Cognitive Bias Modification For Interpretation Research Articles

Targeting hostile attributions in inclusive schools through online cognitive bias modification: A randomised experiment

The tendency to make hostile attributions in ambiguous social situations has been associated with aggression and may be targeted through cognitive bias modification for interpretations (CBM-I). Despite their high prevalence of aggression and internalising problems, children and young people with neurodevelopmental disorders (NDD) or special educational needs (SEN) are markedly absent from CBM-I studies. This pilot study investigates whether online CBM-I can reduce hostile attributions and reactive aggression in inclusive school pupils. In Study 1, 71 pupils (mean age = 12.2, SD = 1.5; 25.4% presented with NDD or SEN) were randomly allocated to complete three sessions of either CBM-I (n = 37) or active control training (n = 34). CBM-I involved interpreting ambiguous scenarios or faces in a non-hostile manner, whereas the control training involved attention and memory exercises without resolving ambiguity. Between-group comparison showed CBM-I to reduce both hostile attributions and reactive aggression. In Study 2, follow-up focus groups with 23 pupils demonstrated the acceptability of training content and delivery. Together, these findings show online CBM-I to be acceptable and effective at reducing both hostile attributions and reactive aggression in an inclusive setting. The possibility of intervention effects on behavioural outcomes and potential confounding variables require further investigation.

Adapting cognitive bias modification to train healthy prospection

Prospection, the mental simulation of future events, has been theoretically linked to physical and mental health. Prior studies have found that prospection is malleable; however, no research to our knowledge has tested whether a scalable intervention explicitly targeting the simulation of positive future outcomes can lead to more generalized positive prospection, and enhance positive outlook and reduce distress. The current study tested a novel, web-based cognitive bias modification for interpretation (CBM-I) program designed to shift prospective bias towards more positive (as opposed to negative) representations of future outcomes among 172 participants selected for having a relatively negative baseline expectancy bias. Results showed that following CBM-I, participants in active training conditions exhibited more positive expectations about the future, and increased self-efficacy and growth mindset. Also, optimism increased and depression and anxiety symptoms decreased following active training, but this also occurred for the control condition. Analyses did not suggest that changes in positive expectations mediated changes in positive outlook outcomes. Results suggest that an online prospection intervention can lead to more positive expectations about future events and improve positive outlook, though open questions remain about what accounts for the training effects.

CBM-I Training and Its Effect on Interpretations of Intent, Facial Expressions, Attention and Aggressive Behavior.

There is abundant evidence suggesting that attention and interpretation biases are powerful precursors of aggression. However, little is known how these biases may interact with one another in the development and maintenance of aggression. Using cognitive bias modification of interpretation (CBM-I), the present study examined whether training more pro-social or hostile intent attributions would affect attention bias, interpretation bias of facial expressions, aggression and mood. University students (17–48 years) were assigned to either a positive training (n = 40), negative training (n = 40), or control training (n = 40). Results showed that the positive training successfully changed measures of intent attributions in a pro-social direction compared to the control training. The negative training changed measures of intent attributions in a hostile direction but not more so than the control training. We found no generalization of the training effects to relevant other outcomes. Possible explanations underlying these findings are discussed.

Multi-session online interpretation bias training for anxiety in a community sample

The present study assessed target engagement, preliminary efficacy, and feasibility as primary outcomes of a free multi-session online cognitive bias modification of interpretation (CBM-I) intervention for anxiety in a large community sample. High trait anxious participants (N = 807) were randomly assigned to a CBM-I condition: 1) Positive training (90% positive-10% negative); 2) 50% positive-50% negative training; or 3) no-training control. Further, half of each CBM-I condition was randomized to either an anxious imagery prime or a neutral imagery prime. Due to attrition, results from six out of eight sessions were analyzed using structural equation modeling of latent growth curves. Results for the intent-to-treat sample indicate that for target engagement, consistent with predictions, decreases in negative interpretations over time were significantly greater among those receiving positive CBM-I training compared to no-training or 50-50 training, and vice-versa for increases in positive interpretations. For intervention efficacy, the decrease in anxiety symptoms over time was significantly greater among those receiving positive CBM-I training compared to no-training. Interaction effects with imagery prime were more variable with a general pattern of stronger results for those completing the anxious imagery prime. Findings indicate that online CBM-I positive training is feasible and shows some promising results, although attrition rates were very high for later training sessions.

