteen minute rTMS sessions 3 days/week for 6 weeks were as effective as 30 minute sessions, providing a pragmatic advantage for shorter treatments.
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http://dx.doi.org/10.1016/j.jad.2021.01.009DOI Listing
March 2021

The effects of left DLPFC tDCS on emotion regulation, biased attention, and emotional reactivity to negative content.

Cogn Affect Behav Neurosci 2020 12 29;20(6):1323-1335. Epub 2020 Oct 29.

School of Psychology, University of Western Australia, Crawley, Australia.

The potentiation of neural activity in lateral prefrontal regions via transcranial direct current stimulation (tDCS) can reduce patterns of biased attention for threat and may facilitate intentional emotion regulation. The current study sought to determine whether left dorsolateral prefrontal cortex tDCS, in combination with intentional down-regulation of emotional responses would reduce negative appraisals of aversive content during emotional regulation (assessed during online tDCS), reduce patterns of biased attention and attention bias variability (assessed offline), and attenuate spontaneous (uninstructed) emotional reactivity to negative content (assessed offline) above tDCS or intentional down-regulation of emotions in isolation. Healthy participants (n = 116) were allocated to one of four experimental conditions involving either active or sham tDCS, combined with an either a down-regulate or maintain emotion regulation task. Attention bias/bias variability was assessed with an attentional probe task, and emotional reactivity was assessed in a negative video viewing task. tDCS did not affect the appraisals of negative stimuli during emotion regulation, and there were no effects on attention bias/bias variability. However, tDCS did attenuate emotional reactivity. Those receiving active stimulation showed smaller elevations in negative mood in response to viewing aversive video content compared with sham. The present findings are consistent with the potential of left frontal tDCS to attenuate negative emotional reactions to aversive content but provide no support for tDCS enhancement of emotion regulation, nor its impact on attention bias or attention bias variability.
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http://dx.doi.org/10.3758/s13415-020-00840-2DOI Listing
December 2020

What is attention bias variability? Examining the potential roles of attention control and response time variability in its relationship with anxiety.

Behav Res Ther 2020 12 6;135:103751. Epub 2020 Oct 6.

School of Psychological Science, University of Western Australia, Crawley, Australia.

The present study examined the underlying role of attention control and response time variability in explaining the relationship between anxiety and two commonly computed measures of attention bias variability: 'moving average' and 'trial-level bias score' measures. Participants (final n = 195) completed measures of anxiety symptomatology, antisaccade performance (attention control), a stand-alone measure of response-time variability, and a probe task measure of attention bias. Average bias and moving average bias variability measures both recorded significant, but low split-half reliability. Both attention bias variability measures and average attention bias were associated with anxiety, and attention control. Both attention bias variability measures correlated with response time variability. Neither attention bias variability measure correlated with average attention bias. Attention control was the single significant mediator of the relationship between anxiety and the trial-level bias score measure of attention bias variability. Neither response time variability nor attention control significantly mediated the relationship between anxiety and the moving average measure of attention bias variability. No evidence was found for the mediating role of response time variability. The present findings suggest that the relationships observed between anxiety and the trial-level bias score measure of attention bias variability in particular may be attributable to the over-arching role of attention control.
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http://dx.doi.org/10.1016/j.brat.2020.103751DOI Listing
December 2020

Effects of cognitive load during interpretation bias modification on interpretation bias and stress reactivity.

J Behav Ther Exp Psychiatry 2020 09 19;68:101561. Epub 2020 Feb 19.

Department of Clinical Psychology, Utrecht University, P.O. Box 80140, 3508 TC, Utrecht, the Netherlands; Department of Psychology, University of Amsterdam, Nieuwe Achtergracht 129-B, 1018 WT, Amsterdam, the Netherlands.

Background And Objectives: Interpretation bias modification can affect stress reactivity, yet results have not been consistent. This inconsistency may be partly due to variability in the degree to which training procedures alter interpretation at a more automatic, rather than strategic, level of processing, and a mismatch in available resources between the training and the stress situation. We tested this possibility by investigating whether imposing a secondary cognitive load during interpretation bias modification would strengthen training-induced effects on both interpretation bias and emotional reactivity.

Method: We trained 71 participants in a single session to interpret ambiguity either positively or negatively. Half of our participants did so while performing a cognitively demanding secondary task. We assessed the effects of these different training regimes on interpretation bias and both self-reported and physiological indices of stress reactivity.

