Cognitive bias modification

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An example of a cognitive bias modification for interpretation (CBM-I) paradigm utilized in MindTrails, an online program developed by anxiety researchers at the University of Virginia. The program displays a cognitive task that disambiguates a scenario to be either positively or negatively valenced (correct responses highlighted in orange). Screenshot of the CBM-I training in MindTrails program, February 2020.jpeg
An example of a cognitive bias modification for interpretation (CBM–I) paradigm utilized in MindTrails, an online program developed by anxiety researchers at the University of Virginia. The program displays a cognitive task that disambiguates a scenario to be either positively or negatively valenced (correct responses highlighted in orange).

Cognitive bias modification (CBM) refers to procedures used in psychology that aim to directly change biases in cognitive processes, such as biased attention toward threat (vs. benign) stimuli and biased interpretation of ambiguous stimuli as threatening. [1] The procedures are designed to modify information processing via cognitive tasks that use basic learning principles and repeated practice to encourage a healthier thinking style in line with the training contingency.

Contents

CBM research emerged as investigators used the same techniques to assess attention bias to the manipulation of attention bias. [2] This allowed for tests of the causal relationship between cognitive biases and emotional states (e.g., does selectively attending to threatening information cause greater anxiety). Over time, CBM paradigms were developed to modify biases in other areas of information processing, including interpretation, memory, motivation (e.g., approach–avoidance behaviors), and attributional style. The early success of the procedures in inducing change in bias led researchers to see the potential benefit of CBM as an intervention for emotional and behavioral disorders. Given that the maladaptive cognitive processes implicated in models of emotional vulnerability and dysfunction are targeted by CBM, there is considerable interest in the theoretical and applied importance of the techniques. As such, many recent studies of CBM have targeted cognitive biases in people with anxiety and depressive symptoms. [3]

Research on the effectiveness of CBM in shifting attention and interpretation biases has indicated promising evidence in adult populations, though there are also some null results. [4] Additionally, CBM can reduce anxiety symptoms and stress vulnerability in some cases though these effects are more mixed. There is also some evidence of CBM’s effectiveness in depression symptomatology. Researchers have pointed to the practical benefits offered by CBM, such as scalability and ease of dissemination, potential for augmentation effects with cognitive-behavioral therapy, and cost-effectiveness. [5] Further research on CBM is needed, however, as the evidence for its long-term effects are less clear, including in children. [4]

Types

An example of a cognitive bias modification for attention (CBM-A) paradigm. A single trial is presented in which a fixation cross appears, followed by two pictures - one smoking and one neutral. This is followed by a probe to which the individual must respond. Visual Probe Task on a PDA.jpg
An example of a cognitive bias modification for attention (CBM-A) paradigm. A single trial is presented in which a fixation cross appears, followed by two pictures – one smoking and one neutral. This is followed by a probe to which the individual must respond.

Two common features are used in the majority of CBM methodologies. [6] First, the cognitive bias targeted for change represents a pattern of selective information processing that is known to characterize psychopathology. For example, individuals with anxiety disorders are characterized by an automatic tendency to attend toward threat, while paying less attention to neutral stimuli. Second, the cognitive bias is altered in a manner that does not involve instructing the individual to intentionally change such information-processing selectivity. Rather, change in the cognitive bias is induced by introducing a contingency designed such that successful task performance will be enhanced by adoption of a new pattern of responding.

Two of the most common types of CBM target attention and interpretation biases. [2] Another type of CBM, approach–avoidance training, targets motivation biases associated with approach and avoidance behaviors.

Attention bias modification

Cognitive bias modification for attention (CBM-A) or attention bias modification (ABM) cognitive tasks are typically designed to draw attention to neutral or positive stimuli, and avoid negative or threatening stimuli. [7] The cognitive tasks utilized in ABM were originally designed for the assessment of attentional bias and later adapted as training tasks. [2]

Common paradigms to manipulate visual attention include the spatial cueing task and visual search task, in addition to the visual probe task . In a typical visual probe trial, a central fixation cross is presented, followed by the brief appearance of a threat and non-threat cue, such as a face with an angry expression and a face with a neutral expression. [7] One of the cues is replaced by a probe, such as a small dot, letter or arrow. The aim is to respond as quickly as possible to identify the probe with a button-press response, for example, to indicate the letter shown or direction of the arrow presented. By having the probe occur routinely in the location where the neutral (rather than negative or threatening) face appeared, the individual learns though practice that attending to the neutral stimulus will enhance their performance on the task because they will be faster to identify the probe.