Examining the effectiveness of cognitive bias modification for perfectionism in exploration of the mediating and moderating effects of body dissatisfaction and self-efficacy

The relationship between perfectionism, body dissatisfaction, and self-efficacy is unclear. This study attempted to distinguish the relationship between different dimensions of perfectionism and to examine how they relate to body dissatisfaction and self-efficacy. Experiment 1 examined the effectiveness of two types of Cognitive Bias Modification for Interpretation (CBM-I) techniques in the induction of perfectionism. Experiment 2 explored the mediation and moderation effects of perfectionism facets, body dissatisfaction, and self-efficacy in the induction of perfectionism. Participants were randomly assigned to one of the four CBM-I conditions and completed self-report measures of trait and state perfectionism, body dissatisfaction, self-efficacy, as well as a behavioural task that assessed perfectionistic behaviours before and after the CBM-I induction. The results indicated no significant differences in perfectionism between the experimental groups and the control groups following the perfectionism induction. Using baseline participant characteristics, body dissatisfaction was found to mediate socially-prescribed perfectionism and self-efficacy. Self-oriented perfectionism moderated the association between body dissatisfaction and self-efficacy. State perfectionism may not be influenced by a single session (30 trials) of CBM-I training. Treatment targeting body dissatisfaction may enhance self-efficacy in socially-prescribed perfectionists. Further, interventions that decrease self-oriented perfectionism may reduce body dissatisfaction while increasing self-efficacy.

Modification of hostile interpretation bias and self-reported aggression in juvenile delinquents: A randomized controlled trial

Background/ObjectiveThe social information processing model holds that aggressive behavior is closely related to the hostile interpretation of ambiguous social cues, suggesting the possibility that an intervention that reduces hostile interpretations could reduce aggression. This study in Mainland China evaluated the remediating effects of cognitive bias modification for interpretation (CBM-I) on the hostile interpretation bias and self-reported aggressive behaviors of male juvenile delinquents, taking into account initial hostile interpretation bias as a possible moderator of the intervention effect. MethodFifty-six male juvenile delinquents aged 16-18 were recruited and randomly assigned to the CBM-I group (n = 28) or the Waiting-List group (n = 28). Interpretation bias and self-reported aggressive behavior were assessed at pre-test and post-test. ResultsThe positive interpretations of participants in the CBM-I group were significantly increased compared with participants in the Waiting-List group. The intervention effect of CBM-I on self-reported physical aggression was significant only for juvenile delinquents with high pre-test hostile interpretation bias. ConclusionsCBM-I can significantly improve the positive interpretation bias of juvenile delinquents, and reduce the self-reported physical aggression for some male juvenile delinquents. The results have implications for providing low-cost and high-efficiency intervention for juvenile delinquents’ self-reported aggression behavior.

Effectiveness of an online interpretation training as a pre-treatment for cognitive behavioral therapy for obsessive-compulsive disorder in youth: A randomized controlled trial

BackgroundCognitive behavioral therapy (CBT) is the treatment of choice for pediatric obsessive-compulsive disorder (OCD), but not all patients profit sufficiently. Long waitlists and wide variations in improvement rates ask for new interventions. We examined the effectiveness of a Cognitive Bias Modification–Interpretation (CBM-I) training that was offered during the waiting period for CBT. We tested 1) whether the CBM-I training is an effective intervention during a waitlist period for CBT, and 2) whether augmenting CBT with CBM-I improves treatment effect. MethodsParticipants (74 children with OCD, 8–18 years) were randomly assigned to either a CBM-I training or a waitlist, both followed by CBT. Resultsindicated that compared to the waitlist, the CBM-I training was effective in reducing OCD severity, with a medium effect size. Patients in the CBM-I training condition started subsequent CBT with less severe OCD, and this advantage was maintained during CBT. However, the CBM-I training did not result in a faster decline of symptoms during subsequent CBT. ConclusionThese findings indicate that CBM-I training could be an easy to implement, helpful intervention during a waitlist period. However, replications in larger samples and comparisons to active control conditions are needed.