Results: Positive and negative interpretation bias modification resulted in training-congruent changes in interpretation bias. There were no group differences in self-reported stress reactivity, but positive interpretation training did improve recovery from stress as indexed by the heart rate measurement. Countering our hypothesis, the addition of cognitive load during the training increased neither the induced interpretive change nor its emotional impact.

Limitations: Sample size was relatively small, though sufficient to detect medium sized effects.

Conclusions: Adding cognitive load to interpretation bias modification does not alter training-induced change in interpretation bias or emotional reactivity.
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http://dx.doi.org/10.1016/j.jbtep.2020.101561DOI Listing
September 2020

tDCS increases anxiety reactivity to intentional worry.

J Psychiatr Res 2020 01 12;120:34-39. Epub 2019 Oct 12.

Centre for the Advancement of Research on Emotion, School of Psychology, University of Western Australia, Australia.

While considerable experimental research has examined the impact of transcranial direct current stimulation (tDCS) on a range of cognitive processes associated with emotional pathology, the impact of tDCS on worry has been comparatively neglected. Given that anxiety pathology is characterised by motivated engagement in worry, and that frontal tDCS has the capacity to enhance goal-oriented cognition, it is important to examine whether tDCS would increase or ameliorate the cognitive and emotional effects of worry. In the current study we examined how tDCS influenced the anxiety response to worry, and the frequency of negative intrusive thoughts. We additionally examined whether stimulation delivered in isolation, or in combination with a mindful-focus task would augment the effects of tDCS. Ninety-seven (75 female) healthy participants received either active or sham anodal tDCS to the left dorsolateral prefrontal cortex, delivered either in isolation or concurrently with a mindful task (four conditions). The frequency of negative thought intrusions was assessed before and after a period of instructed worry, and state anxiety was assessed across the study. Active tDCS was associated with significantly greater elevation in anxiety in response to the worry induction. No effects were observed on the frequency of negative thought intrusions, and the combined delivery of tDCS with the concurrent mindful task did not alter the pattern of observed effects. While inviting replication in a high anxious sample, the present results highlight the possibility that tDCS may interact with motivated engagement in negative patterns of cognition, such as worry, to produce greater emotional reactivity.
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http://dx.doi.org/10.1016/j.jpsychires.2019.10.013DOI Listing
January 2020

GIVE me your attention: Differentiating goal identification and goal execution components of the anti-saccade effect.

PLoS One 2019 23;14(9):e0222710. Epub 2019 Sep 23.

Centre for the Advancement of Research on Emotion, the University of Western Australia, Perth, Western Australia, Australia.

The anti-saccade task is a commonly used method of assessing individual differences in cognitive control. It has been shown that a number of clinical disorders are characterised by increased anti-saccade cost. However, it remains unknown whether this reflects impaired goal identification or impaired goal execution, because, to date, no procedure has been developed to independently assess these two components of anti-saccade cost. The aim of the present study was to develop such an assessment task, which we term the Goal Identification Vs. Execution (GIVE) task. Fifty-one undergraduate students completed a conventional anti-saccade task, and our novel GIVE task. Our findings revealed that individual differences in anti-saccade goal identification costs and goal execution costs were uncorrelated, when assessed using the GIVE task, but both predicted unique variance in the conventional anti-saccade cost measure. These results confirm that the GIVE task is capable of independently assessing variation in the goal identification and goal execution components of the anti-saccade effect. We discuss how this newly introduced assessment procedure now can be employed to illuminate the specific basis of the increased anti-saccade cost that characterises various forms of clinical dysfunction.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0222710PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6756507PMC
March 2020

The relationships between perfectionism, anxiety and depression across time in paediatric eating disorders.

Eat Behav 2019 08 13;34:101305. Epub 2019 Jun 13.

School of Psychology, Curtin University, Perth, Australia.

Objective: The aim was to examine in children and adolescents with eating disorders the relationship between perfectionism, anxiety, and depression at intake assessment and whether intake perfectionism was significantly associated with anxiety and depression at 6 months and 12 months post-intake review.

Method: Participants were 167 females aged 10-17 years (M = 14.6, SD = 1.20) with a diagnosis of an eating disorder, who were assessed at intake to an eating disorders treatment program to receive either inpatient, day or outpatient care. Participants were re-assessed at 6 and 12 months post-intake review.

Results: At intake and 6 and 12 months post intake review perfectionism had a significant positive correlation with anxiety and depression. Perfectionism did not however determine change in anxiety and depression over time at 6 and 12 months post-intake review.

