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Background: Paranoia, the belief that you are at risk of significant physical or emotional harm from others, is a common difficulty, which causes significant distress and impairment to daily functioning, including in psychosis-spectrum disorders. According to cognitive models of psychosis, paranoia may be partly maintained by cognitive processes, including interpretation biases. Cognitive bias modification for paranoia (CBM-pa) is an intervention targeting the bias towards interpreting ambiguous social scenarios in a way that is personally threatening. This study aims to test the efficacy and safety of a mobile app version of CBM-pa, called STOP (successful treatment of paranoia). Methods: The STOP study is a double-blind, superiority, three-arm randomised controlled trial (RCT). People are eligible for the trial if they experience persistent, distressing paranoia, as assessed by the Positive and Negative Syndrome Scales, and show evidence of an interpretation bias towards threat on standardised assessments. Participants are randomised to either STOP (two groups: 6- or 12-session dose) or text-reading control (12 sessions). Treatment as usual will continue for all participants. Sessions are completed weekly and last around 40 min. STOP is completely self-administered with no therapist assistance. STOP involves reading ambiguous social scenarios, all of which could be interpreted in a paranoid way. In each scenario, participants are prompted to consider more helpful alternatives by completing a word and answering a question. Participants are assessed at baseline, after each session, and at 6, 12, 18 and 24 weeks post-randomisation. The primary outcome is the self-reported severity of paranoid symptoms at 24 weeks, measured using the Paranoia Scale. The target sample size is 273 which is powered to detect a 15% symptom reduction on the primary outcome. The secondary outcomes are standardized measures of depression, anxiety and recovery and measures of interpretation bias. Safety is a primary outcome and measured by the Negative Effects Questionnaire and a checklist of adverse events completed fortnightly with researchers. The trial is conducted with the help of a Lived Experience Advisory Panel. Discussion: This study will assess STOP's efficacy and safety. STOP has the potential to be an accessible intervention to complement other treatments for any conditions that involve significant paranoia. Trial registration: ISRCTN registry, ISRCTN17754650. Registered on 03/08/2021. https://doi.org/10.1186/ISRCTN17754650. [ABSTRACT FROM AUTHOR]

Background and Objectives: Autobiographical memories have been found to be related to one's current psychological state. Biases in autobiographical memories in terms of valence, content, and specificity are thought to be related to one's well-being and mental health. Previous studies have shown that by using cognitive bias modification techniques that aim to alter one's interpretation bias, memory valence bias could also be altered. The goal of the current study was to investigate if these techniques can also alter overgenerality of autobiographical memory, a phenomenon strongly associated with different psychopathologies. We hypothesized that creating a positive interpretation would decrease overgenerality of autobiographical memories while a negative interpretation bias would increase overgenerality. Methods: Sixty participants were recruited and divided into two groups, positive vs. negative imagery Cognitive Bias Modification (i-CBM). Both groups completed an Autobiographical Memory Test (AMT) before and after undergoing one i-CBM session (positive or negative). Results: positive i-CBM reduced overgenerality of autobiographical memories, while negative i-CBM increased it. Conclusions: These results suggest that changing one's cognitive interpretation bias also changes one's memory bias. Thus, the same task that reduces negative bias from autobiographical memories also reduces overgenerality of autobiographical memories. In addition, the results strengthen the suggestion that the use of imagery and the ability to generate specific autobiographical memories are related. These findings hold great potential for our understanding of the interconnection between the different cognitive memory biases that lay at the base of several psychopathologies. [ABSTRACT FROM AUTHOR]

Anhedonia, the loss of interest in and pleasure from previously enjoyable activities is a core symptom of depression and presents a major challenge to treatments. Interventions involving positive mental imagery generation have been suggested to reduce anhedonia. However, it is not clear whether the imagery component of such interventions is crucial for these effects. The current study aimed to test this by contrasting repeated generation of positive mental imagery versus positive verbal thoughts. Over a one‐week period, 53 mildly anhedonic adults completed five sessions of a computerized training program involving the generation of either positive images or positive sentences. Compared to participants who generated sentences, participants who generated imagery showed greater improvements from pre‐ to post‐training on an individualized multi‐facetted measure of anhedonia (the Dimensional Anhedonia Rating Scale), but not on standardized measures of anticipated pleasure (the Snaith‐Hamilton Pleasure Scale), depression symptoms, or positive affect. The present study supports the proposal that positive imagery could provide a route to improve anhedonia, with generation of imagery in particular (as opposed to positive thoughts in general) as an important driving mechanism for these effects. This has theoretical and clinical implications for understanding the role of imagery in anhedonia and its treatment. [ABSTRACT FROM AUTHOR]

The approach-avoidance task (AAT) probes tendencies contributing to unwanted behaviours, like excessive snacking, by measuring RT differences between approach and avoidance responses to different stimuli. It retrains such tendencies using repeated avoidance of appetitive stimuli and approach of healthy alternatives. The most common paradigm, the irrelevant-feature AAT, conceals these stimulus-response contingencies by requiring approach or avoidance based on features irrelevant to the tendencies (e.g. frame colour). Unfortunately, it is an unreliable measure and not always successful as a training, likely because the stimuli can be ignored. In the novel dual-feature AAT, the combination of stimulus and irrelevant feature determines responses: participants approach foods and avoid objects surrounded by frame A, and vice versa given frame B. We trained 219 online participants to approach fruit and avoid chocolate using active (7:1 stimulus-to-frame contingency) and sham (1:1 stimulus-to-frame contingency) versions of these two trainings. Compared to sham, active irrelevant-feature training was associated with more selection and desire to eat fruit, and active dual-feature training increased approach bias for fruit. Participants’ perceived rate of approaching fruit versus chocolate correlated with many outcome measures, suggesting contingency awareness plays a major role in AAT training effectiveness, challenging implicit accounts. While the dual-feature paradigm shows potential, its high error rates, RTs, and difficulty mandate improvement. [ABSTRACT FROM AUTHOR]

Abstract Background Paranoia, the belief that you are at risk of significant physical or emotional harm from others, is a common difficulty, which causes significant distress and impairment to daily functioning, including in psychosis-spectrum disorders. According to cognitive models of psychosis, paranoia may be partly maintained by cognitive processes, including interpretation biases. Cognitive bias modification for paranoia (CBM-pa) is an intervention targeting the bias towards interpreting ambiguous social scenarios in a way that is personally threatening. This study aims to test the efficacy and safety of a mobile app version of CBM-pa, called STOP (successful treatment of paranoia). Methods The STOP study is a double-blind, superiority, three-arm randomised controlled trial (RCT). People are eligible for the trial if they experience persistent, distressing paranoia, as assessed by the Positive and Negative Syndrome Scales, and show evidence of an interpretation bias towards threat on standardised assessments. Participants are randomised to either STOP (two groups: 6- or 12-session dose) or text-reading control (12 sessions). Treatment as usual will continue for all participants. Sessions are completed weekly and last around 40 min. STOP is completely self-administered with no therapist assistance. STOP involves reading ambiguous social scenarios, all of which could be interpreted in a paranoid way. In each scenario, participants are prompted to consider more helpful alternatives by completing a word and answering a question. Participants are assessed at baseline, after each session, and at 6, 12, 18 and 24 weeks post-randomisation. The primary outcome is the self-reported severity of paranoid symptoms at 24 weeks, measured using the Paranoia Scale. The target sample size is 273 which is powered to detect a 15% symptom reduction on the primary outcome. The secondary outcomes are standardized measures of depression, anxiety and recovery and measures of interpretation bias. Safety is a primary outcome and measured by the Negative Effects Questionnaire and a checklist of adverse events completed fortnightly with researchers. The trial is conducted with the help of a Lived Experience Advisory Panel. Discussion This study will assess STOP’s efficacy and safety. STOP has the potential to be an accessible intervention to complement other treatments for any conditions that involve significant paranoia. Trial registration ISRCTN registry, ISRCTN17754650. Registered on 03/08/2021. https://doi.org/10.1186/ISRCTN17754650 .

