In this Papers Podcast, Dr. Susanne Schweizer discusses her JCPP Advances paper ‘The relationship between cognitive and affective control and adolescent mental health’ (https://doi.org/10.1002/jcv2.12204). Susanne is the lead author of the paper.
There is an overview of the paper, methodology, key findings, and implications for practice.
Discussion points include:
- Definition of cognitive and affective control and the importance of cognitive and affective control.
- The association between depressive symptoms and cognitive and affective control.
- The implications of the study for interventions for adolescent mental health.
- The implications for future research and for parents, carers and teachers.
In this series, we speak to authors of papers published in one of ACAMH’s three journals. These are The Journal of Child Psychology and Psychiatry (JCPP); The Child and Adolescent Mental Health (CAMH) journal; and JCPP Advances.
Subscribe to ACAMH mental health podcasts on your preferred streaming platform. Just search for ACAMH on; SoundCloud, Spotify, CastBox, Deezer, Google Podcasts, Podcastaddict, JioSaavn, Listen notes, Radio Public, and Radio.com (not available in the EU). Plus we are on Apple Podcasts visit the link or click on the icon, or scan the QR code.
Dr. Susanne Schweizer is a Scientia Associate Professor at the University of New South Wales (UNSW) School of Psychology, where she leads the Developmental Affective Science Lab. A/Prof Schweizer’s programme of research spans the translational spectrum to identify and target transdiagnostic mechanisms involved in developmental sensitivity to anxiety and depression. Her work has contributed to our understanding of affective, cognitive and social determinants of mental health. Importantly in the context of a global youth mental health crisis, her interventions are scalable at low/no cost and have shown promising effects across the Global North and South.
Transcript
[00:00:01.329] Mark Tebbs: Hello, and welcome to the Papers Podcast series for the Association for Child and Adolescent Mental Health, or ACAMH for short. I’m Mark Tebbs, and I’m a Freelance Consultant. Today, I’m really pleased to be talking to Dr. Susanne Schweizer, who is a lead author of a paper entitled “The Relationship Between Cognitive and Affective Control and Adolescent Mental Health,” recently published in JCPP Advances. Susanne, thanks for joining me, really looking forward to our conversation today.
[00:00:35.379] Dr. Susanne Schweizer: Thank you so much for having me.
[00:00:37.250] Mark Tebbs: Good stuff. So, let’s start with a introduction, if you could say, kind of, who you are and maybe talk about the people that you worked with on the paper?
[00:00:46.510] Dr. Susanne Schweizer: Yeah, absolutely. So, I’m an Associate Professor at the University of New South Wales, Sydney, and the first author on this paper is my PhD student, Savannah Minihan. And we worked together with a team from the Black Dog Institute, which was led by Professor Helen Christensen, and Associate Professor Aliza Werner-Seidler. They together ran the Future Proofing Study, from which the data stems that we used in this paper, and from their team we were also joined by Kate Maston and Dev. And also, from my team, we had Levi Kumle who now – who has helped creating the data analysis pipeline on the paper, and they have since moved to Oxford to do their DPhil there.
[00:01:24.630] Mark Tebbs: Thanks for the introductions. So, let’s turn to the paper. If you give us just a brief overview of the paper and as you’re providing the overview, if you can just define some of the, kind of, key terms of the paper.
[00:01:36.729] Dr. Susanne Schweizer: In this paper, we were interested in looking at the association between cognitive and affective control with adolescent mental health. Where we define cognitive control as the capacity to engage and disengage with information, as and when it is goal relevant, and we talk about affective control when this information that we’re processing is affective or emotional in nature. So, for example, in the situation right now, my goal is to focus on the content of what I’m saying, but I also have to disengage from any anxious thoughts about sounding stupid or silly in a public recording. And so that’s affective control, when this information that we’re processing, whether that’s internal or external, is affective.
So, now we were able to look at this association in the Future Proofing Study, which is a sample that includes over 6,000 adolescents, who are part of a cohort study, with a embedded clinical trial. And for this specific research question, for the study that we looked at, for – on which the paper is published that we’re talking about today, we included just over 1,900 adolescents, between the ages of 11 and 16 years, and they were, sort of, on average, they were between 14 and 13 years of age.
We measured cognitive and affective control, and using two different tasks in this study, where cognitive control was on – in the one task required to update information from working memory, and the – in the other task, it was used to shift between different rules on a card sorting game. And so, what we found is that, overall, cognitive and affective control capacity for updating working memory were associated with depressive symptoms. So, there it didn’t matter whether the content that was being processed is emotional or neutral, they were both associated with depressive symptoms, in the direction that those adolescents with better cognitive and affective control reported fewer symptoms of depression themselves at the moment.