The logic guiding this training task follows from the assessment version of the task in which the probe appears equally and randomly following the neutral and threat stimuli. In this case, attention bias for threat is inferred from response times to probes. [8] If an individual has a bias to direct attention to the spatial location of the threat stimuli, this should be reflected by faster response times to probes that appear in the same location as threat cues (threat-congruent trials) than non-threat cues (threat-incongruent trials). Conversely, if an individual has a bias to direct attention away from threat stimuli, this should be reflected by slower response times to probes replacing threat than non-threat cues.

Interpretation bias modification

Cognitive bias modification for interpretation (CBM-I) or interpretation bias modification (IBM) involves cognitive tasks that disambiguate an otherwise ambiguous sentence, paragraph, or picture to be either positively or negatively valenced. [9] Interpretation bias tasks typically aim to increase the extent individuals interpret ambiguous situations in benign ways to encourage more flexible thinking that is less rigidly negative.

The ambiguous situations paradigm is one of the most commonly-used protocols used to manipulate interpretation bias. In this task, individuals are typically presented with short paragraphs describing an ambiguous situation. [10] The emotional resolution of the paragraph is not revealed until the end of the paragraph—for example, "You ask a friend to look over some work you have done. You wonder what he will think about what you've written. He comes back with some comments, which are all very positi_e [word fragment in italics]." The resolution often features a word fragment that the individual is asked to solve. By repeatedly practicing assigning non-threatening meanings to the ambiguous situations, the individual is thought to learn that uncertainty is more likely to be resolved in a benign, rather than negative, way. The resolution of the ambiguity is typically reinforced through a brief question following the word fragment completion that requires the individual to respond in a way that matches the situation's ending as determined by the word fragment.

To see whether the ambiguous situations paradigm is successful in modifying interpretation bias, a "recognition" task that consists of a series of ambiguous scenarios is typically used as an outcome measure. [11] In this task, the scenarios remain ambiguous even after solving the word fragment—for example, "You ask a friend to look over some work you have done. You wonder what he will think about what you've written. He comes back with some comments on a Thur_day [word fragment in italics]." In the second part of the recognition task, the titles of the ambiguous scenarios are displayed, together with four sentences per scenario that reflect different ways of understanding what occurred in the scenario that weren't actually stated. These sentences represent: a) a possible positive interpretation tied to the key emotional meaning of the scenario, b) a possible negative interpretation tied to the key emotional meaning of the scenario, c) a positive sentence that is not tied to the key emotional meaning of the scenario, and d) a negative sentence that is not tied to the key emotional meaning of the scenario. Individuals rate each sentence for its similarity in meaning to the original scenario. Higher similarity ratings for the positive (vs. negative) interpretation tied to the key emotional meaning of the scenario are thought to reflect a more positive interpretation.

Approach–avoidance training

Approach–avoidance training involves cognitive tasks that are designed to induce approach or avoidance behaviors towards specific stimuli. In the approach–avoidance task, a commonly used training protocol, individuals are shown images with a certain distinguishing feature on a computer screen, to which they should react as fast as possible using a joystick. [12] For example, all images tilted to the left are pulled and become larger, while all images tilted to the right are pushed away and shrink in size. This zooming effect creates the visual impression that the pictures are coming closer upon pulling of the joystick, and that they move away upon pushing it.