Background: Patients with alcohol use disorder (AUD) tend to selectively approach alcohol cues in the environment, demonstrating an alcohol‐approach bias. Alcohol‐approach‐bias modification (Alcohol‐ApBM) effectively increases abstinence rates in patients with AUD when added to abstinence‐focused treatment, but the evidence for its proposed working mechanism (reduction of the alcohol‐approach bias) is limited. Moreover, not all patients benefit from Alcohol‐ApBM, and previous research did not identify reliable pretreatment predictors of Alcohol‐ApBM effectiveness. Therefore, the current study focused on learning processes during the Alcohol‐ApBM training itself. Specifically, we examined whether changes in approach‐avoidance tendencies over the course of Alcohol‐ApBM would predict abstinence after inpatient treatment. Methods: The training data of 543 AUD patients in Germany (70% male, M = 47.96, SD = 9.08), receiving Alcohol‐ApBM training during inpatient treatment, were used to examine whether various aspects of learning during training predicted abstinence 1 year after treatment discharge, both separately and in interaction with potential sociodemographic and clinical moderators of Alcohol‐ApBM effectiveness. Results: Overall, successful learning across six Alcohol‐ApBM training sessions was observed; that is, the approach tendency toward alcoholic stimuli was reduced over time. However, none of the examined learning parameters were predictive of abstinence, neither separately nor in combination with clinical or sociodemographic variables. Conclusions: Previous studies have shown that Alcohol‐ApBM is an effective add‐on to abstinence‐focused treatment for AUD, and this study showed that learning took place during Alcohol‐ApBM training. However, specific learning parameters during training did not predict abstinence 1 year after treatment discharge. Therefore, we cannot specify which patients are most likely to benefit from ApBM with regard to abstinence after 1 year. [ABSTRACT FROM AUTHOR]

Background: This systematic review and meta-analysis examined the efficacy of Cognitive Bias Modification of Interpretation (CBM-I) to reduce hostile interpretation bias and aggressive behavior. Methods: We searched PsycINFO, PubMed, Embase, Web of Science, and Cochrane Library databases up until January 1, 2023, and assessed risk of bias using Cochrane's risk of bias tool (RoB 2). We used multi-level meta-analysis to synthesize effect sizes. Results: Fourteen articles including 16 randomized studies met the inclusion criteria, yielding data from 1449 participants. CBM-I had medium effects on hostile interpretation (d = −0.62, p <.001) and benign interpretation (d = 0.71, p <.001), and a small effect on aggressive behavior (d = −0.28, p =.017). However, effects on interpretation bias were significant only for measures that were similar to the training method, suggesting that CBM-I effects do not generalize beyond the training task. Moreover, effects on aggressive behavior were significant only for self-reported aggression, suggesting demand effects. Effects on non-self-reported aggression were small and even zero after excluding one study with an exceptionally large effect size. Conclusion: There currently is insufficient evidence to use CBM-I as a treatment component to reduce aggressive behavior. [ABSTRACT FROM AUTHOR]

This study investigated the efficacy of combined cognitive bias modification (CBM) on perfectionism and intolerance of uncertainty. Fifty‐four university students scoring over 70.5 on the Brief Symptom Measure were randomly assigned to experimental and placebo control groups. The CBM intervention was administered online for 4 weeks. Assessments were given at baseline, after the 4‐week intervention, and 1 month post‐intervention. Results showed a statistically significant decrease in two dimensions of perfectionism, concern over mistakes and parental criticism, and intolerance of uncertainty of those in the experimental group, compared to those in the control group. The findings related to the interpretation of perfectionism revealed a significant interaction effect of time and direction of sentences for the experimental group. Lastly, the experimental group's interpretation bias scores for intolerance of uncertainty showed a statistically significant increase after the intervention compared to those in the control group. The study's findings provide preliminary support for the effectiveness of CBM on perfectionism and intolerance of uncertainty. [ABSTRACT FROM AUTHOR]

Abstract Background Postpartum depression (PPD) affects 30–50% of women with a history of previous depression or bipolar disorder and 8% of women with no history of depression. Negative cognitive biases in the perception of infant cues and difficulties with emotion regulation are replicated risk factors. Current interventions focus on detecting and treating rather than preventing PPD. The aim of this randomized controlled intervention trial is therefore to investigate the potential prophylactic effects of prenatal affective cognitive training for pregnant women at heightened risk of PPD. Methods The study will enrol a total of 292 pregnant women: 146 at high risk and 146 at low risk of PPD. Participants undergo comprehensive assessments of affective cognitive processing, clinical depressive symptoms, and complete questionnaires at baseline. Based on the responses, pregnant women will be categorized as either at high or low risk of PPD. High-risk participants will be randomized to either prenatal affective cognitive training (PACT) or care as usual (CAU) immediately after the baseline testing. The PACT intervention is based on emerging evidence for efficacy of affective cognitive training approaches in depression, including cognitive bias modification, attention bias modification, mindfulness-inspired emotion regulation exercises, and working memory training. Participants randomised to PACT will complete five individual computerised and virtual reality-based training sessions over 5 weeks. The primary outcome is the difference between intervention arms in the incidence of PPD, assessed with an interview 6 months after birth. We will also assess the severity of depressive symptoms, rated weekly online during the first 6 weeks postpartum. Discussion The results will have implications for future early prophylactic interventions for pregnant women at heightened risk of PPD. If the PACT intervention reduces the incidence of PPD, it can become a feasible, non-invasive prophylactic strategy during pregnancy, with positive mental health implications for these women and their children. Trial registration ClinicalTrials.gov NCT06046456 registered 21-09-2023, updated 08-07-2024.

Background: Postpartum depression (PPD) affects 30–50% of women with a history of previous depression or bipolar disorder and 8% of women with no history of depression. Negative cognitive biases in the perception of infant cues and difficulties with emotion regulation are replicated risk factors. Current interventions focus on detecting and treating rather than preventing PPD. The aim of this randomized controlled intervention trial is therefore to investigate the potential prophylactic effects of prenatal affective cognitive training for pregnant women at heightened risk of PPD. Methods: The study will enrol a total of 292 pregnant women: 146 at high risk and 146 at low risk of PPD. Participants undergo comprehensive assessments of affective cognitive processing, clinical depressive symptoms, and complete questionnaires at baseline. Based on the responses, pregnant women will be categorized as either at high or low risk of PPD. High-risk participants will be randomized to either prenatal affective cognitive training (PACT) or care as usual (CAU) immediately after the baseline testing. The PACT intervention is based on emerging evidence for efficacy of affective cognitive training approaches in depression, including cognitive bias modification, attention bias modification, mindfulness-inspired emotion regulation exercises, and working memory training. Participants randomised to PACT will complete five individual computerised and virtual reality-based training sessions over 5 weeks. The primary outcome is the difference between intervention arms in the incidence of PPD, assessed with an interview 6 months after birth. We will also assess the severity of depressive symptoms, rated weekly online during the first 6 weeks postpartum. Discussion: The results will have implications for future early prophylactic interventions for pregnant women at heightened risk of PPD. If the PACT intervention reduces the incidence of PPD, it can become a feasible, non-invasive prophylactic strategy during pregnancy, with positive mental health implications for these women and their children. Trial registration: ClinicalTrials.gov NCT06046456 registered 21-09-2023, updated 08-07-2024. [ABSTRACT FROM AUTHOR]