Developing Cognitive Bias Modification Scenarios for Women with Sexual Interest Arousal Disorder and Comparing Effectiveness with Mindfulness Therapy

The aim of the present study was to develop and validate the scenarios of cognitive bias modification of interpretation (CBM-I) in women with sexual interest arousal disorder (SIAD) and comparing its effectiveness with mindfulness therapy in Iran. This study was performed by mixed method in two phases. In the first phase of the study, CBM treatment scenarios were developed. In the second phase, 45 women with SIAD were selected and randomly divided into three groups (two experimental groups and one control group). In the qualitative phase of the research on the evaluation of the designed scenarios, 80 scenarios remained among the 100 scenarios by meeting the content validity criteria, fidelity, acceptance, and satisfaction with the treatment. Both experimental treatments exceeded the no treatment control but that mindfulness was more effective than CBM-I as measured by the Female Sexual Function Index Questionnaire (p < 0.001). According to the findings, the use of CBM-I to replace positive interpretations with negative interpretations of cognitive bias in SIAD has a clinical application. Therefore, CBM-I can be used as practical treatment along with other treatments to reduce the symptoms of sexual dysfunction.

Which variations of a brief cognitive bias modification session for interpretations lead to the strongest effects?

Brief computerized programs that train less threatening interpretations (termed Cognitive Bias Modification for Interpretations, or CBM-I) can shift interpretation biases and subsequent anxiety symptoms. However, results have been inconsistent, particularly for studies conducted over the Internet. The current exploratory study tests 13 variations of a single brief session of CBM-I, a non-CBM-I cognitive flexibility condition, a neutral condition, and a no task control condition in an analogue sample with moderate to severe anxiety. Results suggest that all conditions, except the neutral scenarios condition and the alternative way to improve cognitive flexibility, led to changes in interpretations (when compared to the no task control condition). Only conditions geared toward increasing imagery during CBM-I and targeting flexibility related to emotional material differed from the no task control condition on other post-training measures. Presenting valenced interpretations of ambiguous information during brief CBM-I, regardless of the format, can lead to changes in interpretation bias. However, most conditions did not differ from the no task control condition on other post-training assessments (and differences that did occur may be due to chance). Future trials should consider further testing of CBM-I that targets flexibility related to emotional material, and should include an increased number of sessions and trials.

Cognitive bias modification of interpretation training for Chinese undergraduates with depressive symptoms

Because depression is highly prevalent among Chinese undergraduates, it is crucial to develop an approach for early intervention and prevention. Cognitive bias modification of interpretation (CBM-I) has been shown to be an effective approach to alleviate anxiety. However, its utility in improving depression needs further verification. The current study sought to evaluate the efficacy of a four-session CBM-I program of depression prevention for Chinese undergraduates. Forty Chinese participants with depressive symptoms (Self-Rating Depression Scale, SDS ≥ 50) were randomly assigned to receive either a CBM-I training or a waitlist control condition. Test results of Ambiguous Scenarios Test for Depression-Related Bias and SDS indicate that the CBM-I training group have more positive interpretations and fewer symptoms of depression after the training compared to the control group. In addition, significant correlation was found between changes in depressive symptoms and changes in interpretation bias. The effect of the CBM-I on depressive symptoms was partially mediated by the change in interpretation bias. The study findings highlight the potential of CBM-I protocol as a brief, simple, and accessible approach for preventing depression.

