Abstract
Cognitive bias modification (CBM) techniques, which experimentally retrain abnormal processing of affective stimuli, are becoming established for various psychiatric disorders. Such techniques have not yet been applied to maternal processing of infant emotion, which is affected by various psychiatric disorders. In a pilot study, mothers of children under 3 years old (n = 32) were recruited and randomly allocated to one of three training exercises, aiming either to increase or decrease their threshold of perceiving distress in a morphed continuum of 15 infant facial images. Differences between pre- and post-training threshold were analysed between and within subjects. Compared to baseline thresholds, the threshold for perceiving infant distress decreased in the lowered threshold group (mean difference −1.7 frames, 95 % confidence intervals (CI) −3.1 to −0.3, p = 0.02), increased in the raised threshold group (1.3 frames, 95 % CI 0.6 to 2.1, p < 0.01) and was unchanged in the control group (0.1 frames, 95 % CI −0.8 to 1.1, p = 0.80). Between-group differences were similarly robust in regression models and were not attenuated by potential confounders. The findings suggest that it is possible to change the threshold at which mothers perceive ambiguous infant faces as distressed, either to increase or decrease sensitivity to distress. This small study was intended to provide proof of concept (i.e. that it is possible to alter a mother’s perception of infant distress). Questions remain as to whether the effects persist beyond the immediate experimental session, have an impact on maternal behaviour and could be used in clinical samples to improve maternal sensitivity and child outcomes.
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Acknowledgments
We are grateful to all the mothers who participated in this study, to the mothers and children involved in creating the database of original images and to Professor Alan Stein (University of Oxford) for providing us access to these images from which we derived our composites. We are also grateful for our respective funding sources: RC is a National Institute of Health Research (NIHR) Academic Clinical Fellow in Psychiatry; K.S.B. is funded by the National Institute for Health Research School for Primary Care Research (NIHR SPCR). The NIHR SPCR is a partnership between the Universities of Birmingham, Bristol, Keele, Manchester, Nottingham, Oxford, Southampton and University College London. RP is supported by an Elizabeth Blackwell Institute Post-Doctoral Fellowship funded by Wellcome Trust Institutional Award (097822/Z/11/ZR). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.
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Key points
• Maternal mental illness is associated with altered maternal sensitivity to infant distress.
• Altered maternal sensitivity may mediate the association between maternal mental illness and adverse child outcomes.
• Maternal sensitivity does not appear to improve following recovery from mental illness.
• This study shows that cognitive bias modification techniques can alter the threshold for perceiving infant distress, and can be used to both increase and decrease sensitivity to infant distress.
• Such techniques may be a novel way of altering maternal sensitivity to improve maternal-child relationships and child outcomes.
• Potential clinical applications include use in mothers with perinatal depression, schizophrenia and autism, but further research is needed.
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Carnegie, R., Shepherd, C., Pearson, R.M. et al. Changing mothers’ perception of infant emotion: a pilot study. Arch Womens Ment Health 19, 167–172 (2016). https://doi.org/10.1007/s00737-015-0565-5
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DOI: https://doi.org/10.1007/s00737-015-0565-5