Cognitive Bias Modification Procedures Research Articles

Cognitive bias modification of inferential flexibility

This research examines the effects of a cognitive bias modification procedure for facilitating inferential flexibility, on inferences, mood, and state rumination. Participants were presented with training scenarios, followed by two consecutive inferences for each scenario. In the training condition, participants repeatedly practiced shifting from a negative inference to a positive one. But in the control condition, the two inferences were of the same valence and no shifting occurred. The training successfully promoted the intended inferential shift on new scenarios (d = 0.72). Moreover, trained participants shifted away more readily from negative inferences for a future negative personal event (d = 1) and generated less negative inferences for this event (d = 0.61). As expected, the trained inferential shift improved mood and reduced state rumination. We discuss the potential to minimize adverse effects of negative inferences by shifting away from them to more positive inferences.

\u2018Relearning how to think\u2019: A brief online intervention to modify biased interpretations in emotional disorders\u2014study protocol for a randomised controlled trial

BackgroundCognitive biases play an important role in the development and maintenance of emotional disorders, such as depression and anxiety. Novel procedures, known as Cognitive Bias Modification (CBM), aim to reduce these dysfunctional information processing modes. This study develops a brief clinically based online intervention programme to modify biased interpretations in depression and anxiety (CBM-IClin), overcoming some methodological issues that have been addressed in previous literature.MethodsVolunteer participants will be recruited via social media and posters at the university. They will be randomly assigned to an experimental group or a waiting list control group. Both groups will complete two assessment sessions (before and after the intervention) consisting of questionnaires measuring cognitive and emotional variables as well as experimental tasks measuring cognitive biases (i.e. attention, memory, and interpretation). After the first assessment session, only participants in the experimental group will receive a link to follow the four CBM-IClin sessions at home. All participants will receive, via email, follow-up questionnaires 2 weeks and 3 months after the second assessment.DiscussionThis study will test the 'Relearning how to think', an online programme potentially beneficial to modify cognitive biases in emotional disorders. Several limitations of previous CBM procedures are addressed, and the impact of the programme both on objective cognitive bias tasks and clinical symptoms will be explored.Trial registrationClinicalTrials.gov NCT03987477. Prospectively registered on June 17, 2019

Biased interpretation in paranoia and its modification

Background and objectivesCognitive models of psychosis implicate interpretation biases as one of the mechanisms involved in the formation and maintenance of symptoms. First we measured the strength of association between interpretation biases and psychosis-relevant traits. Next we manipulated these biases and quantified the effects of doing so on psychosis-relevant outcomes. MethodsExperiment 1 used two measures of interpretation bias in a healthy sample (n = 70). Experiment 2 used a novel cognitive bias modification procedure (CMB-pa) in individuals with moderate trait paranoia (n = 60). ResultsExperiment 1 revealed that over a third of the variance in interpretation bias could be explained by the combined effect of trait measures of paranoia/psychosis. In Experiment 2, CBM-pa produced training-congruent changes in the interpretation of new ambiguous information and influenced the interpretation, attribution and distress associated with a real-life social event. LimitationsThe potentially confounding effects of elevated anxiety and depression on interpretation bias and the restricted range of outcome measures to assess the wider effects of CBM-pa. ConclusionsThese studies are consistent with interpretation biases contributing to the maintenance of paranoia. CBM-pa could next be adapted and evaluated to test its efficacy as a therapeutic intervention.

Cognitive Bias Modification for the Induction of Negative Versus Benign Interpretations of the Self in Individuals with Elevated Social Anxiety: Effects on Self-related and Anxiety Outcomes

