Cognitive Reappraisal for Dyslexia

Today, I present a single article on anxiety and dyslexia. McDowall, Rimfield & Krishnan (2024) published “Cognitive Reappraisal Reduces Academic Anxiety in University Students with Dyslexia” in Mind, Brain & Education. Here are edited excerpts:

University students with dyslexia have greater anxiety than their peers without dyslexia, especially related to their academic studies. Most universities focus on mitigating the learning needs of these students, for example, providing more time during exams. Relatively little attention is paid to the psychological impact of having dyslexia. In this preregistered study, we investigated whether cognitive reappraisal reduced academic anxiety in university students with dyslexia. We codesigned negative and neutral scenarios about academic life with university students with dyslexia. We presented university students (54 students with dyslexia and 51 neurotypical students) with these scenarios about academic life and asked them to rate their anxiety. As hypothesized, we observed that students with dyslexia had higher academic anxiety than those without dyslexia (d = 0.43). When instructed to use cognitive reappraisal, all students, irrespective of having dyslexia or not, benefitted from an anxiety reduction (d = 0.87). Our experimental research indicates cognitive reappraisal may be a valuable tool to support students. Furthermore, it may help those with dyslexia to manage the heightened emotional demands of academia. Intervention trials that assess the real-world implementation of cognitive reappraisal are now warranted.

The academic pressures of university, including high workloads, deadlines, exams, and assessments, are risk factors associated with stress, anxiety, and depression among students (Mofatteh 2021). Tackling university with a specific learning difficulty such as dyslexia, which exacerbates these challenges, may require significantly more emotional resilience. Dyslexia is a learning difficulty characterized by problems with accurate or fluent word recognition, poor decoding, and poor spelling abilities (American Psychiatric Association 2013).  According to the Higher Education Statistics Agency (2023), the prevalence of university students reporting dyslexia (and other specific learning difficulties) has been increasing from 0.45% in the late 90s to 4.6% to date. University students with dyslexia are less likely to pass modules or achieve good grades. Students with dyslexia also face a heightened risk for increased emotional difficulties such as anxiety, depression, and low self-esteem. In this study, we will focus on emotional regulation in people with dyslexia and assess whether a widely used cognitive behavioral therapy (CBT) strategy—cognitive reappraisal—could help students with dyslexia manage the emotional demands of university.

Recent systematic reviews suggest the two most common emotional difficulties faced by students with dyslexia are anxiety and low self-esteem. However, there is some debate as to the specificity of these difficulties. Some studies have suggested that individuals with dyslexia experience generalized increases in anxiety and lower self-esteem. Other studies indicate these increases are specifically tied to completing academic tasks. Specific anxiety around education, as opposed to generalized anxiety which relates to everyday events or activities, can be referred to as academic anxiety, the feelings of apprehension or fear and excessive worry in relation to academic tasks such as assessments evidence for increased academic anxiety in students with dyslexia is quite strong. Students with dyslexia show higher mathematics anxiety and test anxiety. Poor reading ability in students is associated with higher reading anxiety and lower academic achievement. Students with dyslexia were found to have higher academic anxiety and also showed higher state anxiety levels prior to completing a reading task than those without dyslexia. In these studies, the effect sizes range from medium to large (ηp2 = 0.05–0.5). Understanding how to help students with dyslexia manage their academic anxiety could substantially improve their university experience.

Cognitive reappraisal is a highly effective emotional regulation strategy to reduce negative emotions (Gross 2015). It is a fundamental tool in CBT to elicit cognitive change and has been successful in interventions for anxiety. It refers to reframing the way one thinks about a situation to change the emotional impact of the situation. For instance, in a recent study Nook and colleagues showed participants negative images and instructed them to think differently about the image to feel better. Cognitive reappraisal decreased people's negative affect; this was a large effect (d = 1.09) (Nook et al. 2020).  Participants instructed to use reappraisal reported less sadness after watching an emotional film clip (Troy et al. 2010).  Cognitive reappraisal can also reduce social anxiety (Kivity and Huppert 2016), and it is associated with lower levels of anxiety and depression in experimental tasks (Bettis et al. 2019). Compared to strategies such as emotion suppression, cognitive reappraisal led to better interpersonal functioning and well-being (Gross and John 2003). 

