Protocol for an app-based affective control training for adolescents: proof-of-principle double-blind randomized controlled trial

Susanne Schweizer, Jovita T Leung, Rogier Kievit, Maarten Speekenbrink, William Trender, Adam Hampshire, Sarah-Jayne Blakemore, Susanne Schweizer, Jovita T Leung, Rogier Kievit, Maarten Speekenbrink, William Trender, Adam Hampshire, Sarah-Jayne Blakemore

Abstract

Background: 75% of all mental health problems have their onset before the end of adolescence. Therefore, adolescence may be a particularly sensitive time period for preventing mental health problems. Affective control, the capacity to engage with goal relevant and inhibit distracting information in affective contexts, has been proposed as a potential target for prevention. In this study, we will explore the impact of improving adolescents' affective control capacity on their mental health. Methods: The proof-of-principle double-blind randomized controlled trial will compare the effectiveness of an app-based affective control training (AffeCT) to a placebo training (P-Training) app. In total, 200 (~50% females) adolescents (11-19 years) will train for 14 days on their training app. The AffeCT will include three different n-back tasks: visuospatial, auditory and dual (i.e., including both modalities). These tasks require participants to flexibly engage and disengage with affective and neutral stimuli (i.e., faces and words). The P-Training will present participants with a perceptual matching task. The three versions of the P-Training tasks vary in the stimuli included (i.e., shapes, words and faces). The two training groups will be compared on gains in affective control, mental health, emotion regulation and self-regulation, immediately after training, one month and one year after training. Discussion: If, as predicted, the proposed study finds that AffeCT successfully improves affective control in adolescents, there would be significant potential benefits to adolescent mental health. As a free app, the training would also be scalable and easy to disseminate across a wide range of settings. Trial registration: The trial was registered on December 10th 2018 with the International Standard Randomised Controlled Trial Number (Registration number: ISRCTN17213032).

Keywords: Adolescence; Affective control; App-based training; Emotion regulation; Mental health.

Conflict of interest statement

Competing interests: AH is a co-founder of the company that developed the app software. He was not involved in task design nor will he be involved in any data analyses.

Copyright: © 2019 Schweizer S et al.

Figures

Figure 1.. Study timeline.
Figure 1.. Study timeline.
T1 – T4 = Assessment time point 1 – 4; A/B/C = refers to the three different versions of the training tasks available in both training groups; Pre- and post-training assessment = Assessment sessions run prior to and after completing the training phase; Training phase = period of training on the app; 1-month and 1-year online follow up assessment = key outcomes will be assessed online one month and one year following the completion of the training.
Figure 2.. Affective control training tasks.
Figure 2.. Affective control training tasks.
The figure depicts sample trials for each of the three training tasks:A) visuospatialn-back,B) auditoryn –back, andC) dualn-back task. Trials depicted with a light blue background require a “No Match” button press, whereas yellow backgrounds indicate “Match” (i.e., target) trials in the respective modality. The green border provides feedback to participants, where green indicates the response was correct, whereas a red border appears for incorrect trials. Feedback is provided after each response or when a trial times out. The example block in Figure 2 is depicted forn = 1. Match trials for the visuospatialn-back training task are trials where the current face is presented in the same location as the facen positions back. For auditoryn-back match trials, the same word is presented as the onen trials back. The dualn-back training task includes both modalities and both types of target trials (for additional buttons appearing on screen with the dualn-back see the task description below). 2500ms = the maximal (duration is self-paced up to 2500ms) time between onset of one stimulus and the next (i.e., total trial time); 500ms = face presentation time; 150ms = feedback presentation time; 500-950ms = word presentation time. 20 +n = each block consists of 20 +n trials.
Figure 3.. Schedule of enrolment, interventions and…
Figure 3.. Schedule of enrolment, interventions and assessments (SPIRIT).
SPIRIT = Standard Protocol Items: Recommendations for Interventional Trials. T1 = pre-training assessment; T2 = post-training assessment; T3 = 1-month follow-up assessment; T4 = 1-year follow-up assessment.
Figure 4.. Predicted structure of affective and…
Figure 4.. Predicted structure of affective and cognitive functioning at baseline.
The figure offers a schematic representation of the predicted structure of cognitive and affective control in adolescents. Raven’s i1 – 12 = items 1 – 12 on the Raven’s Advanced Progressive Matrices; d’ = d prime on backward digit span; RT = reaction time; rE = proportion random errors; Acc = percentage trials correct. Rectangular boxes = measured variables; ovals = latent constructs.