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Objective: Web-based cognitive bias modification for interpretation (CBM-I) can improve interpretation biases and anxiety symptoms but faces high rates of dropout. This study tested the effectiveness of web-based CBM-I relative to an active psychoeducation condition and the addition of low-intensity telecoaching for a subset of CBM-I participants. Method: 1,234 anxious community adults (Mage = 35.09 years, 81.2% female, 72.1% white, 82.6% not Hispanic) were randomly assigned at Stage 1 of a sequential, multiple-assignment randomized trial to complete five weekly sessions of CBM-I or psychoeducation on our team's public research website. After the first session, for Stage 2, an algorithm attempted to classify CBM-I participants as higher (vs. lower) risk for dropping out; those classified as higher risk were then randomly assigned to complete four brief weekly telecoaching check-ins (vs. no coaching). Results: As hypothesized (https://doi.org/j2xr; Daniel, Eberle, & Teachman, 2020), CBM-I significantly outperformed psychoeducation at improving positive and negative interpretation biases (Recognition Ratings, Brief Body Sensations Interpretation Questionnaire) and anxiety symptoms (Overall Anxiety Severity and Impairment Scale, Anxiety Scale from Depression Anxiety Stress Scales–Short Form), with smaller treatment gains remaining significant at 2-month follow-up. Unexpectedly, CBM-I had significantly worse treatment dropout outcomes than psychoeducation, and adding coaching (vs. no coaching) did not significantly improve efficacy or dropout outcomes (notably, many participants chose not to interact with their coach). Conclusions: Web-based CBM-I appears effective, but supplemental coaching may not mitigate the challenge of dropout. What is the public health significance of this article?: Web-based interventions that provide practice thinking more positively about potentially threatening situations hold promise for shifting the rigidly negative interpretations that maintain anxiety, but many users of these programs do not complete a full course of treatment. The present study's results suggest that providing this training is more effective at improving interpretation biases and anxiety symptoms in anxious adults from the community compared to providing educational material about anxiety. Results also suggest that providing brief check-ins with a coach may not improve the training's effectiveness or the rates of treatment completion. [ABSTRACT FROM AUTHOR]

Whilst opportunities to participate in gambling have increased, access to support for problem gamblers is lacking behind. This lack of balance calls for improved and accessible intervention methods. The present double-blind randomized controlled trial (RCT) explored the effectiveness of two interventions targeting automatic cognitive processes, known as Attentional Bias Modification (AtBM) and Approach Bias Modification (ApBM). It was hypothesized these interventions would reduce gambling behavior and reduce or reverse targeted biases. Participants (N = 331) were community-recruited Flemish (35%) and Dutch (65%) adult problem gamblers motivated to reduce or stop their gambling who received either six sessions of active training (AtBM or ApBM) or of the corresponding sham-training (sham-AtBM or sham-ApBM). Due to high attrition rates (90.1% up to the intervention phase) the study was terminated before completion, since it would greatly limit the validity of any results. A post hoc qualitative study was performed on a subset of participants to gain insight into contributing factors for the high attrition rate. Issues negatively impacting participants' motivation to complete the program were identified, as well as elements of the program that received approval. The results from this study provide a first insight into the potential of the use of online cognitive bias modification (CBM) interventions in problem gambling (PG). Suggestions and directions for future studies are discussed. [ABSTRACT FROM AUTHOR]

Anxiety disorders are characterized by widespread and persistent anxiety or recurrent panic attacks. As a result of their high prevalence, chronicity, and comorbidity, patients' quality of life and functioning are severely compromised. However, several patients do not receive treatment. This review discusses the effectiveness, safety, and limitations of major medications and cognitive bias modification (CBM) for treating anxiety disorders. The possibility of combined treatment is also discussed in the literature. Furthermore, drawing on Chinese cultural perspectives, the authors suggest that anxiety can be recognized, measured, and coped with at three levels of skill (技), vision (术), and Tao (道). The combination of pharmacotherapy and CBM is possibly more effective in treating anxiety disorders than either treatment alone. However, clinicians and patients should participate in the joint decision-making process and consider comprehensive factors. Moderate anxiety has adaptive significance. In the coming years, by combining the downward analytical system of western culture with the upward integrative system of Chinese culture, a comprehensive understanding of anxiety and anxiety disorders should be established, rather than focusing only on their treatment. [ABSTRACT FROM AUTHOR]

Background: Depression often leads to clinical admission. Stimulating positive memory bias through repeated retrieval can counteract a ruminative depressotypic processing style. Cognitive Bias Modification (CBM)-Memory is a psychological intervention, which was evaluated as possible adjunct treatment for depressed inpatients. Methods: A randomized controlled pilot study with a one-week follow-up was implemented to compare the effect of a four-session positive CBM-Memory intervention to a neutral CBM-Memory version. Training-congruent retrieval (as manipulation check), and transfer to rumination (as mechanistic target) and depressive symptoms (self-rated and clinician-rated; indication of clinical relevance) were assessed. Results: In the intention-to-treat sample (N = 81, Mage=35.6/SD = 11.9, 60% female), condition-congruent memory retrieval of previously presented target words was found after the training and at follow-up (large effect-sizes). Positive CBM-Memory intervention resulted in sustained recall bias and largest rumination reduction with a small-medium effect size. Additionally, the conditions did not differ significantly on the reduction in depressive symptoms. Conclusions: Positive CBM-Memory intervention yielded positive recall bias, which was still present one week later. Additionally, the positive condition did yield more decrease in trait (but not state) rumination, providing some support for rumination as mechanistic target of positive CBM-Memory. However, there was no evidence for transfer of the training effect to depressive symptoms, indicating no superiority on clinical recovery of the positive over the neutral condition. Future research should examine a higher dosage, integration of CBM in the treatment provision, and its long-term effects in a well-powered trial. [ABSTRACT FROM AUTHOR]

Harmful alcohol use is a major public health issue. In‐person treatment has been hindered by the restrictions necessary during the Covid‐19 pandemic. This study examined the effects of an at‐home smartphone‐based cognitive bias modification training in heavy drinkers. Experiment 1 tested the effect of a short 20–30‐min smartphone‐based approach‐avoidance training (AAT) on image‐induced craving at a 1‐day follow‐up. Sixty‐two participants consuming 14+ units of alcohol/week were allocated to either the training or waitlist group. Experiment 2 used an updated version of the same short AAT intervention with a sample of n = 107 participants who consumed 20+ units of alcohol/week. Training effects at 1‐week follow‐up were compared to an active control group. Experiment 1 showed a significant reduction in image‐induced craving for the training group at 1‐day follow‐up. Experiment 2 found that AUDIT weekly scores were significantly reduced at 1‐week follow‐up for the training group, all the while craving for soft drinks remained unchanged. Experiment 1 served as a first proof of concept for the efficacy of the new smartphone‐based AAT training, and experiment 2 suggested that training effects on problem alcohol use hold at 1‐week follow‐up. [ABSTRACT FROM AUTHOR]

