An Online Assessment to Evaluate the Role of Cognitive Biases and Emotion Regulation Strategies for Mental Health During the COVID-19 Lockdown of 2020: Structural Equation Modeling Study

Abstract

Background Extant research supports causal roles of cognitive biases in stress regulation under experimental conditions. However, their contribution to psychological adjustment in the face of ecological major stressors has been largely unstudied. Objective We developed a novel online method for the ecological examination of attention and interpretation biases during major stress (ie, the COVID-19 lockdown in March/April 2020) and tested their relations with the use of emotion regulation strategies (ie, reappraisal and rumination) to account for individual differences in psychological adjustment to major COVID-19–related stressors (ie, low depression and anxiety, and high well-being and resilience). Methods Participants completed an online protocol evaluating the psychological impact of COVID-19–related stressors and the use of emotion regulation strategies in response to them, during the initial weeks of the lockdown of March/April 2020. They also completed a new online cognitive task designed to remotely assess attention and interpretation biases for negative information. The psychometric properties of the online cognitive bias assessments were very good, supporting their feasibility for ecological evaluation. Results Structural equation models showed that negative interpretation bias was a direct predictor of worst psychological adjustment (higher depression and anxiety, and lower well-being and resilience; χ29=7.57; root mean square error of approximation=0.000). Further, rumination mediated the influence of interpretation bias in anxiety (P=.045; 95% CI 0.03-3.25) and resilience (P=.001; 95% CI −6.34 to −1.65), whereas reappraisal acted as a mediator of the influence of both attention (P=.047; 95% CI −38.71 to −0.16) and interpretation biases (P=.04; 95% CI −5.25 to −0.12) in well-being. Conclusions This research highlights the relevance of individual processes of attention and interpretation during periods of adversity and identifies modifiable protective factors that can be targeted through online interventions.

Online Contingent Attention Training (OCAT): transfer effects to cognitive biases, rumination, and anxiety symptoms from two proof-of-principle studies

“…The number of trials was established based on previous extensive piloting of sufficient required SST trials to obtain reliable cognitive bias indices related to stress vulnerability and emotional status (Martin-Romero et al, 2023 ). Noteworthy, this design has proven to derive reliable indices of attention and interpretation biases with predictive power to account for individual differences in emotion regulation use and psychological adjustment to major stress (Blanco et al, 2021 ). Each scrambled sentence was composed of 6 words (e.g., “looks bright very the dismal future”) that could be unscrambled with a positive (e.g., “the future looks very bright”) or a negative emotional meaning (e.g., “the future looks very dismal”).…”

“…The beginning of COVID-19 pandemic comprised a significant major stressor for the general population, resulting in increased rates of depression and anxiety (Shevlin et al, 2020 ; Valiente et al, 2021 ). Recent research, conducted in the context of the COVID-19 lockdown situation of early 2020, has shown that people characterized by more negative interpretation and attention biases reported higher levels of depression and anxiety during the lockdown period (Blanco et al, 2021 ). Therefore, training attention and interpretation biases emerged as a clear target to improve emotion regulation and emotional symptom levels in the context of the COVID-19 lockdown.…”

“…Relatedly, recent research has shown that during the COVID-19 lockdown of 2020, a clearly major stressful situation, interpretation and attention biases had a large impact on psychological adjustment to the situation (Blanco et al, 2021 ). This suggests that attention and interpretation biases play a crucial role in the onset and maintenance of emotional disorders (Mathews & MacLeod, 2005 ).…”

A Novel Experience Sampling Method Tool Integrating Momentary Assessments of Cognitive Biases: Two Compliance, Usability, and Measurement Reactivity Studies

“…We created a computerized SST [ 17 ] that allows for app-based assessments of these cognitive biases. This task has been previously validated for the evaluation of attention and interpretation bias in various formats, such as computers [ 18 ], and it has already been used in mobile phones for implementation in ESM procedures [ 20 ]. Participants were required to complete 20 sentences at each ESM assessment a total of 3 times a day for 5 days.…”

“…In a series of experimental studies using this task, it was found that participants showing higher biases toward negative over positive information have poorer abilities to use emotion regulation strategies supporting negative affect downregulation (lower use of reappraisal and higher use of rumination) [ 19 ]. Furthermore, previous studies using the presented novel web-based app have demonstrated that ecological assessments of these negative cognitive biases assessed with this app-based cognitive task through mobile phones are predictive of poorer abilities to use emotion regulation strategies in their daily life functioning, ultimately leading to increased depressive and anxiety symptoms and reduced well-being in the face of major stressors [ 20 ]. Thus, given the large potential of these novel technical approaches to inform advanced health-related research and technology innovations, a thorough analysis of their usability and the conditions that facilitate their compliance is required.…”