Conclusions: Despite perfectionism being significantly associated with anxiety and depression, further research is required to explore the relationships between perfectionism, anxiety and depression over time.
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http://dx.doi.org/10.1016/j.eatbeh.2019.101305DOI Listing
August 2019

Causal underpinnings of working memory and Stroop interference control: Testing the effects of anodal and cathodal tDCS over the left DLPFC.

Cogn Affect Behav Neurosci 2020 02;20(1):34-48

Department of Psychology, University of Koblenz-Landau, Landau, Germany.

By means of transcranial direct current stimulation applied to the left dorsolateral prefrontal cortex, we investigated the causal role of increased or decreased excitability of this brain region for two facets of executive functions: working memory and Stroop interference control. We tested 1) whether anodal tDCS of the left DLPFC enhances working memory 15 minutes after termination of stimulation and in the absence of direct task practice under stimulation; 2) whether anodal tDCS of the left DLPFC enhances interference control, as evidenced by Stroop performance and Stroop sequence effects; and 3) whether cathodal tDCS leads to compromised executive functioning compared to anodal stimulation. In a between-subject design with 88 healthy psychology students, we compared the impact of anodal and cathodal stimulation against a sham condition, on performance on a Stroop task (during active stimulation) and on an n-back task (completed 15 minutes after active stimulation ended). We found significantly enhanced accuracy in the n-back task after anodal stimulation compared with sham, as well as speeded reactions in the Stroop tasks independent of trial type. By contrast, we found no modulation of Stroop interference effects or Stroop sequence effects. No inhibitory effects of cathodal stimulation were observed. These results support the causal role of the left DLPFC in working memory but lend no support to its involvement in Stroop interference control.
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http://dx.doi.org/10.3758/s13415-019-00726-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7012981PMC
February 2020

Efficacy of repetitive transcranial magnetic stimulation in the treatment of depression with comorbid anxiety disorders.

J Affect Disord 2019 06 30;252:435-439. Epub 2019 Mar 30.

The Adelaide Clinic, Ramsay Health Care (SA) Mental Health Services, South Australia, Australia; Discipline of Psychiatry, School of Medicine, The University of Adelaide, South Australia, Australia; Northern Adelaide Local Health Network, South Australia, Australia. Electronic address:

Background: The presence of comorbid anxiety is generally associated with poorer treatment outcomes in people with depression. Repetitive transcranial magnetic stimulation (rTMS) has been shown to be effective for treatment resistant depression, but there has been little research examining rTMS in depressed patients with comorbid anxiety disorders. This study aimed to investigate the efficacy of rTMS in patients with treatment resistant Major Depressive Disorder (MDD) and comorbid anxiety disorders.

Methods: This study included 248 patients with treatment resistant MDD who were treated with rTMS. Of these, 172 patients had one or more comorbid anxiety disorders, so their outcomes were compared with patients who did not have comorbid anxiety.

Results: Patients both with and without comorbid anxiety disorders showed improvement in depression ratings after rTMS treatment, with no significant difference in remission rates between groups. In those with comorbid anxiety disorders, 23.3% met criteria for remission and 39.5% met response criteria. For each anxiety disorder diagnosis, there was a significant reduction in HAM-A, HAM-D21, MADRS and ZUNG scores (p = <0.001 for all).

Limitations: This was not a sham-controlled study, so placebo response rates are not known. Patients were referred by private psychiatrists so are not representative of all patients with depression.

Conclusion: Our study indicates that rTMS is an effective treatment for Major Depressive Disorder in people who have comorbid anxiety disorders.
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http://dx.doi.org/10.1016/j.jad.2019.03.085DOI Listing
June 2019

Effects of interpretation bias modification on unregulated and regulated emotional reactivity.

J Behav Ther Exp Psychiatry 2019 09 3;64:123-132. Epub 2019 Apr 3.

ADAPT lab, Department of Psychology, University of Amsterdam, Nieuwe Achtergracht 129-B, 1018 WT, Amsterdam, the Netherlands; Department of Child Development and Education, University of Amsterdam, Nieuwe Achtergracht 129-B, 1018 WT, Amsterdam, the Netherlands. Electronic address:

Background And Objectives: Although induced changes in interpretation bias can lead to reduced levels of stress reactivity, results are often inconsistent. One possible cause of the inconsistencies in the effects of interpretation bias modification (IBM) on stress reactivity is the degree to which participants engaged in emotion regulation while being exposed to stressors. In this study, we distinguished between the effects of IBM on natural, unregulated stress reactivity and the effects of IBM on people's ability to up- or downregulate this stress reactivity.