Introduction: Abstinence rates after inpatient treatment for alcohol use disorder (AUD) are modest (1-year rate around 50%). One promising approach is to re-train the automatically activated action tendency to approach alcohol-related stimuli (alcohol-approach bias) in AUD patients, as add-on to regular treatment. As efficacy has been demonstrated in well-controlled randomized controlled trials, the important next step is to add alcohol-approach-bias modification (alcohol-ApBM) to varieties of existing treatments for AUD. Therefore, this prospective, multicenter implementation-RCT examined whether adding alcohol-ApBM to regular treatments (various abstinence-oriented treatments including both individual and group-based interventions) would significantly increase abstinence rates compared to receiving regular treatment only, in a variety of naturalistic settings with different therapeutic approaches. Methods: A total of 1,586 AUD inpatients from 9 German rehabilitation clinics were randomly assigned to receive either ApBM in addition to regular treatment or not. Training satisfaction of patients and therapists was measured after training. Success rates were determined at 3, 6, and 12 months post-treatment. Results: Return rates of the post-treatment assessments varied greatly between clinics, often being low (18–76%). Nevertheless, ApBM significantly increased success rates after 3 months. After 6 and 12 months, the differences were not significant. ApBM was evaluated mostly positively by patients and therapists. Discussion/Conclusion: ApBM was an effective add-on to regular treatment of AUD at 3 months follow-up, across a variety of AUD treatment settings. However, low return rates for the clinical outcomes reduced the effect size of ApBM considerably. The application of ApBM proved feasible in varying clinical settings, offering the opportunity to modify automatic processes and to promote abstinence. [ABSTRACT FROM AUTHOR]

Previous research has identified maladaptive emotion regulation as a key factor in psychopathology. Thus, addressing emotion regulation via scalable, low-threshold digital interventions – such as smartphone-based Cognitive Bias Modification (CBM) – holds important therapeutic potential. Using a randomized-controlled crossover trial, we tested the efficacy of an integrated CBM module within the Affect Regulation Training (ART, i.e., CBM-ART) that targeted emotion regulation through elements of appraisal-based and approach avoidance training.Undergraduate students reporting elevated stress were randomized to a one-week active intervention (Mindgames; including psychoeducation, a quiz, and CBM-ART; n = 40), active control training (Emo Shape; including placebo psychoeducation, a quiz, and a placebo swiping task; n = 36) or waitlist (n = 25). Before and after the intervention, we assessed emotion regulation, interpretation bias, stress and depression. We further tested post-training stress reactivity using an anagram task.Results indicated that the active intervention improved negative (OR = 0.35) and positive (OR = 2.40) interpretation biases and symptom measures (d = 0.52–0.87). However, active control training showed attenuated concurrent pre-post changes on interpretation biases (i.e., OR = 0.53 for negative, and OR = 1.49 for positive interpretations) and symptom measures (d = 0.26–0.91). The active intervention was rated positively in terms of acceptability and usability.These findings provide initial evidence for the efficacy and acceptability of an integrated app-based CBM intervention for emotion regulation in reducing interpretation biases and psychopathological symptoms, including stress. However, future studies should disentangle specific mechanisms underlying interventional effects.

Health inequity for marginalized groups increases the risk of developing health problems. Healthcare providers' unconscious bias contributes to this inequity. A novel bias modification method--called Cognitive Bias Modification for stereotype (CBM-S)--is a digital tool designed to be used in conjunction to existing bias training to address medical students' biases toward Māori (an indigenous population in Aotearoa New Zealand). CBM-S encourages non-stereotypical interpretations through relevant and specific text-based scenarios and has been tested against control. To improve the scenario's relevance and specificity, here, we adopted a user-centered approach to materials development for CBM-S that involved iterative inputs from medical students and Māori participants to achieve our objectives. We outlined the material development process for CBM-S to provide a guide for researchers and educators in developing CBM-S training. [ABSTRACT FROM AUTHOR]

Background and Aims: ABC-training is a new intervention to encourage health behavior change that targets the automatic activation of adaptive beliefs (i.e. automatic inferences). The aim of this proof-of-principle study was to test the effectiveness of web-based ABC-training to change outcome expectancies of alcohol drinking in a sample of hazardous drinkers. Design: One exploratory and one confirmatory experiment with two between-subject conditions (online ABC- and control-training) and assessments at baseline and 1 week later (after three sessions of training). Setting: Participants recruited on Prolific Academic completed the web-based study. Participants: Adults with self-reported hazardous alcohol drinking (Experiment 1: 193 adults, United Kingdom, age mean = 46.7 years; Experiment 2: 282 adults, different nationalities, age mean = 38.3 years). Intervention and Comparator: ABC-training involved completing an online task that required choosing personally relevant alternative behaviors to drinking alcohol in personally relevant antecedent contexts to attain personally important outcomes. Comparator was control-training, in which participants selected both the alternative behaviors and alcohol drinking an equal number of times. Training was completed at baseline, after 3 days and after 1 week. Measurements: Primary outcome was change in automatic and self-reported (negative/positive) outcome expectancies of alcohol drinking from baseline to after 1 week. Secondary outcomes were change in weekly alcohol consumption, self-efficacy, craving and motivation (and approach-alcohol associations in Experiment 1). Moderators were baseline outcome scores, motivation, age and alcohol dependency. Findings: Findings of this study are as follows: stronger increase in negative outcome expectancies after ABC- than control-training (Experiment 1: self-report, 95% confidence interval of difference scores (CIdiff) = [0.04, Inf]; automatic, CIdiff = [0.01, Inf]; Experiment 2: self-report, CIdiff = [0.16, Inf]; automatic, CIdiff = [0.002, Inf]). Stronger reduction in self-reported positive outcome expectancies after ABC- than controltraining (Experiment 1: CIdiff = [-Inf, -0.01]; Experiment 2: CIdiff = [-Inf, -0.21]) but mixed findings on automatic positive outcome expectancies (Experiment 1: CIdiff = [-Inf, 0.02]; Experiment 2: CIdiff = [-Inf, -0.001]). Conclusions: ABC-training may change outcome expectancies of alcohol consumption, but testing of clinically relevant effects in other samples is warranted. [ABSTRACT FROM AUTHOR]

The current study aimed to examine the effectiveness of internet-delivered Combined Cognitive Bias Modification (iCBM-C) for interpretation (CBM-I) and attention (CBM-A) for obsessive–compulsive disorder (OCD) symptoms comparatively.Eighty-two participants (mean age = 26.5, SD = 5.93; 79.3% female) with high OCD symptoms were randomly assigned to eight sessions of iCBM-C (n = 22), iCBM-I, (n = 20), iCBM-A (n = 20), or wait-list control (WLC) (n = 20). Assessments of OCD symptoms and beliefs, depression, anxiety, stress, and mood were administered at baseline, post-intervention at week 4 and 1-month follow-up, whereas assessments of interpretation and attentional biases were administered at baseline and post-intervention at week 4. Both iCBM-C and iCBM-I reduced OCD beliefs compared to the iCBM-A, and negative OC-relevant interpretations compared to both iCBM-A and WLC at post-intervention at week 4, with no clear superiority of one intervention over the other. Although both the interventions also reduced OCD symptoms, only iCBM-I was superior to WLC at post-intervention at week 4. There were no differences between groups regarding attentional bias, depression, anxiety, stress, and mood at post-intervention at week 4. There were also no differences between groups in terms of any outcome at 1-month follow-up. Although our findings provide further evidence for the utility of CBM-I for OCD, iCBM-C also revealed promising outcomes. Should these findings be replicated in specific subgroups, iCBM-C has the potential to be accessible and effective treatment for OCD. [ABSTRACT FROM AUTHOR]

