The Effect of Confidence on Dropout Rate and Outcomes in Online Cognitive Bias Modification

Nicola Hohensee,M Joseph Meyer,Bethany A Teachman

doi:10.1007/s41347-020-00129-8

Nicola Hohensee, M Joseph Meyer + Show 1 more

Open Access

https://doi.org/10.1007/s41347-020-00129-8

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Abstract

Cognitive bias modification training for interpretation bias (CBM-I) trains less threat-oriented interpretation patterns using basic learning principles and can be delivered completely online. Thus, CBM-I may increase accessibility of treatment options for anxiety problems. However, online interventions are often affected by pronounced dropout rates, and findings regarding the effectiveness of CBM-I, especially when delivered online, are mixed. Therefore, it is important to identify further predictors of dropout rate and intervention outcomes. The current study uses data from an exclusively online, multi-session CBM-I feasibility trial to investigate the effects of perceived confidence in the likely helpfulness of a CBM-I program (rated at baseline) on subsequent dropout rate, and change in interpretation bias and anxiety symptoms for N = 665 individuals high in trait anxiety. Results showed that higher baseline confidence ratings predicted lower dropout rate, as expected. Partially in line with hypotheses, there was some evidence that higher confidence ratings at baseline predicted greater changes on some interpretation bias measures, but results were not consistent across all measures and fit indices. Inconsistent with hypotheses, confidence did not predict change in anxiety symptoms. Possible explanations for why the nonsignificant findings may have occurred, as well as implications of confidence in online interventions being an early predictor of high risk for dropout, are discussed.

Highlights

For change in Negative Recognition Ratings, a quadratic model, describing greater change from pre-assessment to session three than from session three to session six, showed the best fit with acceptable values for the chi-square statistic, comparative fit index (CFI), and root mean square error of approximation (RMSEA), with only Tucker Lewis Index (TLI) having a value below the recommended guideline of
Brief Body Sensations Interpretations Questionnaire (BBSIQ) brief body sensations interpretations questionnaire, Overall Anxiety Severity and Impairment Scale (OASIS) overall anxiety severity and impairment scale, χ2 Chi-square test, CFI comparative fit index, TLI Tucker Lewis index, RMSEA root mean square error of approximation, AIC Akaike information criterion, BIC Bayesian information criterion; χ2 should be non-significant, CFI and TLI are acceptable above .90 and RMSEA is acceptable below 0.08 and BIC were lowest for the All-Zero-Model
Estimates in the no-Cognitive bias modification training for interpretation bias (CBM-I) condition and the 50/50 CBM-I condition did not differ significantly (p = .07). These results indicate that confidence’s effect on change in BBSIQ scores depends on the CBM-I condition; the effect of confidence is strongest in the positive CBM-I condition, indicating a greater decline in threat interpretations for people with higher confidence

Summary

Introduction

The present study uses data from an initial feasibility trial (Ji et al 2018) to investigate perceived confidence in an online, multi-session CBM-I training and its effect on dropout rate, and change in interpretation bias and anxiety symptoms for individuals high in trait anxiety. BBSIQ brief body sensations interpretations questionnaire, OASIS overall anxiety severity and impairment scale, χ2 Chi-square test, CFI comparative fit index, TLI Tucker Lewis index, RMSEA root mean square error of approximation, AIC Akaike information criterion, BIC Bayesian information criterion; χ2 should be non-significant, CFI and TLI are acceptable above .90 and RMSEA is acceptable below 0.08 and BIC were lowest for the All-Zero-Model (see Table 1).

Results

Conclusion