Method: Both in the context of general anxiety (Experiment 1, N = 59) and social anxiety (Experiment 2, N = 54), we trained participants to interpret ambiguous scenarios in either a positive or a negative manner, and we assessed the effects on unregulated and regulated stress reactivity.

Results: Although we found relatively consistent training-congruent changes in interpretation bias in both experiments, these changes had no effect on either unregulated or regulated stress reactivity.

Limitations: In both experiments, we used healthy student samples and relatively mild emotional stressors.

Conclusions: In line with previous research, our findings suggest that the effects of IBM on unregulated stress reactivity may be small and inconsistent. Differences in the extent to which participants engaged in emotion regulation during stressor exposure are unlikely to account for these inconsistencies.
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http://dx.doi.org/10.1016/j.jbtep.2019.03.009DOI Listing
September 2019

Attention biases in perfectionism: Biased disengagement of attention from emotionally negative stimuli.

J Behav Ther Exp Psychiatry 2019 09 1;64:72-79. Epub 2019 Mar 1.

School of Psychology, Curtin University, Australia.

Background And Objectives: Perfectionism is associated with the development and maintenance of several psychological disorders. Consequently, efforts to better understand perfectionism have potential transdiagnostic impact. One mechanism proposed to underlie perfectionism is an attention bias towards information signalling threats to perfectionism whereby people with elevated perfectionism selectively attend to threatening stimuli.

Method: The present study assessed whether two core dimensions of perfectionism, perfectionistic strivings and perfectionistic concerns, are characterised by a threat-related attention bias, and whether this bias was characterised by attention being more rapidly captured by the stimuli (engagement bias), or of greater difficulty to disengage attention (disengagement bias). Participants (N = 108) completed measures of perfectionistic strivings and concerns, and symptoms of psychological distress before completing a modified dot-probe task to measure attention biases. Attention bias index scores were calculated across three factors: engagement bias vs disengagement bias, perfectionism relevant vs irrelevant stimuli, and negative vs positive emotional stimuli.

Results: Overall, perfectionistic concerns were associated with a disengagement bias for negative stimuli, regardless of whether stimuli were perfectionism relevant or not. No other significant main or interaction effects were observed.

Limitations: The study was cross-sectional in design, and no temporal or causal inferences could be made. Additionally, participants were from a community sample and therefore replication is required in clinical populations.

Conclusion: These findings demonstrate that individuals higher in perfectionistic concerns experience difficulty withdrawing their attention from emotionally negative stimuli. These findings contribute new information to our theoretical understandings of perfectionism and provide support for the cognitive-behavioural model of perfectionism.
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http://dx.doi.org/10.1016/j.jbtep.2019.02.009DOI Listing
September 2019

Investigating the Effects of Inhibition Training on Attentional Bias Change: A Simple Bayesian Approach.

Front Psychol 2018 21;9:2782. Epub 2019 Jan 21.

School of Psychology, UNSW Sydney, Sydney, NSW, Australia.

Attention bias modification (ABM), in which participants are trained to direct attention away from negative information, has been shown to reduce anxiety. However, such findings have been inconsistent. Changes in attentional bias are often absent, suggesting need for further investigation of the underlying mechanisms of ABM, as well as better statistical methods to analyze ABM data in order to reduce inferential error. In this study, we (a) compared inhibition control training to standard ABM training conditions, and (b) demonstrated the benefits of using simple Bayesian analyses to analyze ABM data. We recruited 116 participants and assessed their attentional bias prior to and after training, which involved practice avoiding negative stimuli, attending to negative stimuli, or avoiding a non-emotional, exogenous attentional cue (inhibitory control training). Our results suggested no impact of any of the training conditions on attentional bias. We further demonstrate Bayesian analyses may help control for both Type I and Type II error relative to a frequentist approach.
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http://dx.doi.org/10.3389/fpsyg.2018.02782DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6348260PMC
January 2019

Emotion-in-Motion, a Novel Approach for the Modification of Attentional Bias: An Experimental Proof-of-Concept Study.

JMIR Serious Games 2018 Nov 28;6(4):e10993. Epub 2018 Nov 28.

Centre for the Advancement of Research on Emotion, School of Psychological Science, University of Western Australia, Crawley, Australia.

Background: Individuals with heightened anxiety vulnerability tend to preferentially attend to emotionally negative information, with evidence suggesting that this attentional bias makes a causal contribution to anxiety vulnerability. Recent years have seen an increase in the use of attentional bias modification (ABM) procedures to modify patterns of attentional bias; however, often this change in bias is not successfully achieved.