Background: Cognitive Bias Modification for paranoia (CBM-pa) is a novel, theory-driven psychological intervention targeting the biased interpretation of emotional ambiguity associated with paranoia. Study objectives were (i) test the intervention's feasibility, (ii) provide effect size estimates, (iii) assess dose–response and (iv) select primary outcomes for future trials. Methods: In a double-blind randomised controlled trial, sixty-three outpatients with clinically significant paranoia were randomised to either CBM-pa or an active control (text reading) between April 2016 and September 2017. Patients received one 40 min session per week for 6 weeks. Assessments were given at baseline, after each interim session, post-treatment, and at 1- and 3-months post-treatment. Results: A total of 122 patients were screened and 63 were randomised. The recruitment rate was 51.2%, with few dropouts (four out of 63) and follow-up rates were 90.5% (1-month) and 93.7% (3-months). Each session took 30–40 min to complete. There was no statistical evidence of harmful effects of the intervention. Preliminary data were consistent with efficacy of CBM-pa over text-reading control: patients randomised to the intervention, compared to control patients, reported reduced interpretation bias (d = −0.48 to −0.76), improved symptoms of paranoia (d = −0.19 to −0.38), and lower depressed and anxious mood (d = −0.03 to −0.29). The intervention effect was evident after the third session. Conclusions: CBM-pa is feasible for patients with paranoia. A fully powered randomised control trial is warranted. [ABSTRACT FROM AUTHOR]

Background: Alcohol use disorder (AUD) is highly prevalent and commonly co-occurs with other psychiatric disorders among Veterans. Provisional evidence supports the use of Approach Avoidance Training (AAT) - a form of computer-delivered cognitive bias modification designed to target implicit approach bias for alcohol-related cues - as an adjunctive program to treat AUD. However, the extent to which AAT is effective for improving AUD recovery outcomes in outpatient Veteran samples and those with psychiatric comorbidities has been understudied to date. Here we describe a double-blind randomized controlled trial of AAT versus a comparison condition (Sham) being conducted in Veterans with comorbid psychiatric conditions completing outpatient standard care. Methods: One hundred thirty-six Veterans currently receiving outpatient treatment for AUD will be recruited for this randomized controlled trial with parallel group assignment. Participants will be randomized to either 6 weeks of AAT (n = 68) or Sham (n = 68) training in conjunction with usual care. Assessments will occur at baseline and 6 weeks, 3 months, and 6 months post-baseline. Primary outcome variables will include functional consequences of drinking. Secondary outcome variables will include alcohol consumption, and behavioral indicators of alcohol approach bias. A subset of participants (n = 51) will also complete functional magnetic resonance imaging (fMRI) to assess neural response during an alcohol approach bias assessment. Discussion: This study is the first randomized controlled trial of AAT administered as an adjunctive treatment to standard care in Veterans with AUD and comorbid psychiatric disorders. Additionally, behavioral and neuroimaging data will be used to determine the extent to which AAT targets approach bias for alcohol cues. If effective, AAT may be a promising low-cost adjunctive treatment option for individuals with AUD. Registry name: AAT for Alcohol Use Disorder in Veterans. Trial registration: ClinicalTrials.gov: NCT05372029; Date of Registration: 5/9/2022. [ABSTRACT FROM AUTHOR]

Background: Interpretation biases (IBs) are central in panic disorder, and there is rich evidence showing that these are correlated with and predictive of panic-relevant symptomatology. However, experimental studies are needed to examine the potential causal effects of IBs, as predicted by cognitive models. Methods: Panic-related IBs were manipulated via a sentence-completion Cognitive Bias Modification-Interpretation (CBM-I) training. The sample included N = 112 healthy participants reporting moderate levels of fear of bodily sensations. Participants were randomly allocated to a positive, negative, or control CBM-I condition. To test the trainings' effect on panic-relevant cognitive processing, IBs were assessed via proximal and distal measures. Symptom provocation tasks were applied to test transfer to panic-relevant symptomatology. Results: Results on the proximal measure showed that positive CBM-I led to more positive IBs compared to negative, and control training. Further, positive CBM-I led to more positive IBs on the distal measure as compared to negative CBM-I. However, there were no differential training effects on panic-related symptomatology triggered via the provocation tasks. Conclusion: The findings indicate a limited generalization of the effects of CBM-I on IBs and panic-related symptoms. Potential means to improve generalization, such as applying more nuanced measures and combining CBM-I with psychoeducation are discussed. [ABSTRACT FROM AUTHOR]

Background: Despite considerable research efforts, consistent predictors of cognitive behavioral therapy (CBT) outcome for social anxiety disorder (SAD) are scarce. A dynamic focus on individual symptom reactivity and resilience patterns may show promise in predicting treatment response. This pilot study is the first to investigate whether rate of return to baseline after a one-session positive interpretation training indicates resilience and predicts CBT-response among individuals with SAD. Method: Participants (N = 39) completed an interpretation bias assessment before and after training, and once a day for three days after the training, followed by a six-week CBT-program. Participants completed SAD-assessments pre-treatment, during treatment, and post-treatment. Return to baseline was operationalized as the individualized slope of negative and positive interpretations across interpretation bias assessments. Results: Intention-to-treat analyses showed no significant relation between both negative and positive interpretation bias and CBT-response. Similarly, for completers-only, most analyses also showed no such relationship. Conclusion: These findings suggest that slower return to baseline as a resilience index does not have predictive value for CBT-outcome in individuals with SAD. Future studies should incorporate experience-sampling to capture subtle changes in interpretation bias. [ABSTRACT FROM AUTHOR]

Background: Alcohol‐dependent individuals tend to selectively approach alcohol cues in the environment, demonstrating an alcohol approach bias. Because approach bias modification (ApBM) training can reduce the approach bias and decrease relapse rates in alcohol‐dependent patients when added to abstinence‐focused treatment, it has become a part of regular treatment. Moreover, in selective inhibition (SI) training, responses to one category of stimuli (i.e., alcohol stimuli) are selectively inhibited in an adapted Go/No‐Go task. SI‐Training has been found to effectively devalue the inhibited category and to reduce consumption of alcohol among social drinkers. This study investigated whether SI‐Training can further improve the effects of treatment as usual that includes ApBM, and if so, whether the effect is mediated by a devaluation of the inhibited alcohol stimuli. Methods: Abstinent alcohol‐dependent inpatients (N=434) were randomly assigned to receive 6 sessions of either active (n = 214, 32% female) or sham (n = 220, 38% female) SI‐Training, in addition to standard treatment that includes active ApBM. Ratings were used to assess changes in the evaluation of alcohol stimuli after the training. Relapse rates were assessed 3 and 12 months after treatment discharge. Results: Alcohol stimuli were rated negatively before and after the training, and the training did not influence these ratings. Evaluation of nonalcoholic drinks became more positive after active SI‐Training. Both ApBM and SI‐Training showed the expected training effects on reaction times. Contrary to expectations, SI‐Training conditions did not yield different abstinence rates 3 or 12 months after treatment. Conclusions: We found no evidence supporting the hypothesis that SI‐Training amplifies the relapse‐preventing effect of ApBM. Moreover, alcohol stimuli were rated negatively before and after treatment and were not influenced by SI‐Training. [ABSTRACT FROM AUTHOR]

