Efficacy of cognitive bias modification interventions in anxiety and depression: meta-analysis.

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Abstract

Cognitive bias modification (CBM) interventions are strongly advocated in research and clinical practice.

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A review of current evidence for the causal impact of attentional bias on fear and anxiety.

Geert Crombez, Bruno Verschuere, Ernst Koster … (2014)

Prominent cognitive theories postulate that an attentional bias toward threatening information contributes to the etiology, maintenance, or exacerbation of fear and anxiety. In this review, we investigate to what extent these causal claims are supported by sound empirical evidence. Although differences in attentional bias are associated with differences in fear and anxiety, this association does not emerge consistently. Moreover, there is only limited evidence that individual differences in attentional bias are related to individual differences in fear or anxiety. In line with a causal relation, some studies show that attentional bias precedes fear or anxiety in time. However, other studies show that fear and anxiety can precede the onset of attentional bias, suggesting circular or reciprocal causality. Importantly, a recent line of experimental research shows that changes in attentional bias can lead to changes in anxiety. Yet changes in fear and anxiety also lead to changes in attentional bias, which confirms that the relation between attentional bias and fear and anxiety is unlikely to be unidirectional. Finally, a similar causal relation between interpretation bias and anxiety has been documented. In sum, there is evidence in favor of causality, yet a strict unidirectional cause-effect model is unlikely to hold. The relation between attentional bias and fear and anxiety is best described as a bidirectional, maintaining, or mutually reinforcing relation.

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Cognitive bias modification approaches to anxiety.

Colin MacLeod, Andrew Mathews (2011)

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.

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Approach bias modification in alcohol dependence: do clinical effects replicate and for whom does it work best?

Carolin Eberl, Reinout W. Wiers, Steffen Pawelczack … (2012)

Alcoholism is a progressive neurocognitive developmental disorder. Recent evidence shows that computerized training interventions (Cognitive Bias Modification, CBM) can reverse some of these maladaptively changed neurocognitive processes. A first clinical study of a CBM, called alcohol-avoidance training, found that trained alcoholic patients showed less relapse at one-year follow-up than control patients. The present study tested the replication of this result, and questions about mediation and moderation. 509 alcohol-dependent patients received treatment as usual (primarily Cognitive Behavior Therapy) inpatient treatment. Before and after treatment, the implicit approach bias was measured with the Alcohol Approach-Avoidance Task. Half of the patients were randomly assigned to CBM, the other half received treatment as usual only. Background variables, psychopathology and executive control were tested as possible moderating variables of CBM. One year after treatment, follow-up data about relapse were collected. The group receiving CBM developed alcohol-avoidance behavior and reported significantly lower relapse rates at one-year follow-up. Change in alcohol-approach bias mediated this effect. Moderation analyses demonstrated that older patients and patients with a strong approach-bias at pretest profited most from CBM. CBM is a promising treatment add-on in alcohol addiction and may counter some of the maladaptive neurocognitive effects of long-term alcoholism. Copyright © 2012 Elsevier Ltd. All rights reserved.

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Author and article information

Journal

Journal ID (iso-abbrev): Br J Psychiatry

Title: The British journal of psychiatry : the journal of mental science

ISSN (Electronic): 1472-1465

ISSN (Print): 0007-1250

Publication date (Electronic): Jan 2015

Volume: 206

Issue: 1

Affiliations

[1 ] Ioana A. Cristea, PhD, Department of Clinical Psychology and Psychotherapy, Babeʂ-Bolyai University, Cluj-Napoca, Romania and Clinical Psychology Branch, Department of Surgical, Medical, Molecular and Critical Pathology, University of Pisa, Pisa, Italy; Robin N. Kok, MSc, Department of Clinical Psychology and the EMGO institute for Health and Care Research, Faculty of Psychology and Education, VU University Amsterdam, Amsterdam, The Netherlands and Centre for Mental Health Research, The Australian National University, Acton, Australia; Pim Cuijpers, PhD, Department of Clinical Psychology, VU University and EMGO Institute for Health and Care Research, VU University and VU University Medical Centre, Amsterdam, The Netherlands and Leuphana University, Lüneburg, Germany.

Article

Publisher Item ID: 206/1/7

DOI: 10.1192/bjp.bp.114.146761

PubMed ID: 25561486

SO-VID: ab40874c-4287-456c-8dec-817924bdc219

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Efficacy of cognitive bias modification interventions in anxiety and depression: meta-analysis.

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A review of current evidence for the causal impact of attentional bias on fear and anxiety.

Cognitive bias modification approaches to anxiety.

Approach bias modification in alcohol dependence: do clinical effects replicate and for whom does it work best?

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