Studies of cognitive bias modification for interpretations in the social anxiety literature typically examine the effects of inducing a benign interpretation of ambiguous social situations. This study modifies and extends cognitive bias modification procedures to specifically alter interpretations of the self (CBM-IS) associated with social anxiety disorder and examined the effects of negative CBM-IS versus benign CBM-IS. Participants with elevated social anxiety were randomly allocated to a negative or benign CBM-IS condition. After CBM-IS training, participants were assessed on induced interpretations of the self, completed a speech task, and rated their performance. Negative self-esteem and anxiety were assessed at baseline, post-training, and post-speech. As predicted, negative CBM-IS induced a negative interpretation of the self whereas benign CBM-IS induced a benign interpretation of the self. There were also three key differential effects: (a) a baseline to post-training increase in negative self-esteem following negative CBM-IS but not benign CBM-IS, although the negative self-esteem difference between conditions was no longer evident at post-speech, (b) a greater increase in anxiety from post-training to post-speech following negative CBM-IS relative to benign CBM-IS, and (c) more negative self-ratings of speech performance following negative CBM-IS relative to benign CBM-IS. These findings validate the new CBM-IS procedures, and highlight the potential of these procedures for testing models of social anxiety disorder and for therapeutic intervention to reduce social anxiety.

Brain functional connectivity after cognitive-bias modification and behavioral changes in abstinent alcohol-use disorder patients

The use of the cognitive-bias modification (CBM) method has emerged as a therapeutic complement in the treatment of alcoholism, producing changes at behavioral and brain level. Nevertheless, the impact of the CBM procedure could be improved by the memory retrieval-extinction process (REP). Different studies have demonstrated that the retrieval of drug memories before extinction training later reduced the reinstatement of drug-seeking behavior. The main aim of this work was to study the effect of the CBM procedure itself, as well as in combination with the activation of alcohol-related memories, on the brain oscillatory activity of abstinent patients with alcohol-use disorder. The study sample comprised 33 patients divided into three groups: A-CBM (alcohol-related memory activation + CBM), N-CBM (neutral memory activation + CBM) and N-INT (no-intervention) groups. A resting-state EEG was obtained before and after each protocol, along with the assessment of the automatic action tendencies. A-CBM group showed a general alpha synchronization increase after the protocol, while the other groups did not show any significant change. Besides, A-CBM group showed significant intra and inter-group differences in the automatic action tendencies after the protocol, reflected in higher avoidance bias toward appetitive, aversive and without context alcohol-related stimuli. The alpha phase synchronization increase could be the neural manifestation of the conditioning produced between the alcohol-related stimuli and the automatic avoidance response. Moreover, the activation of the alcohol-related memories favors this conditioning with those alcohol-related stimuli associated with the activated memories, because it increases their threat level for the abstinence maintenance.

Reducing Aggressive Children\u2019s Hostile Attributions: A Cognitive Bias Modification Procedure

Children with aggression problems tend to interpret other’s intentions as hostile in ambiguous social situations. Among clinically referred children with aggressive behavior problems, this hostile attribution style may be relatively rigid and difficult to change, due to prevalent histories of aversive social experience and/or personal vulnerability. The present study examined the effectiveness of a cognitive bias modification (CBM) training to reduce hostile interpretations of facial expressions in clinically referred aggressive boys. We conducted two experiments: Both Study 1 (N = 59, Mage = 11.8) and Study 2 (N = 75, Mage = 11.5) showed that the training effectively reduced hostile interpretation of facial expressions. However, we found no generalization to relevant other outcomes, including state anger and aggression (assessed using a multi-method approach), and hostile attribution assessed in a game context. Taken together, this research illustrates the potential of employing the CBM procedure to reduce aggressive boys’ hostile attributions: The procedure is time and cost-efficient, and relatively easily implemented. Despite this potential, the context-dependency and generalization of effects should be better understood before the procedure can be taken to scale in clinical populations.

Augmenting inpatient treatment for post-traumatic stress disorder with a computerised cognitive bias modification procedure targeting appraisals (CBM-App): protocol for a randomised controlled trial

IntroductionInfluential theories of post-traumatic stress disorder (PTSD) suggest that dysfunctional appraisals of trauma play a key role in the maintenance of symptoms, and this suggestion is increasingly supported by research....