Online Cognitive Bias Modification of Interpretation for Children With Obsessive-Compulsive Disorder

Objective: Numerous children with Obsessive-Compulsive Disorder (OCD) either have no access to its main treatment, i.e. Cognitive Behavioral Therapy (CBT), or fail to respond to it. Cognitive Bias Modification of Interpretation (CBMI) is a novel and promising intervention that targets the incorrect interpretation of intrusive thoughts and impulses, i.e. the characteristics of OCD. The present study aimed to determine the effects of CBMI in children with OCD for the first time. Besides, we evaluated the possibility of online implementation of this intervention. Methods: A sample of 35 children with OCD (aged 7-12 years) were randomly assigned to two study groups. The experimental group (n=18) received CBMI and the controls (n=17) received placebo treatment. Interpretation bias and OCD severity were assessed at pre-test, post-test, and 2-month follow-up stages, using the Obsessive Compulsive Inventory-Child Version (OCICV), Obsessive Beliefs Questionnaire-Child Version (OBQCV), and Ambiguous Scenarios Task (AST). The present study results were analyzed using two-way repeated-measures Analysis of Variance (ANOVA) and Paired Samples t-test. Results: The collected findings demonstrated that after receiving CBMI, children’s propensity to positively interpret ambiguous situations was increased, their tendency towards negative interpretation and OCD severity was also decreased. There was no such significant change in the control group. Furthermore, the effects of CBMI was sustained at the 2-month follow-up step. Conclusion: This study provided preliminary evidence that suggests CBMI is capable of modifying interpretation bias in children with OCD, can reduce the severity of their disorder, and works as an online intervention. This brief and inexpensive intervention could be considered as an auxiliary or standalone treatment for OCD in children.

The effect of cognitive bias modification for interpretation (CBM-I) on social anxiety and mood: Compared text-based scenarios training with picture-word cue training.

The effect of cognitive bias modification for interpretation (CBM-I) on social anxiety and mood: Compared text-based scenarios training with picture-word cue training.

The Efficacy of Intolerance of Uncertainty Intervention on Anxiety and its Mediating Role by Multilayer Linear Model Analysis

Cognitive bias modification-interpretation (CBM-I) is a promising treatment modality for emotional disorders. But the moderate effect sizes emphasize the need to explore the potential mechanism of the CBM-I. Recent research has identified intolerance of uncertainty (IU) as a possible a trans-diagnostic risk and maintaining factor emotional disorders. The current study investigated the impact of a four-session IU-focused CBM-I on reduction of anxiety and determined whether IU mediated the relationship between IU interpretation bias and anxiety. 40 participants selected based on a high IU interpretation bias (IU-IB) were randomly assigned to an active (IU CBM-I) condition and a control CBM-I condition. By longitudinal design, anxiety and uncertainty questionnaires were administered before, after and one month after the intervention. Multilayer linear model analysis indicated that the active IU CBM-I was significantly associated with changes in anxiety from pre-to-post intervention as well as reductions in IU at post-intervention and month-one follow-up. The results also found that IU mediated the relationship between IU interpretation bias and anxiety.

Internet-based interpretation bias modification for body dissatisfaction: A three-armed randomized controlled trial.

Appearance-related interpretation bias is postulated to play a role in the maintenance of body dissatisfaction (BD), a risk factor for body dysmorphic disorder (BDD), and eating disorders (ED). Cognitive bias modification for interpretation (CBM-I) has been shown to reduce maladaptive interpretation bias and symptoms in various emotional disorders. This study investigated the acceptability and efficacy of an easily disseminable, web-based CBM-I program for BD. Individuals with high BD (N = 318) were randomized to a multi-session CBM-I (Sentence Word Association Paradigm [SWAP] with feedback) vs. control (SWAP without feedback) versus waitlist condition. Interpretation bias, BD and associated symptoms were assessed at baseline and post-intervention. Symptoms were monitored up to 1-week and 4-week follow-up. We further investigated transference effects to stress reactivity, as predicted by cognitive-behavioral models, at post-intervention. Appearance-related CBM-I led to a differential pre-post increase in adaptive interpretation patterns, particularly for appearance-related and social situations (d = 0.65-1.18). Both CBM-I and control training reduced BD, BDD symptom severity, and depression. However, CBM-I (vs. control and waitlist) improved appearance-related quality of life (d = 0.51), self-esteem (d = 0.52), and maladaptive appearance-related beliefs (d = 0.47). State stress reactivity was overall reduced in the CBM-I condition (vs. waitlist). Intervention effects largely held stable up to follow-ups. Treatment satisfaction was comparable to other CBM-I studies, with low rates of adverse reactions. These findings support assumptions of cognitive-behavioral models for BD, BDD, and ED, and suggest that web-based CBM-I is an efficacious and acceptable intervention option.

