Cognitive bias modification

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Cognitive bias modification (CBM) refers to the process of modifying cognitive biases in healthy people and also refers to a growing area of psychological (non-pharmaceutical) therapies for anxiety, depression and addiction called cognitive bias modification therapy (CBMT). CBMT is sub-group of therapies within a growing area of psychological therapies based on modifying cognitive processes with or without accompanying medication and talk therapy, sometimes referred to as applied cognitive processing therapies (ACPT). Other ACPTs include attention training,[1] interpretation modification,[2] approach/avoid training,[3] imagery modification training,[4] eye movement desensitization and reprocessing therapy[5] for PTSD.

According to Yiend et al. 2013 in an article in the journal Cognitive Therapy Research, "CBM treatments are a more convenient and flexible than other modes of treatment because they do not require meetings with a therapist. They offer the potential for delivery using modern technologies (e.g. internet or mobile phone) and require minimal supervision. They could therefore become highly cost effective and widely accessible. CBM methods are also less demanding and more acceptable to patients than traditional therapies. This is because personal thoughts and beliefs are not directly interrogated, and there is no need for social interaction or stigmatizing visits to outpatient clinics. Similarly, patient insight is not required because CBM seeks to target the underlying maintaining cognitive bias directly; therefore, patient engagement is likely to be easier. In sum, CBM methods offer a high gain, low cost treatment option because they can circumvent many of the practical and psychological requirements that disadvantage competing psychological interventions."[6]

CBMT techniques are technology assisted therapies that are delivered via a computer with or without clinician support. CBM combines evidence and theory from the cognitive model of anxiety,[7] cognitive neuroscience[8][9] and attentional models.[10][11][12]

CBM can be seen as one version of attentional retraining. It has been described as a 'cognitive vaccine'.[13]

Efficacy evidence base and other research[edit]

CBMT is a growing area of evidence-based psychological therapy,[14][15][16] in which cognitive processes are modified in an effort to relieve suffering from mental illnesses such as:

Some preliminary evidence indicates that CBM can change brain activity, moving prefrontal cortex activity more to the left side, which in turn is associated with more positive and happier thinking.[43]


Some CBM apps ask the user to consistently select 'good' or 'positive' images over 'bad' or 'negative' ones. For CBM applications that are designed to reduce anxiety, the user may be asked to repeatedly select the smiling face amongst a group of faces, to help overcome the tendency to focus on negative or threatening social cues. CBM may also be useful in the treatment of mood and addiction disorders.

A layman's explanation: how does it reduce anxiety?[edit]

(From Beard, C., R.B. Weisberg, and N. Amir, Combined cognitive bias modification treatment for social anxiety disorder: a pilot trial. Depression and Anxiety, 2011. 28(11): p. 981-988.[44])

"CBMT changes how you think and mentally respond to everyday things in your life—your mental habits. CBMT changes mental habits in a new way that may be better than past treatments. These mental habits are often hard to control. For example, people with anxiety have a tendency to focus their attention on negative information. They also tend to interpret ambiguous information as negative. This habit is so automatic that it is very difficult to "catch" or change on purpose. However, just like other habits, such as typing or riding a bicycle, with practice we can change these mental habits and have new 'nonanxiety-related' habits become automatic."

Attention bias[edit]

"People differ in how they focus their attention. What you pay attention to plays an important role in how safe or unsafe you feel. If you tend to focus your attention on negative aspects of a situation or cues that might signal danger, you will be more likely to become excessively anxious. Also, the more you look for something, the more likely it is that you will find it; so, if you are always looking for signs of danger, you will be more likely to see danger."[citation needed]

Interpretation bias[edit]

"People differ in how they interpret ambiguous information in their environment as well. An interpretation bias or a tendency to interpret situations negatively also plays an important role in how safe or unsafe each situation seems to you. If you tend to think of situations as negative, you will be more likely to become excessively anxious. Because, in everyday life, many situations are ambiguous, a negative interpretation bias will lead to most situations being seen as negative. Moreover, by expecting a negative outcome, people with anxiety often create what is called a "self-fulfilling prophecy". For example, if you walk into a party and expect people will not talk to you, you may be cold to them, and as a result, it is more likely that they will not talk to you."

Attention training[edit]

The attentional bias is one of several different cognitive biases. The attentional bias is the tendency of certain salient cues in a person's environment to preferentially draw and/or hold the person's attention. For example, individuals with anxiety disorders demonstrate an automatic attentional bias towards threatening cues in their environment and drug users and addicts demonstrate an automatic attentional bias towards drug related cues in their environment.[45][46]

The rise of research in cognitive bias modification has led to the recent publication of a special issue of the Journal of Abnormal Psychology[15] focusing on the methods and technologies used for cognitive bias modification in psychopathology. Attentional retraining as cognitive bias modification is predicated on the observed attentional bias evident in psychopathology. The most common task used to retrain attention in psychopathologies is the dot-probe task developed originally by Macleod et al. (1986). If attentional biases have a causal role on the maintenance of anxiety or drug addictions then lowering the attentional biases should therefore lower feelings of anxiety amongst the anxious and craving and promote abstinence amongst the drug-addicted.

Criticisms and limitations[edit]

One concern is whether CBM modification procedures will achieve lasting benefits. This is not yet clear from research.[47]

Another concern is that participants with cognitive vulnerability are not able to maintain their new learning even within a CBM course, with their negative cognitive bias beginning to re-emerge over time.[48]

A 2015 meta-analysis of 49 trials looking at outcomes for anxiety and depression casts doubt on value of CBM. The paper concluded that 'CBM may have small effects on mental health problems, but it is also possible that there are no significant clinically relevant effects.' It notes that research is hampered by small, low-quality trials and by risk of publication bias.[49]

Likewise, a recent meta-analysis[50] has found that although attention bias modification (ABM) can be used as a treatment for several primary characteristics of social anxiety disorder (SAD), the durability of treatment and inability to treat secondary symptoms has been raised as potential issues. In this meta-analysis, the authors assessed the efficacy of ABM for SAD on symptoms, reactivity to speech challenge, attentional bias (AB) toward threat, and secondary symptoms at posttraining as well as SAD symptoms at 4-month follow-up. A systematic search in bibliographical databases uncovered 15 randomized studies involving 1043 individuals that compared ABM to a control training procedure. Data were extracted independently by two raters. All analyses were conducted on intent-to-treat data. Results revealed that ABM produces a small but significant reduction in SAD symptoms (g = 0.27), reactivity to speech challenge (g = 0.46), and AB (g = 0.30). These effects were moderated by characteristics of the ABM procedure, the design of the study, and trait anxiety at baseline. However, effects on secondary symptoms (g = 0.09) and SAD symptoms at 4-month follow-up (g = 0.09) were not significant. Although there was no indication of significant publication bias, the authors identified that quality of the studies was substandard and wedged the effect sizes. From a clinical point of view, these findings imply that ABM is not yet ready for wide-scale dissemination as a treatment for SAD in routine care.

See also[edit]


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