Working mechanisms of a general positivity approach-avoidance training: Effects on action tendencies as well as on subjective and physiological stress responses

The general positivity training, a Cognitive Bias Modification procedure modifying individuals' approach-avoidance tendencies to positively and negatively valenced pictures by means of a joystick task, has been proven effective in attenuating stress reactivity in dysphoric students. The present study explored which training component (pull positive pictures, push negative pictures, or both) is the active one in changing action tendencies and stress responses. Two-hundred-and-thirteen students completed one of four approach-avoidance trainings before being exposed to a stressful speech-task: The general positivity training (pull positive and push negative pictures), a training to approach positive pictures and avoid empty pictures (ApP), a training to avoid negative pictures and approach empty pictures (AvN), or a sham-training. The pattern of results suggests that the groups trained to avoid negative pictures showed a stronger increase in positive approach-avoidance tendencies than the other two groups. However, only the positivity training induced significant within-group changes in positive bias. The groups further did not differ in self-report or cardiovascular measures of anxiety in response to the stress-task. Instead, the training affected mood directly: Exposure to negative pictures during the training increased state anxiety. Generalizability of the findings is limited by using an unselected student sample. Also, the use of empty pictures as neutral stimuli in the ApP and AvN could have weakened training effects in these groups. Although our results hint at the importance of avoiding negative pictures for modifying an approach-avoidance bias, only the positivity training with both components may effectively induce a positive bias. Remarkably, we failed to replicate and extend previously reported effects of the training on stress-responses. Hence, it remains questionable whether the changes in bias reflect changes in underlying cognitive processing tendencies or task-specific learning effects.

Attentional bias modification in depression through gaze contingencies and regulatory control using a new eye-tracking intervention paradigm: study protocol for a placebo-controlled trial.

BackgroundAttentional biases, namely difficulties both to disengage attention from negative information and to maintain it on positive information, play an important role in the onset and maintenance of the disorder. Recently, researchers have developed specific attentional bias modification (ABM) techniques aimed to modify these maladaptive attentional patterns. However, the application of current ABM procedures has yielded, so far, scarce results in depression due, in part, to some methodological shortcomings.The aim of our protocol is the application of a new ABM technique, based on eye-tracker technology, designed to objectively train the specific attentional components involved in depression and, eventually, to reduce depressive symptoms.MethodsBased on sample size calculations, 32 dysphoric (BDI ≥13) participants will be allocated to either an active attentional bias training group or a yoked-control group. Attentional training will be individually administered on two sessions in two consecutive days at the lab. In the training task series of pairs of faces (i.e. neutral vs. sad; neutral vs. happy; happy vs. sad) will be displayed. Participants in the training group will be asked to localize as quickly as possible the most positive face of the pair (e.g., the neutral face in neutral vs. sad trials) and maintain their gaze on it for 750 ms or 1500 ms, in two different blocks, to advance to the next trial. Participants’ maintenance of gaze will be measured by an eye-tracking apparatus. Participants in the yoked-control group will be exposed to the same stimuli and the same average amount of time than the experimental participants but without any instruction to maintain their gaze or any feedback on their performance. Pre and post training measures will be obtained to assess cognitive and emotional changes after the training.DiscussionThe findings from this research will provide a proof-of-principle of the efficacy of eye-tracking paradigms to modify attentional biases and, consequently, to improve depressed mood. If the findings are positive, this new training approach may result in the improvement of cognitive bias modification procedures in depression.Trial registrationThis trial was retrospectively registered on July 28, 2016 with the ClinicalTrials.gov NCT02847793 registration number and the title ‘Attentional Bias Modification Through Eye-tracker Methodology (ABMET)’.Electronic supplementary materialThe online version of this article (doi:10.1186/s12888-016-1150-9) contains supplementary material, which is available to authorized users.

Depressive and Anxious Symptomatology Moderate the Relationship Between Childhood Emotional Abuse Severity and Attentional Bias on the Modified Stroop Task

Research has demonstrated that the impact of childhood abuse often outlasts the initial abuse experiences, paving the way for a myriad of psychological difficulties in adulthood. Attentional bias might serve as a pathway from childhood abuse to negative outcomes associated with such experiences. The primary aim of the study was to investigate the impact of childhood emotional abuse (CEA) experiences on the presence of attentional bias in a sample of college women by comparing performance on a modified Stroop task between CEA survivors (n = 28) and a nonabused control group (n = 31). Results suggest that for CEA survivors, psychological symptoms moderated the relationship between CEA severity and attentional bias to specific word types. Results underscore the importance in continued exploration of the relationship among childhood emotional abuse, attentional bias, and concurrent psychopathology. Results also suggest that modification of attentional biases, via cognitive bias modification procedures, could help mitigate the impact of childhood abuse experiences on psychological well-being in adult survivors.