References

    1. Kessler RC, Chiu WT, Demler O, et al. : Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005;62(6):617–27. 10.1001/archpsyc.62.6.617
    1. Breslau J, Gilman SE, Stein BD, et al. : Sex differences in recent first-onset depression in an epidemiological sample of adolescents. Transl Psychiatry. 2017;7(5):e1139. 10.1038/tp.2017.105
    1. Kovacs M, Obrosky S, George C: The course of major depressive disorder from childhood to young adulthood: Recovery and recurrence in a longitudinal observational study. J Affect Disord. 2016;203:374–81. 10.1016/j.jad.2016.05.042
    1. Wilson S, Vaidyanathan U, Miller MB, et al. : Premorbid risk factors for major depressive disorder: are they associated with early onset and recurrent course? Dev Psychopathol. 2014;26(4 Pt 2):1477–93. 10.1017/S0954579414001151
    1. Sawyer SM, Azzopardi PS, Wickremarathne D, et al. : The age of adolescence. Lancet Child Adolesc Health. 2018;2(3):223–8. 10.1016/S2352-4642(18)30022-1
    1. Lee FS, Heimer H, Giedd JN, et al. : Mental health. Adolescent mental health--opportunity and obligation. Science. 2014;346(6209):547–9. 10.1126/science.1260497
    1. Schweizer S, Satpute AB, Atzil S, et al. : The impact of affective information on working memory: A pair of meta-analytic reviews of behavioral and neuroimaging evidence. Psychol Bull. 2019;145(6):566–609. 10.1037/bul0000193
    1. Cohen-Gilbert JE, Thomas KM: Inhibitory control during emotional distraction across adolescence and early adulthood. Child Dev. 2013;84(6):1954–66. 10.1111/cdev.12085
    1. Davidovich S, Collishaw S, Thapar AK, et al. : Do better executive functions buffer the effect of current parental depression on adolescent depressive symptoms? J Affect Disord. 2016;199:54–64. 10.1016/j.jad.2016.03.049
    1. Hare TA, Casey BJ: The neurobiology and development of cognitive and affective control. Cogn Brain Behav. 2005;9(3):273–286.
    1. Kilford EJ, Foulkes L, Potter R, et al. : Affective bias and current, past and future adolescent depression: a familial high risk study. J Affect Disord. 2015;174:265–71. 10.1016/j.jad.2014.11.046
    1. Schweizer S, Parker J, Leung JT, et al. : Age-related differences in affective control and its association with mental health difficulties. Dev Psychopathol. 2019;1–13. 10.1017/S0954579419000099
    1. Gross JJ: Emotion regulation: affective, cognitive, and social consequences. Psychophysiology. 2002;39(3):281–91. 10.1017/S0048577201393198
    1. Klimstra TA, Kuppens P, Luyckx K, et al. : Daily Dynamics of Adolescent Mood and Identity. J Res Adolesc. 2015;26(3):459–73. 10.1111/jora.12205
    1. Larson RW, Moneta G, Richards MH, et al. : Continuity, stability, and change in daily emotional experience across adolescence. Child Dev. 2002;73(4):1151–1165. 10.1111/1467-8624.00464
    1. Maciejewski DF, van Lier PA, Branje SJ, et al. : A 5-Year Longitudinal Study on Mood Variability Across Adolescence Using Daily Diaries. Child Dev. 2015;86(6):1908–21. 10.1111/cdev.12420
    1. Riediger M, Klipker K: Emotion regulation in adolescence. In: Handbook of emotion regulation 2nd ed. New York, N.Y.: Guilford Press;2015;187–202.
    1. Cohen N, Mor N: Enhancing reappraisal by linking cognitive control and emotion. Clin Psychol Sci. 2018;6(1):155–63. 10.1177/2167702617731379
    1. Cohen N, Mor N, Henik A: Linking executive control and emotional response a training procedure to reduce rumination. Clin Psychol Sci. 2015;3(1):15–25. 10.1177/2167702614530114
    1. Cohen N, Ochsner KN: From surviving to thriving in the face of threats: the emerging science of emotion regulation training. Curr Opin Behav Sci. 2018;24:143–155. 10.1016/j.cobeha.2018.08.007
    1. Schweizer S, Grahn J, Hampshire A, et al. : Training the emotional brain: improving affective control through emotional working memory training. J Neurosci. 2013;33(12):5301–11. 10.1523/JNEUROSCI.2593-12.2013
