Interpretation Bias Modification Research Articles

A Web-Based Cognitive Bias Modification Intervention (Re-train Your Brain) for Emerging Adults With Co-occurring Social Anxiety and Hazardous Alcohol Use: Protocol for a Multiarm Randomized Controlled Pilot Trial

BackgroundAlcohol use and anxiety disorders commonly co-occur, resulting in a more severe clinical presentation and poorer response to treatment. Research has shown that approach bias modification (ApBM) and interpretation bias modification (IBM) cognitive retraining interventions can be efficacious adjunctive treatments that improve outcomes for alcohol use and social anxiety, respectively. However, the acceptability, feasibility, and clinical utility of combining ApBM and IBM programs to optimize treatments among comorbid samples are unknown. It is also unclear whether integrating ApBM and IBM within each training session or alternating them between each session is more acceptable and efficacious.ObjectiveThis paper describes the protocol for a randomized controlled pilot trial investigating the feasibility, acceptability, and preliminary efficacy of the Re-train Your Brain intervention—an adjunct web-based ApBM+IBM program—among a clinical sample of emerging adults with hazardous alcohol use and social anxiety.MethodsThe study involves a three-arm randomized controlled pilot trial in which treatment-seeking emerging adults (18-30 years) with co-occurring hazardous alcohol use and social anxiety will be individually randomized to receive the Re-train Your Brain integrated program, delivered with 10 biweekly sessions focusing on both social anxiety and alcohol each week, plus treatment as usual (TAU; ie, the model of care provided in accordance with standard practice at their service; n=30); the Re-train Your Brain alternating program, delivered with 10 biweekly sessions focusing on social anxiety one week and alcohol the next week, plus TAU (n=30); or TAU only (n=30). Primary outcomes include feasibility (uptake, follow-up rates, treatment adherence, attrition, and adverse events) and acceptability (system usability, client satisfaction, user experience, and training format preference). Secondary efficacy outcomes include changes in alcohol approach and interpretation biases, social anxiety, and alcohol use (eg, drinks per day, binge drinking, drinking motives, severity of dependence, and cravings). The primary end point will be posttreatment (6 weeks postbaseline), with a secondary end point at 3 months postbaseline. Descriptive statistics will be conducted for primary outcomes, whereas intention-to-treat, multilevel mixed effects analysis for repeated measures will be performed for secondary outcomes.ResultsThis study is funded from 2019 to 2023 by Australian Rotary Health. Recruitment is expected to be completed by mid-2022 to late 2022, with follow-ups completed by early 2023.ConclusionsThis study will be the first to evaluate whether an ApBM+IBM program is acceptable to treatment-seeking, emerging adults and whether it can be feasibly delivered via the web, in settings where it will ultimately be used (eg, at home). The findings will broaden our understanding of the types of programs that emerging adults will engage with and whether the program may be an efficacious treatment option for this comorbidity.Trial RegistrationAustralian New Zealand Clinical Trials Registry ACTRN12620001273976; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=364131International Registered Report Identifier (IRRID)PRR1-10.2196/28667

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.

The effects of cognitive bias modification for attention and interpretation on the postoperative psychological resilience and quality of life of patients with pituitary adenoma: a randomized trial.

Negative emotions such as anxiety and depression may have a bearing on patients' psychological resilience and quality of life (QoL) following surgery. Cognitive bias modification (CBM) for attention and interpretation has been confirmed to alleviate anxiety and depression. However, the psychological effects of CBM attention and interpretation on Chinese patients with pituitary adenoma have hardly received research attention. This prospective interventional study enrolled 100 patients undergoing surgical treatment for pituitary adenoma. Participants were divided into an experimental group and a control group, with 50 cases in each group. Baseline characteristics of included patients were collected. Patients in the control group were given routine training, and those in experimental group received routine training plus CBM attention and interpretation training. The Connor-Davidson Resilience Scale (CD-RISC) was used to assess patients' psychological resilience. The patients' levels of anxiety and depression were assessed using the Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS). QoL was assessed based on the European Organization for Research and Treatment of Cancer QoL Questionnaire (EORTC QLQ-C30). No statistical difference was found between the 2 groups in CD-RISC, SAS, SDS, or QoL score at baseline (P>0.05). After CBM training, psychological resilience and QoL in the experimental group improved, and the levels of anxiety and depression decreased (P<0.05). Furthermore, the experimental group showed statistically superior psychological resilience and QoL than the control group. The levels of anxiety and depression in the experimental group were statistically lower than those in the control group (P<0.05). CBM for attention and interpretation effectively improves the psychological resilience of patients and reduces the symptoms of anxiety and depression, thus improving patients' postoperative QoL. Chinese Clinical Trial Registry Identifier: ChiCTR2100045899.

Interpretation bias modification for hostility: A randomized clinical trial.