Ruminative Thinking

Impairments in cognitive processes have been theorized to play a critical role in rumination, a well-established risk factor for depression. In this review, we outline central theories that present cognitive impairments as causal contributors to ruminative thinking and review relevant findings from cross-sectional and prospective studies. We then focus on experimental evidence gathered within the paradigm of cognitive bias modification (CBM). Although CBM has generated considerable interest in relation to anxiety and depression, it has only recently emerged in the field of rumination. After considering the purpose and possible advantages of CBM procedures, we review CBM work related to rumination and discuss key limitations and implications within this developing area of research. Among our recommendations, we outline ways to contrast and integrate cognitive theories of rumination, as well as to obtain stronger bias modification procedures.

Looking on the bright side in social anxiety: the potential benefit of promoting positive mental imagery

Current cognitive models of social phobia converge on the view that negative imagery is a key factor in the development and maintenance of the disorder. Research to date has predominantly focussed on the detrimental impact of negative imagery on cognitive bias and anxiety symptoms, while the potential benefit of promoting positive imagery has been relatively unexplored. Emerging evidence suggests however that positive imagery could have multiple benefits such as improving positive affect, self-esteem and positive interpretation bias, and enhancing social performance. The present article defends the view that combining bias induction with a repeated practice in generating positive imagery in a cognitive bias modification procedure could represent a promising area for future research and clinical innovation in social anxiety disorder.

When Ignorance is Bliss: Explicit Instruction and the Efficacy of CBM-A for Anxiety

There is growing evidence that cognitive bias modification procedures targeting attention (CBM-A) can alter anxiety reactivity in the laboratory, and also can yield therapeutic benefits for clinically anxious patients. These promising findings underscore the need for investigators to delineate the conditions under which CBM-A procedures are effective. In the present research we conducted two studies to empirically determine whether CBM-A continues to be effective when participants are informed of the training contingency and instructed to actively practice the target pattern of attentional selectivity. These studies were designed to address two key questions relating to this issue. First, if participants are informed of the training contingency and instructed to practice the target pattern of attentional selectivity, then will the CBM-A manipulation still effectively modify attentional response to negative information? Second, if it does still modify attentional response to negative information under these conditions, then will this change in attentional selectivity still serve to alter anxiety responses to a stressful experience? The results indicate that when participants are informed of the training contingency and instructed to practice the target pattern of attentional selectivity, then the CBM-A manipulation continues to exert an impact on attentional selectivity, but this modification of attentional bias no longer affects anxiety reactivity to a subsequent stressor. We discuss both the theoretical and practical implications of these findings.

Cognitive bias modification procedures in the management of mental disorders

To review recent research on the therapeutic impact of cognitive bias modification (CBM) procedures, designed to train direct change in the patterns of attentional and interpretive bias known to characterize particular forms of psychopathology. CBM designed to change attentional selectivity has proven capable of modifying attentional biases associated with emotional dysfunction, pain disorders, eating disorders and addictions. CBM designed to change interpretive selectivity has proven capable of modifying the tendency to resolve ambiguity in a negative manner that is characteristic of emotional dysfunction. Recent research confirms that both forms of CBM can alter the severity of symptoms associated with psychopathology. Extended delivery of such CBM approaches now has been shown to yield therapeutic benefits for a range of anxiety disorders, and in the case of CBM-A has augmented the efficacy of treatment for alcohol dependence. CBM approaches have passed the proof-of-concept stage, and recent small-scale trials attest to their likely clinical value. There is a pressing need for large-scale randomized controlled trials, to compare the efficacy of CBM with that of alternative approaches, and to identify how CBM can most effectively be integrated into multimodal treatment programs.