Shifting ability, on the other hand, was not associated with depressive symptoms. However, it was associated with self-reported psychiatric history. So whether or not they had experienced a mental health problem in the past, or were currently experiencing a mental health problem. And there we saw that those who reported having had a mental health problem, they made more errors on this shifting task, compared to those who did not report having had a mental health problem. And the errors were specifically more in the affective condition, so when the content was emotional, but not when the content of – was neutral, we didn’t see a difference there.
[00:04:00.959] Mark Tebbs: Brilliant, thank you for that overview and for the introduction of those key terms. So, take us back to the start, so what were your original research hypotheses? It’d be really useful to just understand your starting position.
[00:04:12.480] Dr. Susanne Schweizer: We have in the past proposed that affective control is particularly central to successful emotion regulation in adolescents. So, it’s required to select situationally appropriate emotion regulation strategies, and, also, to shift between strategies, when a strategy is no longer adequate, or maybe it’s no longer required, because we’ve successfully down regulated our negative emotions.
Affective control is also important in the context of overriding prepotent behavioural or cognitive responses. Such as, for example, cognitive bias, so if I tend to always interpret an ambiguous social situation negatively, then I require affective control to override this negative interpretation and to come up possibly with a more benign or more positive resolution of the situation.
So, being putatively involved in emotion regulation and overriding cognitive biases, affective control should then be associated with mental health. And in adolescents, however, this capacity is still developing, and adolescence is associated with experiencing more negative affect, more rapid fluctuations in affect. And so, if this capacity is still developing, and it is central to emotion regulation, then maybe that is part of why adolescence is still – is such a vulnerable period for the onset of mental health problems.
Now, in the literature, cognitive control has typically been investigated over affective control, cognitive control being this capacity, investigated only using neutral material, so we know actually really quite little about affective control. When cognitive control has been measured in relation to emotional health, mental health, in adolescents, then it’s been measured using shifting, updating and inhibition tasks, because those are the facets commonly used to operationalise cognitive control. And cross-sectional studies, so this is a meta-analysis from a couple of years ago, showed that cross-sectional studies don’t show a reliable association between cognitive control and symptoms of depression in adolescents.
But a more recent study, that was published maybe a year ago, a meta-analysis, which looked at prospective studies. So looking prospectively at the association between cognitive control and adolescent depression, they did show an association, in the sense that those with lower levels of cognitive control were more likely to then in the future report symptoms of depression.
But, again, the literature – there’s much less literature looking at affective control, so when we use these same tasks, including affective information, and the current study allowed us to do that, because this is now a well powered sample, so it’s a large cohort, and we were able to look at these questions, looking at both cognitive control and affective control independently, because we had tasks that measured both. And we could look at them – at the association with both concurrent reports of depressive symptoms, but, also, reports of past mental health problems, and see whether there was an association that would, sort of, tap – of course, it’s not prospective, but it would tap more into that, sort of, longer-term association with mental health.
So, we investigated a number of specific questions. So, first of all, we wanted to see, in this adolescent sample, was there a difference in affective and cognitive control performance? So, if affective control is slower to develop, then they should be worse in the affective compared to the cognitive control task. Then we were also interested to see whether there was an association between depressive symptoms and cognitive, and especially affective control, and, similarly, whether there was an association between cognitive and affective control, and a self-reported history of psychiatric problems.
[00:07:58.000] Mark Tebbs: Okay, so how did you go about the study? Were there any particular methodological challenges that you’ve had to overcome?
[00:08:06.180] Dr. Susanne Schweizer: So, what was important, as I just said, you know, this was a large sample, so that was really good, and it was pop – almost population representative. It was – there was an overrepresentation of high socioeconomic status, but it was relatively representative in terms of ethnic origin and gender distribution, and things like that. That was a, sort of, methodological advantage of this study.
The other thing is that they completed these two tasks in, importantly, neutral and then affective condition. So, they did an updating task, where they had to update numbers in working memory, so they were presented with a series of numbers, and then they had to repeat them backwards. But these numbers represented over – either neutral images or affective images. So they did exactly the same task, under these two conditions, and so, we were able to really directly compare the impact of the affective compared to neutral information.
And, similarly, in the shifting task, they sorted cards, according to three rows, and in the neutral condition, those rows were shape, number and colour, and we had the number and colour consistent in the emotional condition, but then instead of shapes they were sorting emotional expressions on the faces that appeared on the cards. So, they were very well-controlled tasks, that allowed us to directly compare affective and neutral cognitive control.
