The Effectiveness of Cognitive Bias Modification Interventions in Anxiety and Depressive Disorders: A Network Meta-Analysis

Abstract

Background: Cognitive bias modification (CBM), targeting attentional biases (ABM) or interpretation biases (CBMI), are prototypical examples of mechanistically derived treatments, but their effectiveness is contentious. We examined the relative effectiveness of CBM for anxious and depressive symptomatology. Methods: For this systematic review and network meta-analysis (NMA), we searched PubMed, PsycINFO, EMBASE and Cochrane Central Register through January 15 th 2019, We included randomized controlled trials of CBM versus control conditions for adults with clinical or subclinical anxiety or depression. Two researchers independently selected studies and evaluated risk of bias with the Cochrane Collaboration tool. Primary outcomes encompassed anxiety and depression in trials targeting these conditions. We computed standardized mean differences (SMD) with a restricted maximum likelihood random effects model. Findings: From 1665 records, we selected 82 trials, 65 (N=3788) on anxiety and 17 (N= 863) on depression. In a well-connected network of anxiety trials, CBMI outperformed waitlist (SMD = -0·48, 95% CI: -0·84 to -0·12) and sham training (SMD = -0·31, 95% CI: -0·53 to -0·09) for the primary outcome. ABM showed benefits only in sensitivity analyses excluding PTSD trials. Prediction intervals were large, including an SMD of 0. Networks of depression trials displayed evidence of inconsistency. Interpretation: CBM interventions showed consistent but small benefits, however heterogeneity and risk of bias undermine the reliability of these findings. Larger, definitive trials for CBMI for anxiety might be warranted. Insufficient evidence precludes conclusions for depression. Funding Statement: Raluca Georgescu, Liviu A. Fodor and Ioana A. Cristea were supported by a grant from the Romanian Ministry of Research and Innovation, CNCS – UEFISCDI (project number PN-III-P1-1.1-TE-2016-1054). Declaration of Interests: Dr. Cristea reports grants from Romanian Ministry of Research and Innovation, CNCS – UEFISCDI , during the conduct of the study. Dr. Georgescu reports grants from Romanian Ministry of Research and Innovation, CNCS – UEFISCDI , during the conduct of the study. Dr. Fodor reports grants from Romanian Ministry of Research and Innovation, CNCS – UEFISCDI , during the conduct of the study. Dr. Furukawa reports grants and personal fees from Mitsubishi-Tanabe, personal fees from MSD, personal fees from Shionogi, outside the submitted work; In addition, Dr. Furukawa has a patent 2018-177688 pending. All remaining authors declare no conflicts of interest. Ethics Approval Statement: (PROSPERO registration: CRD42018086113).