Identification of children’s threat- related interpretation bias following trauma and the evaluation of a cognitive bias training intervention by Susan Hogan Thesis Submitted to Flinders University for the degree of Doctor of Philosophy College of Education, Psychology and Social Work 5 August 2019 i TABLE OF CONTENTS Summary ......................................................................................................................................... v Declaration ................................................................................................................................... viii Acknowledgements ........................................................................................................................ ix CHAPTER 1 .................................................................................................................................... 1 Introduction ..................................................................................................................................... 1 Cognitive models of child anxiety .............................................................................................. 4 Information processing biases in PTSD ...................................................................................... 5 The cognitive model of PTSD ..................................................................................................... 6 Cognitive Bias Modification of Interpretations .......................................................................... 8 CBM-I in children and youth .................................................................................................... 11 CBM-I with children ................................................................................................................. 11 CBM-I with youth ..................................................................................................................... 15 Effectiveness of CBM-I in at-risk child samples and those with clinical levels of symptoms . 19 CBM-I in youth with clinical levels of symptoms .................................................................... 21 CBM-I compared with CBT ...................................................................................................... 23 CBM-I and adult analogue trauma studies ................................................................................ 26 Summary ................................................................................................................................... 27 CHAPTER 2 .................................................................................................................................. 30 Study 1 ........................................................................................................................................... 30 Method .......................................................................................................................................... 37 Creation of the Test of Interpretation Bias ................................................................................ 37 Participants ................................................................................................................................ 39 Measures .................................................................................................................................... 41 Procedure ................................................................................................................................... 43 Results ........................................................................................................................................... 44 Discussion ..................................................................................................................................... 51 CHAPTER 3 .................................................................................................................................. 58 Study 2 ........................................................................................................................................... 58 Method .......................................................................................................................................... 64 Participants ................................................................................................................................ 64 Measures .................................................................................................................................... 66 Cognitive Bias Training ............................................................................................................ 69 Procedure ................................................................................................................................... 71 Statistical Analyses ................................................................................................................... 72 ii Results ........................................................................................................................................... 73 Preliminary analyses ................................................................................................................. 73 Inter-correlations of interpretation bias and outcome measures ............................................... 74 Effect of CBM-I intervention training on symptom outcome measures ................................... 75 Moderator Analyses .................................................................................................................. 77 Training effect on mood ............................................................................................................ 77 Can CBM-I lower the risk of developing later maladjustment? ............................................... 78 Discussion ..................................................................................................................................... 85 CHAPTER 4 .................................................................................................................................. 97 Study 3 ........................................................................................................................................... 97 Method ........................................................................................................................................ 104 Participants .............................................................................................................................. 104 Measures .................................................................................................................................. 108 Cognitive Bias Training .......................................................................................................... 111 Procedure ................................................................................................................................. 113 Statistical Analyses ................................................................................................................. 114 Results ......................................................................................................................................... 115 Discussion ................................................................................................................................... 124 CHAPTER 5 ................................................................................................................................ 132 General discussion ....................................................................................................................... 132 References ................................................................................................................................... 148 Appendix A ................................................................................................................................. 175 Study 1 Test of Interpretive Bias Form A 12-item dichotomous format ................................ 175 Appendix B ................................................................................................................................. 176 Study 1 Test of Interpretive Bias Form B 12-item dichotomous format ................................ 176 Appendix C ................................................................................................................................. 177 Study 1 Test of Interpretive Bias Form A 12-item Likert format ........................................... 177 Appendix D ................................................................................................................................. 179 Study 1 Test of Interpretive Bias Form B 12-item Likert format ........................................... 179 Appendix E .................................................................................................................................. 181 Study 3 Test of Interpretive Bias 24-item Likert format ......................................................... 181 Appendix F .................................................................................................................................. 185 Study 1 Correlations between the Test of Interpretive Bias and outcome measures .............. 185 Appendix G ................................................................................................................................