Now, the methodological challenge that we came across was not one that we had expected, but this is a thing that can happen in a large study like that, where this is just one part of an overarching study. So, for the – for this cohort study, they developed an app, and this app was used for the entire study, also for the – to administer the randomised trial, the CBT trial, to some of the participants.
Through that app, the app developers had programmed the working memory task, so the updating task, where participants had to report back the numbers in reverse order, they had programmed that to included palindromes. Now, palindrome is the same from the front to the back, doesn’t matter which way round you say it, and so, of course, if the task is to encode people’s capacity to report the numbers in reverse order, that doesn’t work with a palindrome. And so, we weren’t aware that this had happened until we saw the full set of data, because, of course, that happens very rarely and so, in the pilot testing, that didn’t happen.
And so we ran the study, the analyses, both including and excluding those trials with palindromes, those participants that had a trial with palindromes, but it didn’t actually – results held and were consistent, whether or not we included those, so that was fortunate. But that was a methodological challenge that we very much did not anticipate.
[00:10:58.310] Mark Tebbs: Yeah, always, kind of, throw these curveballs at you, don’t they? So…
[00:11:03.700] Dr. Susanne Schweizer: Yeah.
[00:11:04.700] Mark Tebbs: So, what were the key findings from the study?
[00:11:06.520] Dr. Susanne Schweizer: So, a number of findings. So, with regard to the first hypothesis, actually, adolescents in our study were just as good in the affective as in the cognitive control conditions. So they were not more impaired when they had to process emotional material, they were just as able to do that. So, it looks like, at least in this sample, this capacity matures fairly early.
But what we did see is that self-reported symptoms of depression were associated with poorer cognitive and affective control. So, it didn’t matter the context in which cognitive control was applied, whether it was applied to neutral or affective material, it was just overall lower when – as a function of individual symptoms of depression.
When we looked at the se – shifting task, there was no overall association of the shifting task, or, indeed, a specific association of cognitive or affective control with depressive symptoms. However, there was an association in line with what we’ve seen in the past with psychiatric history. So, those adolescents who reported having been diagnosed with a mental health problem in the past, they showed worse performance on the affective version of the shifting task, compared to the cognitive control version. And this difference was not seen in adolescents who did not report having had a psychiatric history, so didn’t report any previous mental health problems, and that was specific and interesting.
[00:12:34.820] Mark Tebbs: Good, thank you. So, let’s turn to the implications of the study. So, what are the implications, maybe start on the, kind of, intervention perspective?
[00:12:41.990] Dr. Susanne Schweizer: Yeah, absolutely. I think our, you know, gold standard interventions, our interventions of choice, for a range of adolescent mental health problems, but certainly for depression, is cognitive behaviour therapy. Now cognitive behaviour therapy is cognitively demanding. It requires things like restructuring, so thinking about situations differently, coming up with alternative interpretations, overriding these cognitive biases. But this is done at a time where cognitive and affective control, importantly, are lower, according to these findings, but also according, you know, to the wider literature.
And I think that’s something that we need to bear in mind when we’re interacting with people that come into a treatment setting for symptoms of depression, but also I think other mental health problems, is that we need to, kind of, be aware of, at least temporarily, limited cognitive resources.
[00:13:36.910] Mark Tebbs: Yeah, and what about from a research perspective? What are the, kind of, implications of the study from this perspective?
[00:13:44.620] Dr. Susanne Schweizer: Yeah, I think a number of implications and from a research perspective. First, I think what’s interesting is this dissociation in the findings between the current symptom level, as opposed to the “historical mental health picture.” And, again, that’s something we have seen in past research as well, is that this self-reported psychiatric history can be a really interesting important construct to maybe get at a, sort of, longer-term picture, compared to just current symptoms.
And I think – so, that’s one thing to bear in mind. You know, we tend to frown upon a little bit, “Oh, this is self-reported, this is not – we don’t know for a fact that they’ve had a diagnosis.” That’s true, we rely on self-report, but we do that a lot in psychological research and, indeed, in treatment settings as well, we do tend to trust the person who we’re interacting with and their responses. And I think, at least from the current study, but, also, from previous studies that we’ve run with this construct, it does encompass something beyond just the current symptom levels, and I think that is interesting and meaningful to interpret. That’s one of the implications from a research perspective.
The other one, very importantly, which, you know, I’ve based a lot of my research around, is that we look at processing of neutral and affective information separately, but importantly, using the same tasks. Because sometimes people say, “Why am I now looking at this construct of ‘hot’ cognition and emotional cognition, and I’m also looking at neutral condition, a ‘cold,’ cognition?” But they do that using separate tasks.