    1. Cohen N, Margulies DS, Ashkenazi S, et al. : Using executive control training to suppress amygdala reactivity to aversive information. Neuroimage. 2016;125:1022–31. 10.1016/j.neuroimage.2015.10.069
    1. Course-Choi J, Saville H, Derakshan N: The effects of adaptive working memory training and mindfulness meditation training on processing efficiency and worry in high worriers. Behav Res Ther. 2017;89:1–13. 10.1016/j.brat.2016.11.002
    1. Keshavan MS, Vinogradov S, Rumsey J, et al. : Cognitive training in mental disorders: update and future directions. Am J Psychiatry. 2014;171(5):510–522. 10.1176/appi.ajp.2013.13081075
    1. Koster EHW, Hoorelbeke K, Onraedt T, et al. : Cognitive control interventions for depression: A systematic review of findings from training studies. Clin Psychol Rev. 2017;53:79–92. 10.1016/j.cpr.2017.02.002
    1. Motter JN, Devanand DP, Doraiswamy PM, et al. : Computerized Cognitive Training for Major Depressive Disorder: What's Next? Front Psychiatry. 2015;6: 137. 10.3389/fpsyt.2015.00137
    1. Xiu L, Zhou R, Jiang Y: Working memory training improves emotion regulation ability: Evidence from HRV. Physiol Behav. 2016;155:25–29. 10.1016/j.physbeh.2015.12.004
    1. Cortese S, Ferrin M, Brandeis D, et al. : Cognitive training for attention-deficit/hyperactivity disorder: meta-analysis of clinical and neuropsychological outcomes from randomized controlled trials. J Am Acad Child Adolesc Psychiatry. 2015;54(3):164–74. 10.1016/j.jaac.2014.12.010
    1. Kirk HE, Gray K, Riby DM, et al. : Cognitive training as a resolution for early executive function difficulties in children with intellectual disabilities. Res Dev Disabil. 2015;38:145–60. 10.1016/j.ridd.2014.12.026
    1. Hollis C, Falconer CJ, Martin JL, et al. : Annual Research Review: Digital health interventions for children and young people with mental health problems - a systematic and meta-review. J Child Psychol Psychiatry. 2017;58(4):474–503. 10.1111/jcpp.12663
    1. Choi J, Corcoran CM, Fiszdon JM, et al. : Pupillometer-based neurofeedback cognitive training to improve processing speed and social functioning in individuals at clinical high risk for psychosis. Psychiatr Rehabil J. 2017;40(1):33–42. 10.1037/prj0000217
    1. Loewy R, Fisher M, Schlosser DA, et al. : Intensive Auditory Cognitive Training Improves Verbal Memory in Adolescents and Young Adults at Clinical High Risk for Psychosis. Schizophr Bull. 2016;42 suppl 1:S118–S126. 10.1093/schbul/sbw009
    1. Revell ER, Neill JC, Harte M, et al. : A systematic review and meta-analysis of cognitive remediation in early schizophrenia. Schizophr Res. 2015;168(1–2):213–222. 10.1016/j.schres.2015.08.017
    1. Knoll LJ, Fuhrmann D, Sakhardande AL, et al. : A Window of Opportunity for Cognitive Training in Adolescence. Psychol Sci. 2016;27(12):1620–31. 10.1177/0956797616671327
    1. Schweizer S, Hampshire A, Dalgleish T: Extending brain-training to the affective domain: increasing cognitive and affective executive control through emotional working memory training. PLoS One. 2011;6(9):e24372. 10.1371/journal.pone.0024372
    1. Schweizer S, Samimi Z, Hasani J, et al. : Improving cognitive control in adolescents with post-traumatic stress disorder (PTSD). Behav Res The. 2017;93:88–94. 10.1016/j.brat.2017.03.017
    1. Heatherton TF, Wagner DD: Cognitive neuroscience of self-regulation failure. Trends Cogn Sci. 2011;15(3):132–9. 10.1016/j.tics.2010.12.005
    1. Koster EHW, De Lissnyder E, Derakshan N, et al. : Understanding depressive rumination from a cognitive science perspective: the impaired disengagement hypothesis. Clin Psychol Rev. 2011;31(1):138–45. 10.1016/j.cpr.2010.08.005