Objective: Hostility is a transdiagnostic phenomenon that can have a profound negative impact on interpersonal functioning and psychopathological severity. Evidence suggests that cognitive bias modification for interpretation bias (CBM-I) potentially reduces hostility. However, stringent efficacy studies in people with clinical levels of hostility are currently lacking. Method: The present study investigated the effects of CBM-I in two studies: one feasibility study (Study 1) in a mixed clinical-community sample of men (N = 29), and one randomized clinical study (Study 2) in a mixed-gender sample with clinical levels of hostility (N = 135), pre-registered at https://osf.io/r46jn. We expected that CBM-I would relate to a larger increase in benign interpretation bias and larger reductions in hostile interpretation bias, hostility symptoms and traits, and general psychiatric symptoms at post-intervention compared to an active control (AC) condition. We also explored the beneficial carry-over effects of CBM-I on working alliance in subsequent psychotherapy 5 weeks after finishing CBM-I (n = 17). Results: Results showed that CBM-I increased benign interpretation bias in both studies and partially reduced hostile interpretation bias in Study 2, but not in Study 1. Findings of Study 2 also showed greater reductions in behavioral (but not self-reported) aggression in CBM-I relative to control, but no condition differences were found in self-report hostility measures and general psychiatric symptoms. Conclusions: Overall, we found modest support for CBM-I as an intervention for hostility, with some evidence of its efficacy for hostile interpretation bias and aggression. We discuss study limitations as well as directions for future research. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

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.

Supplemental Material for Interpretation Bias Modification for Hostility: A Randomized Clinical Trial

Supplemental Material for Interpretation Bias Modification for Hostility: A Randomized Clinical Trial

The influence of social anxiety on interpersonal information processing in a military-life environment: A cross-sectional study.

Although social anxiety as a ubiquitous emotion impacting people's social behaviors has aroused much researchers’ interest in exploring its cognitive behavioral model, no previous study has focused on soldiers with different social anxiety within the context of the specific military environment.To explore the associations between social anxiety and interpersonal information processing concerted on interpretation and judgment, the study may provide an intervention point for soldiers to ameliorate social anxiety and accommodate to the military-life environment.A self-reported questionnaire and 2 behavioral tasks were conducted in the cross-section study to explore the associations.Seventy-four soldiers were randomly recruited from a naval base. The Interpersonal Anxiety Scale was used to assess social anxiety of soldiers. Two behavioral tasks were designed to test the characteristics of interpersonal information processing, one for interpretation bias and the other for judgment bias.This cross-sectional study showed social anxiety had a significant negative correlation with interpretation bias and abidance (as judgment bias), signaling that soldiers with higher levels of social anxiety had a stronger tendency to negative interpretation bias and showed lower abidance. The mediating effect analysis showed the interpretation bias could indirectly affect the soldier's abidance through social anxiety. Notably, none of the interaction effects of social anxiety and social information types were statistically significant; therefore, the level of social anxiety predetermined the abidance of soldiers.Soldiers’ social anxiety has an influence on processing military-life interpersonal information, and it plays a certain intermediary role in the associations between low abidance and negative interpretation bias. The stronger negative interpretation bias than positive bias of soldiers, the higher social anxiety they could show with the less possibility to abide, which might result in behaviors against the military collective requirements. Social anxiety has the primary effect on the abidance of soldiers; hence, in the future, the interpretation bias modification could be a plausible cognitive-behavior therapy to help soldiers ameliorate social anxiety, thus contributing to enhancing their sense of belonging to the troops and accommodation to military life.

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.

Acceptability and Co-Development of an Online Cognitive Bias Modification Intervention for Emerging Adults With Hazardous Alcohol Use and Social Anxiety: A Mixed Methods Study.

Approach bias modification (ApBM) and interpretation bias modification (IBM) are two promising adjunct treatments for alcohol use and social anxiety, respectively. However, the acceptability of combining ApBM and IBM into one program for people who experience both of these disorders is unknown. The present study describes the codevelopment of a new, hybrid ApBM+IBM program and provides insight into the perceptions of acceptability from service providers and emerging adults. Service providers (n=14) and emerging adults aged 18 to 25years with lived experience of hazardous alcohol use and heightened social anxiety (n=15) were recruited via online advertisements and through existing networks. All participants were shown a beta version of the program and asked to complete qualitative and quantitative questions to ascertain feedback on the program's acceptability and suggestions for improvement. Themes emerged relating to the ApBM+IBM program's quality and usefulness, appropriateness, motivation and engagement, and potential clinical value. The program was well received and deemed acceptable for the target age group. It was rated particularly highly with regard to the overall quality and ease of use. Emerging adults had fewer suggestions for how the intervention might be revised; however, there were suggestions from both groups regarding the need for a compelling rationale at the outset of treatment and a suggestion to include a motivational interviewing and psychoeducational-based module prior to the first training session, to increase user buy-in and engagement. The current findings reflect positively on the acceptability of a hybrid ApBM+IBM for emerging adults with co-occurring hazardous alcohol use and social anxiety. Service providers and emerging adults identified a number of ways to improve the design and implementation of the program, which will likely improve adherence to, and outcomes of, the intervention when added as an adjunct to treatment as usual.

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.

Interpretation bias modification to reduce body dissatisfaction \u2013 a randomized controlled pilot study in women with elevated weight and shape concerns

BackgroundRecent research has identified several cognitive biases in patients with eating disorders, such as a tendency to interpret ambiguous information about one’s own body in a negative way. The so-called “negative interpretation bias” is considered to be a key factor in maintaining maladaptive cognitions and behaviors in eating disorders. Studies on modification of the negative interpretation bias in eating disorders have yielded mixed results. This randomized controlled pilot study examined whether a specially adapted, computerized version of the Scrambled Sentences Task modifies negative interpretation bias in women with elevated body dissatisfaction.MethodsThe sample consisted of 40 normal-weight women with elevated body dissatisfaction, randomly assigned either to an intervention or a no-intervention control group (each n = 20). The intervention group received six sessions (within two weeks) of a newly-developed interpretation bias modification training that involved unscrambling positively valenced, body image-related sentences. The control group received no intervention. In both groups, body image-related negative interpretation bias (main outcome), trait body dissatisfaction and thin-ideal cue reactivity were assessed at baseline and two weeks later. Additionally, in the intervention condition, the trajectory of expected reductions in the thin-ideal internalization was measured during each training session.ResultsIn both conditions, body image-related negative interpretation bias and trait body dissatisfaction decreased significantly from pre- to post-assessment; however, a specific effect imparted by the interpretation bias modification training was not found. Groups did not differ in thin-ideal cue reactivity. In the intervention group, thin-ideal internalization decreased significantly over the training sessions.ConclusionsThe findings do not support use of body image-related interpretation bias modification in its current form in the treatment of body dissatisfaction. Further research involving different versions of the training and clinical samples is warranted.

The Efficacy of Interpretation Bias Modification Program for Pain Outcomes

The Efficacy of Interpretation Bias Modification Program for Pain Outcomes

Using Interpretation Bias Modification to Reduce Anger in Veterans with Posttraumatic Stress Disorder: A Pilot Study.

Difficulty controlling anger is the most commonly reported reintegration concern among veterans with posttraumatic stress disorder (PTSD). One of the mechanisms associated with problematic anger is a tendency to interpret ambiguous interpersonal situations as hostile, known as the hostile interpretation bias (HIB). A computer-based interpretation bias modification (IBM) intervention has been shown to successfully reduce HIB and anger but has not been tested in veterans with PTSD. The current study was a pilot trial of this IBM intervention modified to address problematic anger among veterans with PTSD. Veterans with PTSD and a high level of anger (N = 7) completed eight sessions of IBM treatment over the course of 4 weeks. Participants completed self-report questionnaires at pre- and posttreatment assessment visits, as well as a treatment acceptability interview at posttreatment. Veterans experienced large reductions in hostile interpretation bias and anger from pre- to posttreatment, ds = 1.03-1.96, although these estimates may be unstable due to the small sample size. The feasibility for recruitment, retention, and treatment completion were high. Questionnaire and interview data demonstrated that most participants were satisfied with the treatment and found it helpful and easy to use. Overall, IBM for anger was feasible and acceptable to veterans with PTSD and was associated with reductions in hostile interpretations and self-reported anger outcomes. Further research examining this approach is warranted.

Efficacy of cognitive bias modification interventions in anxiety and depressive disorders: a systematic review and network meta-analysis.

Cognitive bias modification (CBM) therapies, including attention bias modification, interpretation bias modification, or approach and avoidance training, are prototypical examples of mechanistically derived treatments, but their effectiveness is contentious. We aimed to assess the relative effectiveness of various CBM interventions for anxious and depressive symptomatology. For this systematic review and network meta-analysis, we searched PubMed, PsycINFO, Embase, and Cochrane Central Register from database inception up until Feb 7, 2020. We included randomised controlled trials of CBM versus control conditions or other forms of CBM for adults aged 18 years and older with clinical or subclinical anxiety or depression measured with a diagnostic interview or a validated clinical scale. We excluded studies comparing CBM with a non-CBM active intervention. Two researchers independently selected studies and evaluated risk of bias with the Cochrane Collaboration tool. Primary outcomes encompassed anxiety and depressive symptoms measured with validated clinical scales. We computed standardised mean differences (SMDs) with a restricted maximum likelihood random effects model. This study is registered with PROSPERO, CRD42018086113. From 2125 records we selected 85 trials, 65 (n=3897) on anxiety and 20 (n=1116) on depression. In a well connected network of anxiety trials, interpretation bias modification outperformed waitlist (SMD -0·55, 95% CI -0·91 to -0·19) and sham training (SMD -0·30, -0·50 to -0·10) for the primary outcome. Attention bias modification showed benefits only in post-hoc sensitivity analyses excluding post-traumatic stress disorder trials. Prediction intervals for all findings were large, including an SMD of 0. Networks of depression trials displayed evidence of inconsistency. Only four randomised controlled trials had low risk of bias on all six domains assessed. CBM interventions showed consistent but small benefits; however heterogeneity and risk of bias undermine the reliability of these findings. Larger, definitive trials for interpretation bias modification for anxiety might be warranted, but insufficient evidence precludes conclusions for depression. Romanian Ministry of Research and Innovation, The National Council for Scientific Research-The Executive Agency for Higher Education, Research, Development and Innovation Funding.