Objective: This study presents a novel ABM procedure, Emotion-in-Motion, requiring individuals to engage in patterns of attentional scanning and tracking within a gamified, complex, and dynamic environment. We aimed to examine the capacity of this novel procedure, as compared with the traditional probe-based ABM procedure, to produce a change in attentional bias and result in a change in anxiety vulnerability.

Methods: We administered either an attend-positive or attend-negative version of our novel ABM task or the conventional probe-based ABM task to undergraduate students (N=110). Subsequently, participants underwent an anagram stressor task, with state anxiety assessed before and following this stressor.

Results: Although the conventional ABM task failed to induce differential patterns of attentional bias or affect anxiety vulnerability, the Emotion-in-Motion training did induce a greater attentional bias to negative faces in the attend-negative training condition than in the attend-positive training condition (P=.003, Cohen d=0.87) and led to a greater increase in stressor-induced state anxiety faces in the attend-negative training condition than in the attend-positive training condition (P=.03, Cohen d=0.60).

Conclusions: Our novel, gamified Emotion-in-Motion ABM task appears more effective in modifying patterns of attentional bias and anxiety vulnerability. Candidate mechanisms contributing to these findings are discussed, including the increased stimulus complexity, dynamic nature of the stimulus presentation, and enriched performance feedback.
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http://dx.doi.org/10.2196/10993DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6291684PMC
November 2018

Hip Hip Hooray, ECT turns 80!

Authors:
Patrick Clarke

Australas Psychiatry 2019 Feb 26;27(1):53-55. Epub 2018 Nov 26.

Senior Clinical Lecturer, The University of Adelaide, Adelaide, SA, and; Director of Transcranial Magnetic Stimulation, Ramsay Health, North Adelaide, SA, Australia.

Objective:: This paper reviews the history of electroconvulsive therapy (ECT) with an emphasis on the Australian context over the past 30 years. The review includes data collection, the contribution of the RANZCP, and changes in legislation.

Conclusion:: ECT remains the most effective treatment for severe depression. Since the 1950s efforts have been made to make it more effective, tolerable and acceptable. Over the same period, significant social and political forces have acted to have the practice of ECT restricted or banned. Psychiatrists, through the RANZCP and other bodies, have the responsibility to promote quality ECT practice, advocate for patients, carers, and clinicians, counter inaccurate negative portrayals, and lobby for balanced legislation for ECT and other neurostimulation.
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http://dx.doi.org/10.1177/1039856218815753DOI Listing
February 2019

Inhibitory attentional control in anxiety: Manipulating cognitive load in an antisaccade task.

PLoS One 2018 16;13(10):e0205720. Epub 2018 Oct 16.

School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Bentley, Australia.

Theorists have proposed that heightened anxiety vulnerability is characterised by reduced attentional control performance and have made the prediction in turn that elevating cognitive load will adversely impact attentional control performance for high anxious individuals to a greater degree than low anxious individuals. Critically however, existing attempts to test this prediction have been limited in their methodology and have presented inconsistent findings. Using a methodology capable of overcoming the limitations of previous research, the present study sought to investigate the effect of manipulating cognitive load on inhibitory attentional control performance of high anxious and low anxious individuals. High and low trait anxious participants completed an antisaccade task, requiring the execution of prosaccades towards, or antisaccades away from, emotionally toned stimuli while eye movements were recorded. Participants completed the antisaccade task under conditions that concurrently imposed a lesser cognitive load, or greater cognitive load. Analysis of participants' saccade latencies revealed high trait anxious participants demonstrated generally poorer inhibitory attentional control performance as compared to low trait anxious participants. Furthermore, conditions imposing greater cognitive load, as compared to lesser cognitive load, resulted in enhanced inhibitory attentional control performance across participants generally. Crucially however, analyses did not reveal an effect of cognitive load condition on anxiety-linked differences in inhibitory attentional control performance, indicating that elevating cognitive load did not adversely impact attentional control performance for high anxious individuals to a greater degree than low anxious individuals. Hence, the present findings are inconsistent with predictions made by some theorists and are in contrast to the findings of earlier investigations. These findings further highlight the need for research into the relationship between anxiety, attentional control, and cognitive load.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0205720PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6191120PMC
April 2019

Does rTMS reduce depressive symptoms in young people who have not responded to antidepressants?

