Efficacy of a smartphone-based Cognitive Bias Modification program for emotion regulation: A randomized-controlled crossover trial

Abstract

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.

Keywords: Affect regulation training; Cognitive Bias Modification; E-mental health; Emotion regulation; Stress.

Fig. 1

Study procedure. Notes. CBM-ART = Cognitive Bias Modification-Affect Regulation Training, CC=Control Condition, CES-D=Center For Epidemiologic Studies Depression Scale, ERSQ-ES = Emotion Regulation Skills Questionnaire-Emotion Specific Instrument, PSS-10 = Perceived Stress Scale-10, SUS=System Usability Scale, SWAP=Sentence Word Association Paradigm, WLC=Waitlist Condition.

Fig. 2

CONSORT flow diagram. Notes. Flow of participants through phases of study according to the CONSORT guidelines.

Fig. 3

Estimated endorsement probabilities for valent interpretations on the SWAP. Notes. Estimated mean values derived from Generalized Linear Mixed Models. Error bars indicate the 95% CI for within-group comparisons. CBM-ART=Cognitive Bias Modification-Affect Regulation Training, CC=Control Condition, WLC=Wait List Condition.