    1. Bar-Haim Y, Lamy D, Pergamin L, et al. : Threat-related attentional bias in anxious and nonanxious individuals: a meta-analytic study. Psychol Bull. 2007;133(1):1–24. 10.1037/0033-2909.133.1.1
    1. Admon R, Pizzagalli DA: Dysfunctional Reward Processing in Depression. Curr Opin Psychol. 2015;4:114–8. 10.1016/j.copsyc.2014.12.011
    1. Preston SD, Stansfield RB: I know how you feel: task-irrelevant facial expressions are spontaneously processed at a semantic level. Cogn Affect Behav Neurosci. 2008;8(1):54–64. 10.3758/CABN.8.1.54
    1. Lezak MD: Neuropsychological assessment. New York, N.Y.: Oxford University Press;1995.
    1. Suresh K: An overview of randomization techniques: An unbiased assessment of outcome in clinical research. J Hum Reprod Sci. 2011;4(1):8–11. 10.4103/0974-1208.82352
    1. Schweizer S, Leung JT, Kievit R, et al. : Protocol for an App-Based Affective Control Training for Adolescents.2019. 10.17605/
    1. Loosli SV, Buschkuehl M, Perrig WJ, et al. : Working memory training improves reading processes in typically developing children. Child Neuropsychol. 2012;18(1):62–78. 10.1080/09297049.2011.575772
    1. Duckworth AL, Grant H, Loew B, et al. : Self-regulation strategies improve self-discipline in adolescents: benefits of mental contrasting and implementation intentions. Educ Psychol. 2011;31(1):17–26. 10.1080/01443410.2010.506003
    1. Galla BM, Plummer BD, White RE, et al. : The Academic Diligence Task (ADT): Assessing Individual Differences in Effort on Tedious but Important Schoolwork. Contemp Educ Psychol. 2014;39(4):314–25. 10.1016/j.cedpsych.2014.08.001
    1. Yeager DS, Henderson MD, Paunesku D, et al. : Boring but important: a self-transcendent purpose for learning fosters academic self-regulation. J Pers Soc Psychol. 2014;107(4):559–80. 10.1037/a0037637
    1. Bradley BP, Lang PJ: Affective Norms for English Words (ANEW): Instruction manual and affective ratings. Technical report C-1, Gainesville, FL.: The Center for Research Psychophysiology University of Florida;1999.
    1. Foulkes L, Blakemore SJ: Is there heightened sensitivity to social reward in adolescence? Curr Opin Neurobiol. 2016;40:81–5. 10.1016/j.conb.2016.06.016
    1. Forbes EE, Dahl RE: Research Review: altered reward function in adolescent depression: what, when and how? J Child Psychol Psychiatry. 2012;53(1):3–15. 10.1111/j.1469-7610.2011.02477.x
    1. Luking KR, Pagliaccio D, Luby JL, et al. : Reward Processing and Risk for Depression Across Development. Trends Cogn Sci. 2016;20(6):456–68. 10.1016/j.tics.2016.04.002
    1. Ma DS, Correll J, Wittenbrink B: The Chicago face database: A free stimulus set of faces and norming data. Behav Res Methods. 2015;47(4):1122–35. 10.3758/s13428-014-0532-5
    1. Langner O, Dotsch R, Bijlstra G, et al. : Presentation and validation of the Radboud Faces Database. Cogn Emot. 2010;24(8):1377–1388. 10.1080/02699930903485076
    1. DeBruine L, Jones B: Face Research Lab London Set.2017.
    1. Meuwissen AS, Anderson JE, Zelazo PD: The creation and validation of the Developmental Emotional Faces Stimulus Set. Behav Res Methods. 2017;49(3):960–6. 10.3758/s13428-016-0756-7
    1. Egger HL, Pine DS, Nelson E, et al. : The NIMH Child Emotional Faces Picture Set (NIMH-ChEFS): a new set of children’s facial emotion stimuli. Int J Methods Psychiatr Res. 2011;20(3):145–56. 10.1002/mpr.343
    1. Dubow EF, Boxer P, Huesmann LR: Long-term Effects of Parents' Education on Children's Educational and Occupational Success: Mediation by Family Interactions, Child Aggression, and Teenage Aspirations. Merrill Palmer Q (Wayne State Univ Press). 2009;55(3):224–49. 10.1353/mpq.0.0030
    1. Fuhrmann D, Schweizer S, Leung J, et al. : The neurocognitive correlates of academic diligence in adolescent girls. Cogn Neurosci. 2019;10(3):88–99. 10.1080/17588928.2018.1504762