BackgroundCognitive Bias Modification (CBM) has garnered interest as a potential addiction treatment. CBM interventions such as Approach Avoidance Training (AAT) are designed to alter automatic tendencies to approach drugs or drug-related cues. In our previous work, the cannabis AAT (CAAT) reduced cannabis approach bias, which was related to reduced cannabis use, among 80 non-treatment-seeking cannabis-using youth (Jacobus et al., 2018). In this preliminary examination, a subsample of these youth underwent neuroimaging to explore CAAT's effect on cannabis cue-related neural activation.MethodsSub-study participants were 41 cannabis-using youth ages 17-21 (mean age = 18.83; 47.5% female). Participants completed a cannabis cue-reactivity task during a functional MRI scan pre- and post CAAT-training or CAAT-sham to examine CAAT-related neural changes.ResultsThirty-seven youth completed all six CAAT (n = 19) or CAAT-sham (n = 18) training sessions and had usable neuroimaging data. The group*time interaction on cannabis approach bias reached trend-level significance (p = .055). Change in approach bias slopes from pre-to post-treatment was positive for CAAT-sham (increased approach bias) and negative for CAAT-training (change to avoidance bias), consistent with the larger study. No significant changes emerged for cannabis cue-induced activation following CAAT-training or CAAT-sham in whole brain or region of interest analyses. However, active CAAT-training was associated with small-to-medium decreases in amygdala (Cohen's dz = 0.36) and medial prefrontal cortex (Cohen's dz = 0.48) activation to cannabis cues.ConclusionsDespite reducing cannabis use in the larger sample, CAAT-training did not alter neural cannabis cue-reactivity in the sub-study compared to CAAT-sham. More research is needed to understand neural mechanisms underlying AAT-related changes in substance use.

Aims: For the first time, to our knowledge, in a clinical sample with alcohol use disorder (AUD), this study compared the effects of two versions of alcohol‐specific inhibition training (Alc‐IT) on drinking outcomes and on experimental parameters assessing two possible working mechanisms: stimulus devaluation and inhibitory enhancement. Design: Multi‐centre, double‐blind, three‐arm clinical RCT with 3‐, 6‐ and 12‐month follow‐up comparing standard Alc‐IT, improved Alc‐IT and an active control condition. Setting: Three specialized AUD treatment centres in Switzerland. Participants: A total of 242 detoxified, recently abstinent patients with severe AUD (18–60 years; 29.8% female). Intervention and Comparator: Both interventions [standard Alc‐IT (n = 84) and improved Alc‐IT (n = 79)] and the comparator [unspecific inhibition training (n = 79)] consisted of six sessions of a modified inhibitory task (Go/NoGo task) with alcohol‐related and neutral stimuli. Both versions of Alc‐IT required response inhibition in alcohol‐related trials but differed in Go/NoGo ratios (standard: 50/50; improved: 75/25), with improved Alc‐IT posing higher inhibitory demands. The control condition, an unspecific inhibition training, featured alcohol‐related pictures in Go as well as NoGo trials. Measurements The primary outcome, percentage of days abstinent, was assessed at 3‐month follow‐up with a time‐line follow‐back interview. Findings The group receiving improved Alc‐IT showed a significantly higher percentage of days abstinent at 3‐month follow‐up compared with the control group [γcontrol = 74.30; γimproved = 85.78; β = 11.48, 95% confidence interval (CI) = 2.57, 20.40, P = 0.012, adjusted r2 = 0.062], while for standard Alc‐IT no effect significantly different from zero was detected (γstandard = 70.95; β = −3.35, 95% CI = −12.20, 5.50, P = 0.457, adjusted r2 = −0.04). Conclusions: Alcohol‐specific inhibition training with high inhibitory demands increased days abstinent at 3‐month follow‐up in patients with severe alcohol use disorder. Such an improved, inhibitory‐demanding, alcohol‐specific inhibition training outperformed the standard version of alcohol‐specific inhibition training, suggesting an inhibitory working mechanism. [ABSTRACT FROM AUTHOR]

Supplemental Digital Content is Available in the Text. Cognitive bias modification of interpretation improved pain severity and pain interference compared with placebo. Psychoeducation did not improve the efficacy of cognitive bias modification of interpretation. Cognitive bias modification for interpretation (CBM-I) is an effective intervention for anxiety, but there is only a single trial in people with chronic pain. The aim of this randomized controlled trial was to test CBM-I with and without psychoeducation for people with chronic pain. We randomized 288 participants to 4 groups comprising treatment (CBM-I vs placebo) with or without psychoeducation. One hundred and eighty-three participants (64%) completed 4, 15-minute training sessions over 2 weeks. The coprimary outcomes were pain interference and pain intensity. We also measured interpretation bias, fear of movement, catastrophizing, depression, anxiety, and stress. Participants with more psychopathology at baseline were more likely to dropout, as were those allocated to psychoeducation. Intention-to-treat analyses using linear mixed models regression were conducted. Training effects of CBM-I were found on interpretation bias, but not a near-transfer task. Cognitive bias modification of interpretation improved both primary outcomes compared with placebo. For pain interference, there was also a main effect favoring psychoeducation. The CBM-I group improved significantly more than placebo for fear of movement, but not catastrophizing, depression, or anxiety. Cognitive bias modification of interpretation reduced stress but only for those who also received psychoeducation. This trial shows that CBM-I has promise in the management of pain, but there was limited evidence that psychoeducation improved the efficacy of CBM-I. Cognitive bias modification of interpretation was administered entirely remotely and is highly scalable, but future research should focus on paradigms that lead to better engagement of people with chronic pain with CBM-I. [ABSTRACT FROM AUTHOR]

Objectives: This study developed and pilot‐tested an adaptation of Cognitive Bias Modification (CBM) to target two aspects of relational flexibility in couples: the ability to generate alternative perspectives, and the ability to respond nondefensively when alternative partner perspectives are raised within challenging relationship situations (referred to as flexibility in partner perspectives). Methods: CBM‐FlexC training materials were developed in Phase 1, and expert users (N = 4) and end‐point users (N = 7) provided qualitative feedback. Feasibility and preliminary efficacy of CBM‐FlexC were evaluated in Phase 2, using an online sample of distressed couples (N = 18). Using a multiple baseline design, participants completed three baseline assessments, six CBM‐FlexC sessions over 2 weeks, and a 1‐month follow‐up. Results: CBM‐FlexC training resulted in greater flexibility in partner perspectives, relationship satisfaction, and general psychological flexibility compared to baseline, and improvements were maintained 1‐month after training when using mixed‐effects models. However, analyses of reliable change (based on graphical inspection and the Reliable Change Index) indicated that most participants did not experience reliable improvement in flexibility in partner perspectives, or relationship satisfaction. Conclusion: This pilot study provides some positive signals regarding the potential efficacy of CBM‐FlexC, while pointing to the need for further development to strengthen its effects. [ABSTRACT FROM AUTHOR]