And, of course, using a separate task, you – there is so much associated with simple tasks, performance with task demands, etc., you can make some inferences, but I think the inferences can be much more powerful if you use exactly methodologically the same task, but simply vary affective demands by including, you know, either as we did in the updating task, affective distractors, or in the shifting task, affective task material. That’s another important implication in my opinion.
Then, as always, when we don’t measure things directly in the laboratory, we need to make sure that we communicate very, very clearly. If we – if it is not us that are developing the task material, then we really need to take on this extra layer of meta-thinking, I guess, about our tasks, about our paradigms, and really think of everything that is just natural and obvious to us and communicate it clearly to the people who may be working on developing our paradigms.
[00:16:25.100] Mark Tebbs: Brilliant, thank you. So, we’ve got a lot of parents and Teachers and carers who listen to the podcast, so I’m just wondering whether there are any, kind of, messages to parents or carers maybe, of a young person experiencing depression?
[00:16:39.620] Dr. Susanne Schweizer: Yeah, absolutely. I think this probably is sort of echoing the implications to the Clinician, is when we experience low mood, when we experience symptoms of depression as a young person, then cognitive resources are limited. Because much of that is taken up by these negative thoughts, by – so engaging repetitive, negative thinking we know is highly cognitively demanding, that takes up a lot of our resources, leaving much fewer resources to engage in our adaptive, regulatory strategies.
But it also leave less resources to engage with schoolwork for educators, so it takes away capacity for us to engage with academic content. And that doesn’t mean that we necessarily have inferior academic skills, we may just need a bit longer, or it may – or we may be able to live our potential more fully when the symptoms reside. And so, having patients with these young people going through these episodes of mood disorders, or indeed other type of mental health problems, I think is key.
And I think for parents also, being aware that it’s not necessarily that they don’t want to listen, or that they haven’t been paying attention, it can be simply, it can just be harder to pay attention, because your resources, again, are being taken up by these negative thoughts, by other thoughts, that they’re just trying to inhibit, but that just keep reoccurring. And that is just very, very taxing on their cognitive resources.
[00:18:16.659] Mark Tebbs: Yeah, yeah, it’s such an important area of research. I’m just wondering whether you’ve got any more research in the pipeline, is there any follow-up studies that you’re conducting?
[00:18:27.640] Dr. Susanne Schweizer: Yeah, so what’s wonderful about the Future Proofing Study is that it’s an ongoing study, so it’s a cohort study, so it’s longitudinal. So, we have just gotten one year data, and so, while we can, sort of, make inferences, or, sort of, make speculations in the current data, that these are, sort of, longer-term effects that are reflected in the psychiatric history construct, we can actually test that in the longitudinal data now. And what that will also allow us to do, we didn’t have the power here to go and look at individual disorders within that psychiatric history construct, but now, we will be able to look at a much wider range of symptoms, and then be looking at how they may be differentially associated with affective and/or cognitive control. So, that’s one of the really immediate things.
We are also just about to analyse – we’ve just finished recruitment for a training study, where we specifically trained affective control in a, sort of, more gamified version, and we also trained its direct application in a cognitive bias modification task. So, we really tried to boost young people’s capacity to, sort of, selectively engage and disengage from affective information, as and when it’s relevant to their goals, but when it’s also helpful to disengage, then to be able to disengage from it. And so, yeah, we’re just about to analyse this data to see whether this may be a way forward, in terms of helping boost young people’s cognitive and affective control capacity.
[00:19:54.470] Mark Tebbs: Really looking forward to hearing the results of that study. So, we’re coming to the end of the podcast, is there a final take home message for our listeners?
[00:20:04.820] Dr. Susanne Schweizer: I think maybe the take home message for me is that we – that it is important to – when we study cognition and mental health, it is important to study emotional material in cognition. ‘Cause I think that is what day-to-day individuals with mental health problems are facing, is those negative thoughts, those unwanted thoughts, and understanding how we process emotional information therefore is really critical, if we want a way forward to help people have the capacity to start to inhibit these negative thoughts, or to start to restructure these negative thoughts. Yeah, I think that’s probably my main key take home message from the – from those findings.
[00:20:45.660] Mark Tebbs: Thank you so much for your time and for such an interesting conversation. For more details on Dr. Susanne Schweizer, please visit the ACAMH website, www.acamh.org, and Twitter @ACAMH. ACAMH is spelt A-C-A-M-H, and don’t forget to follow us on your preferred streaming platform, let us know if you enjoy the podcast, with a rating or review, and do share with friends and colleagues.