In this study, we investigated whether cognitive reappraisal can reduce academic anxiety in university students with and without dyslexia. We also explored whether those with dyslexia experience differential benefit from cognitive reappraisal. We predicted that students with dyslexia might benefit more than neurotypical students from reappraisal because of the greater potential for change due to their higher academic anxiety. They may also benefit more because of the reduced use of emotional coping strategies in those with greater anxiety in academic subjects.

To assess whether cognitive reappraisal was effective, we adapted the design used by Nook et al. (2020) presenting challenging and neutral academic scenarios to students with and without dyslexia. These situations were codesigned with experts by experience (i.e., those with lived experience of dyslexia). Participants were asked to rate their anxiety in these different situations. They were given instructions on how to use cognitive reappraisal and asked to apply it to one set of negative scenarios. We then tested the following preregistered hypotheses: (1) University students with dyslexia will experience higher academic anxiety than students without dyslexia when faced with challenging academic scenarios. (2) Using cognitive reappraisal will reduce academic anxiety in all participants. (3) University students with dyslexia will benefit more from cognitive reappraisal than students without dyslexia.

In our study, we observed that students with dyslexia experienced heightened academic anxiety. This is consistent with previous studies, which have shown academic anxiety is higher in university students with dyslexia. Our study was the first to use experimental methods to measure states of academic anxiety and cognitive reappraisal ability in people with dyslexia. To elicit an emotional response, we provided students with examples of realistic scenarios at university (meeting deadlines, taking exams, writing essays, failing assignments, and long reading lists), which were codesigned by people with lived experience.

In our study, as expected, students with dyslexia showed higher emotional reactivity scores than the nondyslexic students, indicating that the negative scenarios elicited greater anxiety for those with a history of reading difficulties. Critically, the neutral scenarios were not associated with the same rise in anxiety. As academic challenges are an inevitable part of university, this increased anxiety could considerably impact their overall university experience. Furthermore, these students may find themselves at a greater risk of poor academic performance as a consequence of academic anxiety. However, some levels of academic anxiety can also drive academic performance. Our results suggest a need to build awareness about the emotional challenges faced by dyslexic students at university. The nature of these scenarios also provides insight into the types of tasks that students with dyslexia consider challenging—it is noteworthy that many of these are not strictly about reading. University students may have developed strategies to cope with their reading difficulties; instead, they may face greater pressure from the demands university life makes on organization, memory, or structuring essays.

There is significant debate about the nature of anxiety in dyslexia and whether it is generalized or specific. In our study, in addition to our experimental measures, we used questionnaires to measure academic anxiety and general anxiety. In line with what we observed experimentally, students with dyslexia reported higher academic anxiety than students without dyslexia. Yet, differences between students with and without dyslexia on the measure of generalized anxiety were not significant (and our Bayesian analyses indicated anecdotal evidence for the null). Our findings are consistent with the idea that students with dyslexia have greater academic anxiety—but not necessarily general anxiety—than students without dyslexia.

There is some debate on how subtypes of dyslexia relate to emotional reactivity, but empirical data are limited (McArthur et al. 2020).  Given we had both phonological decoding and sight word efficiency scores, we explored whether these subskills of reading differentially correlated with emotional reactivity. We found that phonemic decoding emerged as the only significant unique contributor in explaining academic anxiety over and above variance accounted for by age and sight word. At face value, this supports the theory that there are subtypes of dyslexia that could influence the association between mental health difficulties and dyslexia. Phonological processing is considered the core deficit in dyslexia, and difficulties in this domain may be the key driver of difficulties in reading speed. However, it may simply be that phonemic decoding was the hardest task for all participants and, therefore, was related to academic anxiety.

In summary, this study examined the efficacy of cognitive reappraisal—an emotional regulation strategy—for reducing academic anxiety in university students with dyslexia. As expected, students with dyslexia were found to have higher levels of academic anxiety compared to their peers. Cognitive reappraisal was found to reduce academic anxiety in both students with and without dyslexia. Both groups benefited from the strategy. The results are promising, suggesting that cognitive reappraisal can be a valuable tool for alleviating academic anxiety for students with dyslexia. Future research is needed to incorporate cognitive reappraisal in interventions designed to support students with dyslexia. By supporting students with dyslexia in managing their academic anxiety, we not only enhance their educational experience but also equip them with essential tools to tackle challenging academic situations throughout their lives.

I thought this article was helpful both in differentiating academic anxiety from general anxiety and illustrating the value of cognitive reappraisal in reducing academic anxiety in university students with dyslexia. It’s especially interesting that cognitive reappraisal benefited all the students, whether they had dyslexia or not.