Adding cognitive bias modification (CBM) to treatment as usual for alcohol use disorders has been found to reduce relapse rates. However, CBM has not yielded effects as a stand-alone intervention. One possible reason may be that this is due to CBM effects being underpinned by inferential rather than associative mental mechanisms. This change in perspective has led to a proposed improved version of CBM: Inference-based ABC training. In ABC training, participants learn to relate the antecedents (A) of their addiction behavior to alternative behaviors (B) and to their expected consequences (C) in relation to their long-term goals. Mechanisms triggering and maintaining addiction, such as those targeted during ABC training, can differ between people. Ecological Momentary Assessment (EMA) and derived personalized statistics, including models depicting relationships between variables (i.e., personalized networks), are therefore promising tools to help to optimally personalize this training. In this paper, we (1) explain the theoretical background and first implementations of ABC training; (2) present novel approaches to personalize treatment based on EMA; (3) propose ways forward to integrate improved CBM approaches and EMA to potentially advance addiction treatment; and (4) discuss promises and challenges of these proposed new approaches. [ABSTRACT FROM AUTHOR]

Social anxiety is associated with diminished automatic approach toward positive social cues that may limit the ability to connect with others. This diminished approach bias may be a modifiable treatment target. We evaluated the effects of an approach avoidance training procedure on positive emotions, social relationship outcomes, clinical symptoms, and neural indices of social approach and reward processing. Forty-five individuals with social anxiety disorder were randomized (parallel 1:1 randomization) to complete computerized Approach Positive training (n = 21) or Balanced training(n = 24). Sessions included a standardized social interaction task. Participants were blind to training group. Participants completed clinical outcome measures and functional magnetic resonance imaging at baseline and post intervention with an MRI-compatible AAT and the social incentive delay task (SID). Both groups displayed significant improvements of similar magnitude on the primary outcome of social connectedness (between group post-treatment d = −0.21) but not positive affect (d = −0.09), from before to after treatment, persisting through follow-up. Groups demonstrated significant improvements on additional outcomes including anxiety, depression, and anhedonia symptoms. Participants in Approach Positive AAT demonstrated increased activation in the thalamus and medial prefrontal cortex during social versus neutral- approach relative to Balanced AAT during the fMRI AAT. Participants in Balanced AAT showed increased activation in regions within an a priori-defined striatum region of interest mask during anticipation of social reward (vs. baseline) in the SID relative to Approach Positive AAT. At a neural processing level AAT may influence the valuation and motivations associated with positive social cues regulated by the mPFC and thalamus. NCT02136212 , NIMH R00MH090243. • Approach bias training with social interaction was compared to a control. • Both groups showed reductions in symptoms over time. • Differential neural response between groups was observed. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Imaginal retraining (IR) is an emerging intervention technique in which people imagine avoidance behaviors towards imagined foods or other substances, such as throwing them away. Although IR shows promise in reducing initial craving for a range of substances, including alcohol and tobacco, effects appear less robust for craving for energy-dense foods. This raises the question of how IR for food craving can be improved. Here, we address this question informed by emerging findings from IR dismantling studies and the field of regular cognitive bias modification training paradigms. Based on current insights, we suggest the most optimal 'craving-reduction' effects for energy-dense food can likely be expected for IR that includes an overt motor movement. While it is not yet clear what movement works best for food, we suggest a tailored movement or Go/No-Go-based stop movement has the potential to be most effective. The most likely mechanism in reducing craving is cue-devaluation of trained vivid craving images regarding specific energy-dense food products. Future work is needed that investigates and assess the underlying mechanisms (e.g., updating beliefs; cue-devaluation), task characteristics (e.g., IR instructions; specific motor movements) and individual characteristics (e.g., perceived craving; vividness of food imagination) that determine IR effects. [ABSTRACT FROM AUTHOR]

External environmental factors and internal cognitive bias affect college students' anxiety while job hunting. The current study is an intervention study on alleviating employment anxiety among college students through an Interpretation Bias Modification (IBM) computer-based intervention. A total of 79 valid participants were recruited. The Interpretation Bias Modification (IBM) group participants were required to complete employment-related IBM Internet training twice a week for three weeks. The placebo control group participants were required to complete neutral Internet training at the same frequency. The waiting list control group did not undergo any training. The groups were tested at three time points: prior to the intervention (pre-test), immediately after (post-test), and one month after the intervention (one-month follow-up). The IBM intervention group [ F (2, 72) = 31.68, p < 0.001] showed greater significance in reducing employment anxiety than participants in the placebo control group [ F (2, 72) = 9.83, p < 0.001] from the pre-test to one-month follow-up. There was no significant difference in employment anxiety among the waiting-list control group over time. The IBM intervention for college students can effectively decrease employment anxiety and reduce interpretation bias, which can be maintained at the one-month follow-up. • Tests an Interpretation Bias Modification intervention to reduce employment anxiety. • Participants included intervention, placebo control, and wait list control groups. • The intervention decreased employment anxiety, which is associated with reduced employment-related interpretation bias. • Change played a mediating role in employment-related interpretation bias. [ABSTRACT FROM AUTHOR]

Abstract Background Although effective treatments for smoking cessation are available, long-term abstinence is the exception rather than the norm. Accordingly, there is a need for novel interventions that potentially improve clinical outcome. Although implicit information processing biases, for example approach biases for smoking-related stimuli, are ascribed a dominant role in the maintenance of tobacco dependence, these biases are hardly targeted in current treatment. Past research has shown that so-called Approach Bias Modification (AppBM) trainings, aiming to modify this bias, lead to improved long-term abstinence in abstinent alcoholic inpatients when delivered as an add-on to treatment-as-usual. Findings on the efficacy of AppBM in smoking have been inconsistent. The present large-scale clinical trial pursues two goals. First, it aims to investigate the efficacy of AppBM as an add-on to treatment-as-usual in a representative sample of adult smokers. Second, possible mechanisms of change are investigated. Methods The study is a randomized-controlled, double-blind, parallel-group superiority trial. We aim at a final sample of at least 336 adult smokers. Participants are allocated with a 1:1:1 allocation ratio to one of the following conditions: (1) treatment-as-usual + AppBM, (2) treatment-as-usual + Sham, (3) treatment-as-usual only. During the add-on training, participants are presented smoking-related and positive pictures and are instructed to respond by either pushing or pulling a joystick, depending on the tilt of the pictures (5○ to the left/right). During AppBM, all smoking-related pictures are tilted in the direction that is associated with pushing, thereby aiming to train an avoidance bias for smoking. All positive pictures are tilted in the direction associated with pulling. During Sham, the contingency is 50/50. Participants are assessed before and after the intervention and at a 6-month follow-up. The primary outcome is prolonged abstinence, and secondary outcomes include smoking-related variables and psychological distress. Additionally, the motivational significance of smoking-related stimuli (i.e., approach bias, valence) is assessed with different experimental tasks (Approach-Avoidance Task; Single Target Implicit Association Test) and psychophysiological measures. Discussion This is the first large-scale clinical trial investigating the efficacy of AppBM as an add-on in smokers including a TAU only condition. Additionally, it is the first study to systematically investigate potential mechanisms mediating the effects of treatment on clinical outcome. Trial registration German Clinical Trials Register, DRKS00019221 , 11/11/2019

