A comparison of cognitive bias modification for interpretation and computerized cognitive behavior therapy: effects on anxiety, depression, attentional control, and interpretive bias

Abstract

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.

Figure 1. Consolidated Standards of Reporting Trials (CONSORT) diagram illustrating flow of participants through the study. CBM-I = cognitive bias modification for interpretation; cCBT = computer-aided version of cognitive behavioral therapy.

Figure 2. Mean difference scores (pre- minus postintervention) for the Fear of Negative Evaluation Scale (FNE), Social Phobia Inventory (SPIN), Trait scale of the Spielberger State–Trait Anxiety Inventory (STAI), Beck Depression Inventory–II (BDI-II), and Attentional Control Scale (ACS; post- minus preintervention) by group (a higher score indicates greater improvement in anxiety, depression, and attentional control). Error bars represent ± 1 standard error. CBM-I = cognitive bias modification for interpretation; cCBT = computer-aided version of cognitive behavioral therapy.

Figure 3. Mean difference scores (pre- minus postintervention) for the Scrambled Sentences Test (SST) by group (a more positive score indicates a greater reduction in the proportion of negative resolutions generated). Error bars represent ± 1 standard error. CBM-I = cognitive bias modification for interpretation; cCBT = computer-aided version of cognitive behavioral therapy.