Training involves selectively inducing avoidance of one type of stimulus and/or approach of another—for example, training avoidance behavior to alcohol-related stimuli for individuals with an alcohol use disorder by repeatedly practicing pushing the joystick when alcohol stimuli appear (and pulling the joystick for comparison stimuli), or training approach behavior to spider stimuli for individuals with arachnophobia by repeatedly practicing pulling the joystick when spider pictures appear (and pushing the joystick for comparison stimuli). [12] [13]

To see whether the training paradigm was successful in modifying approach–avoidance bias, the reaction time when participants are instructed to push away the target stimuli (e.g., alcohol or spider cues) compared to when participants are instructed to push away the comparison stimuli are contrasted, along with the analogous contrast for pulling the target vs. comparison stimuli.

Criticisms and limitations

One concern is whether CBM modification procedures will reliably change symptoms and achieve lasting benefits. This is not yet clear from research. [14]

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. [15]

Likewise, a recent meta-analysis [16] 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

Related Research Articles

<span class="mw-page-title-main">Cognitive bias</span> Systematic pattern of deviation from norm or rationality in judgment

A cognitive bias is a systematic pattern of deviation from norm or rationality in judgment. Individuals create their own "subjective reality" from their perception of the input. An individual's construction of reality, not the objective input, may dictate their behavior in the world. Thus, cognitive biases may sometimes lead to perceptual distortion, inaccurate judgment, illogical interpretation, and irrationality.

<span class="mw-page-title-main">Wishful thinking</span> Formation of beliefs based on what might be pleasing to imagine

Wishful thinking is the formation of beliefs based on what might be pleasing to imagine, rather than on evidence, rationality, or reality. It is a product of resolving conflicts between belief and desire. Methodologies to examine wishful thinking are diverse. Various disciplines and schools of thought examine related mechanisms such as neural circuitry, human cognition and emotion, types of bias, procrastination, motivation, optimism, attention and environment. This concept has been examined as a fallacy. It is related to the concept of wishful seeing.

<span class="mw-page-title-main">Arousal</span> State of being awoken

Arousal is the physiological and psychological state of being awoken or of sense organs stimulated to a point of perception. It involves activation of the ascending reticular activating system (ARAS) in the brain, which mediates wakefulness, the autonomic nervous system, and the endocrine system, leading to increased heart rate and blood pressure and a condition of sensory alertness, desire, mobility, and reactivity.

Systematic desensitization, or graduated exposure therapy, is a behavior therapy developed by the psychiatrist Joseph Wolpe. It is used when a phobia or anxiety disorder is maintained by classical conditioning. It shares the same elements of both cognitive-behavioral therapy and applied behavior analysis. When used in applied behavior analysis, it is based on radical behaviorism as it incorporates counterconditioning principles. These include meditation and breathing. From the cognitive psychology perspective, cognitions and feelings precede behavior, so it initially uses cognitive restructuring.

<span class="mw-page-title-main">Affective neuroscience</span> Study of the neural mechanisms of emotion

Affective neuroscience is the study of how the brain processes emotions. This field combines neuroscience with the psychological study of personality, emotion, and mood. The basis of emotions and what emotions are remains an issue of debate within the field of affective neuroscience.

<span class="mw-page-title-main">Affect (psychology)</span> Experience of feeling or emotion

Affect, in psychology, refers to the underlying experience of feeling, emotion, attachment, or mood.

Social inhibition is a conscious or subconscious avoidance of a situation or social interaction. With a high level of social inhibition, situations are avoided because of the possibility of others disapproving of their feelings or expressions. Social inhibition is related to behavior, appearance, social interactions, or a subject matter for discussion. Related processes that deal with social inhibition are social evaluation concerns, anxiety in social interaction, social avoidance, and withdrawal. Also related are components such as cognitive brain patterns, anxious apprehension during social interactions, and internalizing problems. It also describes those who suppress anger, restrict social behavior, withdraw in the face of novelty, and have a long latency to interact with strangers. Individuals can also have a low level of social inhibition, but certain situations may generally cause people to be more or less inhibited. Social inhibition can sometimes be reduced by the short-term use of drugs including alcohol or benzodiazepines. Major signs of social inhibition in children are cessation of play, long latencies to approaching the unfamiliar person, signs of fear and negative affect, and security seeking. