Laura Hoppitt

Cognitive bias modification for attention and interpretation reduces trait and state anxiety in anxious patients referred to an out-patient service: Results from a pilot study

It is well established that anxious individuals show biases in information processing, such that they attend preferentially to threatening stimuli and interpret emotional ambiguity in a threatening way. It has also been established that these biases in attention and interpretation can causally influence anxiety. Recent advances in experimental work have involved the development of a paradigm known as Cognitive Bias Modification (CBM), a constellation of procedures which directly modify bias using computerised tasks. Excitingly, these procedures have been shown to reduce bias in attention to threat (CBM-A), and to promote a positive interpretive bias (CBM-I) in anxious populations; furthermore, these modifications are associated with reductions in anxiety. We believe that these techniques have the potential to create a real clinical impact for people with anxiety. Initial studies involved volunteer participants who reached criteria for clinical diagnoses to be made, but emerging evidence suggests that patients referred for therapy also benefit. For the purposes of experimentation researchers have normally looked at one procedure at a time. In order to try to maximise the potential clinical impact we wished to investigate whether the combination of the procedures would be more effective than either alone. We also wished to investigate whether the procedures could be carried out in routine clinical settings with patients referred to an out-patient psychological treatment service. We therefore carried out a pilot study using a combined approach of CBM-A and CBM-I with a sample of 13 anxious patients referred to an out-patient psychology service for cognitive therapy. The results showed successful reductions in threat related attentional and interpretive bias, as well as reductions in trait and state anxiety. Participant reports describe the procedures as acceptable, with the attentional task experienced as boring, but the interpretive one experienced as helpful. While recognising the methodological problems of the pilot study we believe that these results give indications that the techniques could provide an effective intervention for anxiety, and that further study is well justified.

Computer Game Play Reduces Intrusive Memories of Experimental Trauma via Reconsolidation-Update Mechanisms

Memory of a traumatic event becomes consolidated within hours. Intrusive memories can then flash back repeatedly into the mind’s eye and cause distress. We investigated whether reconsolidation—the process during which memories become malleable when recalled—can be blocked using a cognitive task and whether such an approach can reduce these unbidden intrusions. We predicted that reconsolidation of a reactivated visual memory of experimental trauma could be disrupted by engaging in a visuospatial task that would compete for visual working memory resources. We showed that intrusive memories were virtually abolished by playing the computer game Tetris following a memory-reactivation task 24 hr after initial exposure to experimental trauma. Furthermore, both memory reactivation and playing Tetris were required to reduce subsequent intrusions (Experiment 2), consistent with reconsolidation-update mechanisms. A simple, noninvasive cognitive-task procedure administered after emotional memory has already consolidated (i.e., > 24 hours after exposure to experimental trauma) may prevent the recurrence of intrusive memories of those emotional events.

A Comparison of Cognitive Bias Modification for Interpretation and Computerized Cognitive Behavior Therapy: Effects on Anxiety, Depression, Attentional Control, and Interpretive Bias

Objective: Computerized cognitive behavioral therapy (cCBT) and cognitive bias modification for interpretation (CBM-I) both have demonstrated efficacy in alleviating social anxiety, but how they compare with each other has not been investigated. The present study tested the prediction that both interventions would reduce anxiety relative to a no-intervention comparison condition, but CBM-I would be particularly effective at modifying threat-related cognitive bias under high mental load. Method: Sixty-three primarily Caucasian adults (mean age = 22.7, SD = 5.87; 68.3% female) with high social anxiety, randomly allocated to 3 groups: CBM-I (n = 21), cCBT (n = 21), and a no-intervention control group (n = 21) provided complete data for analysis. Pre- and postintervention (4 sessions lasting 2 weeks, control participants only attended the pre–post sessions) self-report measures of anxiety, depression, attentional control, and threat-related interpretive bias were completed. In addition, interpretive bias under high versus low cognitive load was measured using the Scrambled Sentences Test. Results: Both CBM-I and cCBT groups reported significantly reduced levels of social anxiety, trait anxiety, and depression and improved attentional control, relative to the control group, with no clear superiority of either active intervention. Although both active conditions reduced negative bias on the Scrambled Sentences Test completed under mental load, CBM-I was significantly more effective at doing so. Conclusions: The results suggest that although not differing in therapeutic efficacy, CBM-I and cCBT might differ in the resilience of their effects when under mental load.

Cognitive Bias Modification: The Critical Role of Active Training in Modifying Emotional Responses

Training participants to select threat or nonthreat interpretations of emotionally ambiguous stimuli or passively exposing them to valenced scenarios can modify later interpretation of ambiguity. However, only when encouraged to actively select meanings do congruent changes in emotional response occur during training itself (Mathews & Mackintosh, 2000). The present study assessed the more critical question of whether active training is also necessary for modifying subsequent emotional responses to images of new ambiguous scenarios presented after training. As predicted, active training did lead participants to rate their images of emotionally ambiguous scenarios as being more unpleasant after training as compared to a matched passive condition. This finding supports the view that active generation of meaning during interpretive training is critical for the modification of later emotional responses.

Effects of standard and explicit cognitive bias modification and computer-administered cognitive-behaviour therapy on cognitive biases and social anxiety.

Background and objectives This study examines the effects of a single session of Cognitive Bias Modification to induce positive Interpretative bias (CBM-I) using standard or explicit instructions and an analogue of computer-administered CBT (c-CBT) program on modifying cognitive biases and social anxiety. Methods A sample of 76 volunteers with social anxiety attended a research site. At both pre- and post-test, participants completed two computer-administered tests of interpretative and attentional biases and a self-report measure of social anxiety. Participants in the training conditions completed a single session of either standard or explicit CBM-I positive training and a c-CBT program. Participants in the Control (no training) condition completed a CBM-I neutral task matched the active CBM-I intervention in format and duration but did not encourage positive disambiguation of socially ambiguous or threatening scenarios. Results Participants in both CBM-I programs (either standard or explicit instructions) and the c-CBT condition exhibited more positive interpretations of ambiguous social scenarios at post-test and one-week follow-up as compared to the Control condition. Moreover, the results showed that CBM-I and c-CBT, to some extent, changed negative attention biases in a positive direction. Furthermore, the results showed that both CBM-I training conditions and c-CBT reduced social anxiety symptoms at one-week follow-up. Limitations This study used a single session of CBM-I training, however multi-sessions intervention might result in more endurable positive CBM-I changes. Conclusions A computerised single session of CBM-I and an analogue of c-CBT program reduced negative interpretative biases and social anxiety.

Cognitive bias modification in the treatment of social anxiety in early psychosis: a single case series.

BACKGROUND Social anxiety is a common problem among people who are recovering from psychosis. At present there is no evidence based psychological treatment targeting social anxiety in this population. Cognitive Bias Modification for Interpretation (CBM-I) has been shown to be effective in reducing social anxiety in people who do not have a history of psychosis. AIMS To assess the feasibility and acceptability of the CBM-I methodology for use in a clinical setting with people who are experiencing social anxiety following an episode of psychosis. METHOD Eight participants with social anxiety were recruited from an early intervention service. A single session of computerized CBM-I was conducted, with mood and cognitive interpretation bias being assessed before and after the session. RESULTS All participants reported an improvement in mood immediately following the CBM-I session (n=8). For those participants who had a negative interpretation bias, none became more negative following the CBM-I session, with three out of six participants showing a beneficial change. CONCLUSION These results suggest that CBM-I is acceptable for use with people who are experiencing social anxiety following a psychotic episode. Further research looking at how CBM-I could be made more interactive and producing more applicable scenarios for use in a clinical setting is recommended.

Cancer fear and the interpretation of ambiguous information related to cancer

We tested the hypothesis that people with a high fear of cancer would be more likely to interpret ambiguous information about cancer in a negative manner compared with people low on cancer fear. Adults (n=47) aged 50–70, who scored either high (n=16) or low (n=31) on cancer fear, took part in a laboratory-based ambiguous sentences task. Participants were presented with ambiguous cancer and social threat scenarios mixed with unambiguous neutral scenarios. Interpretations were assessed in a recognition task, by asking participants to rate disambiguated sentences in terms of how similar in meaning they were to the originals. People high on cancer fear were more likely to endorse negative interpretations of the original ambiguous cancer scenarios than were people low on cancer fear. This negative interpretation bias was specific to cancer scenarios and was not observed for the social threat scenarios.

Modifying social anxiety related to a real-life stressor using online Cognitive Bias Modification for interpretation

Modifying threat related biases in attention and interpretation has been shown to successfully reduce global symptoms of anxiety in high anxious and clinically anxious samples (termed Cognitive Bias Modification, CBM). However, the possibility that CBM can be used as a way to prevent anxiety associated with an upcoming real-life stressful event in vulnerable populations has yet to be systematically examined. The present study aimed to assess whether a two-week course of online CBM for interpretations (CBM-I) could reduce social evaluative fear when starting university. Sixty-nine students anxious about starting university completed five sessions of online CBM in the two weeks prior to starting university, or completed a placebo control intervention. Results indicated that CBM-I reduced social evaluative fear from baseline to day one of starting university to a greater extent than the placebo control intervention. Also, there was a greater reduction in state anxiety and a trend indicating a greater reduction in social evaluative fear in the CBM-I group at 4 weeks follow-up. Results suggest that CBM-I could be used as a preventative tool to help reduce anxiety specific to challenging life events.

Hypomanic Experience in Young Adults Confers Vulnerability to Intrusive Imagery After Experimental Trauma: Relevance for Bipolar Disorder.

Emotional mental imagery occurs across anxiety disorders, yet is neglected in bipolar disorder despite high anxiety comorbidity. Furthermore, a heightened susceptibility to developing intrusive mental images of stressful events in bipolar disorder and people vulnerable to it (with hypomanic experience) has been suggested. The current study assessed, prospectively, whether significant hypomanic experience (contrasting groups scoring high vs. low on the Mood Disorder Questionnaire, MDQ) places individuals at increased risk of visual reexperiencing after experimental stress. A total of 110 young adults watched a trauma film and recorded film-related intrusive images for 6 days. Compared to the low MDQ group, the high MDQ group experienced approximately twice as many intrusive images, substantiated by convergent measures. Findings suggest hypomanic experience is associated with developing more frequent intrusive imagery of a stressor. Because mental imagery powerfully affects emotion, such imagery may contribute to bipolar mood instability and offer a cognitive treatment target.

Specificity Effects in the Modification of Interpretation Bias and Stress Reactivity

There are now a number of experimental studies showing that modification of interpretation biases can influence later emotional vulnerability. We present a series of three experiments in which the first two studies showed no such effects, apparently due to the content of training differing in certain critical respects from that of the intended target for modification: namely, coping with the experience of failure. When content of training and emotional stressor tasks were matched in Experiment Three the expected effects of bias modification on stress reactivity was evident. In other words, over the three experiments, negative emotional response due to failure in an apparently easy (but actually difficult) cognitive test was modified as expected only when training involved both content related to achievement threat and benign appraisals for failure. These results demonstrate the importance of matching the content of training to the intended target for change and have implications for transferring cognitive bias modification methods from the laboratory to clinical settings.