Early Interv Psychiatry 2019 10 10;13(5):1129-1135. Epub 2018 Oct 10.

Discipline of Psychiatry, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia.

Aim: Depression is common in young people, and there is a need for safe, effective treatments. This study examined the efficacy of repetitive transcranial magnetic stimulation in a sample of young people aged 17 to 25 years.

Methods: This retrospective study included 15 people aged 17 to 25 years referred by their private psychiatrists affiliated with Ramsay Health Care, South Australia Mental Health Services. All patients met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for treatment-resistant Major Depressive Disorder. Eleven patients received right unilateral treatment and four patients received bilateral treatment. Patients were assessed at baseline and after treatment.

Results: There was a significant improvement on the Hamilton Rating Scale for Depression (t(14) = 4.71, P < 0.0001); Montgomery-Åsperg Depression Rating Scale (t(14) = 3.96, P < 0.01) and the Zung Self-Rating Depression Scale (t(14) = 4.13, P < 0.01). There was no difference in response by gender or age. The response rates in these young people did not differ significantly from those of adults aged 25 to 82 years.

Conclusion: This open label, naturalistic study suggests that repetitive transcranial magnetic stimulation is an effective treatment in young adults who have treatment-resistant depression. Randomized sham-controlled studies are needed to further investigate the efficacy of this treatment in this age group.
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http://dx.doi.org/10.1111/eip.12743DOI Listing
October 2019

The effects of attentional bias modification on emotion regulation.

J Behav Ther Exp Psychiatry 2019 03 30;62:38-48. Epub 2018 Aug 30.

Department of Psychology, University of Amsterdam, Nieuwe Achtergracht 129-B, 1018 WT, Amsterdam, the Netherlands. Electronic address:

Background And Objectives: In two experiments, we investigated the effects of Attentional Bias Modification (ABM) on emotion regulation, i.e. the manner in which people influence emotional experiences. We hypothesized that decreases in attentional bias to threat would impair upregulation and improve downregulation of negative emotions, while increases in attentional bias to threat would improve upregulation and impair downregulation of negative emotions.

Methods: Using the emotion-in-motion paradigm (Experiment 1, N = 60) and the visual search task (Experiment 2, N = 58), we trained participants to attend to either threatening or positive stimuli and we assessed emotion intensity while observing, upregulating, and downregulating emotions in response to grids of mixed emotional pictures.

Results: In Experiment 1, the attend positive group reported more positive emotions while merely watching grids of training pictures and the attend threat group showed impaired upregulation of negative affect. In Experiment 2, the attend threat group reported intensified negative emotions for all three instructions, while the attend positive group remained largely stable over time.

Limitations: We cannot unequivocally attribute these changes in emotion regulation to changes in attentional bias, as neither of the experiments yielded significant changes in attentional bias to threat.

Conclusions: By showing that attentional bias modification procedures affect the manner in which people deal with emotions, we add empirical weight to the conceptual overlap between attentional bias modification and emotion regulation.
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http://dx.doi.org/10.1016/j.jbtep.2018.08.010DOI Listing
March 2019

Perfectionism is associated with higher eating disorder symptoms and lower remission in children and adolescents diagnosed with eating disorders.

Eat Behav 2018 08 18;30:55-60. Epub 2018 May 18.

School of Psychology, Curtin University, Perth, Australia. Electronic address:

Objective: The link between perfectionism and eating disorders is well established in adults, however little research has been conducted in children and adolescents. The aim was to examine if perfectionism was a predictor of eating disorder symptoms at intake assessment, and 6 and 12 month review.

Method: There were 175 children and adolescents aged 10-17 years (M = 14.47 years, SD = 1.31) who were assessed using the Eating Disorders Inventory-3 perfectionism subscale and the child adapted Eating Disorders Examination at intake, 6 and 12 months review.

Results: There was a significant association between perfectionism and symptoms of eating disorders at intake assessment and at 6 and 12 month review. Higher perfectionism at intake predicted a lower likelihood of remission at 12 months.

Discussion: The findings suggest that similar to adult samples, perfectionism is significantly associated with eating disorder symptoms in children and adolescents. Further research is required to examine the impact of perfectionism on eating disorder symptoms in longitudinal research with children and adolescents with eating disorders.
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http://dx.doi.org/10.1016/j.eatbeh.2018.05.008DOI Listing
August 2018

Attentional control predicts change in bias in response to attentional bias modification.

Behav Res Ther 2017 Dec 11;99:47-56. Epub 2017 Sep 11.