HabitWorks: Development of a CBM-I Smartphone App to Augment and Extend Acute Treatment

The month following discharge from acute psychiatric care is associated with increased risk of relapse, rehospitalization, and suicide. Effective and accessible interventions tailored to this critical transition are urgently needed. Cognitive bias modification for interpretation (CBM-I) is a low-intensity intervention that targets interpretation bias, a transdiagnostic process implicated in the development and maintenance of emotional disorders. We describe the development of a CBM-I smartphone app called HabitWorks as an augmentation to acute care that extends through the high-risk month postdischarge. We first obtained input from various stakeholders, including adults who had completed partial hospital treatment (patient advisory board), providers, CBM experts, and clinic program directors. We then iteratively tested versions of the app, incorporating feedback over three waves of users. Participants were recruited from a partial hospital program and completed CBM-I sessions via the HabitWorks app while attending the hospital program and during the month postdischarge. In this Stage 1A treatment development work, we obtained preliminary data regarding feasibility and acceptability, adherence during acute care, and target engagement. Pilot data met our a priori benchmarks. While adherence during acute treatment was good, it decreased during the postacute period. Qualitative feedback was generally positive and revealed themes of usability and helpfulness of app features. Participants varied in their perception of skill generalization to real-life situations. The feasibility and acceptability data suggest that a controlled trial of HabitWorks is warranted.

Neural correlates of cognitive bias modification for interpretation.

The effectiveness of cognitive bias modification for interpretation (CBM-I), a treatment method employed to reduce social anxiety (SA), has been examined. However, the neural correlates of CBM-I remain unclear, and we aimed to elucidate brain activities during intervention and activity changes associated with CBM-I effectiveness in a pre–post intervention comparison. Healthy participants divided into two groups (CBM, control) were scanned before, during and after intervention using functional magnetic resonance imaging. Ambiguous social situations followed by positive outcomes were repeatedly imagined by the CBM group during intervention, while half of the outcomes in the control group were negative. Whole-brain analysis revealed that activation of the somatomotor and somatosensory areas, occipital lobe, fusiform gyrus and thalamus during intervention was significantly greater in the CBM than in the control group. Furthermore, altered activities in the somatomotor and somatosensory areas, occipital lobe and posterior cingulate gyrus during interpreting ambiguous social situations showed a significant group × change in SA interaction. Our result suggests that when facing ambiguous social situations, positive imagery instilled by CBM-I is recalled, and interpretations are modified to contain social reward. These findings may help to suggest an alternative manner of enhancing CBM-I effectiveness from a cognitive-neuroscience perspective.

Cognitive bias modification for threat interpretations: Impact on anxiety symptoms and stress reactivity.

Cognitive bias modification for interpretations (CBM-I) is a computerized intervention that has received increasing attention in the last decade as a potential experimental intervention for anxiety. Initial CBM-I trials with clinical populations suggest the potential utility of this approach. However, most CBM-I experiments have been conducted with unaffected samples, few (one or two) training sessions, and have not examined transfer effects to anxiety-related constructs such as stress reactivity. This study compared a 12-session CBM-I intervention (n = 12) to an interpretation control condition (ICC; n = 12) in individuals (N = 24) with elevated trait anxiety on interpretation bias, anxiety symptom, and stress reactivity outcomes (electrodermal activity, heart rate, and respiratory sinus arrhythmia). Compared to the ICC group, participants assigned to CBM-I experienced significantly greater improvements in interpretation bias and anxiety symptoms by post-intervention 4 weeks later, with impact on anxiety maintained at 1-month follow-up. While CBM-I and ICC groups did not differ in stress reactivity during an acute stressor at pre-intervention, the CBM-I group evidenced improved stress reactivity at post-intervention compared to ICC on two psychophysiological indices, electrodermal activity and heart rate. The results of this pilot study suggest that CBM-I may hold promise for reducing anxiety symptoms, as well as impact psychophysiological arousal during an acute stressor.