Cognitive Bias Modification Approaches to Anxiety

Clinical anxiety disorders and elevated levels of anxiety vulnerability are characterized by cognitive biases, and this processing selectivity has been implicated in theoretical accounts of these conditions. We review research that has sought to evaluate the causal contributions such biases make to anxiety dysfunction and to therapeutically alleviate anxiety using cognitive-bias modification (CBM) procedures. After considering the purpose and nature of CBM methodologies, we show that variants designed to modify selective attention (CBM-A) or interpretation (CBM-I) have proven capable of reducing anxiety vulnerability and ameliorating dysfunctional anxiety. In addition to supporting the causal role of cognitive bias in anxiety vulnerability and dysfunction and illuminating the mechanisms that underpin such bias, the findings suggest that CBM procedures may have therapeutic promise within clinical settings. We discuss key issues within this burgeoning field of research and suggest future directions CBM research should take to maximize its theoretical and applied value.

Modifying threat-related interpretive bias in adolescents.

Socially anxious feelings sharply increase during adolescence and such feelings have been associated with interpretive biases. Studies in adults have shown that interpretive biases can be modified using Cognitive Bias Modification procedures (CBM-I) and subsequent effects on anxiety have been observed. The current study was designed to examine whether the CBM-I procedure has similar effects in adolescents. Unselected adolescents were randomly allocated to either a positive interpretation training (n = 88) or a placebo-control condition (n = 82). Results revealed that the training was successful in modifying interpretations and effects generalized to a new task. The interpretive bias effects were most pronounced in individuals with a threat-related interpretive bias at pre-test. No effects on state anxiety were observed. The current findings are promising with regard to applying bias modification procedures to adolescents, while further research is warranted regarding emotional effects.

Conflict Adaptation in Generalized Anxiety Disorder: Small Paradigm Twist, Large Scientific Leap

Conflict Adaptation in Generalized Anxiety Disorder: Small Paradigm Twist, Large Scientific Leap

Trained interpretive bias survives mood change

Evidence is accumulating that interpretations can be trained using Cognitive Bias Modification procedures (CBM). The effects are replicable, stable over time and there is some evidence of generalizability. As a next step in determining the boundaries of the CBM model, the present experiment was designed to test whether modified interpretive style endures fluctuations in mood. Participants were trained to interpret ambiguous scenarios in either a positive ( n = 42) or negative ( n = 40) way. Then, participants were exposed to either a positive ( n = 41) or negative ( n = 41) mood induction procedure to change their current mood state. Results showed that the modified interpretive bias did not change in reaction to a mood change. That is, differences in interpretation of new ambiguous information were related to the interpretive bias modification procedure and not to the current mood state.

Is manipulation of mood a critical component of cognitive bias modification procedures?

This paper investigates whether changes in mood state are an important component of cognitive bias modification (CBM) procedures. In a novel CBM procedure participants read either positive or negative statements relating to social issues for 5 min. Interpretation bias was measured by means of a scrambled sentence test, which was presented both before and after the CBM procedure. Participants who read the positive statements made more positive resolutions to the scrambled sentences, while participants who read the negative statements made more negative resolutions. Thus, the appropriate positive and negative interpretative biases were induced by the CBM procedure. However, significant mood changes also occurred following CBM. In Experiment 2, a musical mood induction procedure was presented with depressing or elating music. As before, a scrambled sentence test was presented both before and after the musical mood induction. Mood changed in accordance with the valence of the music to the same extent as with CBM. Critically however, performance on the scrambled sentence task did not change for both groups. This demonstrates that a change in mood state is not sufficient for a change in cognitive bias to occur.

Comparing visual and auditory presentation for the modification of interpretation bias

This experiment compares the effects of visual vs. auditory presentation of cognitive bias modification (CBM) training scenarios upon interpretation style and emotional vulnerability. For both modalities, negative, but not positive interpretation biases were successfully induced relative to a baseline. Mood declined for the auditory but not the visual group throughout the CBM procedure, irrespective of the valence of the CBM condition. This deterioration in mood raises an important methodological issue and indicates that the increased testing time brought about by auditory compared to visual presentation needs to be addressed. The CBM procedures did not influence emotional vulnerability as assessed by behavioural measures, but counter-to-prediction, CBM procedures did increase self-reported depression vulnerability for the positive but not negative CBM condition.