Abstract
The current meta-analysis explores the strength of effects of cognitive bias modification training for interpretation bias (CBM-I) on positive (i.e., adaptive) interpretations and mood as well as the training and sample characteristics influencing these effects. Data-bases were searched with the key words “interpret* bias AND training” and “interpret* bias AND modif*”. Reference lists of identified articles were checked and authors of identified articles were contacted for further relevant articles and unpublished data. Studies were reviewed for inclusion with eligibility criteria being that the study (a) aimed to target interpretation biases through any kind of training, (b) assessed mood and/or interpretation bias as outcome measures, (c) allocated individuals to training conditions at random, and (d) recruited adult samples. A meta-analytic multilevel mixed-effects model was employed to assess standardized mean changes in interpretation bias, negative mood, and emotional reactivity. In addition, several training and sample characteristics were explored for their potential to enhance benign training effectiveness. On average, benign CBM-I resulted in an increase in positive interpretation bias (p<.01) and a decrease in negative mood state (p<.001), but did not affect emotional reactivity. These effects were not consistently different from control conditions with no or neutral training. However, within benign training conditions imagery instructions and more training sessions were related to larger cognitive and mood effects, whereas feedback about training performance and inclusion of non-benign training items (instead of including benign items only) boosted cognitive effects only. Finally, training was more effective in women (cognitive and mood effects) and presumably samples with symptomatic emotional dysregulation (cognitive effects). Although the effects of emotional dysregulation and number of training sessions could not well be distinguished, there is an indication that when used with imagery instructions and more training sessions, benign CBM-I can be employed as a useful complementary treatment to usual psychotherapies.
Highlights
Relevant anxiety and depression are common, affecting up to 30% of individuals during their lifetime [1,2]
To the extent that benign cognitive bias modification training for interpretation bias (CBM-I) was effective at changing interpretational style and mood within the benign condition, we investigated whether this effect varied across various training characteristics and across sample characteristics, such as age, sex, and the inclusion of high symptomatic individuals
Conclusions results were less strong as previously suggested, it may be concluded that benign Cognitive bias modification (CBM)-I has clinical potential
Summary
Relevant anxiety and depression are common, affecting up to 30% of individuals during their lifetime [1,2]. These conditions are distressing, disruptive, and costly [1], prompting calls for more research into their treatment and prevention. Cognitive bias modification (CBM) training may be able to partially address this need. CBM training aims to modify information-processing biases linked to anxiety and depression through computerized, repeated practice that reinforces more adaptive styles of processing. An added benefit of CBM is that it can be implemented with relative ease. While recent individual studies appear promising, questions remain on the degree to which CBM can ‘correct’ biases and reduce symptomatology
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