How Anxious are You Right Now? Using Ecological Momentary Assessment to Evaluate the Effects of Cognitive Bias Modification for Social Threat Interpretations

Reducing one’s tendency to interpret ambiguous situations negatively can improve symptoms of social anxiety. This study examines the effectiveness of a 1-week period of online Cognitive Bias Modification for Interpretations (CBM-I) for socially anxious individuals. In addition to measuring intervention effectiveness through traditional trait measures, this study investigates whether associated state measures are sensitive to intervention effects in daily life. One-hundred and six participants scoring high on a measure of trait social anxiety completed two in-lab sessions separated by 5 weeks of ecological momentary assessment, with 51 participants randomly assigned to receive the online CBM-I intervention halfway through the 5-week monitoring period. CBM-I training was more effective than monitoring alone in reducing trait negative interpretation bias, indicating target engagement. However, this change was not reliably accompanied by changes on other cognitive processing style outcomes. Further, while trait and state social anxiety symptoms and fear of negative evaluation improved, these changes were not unique to the CBM-I intervention group. This study demonstrates the challenges and opportunities associated with investigating intervention effects in daily life.

Positive Thinking is Not Adaptive Thinking: A Cognitive-Behavioral Take on Interpretation Bias Modification for Social Anxiety

Interpretation biases are a core feature of social anxiety. Used to automatically train positive interpretation biases, the existing versions of Cognitive Bias Modification for Interpretation (CBM-I) render mixed results. The current study presents the development and testing of a one-session novel adaptation of CBM-I for social anxiety that provides an adaptive instead of a positive meaning to socially loaded situations. Informed by Rational-Emotive Behavior Therapy and latest theoretical upgrades, we argue that biases exist on a continuum from adaptive to maladaptive and defining them by valence may fuel unrealistic positive illusions. A hundred forty volunteers with high social anxiety were randomized to the CBM-I or to the sham-training condition. Baseline, post-training, and during impromptu speech assessments of self-reported anxiety were made, while adaptive interpretation bias was measured at baseline and post-training. First, near-transfer effects in favor of the CBM-I group were found. Second, no far-transfer effects were found regarding the anxiety experienced during the speech. Third, a main finding was that changes in interpretation bias fully mediated training effects on anxiety. To our knowledge, this is the first CBM-I study to evidence that experimentally induced changes in interpretation mediate changes in anxiety. The therapeutic potential of this new adaptation of CBM-I requires testing in clinical samples.

Effects of modifying interpretation bias on transdiagnostic repetitive negative thinking.

Repetitive negative thinking (RNT; e.g., worry and rumination) is common across emotional disorders, as is the tendency to generate negative interpretations (interpretation bias). Ameliorating negative interpretations via cognitive bias modification of interpretations (CBM-I) reduces worry/rumination, and improves mood in people diagnosed with generalized anxiety disorder (GAD) or depression. We investigated whether these findings generalize to high worry or rumination populations, irrespective of diagnosis, and whether effects are increased by enhancing emotional engagement with training with active generation of positive resolutions of ambiguity and imagery. Community volunteers with excessive worry and/or rumination, who were above clinical cut-off on anxiety and/or depression measures, were allocated to an active control condition (n = 54), interpretation training condition with prior activation of RNT (CBM_RNT; n = 54), or training condition augmented with positive outcome generation and imagery (CBM_ENH; n = 53). Interpretation bias, RNT, and mood were assessed before and following 10 Internet-based sessions completed within a 1-month period. RNT and mood questionnaires were also completed at 1-month follow-up. After training, both forms of CBM-I (vs. control) facilitated more positive interpretations and reduced negative intrusions during a worry task. At 1-month follow-up, anxiety, depression, RNT, and worry in the past week were lower in the CBM-I than control conditions, but not rumination or trait worry. Compared with standard CBM-I, the augmented form facilitated more positive interpretations, reduced negative intrusions after training, and reduced trait rumination at 1-month follow-up, but it did not augment effects on trait worry, anxiety or depression. Interpretation bias maintains transdiagnostic RNT and Internet-based CBM-I can reduce longer-term RNT. (PsycINFO Database Record (c) 2020 APA, all rights reserved).