Centre for the Advancement of Research on Emotion, School of Psychology, University of Western Australia, Australia; School Psychology and Speech Pathology, Curtin University, Australia.

Procedures that effectively modify attentional bias to negative information have been examined for their potential to be a source of therapeutic change in emotional vulnerability. However, the degree to which these procedures modify attentional bias is subject to individual differences. This generates the need to understand the mechanisms that influence attentional bias change across individuals. The present study investigated the association between individual differences in attentional control and individual differences in the magnitude of bias change evoked by an attentional bias modification procedure. The findings demonstrate that individual differences in two facets of attentional control, control of attentional inhibition and control of attentional selectivity, were positively associated with individual differences in the magnitude of attentional bias change. The present findings inform upon the cognitive mechanisms underpinning change in attentional bias, and identify a target cognitive process for research seeking to enhance the therapeutic effectiveness of attentional bias modification procedures.
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http://dx.doi.org/10.1016/j.brat.2017.09.002DOI Listing
December 2017

Gaze-Based Assessments of Vigilance and Avoidance in Social Anxiety: a Review.

Curr Psychiatry Rep 2017 Sep;19(9):59

Centre for the Advancement of Research on Emotion, School of Psychological Science, University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009, Australia.

Purpose Of Review: A broad base of research has sought to identify the biases in selective attention which characterize social anxiety, with the emergent use of eye tracking-based methods. This article seeks to provide a review of eye tracking studies examining selective attention biases in social anxiety.

Recent Findings: Across a number of contexts, social anxiety may be associated with a mix of both vigilant and avoidant patterns of attention with respect to the processing of emotional social stimuli. Socially anxious individuals may additionally avoid maintaining eye contact and may exhibit a generalized vigilance via hyperscanning of their environment. The findings highlight the utility of eye tracking methods for increasing understanding of the gaze-based biases which characterize social anxiety disorder, with promising avenues for future research.
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http://dx.doi.org/10.1007/s11920-017-0808-4DOI Listing
September 2017

Attentional bias mediates the effect of neurostimulation on emotional vulnerability.

J Psychiatr Res 2017 10 22;93:12-19. Epub 2017 May 22.

Centre for the Advancement of Research on Emotion, School of Psychology, University of Western Australia, 35 Stirling Hwy, Crawley WA 6009, Australia; School of Psychology and Speech Pathology, Curtin University, Kent St, Bentley WA 6102, Australia. Electronic address:

Transcranial direct current stimulation (tDCS) is a neuromodulatory technique which has garnered recent interest in the potential treatment for emotion-based psychopathology. While accumulating evidence suggests that tDCS may attenuate emotional vulnerability, critically, little is known about underlying mechanisms of this effect. The present study sought to clarify this by examining the possibility that tDCS may affect emotional vulnerability via its capacity to modulate attentional bias towards threatening information. Fifty healthy participants were randomly assigned to receive either anodal tDCS (2 mA/min) stimulation to the left dorsolateral prefrontal cortex (DLPFC), or sham. Participants were then eye tracked during a dual-video stressor task designed to elicit emotional reactivity, while providing a concurrent in-vivo measure of attentional bias. Greater attentional bias towards threatening information was associated with greater emotional reactivity to the stressor task. Furthermore, the active tDCS group showed reduced attentional bias to threat, compared to the sham group. Importantly, attentional bias was found to statistically mediate the effect of tDCS on emotional reactivity, while no direct effect of tDCS on emotional reactivity was observed. The findings are consistent with the notion that the effect of tDCS on emotional vulnerability may be mediated by changes in attentional bias, holding implications for the application of tDCS in emotion-based psychopathology. The findings also highlight the utility of in-vivo eye tracking measures in the examination of the mechanisms associated with DLPFC neuromodulation in emotional vulnerability.
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http://dx.doi.org/10.1016/j.jpsychires.2017.05.008DOI Listing
October 2017

Individuals with clinically significant insomnia symptoms are characterised by a negative sleep-related expectancy bias: Results from a cognitive-experimental assessment.

Behav Res Ther 2017 Aug 17;95:71-78. Epub 2017 May 17.