    1. Petersen AC, Crockett L, Richards M, et al. : A self-report measure of pubertal status: Reliability, validity, and initial norms. J Youth Adolesc. 1988;17(2):117–33. 10.1007/BF01537962
    1. Watson D, Clark LA, Tellegen A: Development and validation of brief measures of positive and negative affect: the PANAS scales. J Pers Soc Psychol. 1988;54(6):1063–70. 10.1037/0022-3514.54.6.1063
    1. Goodman R: The Strengths and Difficulties Questionnaire: a research note. J Child Psychol Psychiatry. 1997;38(5):581–6. 10.1111/j.1469-7610.1997.tb01545.x
    1. Goodman R, Ford T, Simmons H, et al. : Using the Strengths and Difficulties Questionnaire (SDQ) to screen for child psychiatric disorders in a community sample. Br J Psychiatry. 2000;177(6):534–9. 10.1192/bjp.177.6.534
    1. Becker A, Rothenberger A, Sohn A, et al. : Six years ahead: a longitudinal analysis regarding course and predictive value of the Strengths and Difficulties Questionnaire (SDQ) in children and adolescents. Eur Child Adolesc Psychiatry. 2015;24(6):715–25. 10.1007/s00787-014-0640-x
    1. Goodman A, Goodman R: Population mean scores predict child mental disorder rates: validating SDQ prevalence estimators in Britain. J Child Psychol Psychiatry. 2011;52(1):100–8. 10.1111/j.1469-7610.2010.02278.x
    1. Goodman R: Psychometric properties of the strengths and difficulties questionnaire. J Am Acad Child Adolesc Psychiatry. 2001;40(11):1337–45. 10.1097/00004583-200111000-00015
    1. Gratz KL, Roemer L: Multidimensional assessment of emotion regulation and dysregulation: Development, factor structure, and initial validation of the difficulties in emotion regulation scale. J Psychopathol Behav Assess. 2004;26(1):41–54. 10.1023/B:JOBA.0000007455.08539.94
    1. Neumann A, van Lier PA, Gratz KL, et al. : Multidimensional assessment of emotion regulation difficulties in adolescents using the Difficulties in Emotion Regulation Scale. Assessment. 2010;17(1):138–149. 10.1177/1073191109349579
    1. Finkenauer C, Engels R, Baumeister R: Parenting behaviour and adolescent behavioural and emotional problems: The role of self-control. Int J Behav Dev. 2005;29(1):58–69. 10.1080/01650250444000333
    1. Tangney JP, Baumeister RF, Boone AL: High self-control predicts good adjustment, less pathology, better grades, and interpersonal success. J Pers. 2004;72(2):271–324. 10.1111/j.0022-3506.2004.00263.x
    1. Righetti F, Finkenauer C: If you are able to control yourself, I will trust you: the role of perceived self-control in interpersonal trust. J Pers Soc Psychol. 2011;100(5):874–86. 10.1037/a0021827
    1. Barceló F: The Madrid card sorting test (MCST): a task switching paradigm to study executive attention with event-related potentials. Brain Res Brain Res Protoc. 2003;11(1):27–37. 10.1016/S1385-299X(03)00013-8
    1. Dan-Glauser ES, Scherer KR: The Geneva affective picture database (GAPED): a new 730-picture database focusing on valence and normative significance. Behav Res Methods. 2011;43(2):468–77. 10.3758/s13428-011-0064-1
    1. Raven JC: Guide to the standard progressive matrices. London: HK Lewis;1960.
    1. Raven J: The Raven's progressive matrices: change and stability over culture and time. Cogn Psychol. 2000;41(1):1–48. 10.1006/cogp.1999.0735
    1. R Core Team: R: A language and environment for statistical computing. R Foundation for Statistical Computing;2013.
    1. Kievit RA, Brandmaier AM, Ziegler G, et al. : Developmental cognitive neuroscience using latent change score models: A tutorial and applications. Dev Cogn Neurosci. 2018;33:99–117. 10.1016/j.dcn.2017.11.007
    1. : Shedding light on the association between repetitive negative thinking and deficits in cognitive control - A meta-analysis. Clin Psychol Rev.63: 10.1016/j.cpr.2018.06.001 56-65 10.1016/j.cpr.2018.06.001

Source: PubMed

Sponsorer och medarbetare

Medicinska tillstånd

Läkemedelsinterventioner

3
Prenumerera