Objects: This study aimed to elucidate the effect of cognitive bias modification on depression. Methods: This research included 10 randomized studies searching four major databases: PubMed, Embase, PsycINFO, and Cochrane Library, with a total sample size of 467. Moreover, they were examined for quality and possible publication bias. Results: Cognitive bias modification (CBM) had statistically significant results, g = −0.64, 95% CI = [−0.97–0.32]. The interpretation of cognitive bias modification shows the highest effect size, g = −1.45, 95% CI = [−2.05–0.88]. When the training place is located in the laboratory, the training effect is significant, g = −1.11, 95% CI = [−1.62–0.61]. The difference is statistically significant when the training environment was changed to home, g = −0.28, 95% CI = [−0.51–0.05]. CBM has a statistical effect on moderate-to-severe depression, g = −0.70, 95% CI = [−1.04–0.36]. Conclusion: We found that CBM had a moderate therapeutic effect on depression, whether the setting was at home or in the lab. Especially when the interpretation of cognitive bias modification (CBM-I) was used, we got the highest effect value. Furthermore, CBM has a statistical effect on moderate-to-severe depression. [ABSTRACT FROM AUTHOR]

Mitigating the negative impacts of anthropogenic climate change is among the most serious and pressing challenges facing the global community. Despite the severity of the issue, there seems to be a lack of attention paid to climate change in our daily lives. Yet, climate change-related information can capture observers’ attention, and when attention is drawn to a particular environmental risk, the perceived severity of this attended risk is enhanced. The question then is whether attention to climate change-related information can be modified or enhanced. Here, we report the results of two experiments using single-session attention bias modification training procedures designed to increase attentional focus on climate change-related information. In Experiment 1, attention training to emotionally positive images of climate change (e.g., potential solutions such as windmills and solar panels) increased attention to these images, but not emotionally negative images of climate change (e.g., air pollution, natural disasters, and melting ice). In Experiment 2, this effect was replicated. In addition, Experiment 2 revealed that training to emotionally negative images of climate change increased attention to negative images of climate change, and there was a trend for this enhanced attention to generalize to positive images of climate change. Furthermore, attention training towards negative images of climate change enhanced self-reported levels of concern about climate change. Collectively, our results suggest that attention training can increase the allocation of attention to climate change-related information and, under certain training conditions, concern for climate change increases. [ABSTRACT FROM AUTHOR]

Background and aims: Approach bias modification (ApBM) targeting alcohol approach bias has been previously shown to reduce likelihood of relapse during the first 2 weeks following inpatient withdrawal treatment (IWT). We tested whether ApBM's effects endure for a longer period by analysing alcohol use outcomes 3, 6 and 12 months post‐discharge. Design: A double‐blind, sham‐controlled randomized controlled trial. Setting: Four IWT units in Melbourne, Australia. Participants: Three hundred alcohol IWT patients (173 men, 126 women, 1 non‐binary; mean age 43.5 years) were recruited between 4 June 2017 and 14 July 2019. Follow‐up data collection was completed on 22 September 2020. Intervention and control training: Four ApBM sessions were delivered during IWT. ApBM trained participants (n = 147) to avoid alcohol and approach non‐alcohol beverage cues. Controls (n = 153) responded to the same stimuli, but without approach/avoidance training. Measurements Date of first lapse was recorded for non‐abstinent participants to determine time to first lapse. Time‐line follow‐back interviews assessed past‐month alcohol consumption at each follow‐up, with participants reporting no alcohol consumption classified as abstinent. In analyses of past‐month abstinence, non‐abstinence was assumed in participants lost to follow‐up. Number of past‐month drinking days, standard drinks and heavy drinking days (five or more standard drinks for women or non‐binary; six or more standard drinks for men) were calculated for non‐abstinent participants at each follow‐up. Findings ApBM significantly delayed time to first lapse [ApBM median: 53 days, 95% confidence interval (CI) = 21–61; controls = 12 days, 95% CI = 9–21, P = 0.045]. Past‐month abstinence rates at 3‐, 6‐ and 12‐month follow‐ups were 33/153 (21.6%), 30/153 (19.6%), and 24/153 (15.7%) in controls; and 51/147 (34.7%), 30/147 (20.4%) and 29/147 (19.7%) in the ApBM group, respectively. Past‐month abstinence was significantly more likely in ApBM participants than controls at the 3‐month follow‐up [odds ratio (OR) = 1.93, 95% CI = 1.16–3.23, P = 0.012], but not at 6‐ or 12‐month follow‐ups (6‐month OR = 1.05, 95% CI = 0.60–1.95, P = 0.862; 12‐month OR = 1.32, 95% CI = 0.73–2.40, P = 0.360). No significant group differences were found for indices of alcohol consumption in non‐abstinent participants. Conclusions: Approach bias modification for alcohol delivered during inpatient withdrawal treatment helps to prevent relapse, increasing rates of abstinence from alcohol for at least 3 months post‐discharge. [ABSTRACT FROM AUTHOR]

Background: Digital mental health is a promising paradigm for individualized, patient-driven health care. For example, cognitive bias modification programs that target interpretation biases (cognitive bias modification for interpretation [CBM-I]) can provide practice thinking about ambiguous situations in less threatening ways on the web without requiring a therapist. However, digital mental health interventions, including CBM-I, are often plagued with lack of sustained engagement and high attrition rates. New attrition detection and mitigation strategies are needed to improve these interventions., Objective: This paper aims to identify participants at a high risk of dropout during the early stages of 3 web-based trials of multisession CBM-I and to investigate which self-reported and passively detected feature sets computed from the participants interacting with the intervention and assessments were most informative in making this prediction., Methods: The participants analyzed in this paper were community adults with traits such as anxiety or negative thinking about the future (Study 1: n=252, Study 2: n=326, Study 3: n=699) who had been assigned to CBM-I conditions in 3 efficacy-effectiveness trials on our team's public research website. To identify participants at a high risk of dropout, we created 4 unique feature sets: self-reported baseline user characteristics (eg, demographics), self-reported user context and reactions to the program (eg, state affect), self-reported user clinical functioning (eg, mental health symptoms), and passively detected user behavior on the website (eg, time spent on a web page of CBM-I training exercises, time of day during which the exercises were completed, latency of completing the assessments, and type of device used). Then, we investigated the feature sets as potential predictors of which participants were at high risk of not starting the second training session of a given program using well-known machine learning algorithms., Results: The extreme gradient boosting algorithm performed the best and identified participants at high risk with macro-F 1 -scores of .832 (Study 1 with 146 features), .770 (Study 2 with 87 features), and .917 (Study 3 with 127 features). Features involving passive detection of user behavior contributed the most to the prediction relative to other features. The mean Gini importance scores for the passive features were as follows: .033 (95% CI .019-.047) in Study 1; .029 (95% CI .023-.035) in Study 2; and .045 (95% CI .039-.051) in Study 3. However, using all features extracted from a given study led to the best predictive performance., Conclusions: These results suggest that using passive indicators of user behavior, alongside self-reported measures, can improve the accuracy of prediction of participants at a high risk of dropout early during multisession CBM-I programs. Furthermore, our analyses highlight the challenge of generalizability in digital health intervention studies and the need for more personalized attrition prevention strategies., (©Sonia Baee, Jeremy W Eberle, Anna N Baglione, Tyler Spears, Elijah Lewis, Hongning Wang, Daniel H Funk, Bethany Teachman, Laura E Barnes. Originally published in JMIR Mental Health (https://mental.jmir.org), 20.12.2024.)