Centre for the Advancement of Research on Emotion, School of Psychology, University of Western Australia, Australia; School of Psychology and Speech Pathology, Curtin University, Australia. Electronic address:

Cognitive models of insomnia consistently suggest that negative expectations regarding the consequences of poor sleep contribute to the maintenance of insomnia. To date, however, no research has sought to determine whether insomnia is indeed characterised by such a negative sleep-related expectancy bias, using objective cognitive assessment tasks which are more immune to response biases than questionnaire assessments. Therefore, the current study employed a reaction-time task assessing biased expectations among a group with clinically significant insomnia symptoms (n = 30) and a low insomnia symptoms group (n = 40). The task involved the presentation of scenarios describing the consequences of poor sleep, and non-sleep related activities, which could be resolved in a benign or a negative manner. The results demonstrated that the high insomnia symptoms group were disproportionately fast to resolve sleep-related scenarios in line with negative outcomes, as compared to benign outcomes, relative to the low insomnia symptoms group. The two groups did not differ in their pattern of resolving non-sleep related scenarios. This pattern of findings is entirely consistent with a sleep-specific expectancy bias operating in individuals with clinically significant insomnia symptoms, and highlights the potential of cognitive-experimental assessment tasks to objectively index patterns of biased cognition in insomnia.
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http://dx.doi.org/10.1016/j.brat.2017.05.010DOI Listing
August 2017

Attentional bias modification training for insomnia: A double-blind placebo controlled randomized trial.

PLoS One 2017 19;12(4):e0174531. Epub 2017 Apr 19.

Department of Developmental Psychology, University of Amsterdam, Amsterdam, the Netherlands.

Background: Attentional bias toward sleep-related information is believed to play a key role in insomnia. If attentional bias is indeed of importance, changing this bias should then in turn have effects on insomnia complaints. In this double-blind placebo controlled randomized trial we investigated the efficacy of attentional bias modification training in the treatment of insomnia.

Method: We administered baseline, post-test, and one-week follow-up measurements of insomnia severity, sleep-related worry, depression, and anxiety. Participants meeting DSM-5 criteria for insomnia were randomized into an attentional bias training group (n = 67) or a placebo training group (n = 70). Both groups received eight training sessions over the course of two weeks. All participants kept a sleep diary for four consecutive weeks (one week before until one week after the training sessions).

Results: There was no additional benefit for the attentional bias training over the placebo training on sleep-related indices/outcome measures.

Conclusions: The absence of the effect may be explained by the fact that there was neither attentional bias at baseline nor any reduction in the bias after the training. Either way, this study gives no support for attentional bias modification training as a stand-alone intervention for ameliorating insomnia complaints.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0174531PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5396867PMC
April 2017

Attention bias modification training under working memory load increases the magnitude of change in attentional bias.

J Behav Ther Exp Psychiatry 2017 Dec 21;57:25-31. Epub 2017 Feb 21.

Centre for the Advancement of Research on Emotion, School of Psychology, University of Western Australia, Australia.

Background And Objectives: Attention bias modification (ABM) procedures have shown promise as a therapeutic intervention, however current ABM procedures have proven inconsistent in their ability to reliably achieve the requisite change in attentional bias needed to produce emotional benefits. This highlights the need to better understand the precise task conditions that facilitate the intended change in attention bias in order to realise the therapeutic potential of ABM procedures. Based on the observation that change in attentional bias occurs largely outside conscious awareness, the aim of the current study was to determine if an ABM procedure delivered under conditions likely to preclude explicit awareness of the experimental contingency, via the addition of a working memory load, would contribute to greater change in attentional bias.

Methods: Bias change was assessed among 122 participants in response to one of four ABM tasks given by the two experimental factors of ABM training procedure delivered either with or without working memory load, and training direction of either attend-negative or avoid-negative.

Results: Findings revealed that avoid-negative ABM procedure under working memory load resulted in significantly greater reductions in attentional bias compared to the equivalent no-load condition.

Limitations: The current findings will require replication with clinical samples to determine the utility of the current task for achieving emotional benefits.

Conclusions: These present findings are consistent with the position that the addition of a working memory load may facilitate change in attentional bias in response to an ABM training procedure.
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http://dx.doi.org/10.1016/j.jbtep.2017.02.003DOI Listing
December 2017

How effective is repetitive transcranial magnetic stimulation for bipolar depression?

J Affect Disord 2017 02 27;209:270-272. Epub 2016 Nov 27.

Ramsay Health Care (SA) Mental Health Services, Ramsay Health Care, Adelaide, SA, Australia; Discipline of Psychiatry, School of Medicine, The University of Adelaide, Adelaide, SA, Australia; Northern Adelaide Local Health Network, Adelaide, SA, Australia.

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http://dx.doi.org/10.1016/j.jad.2016.11.041DOI Listing
February 2017
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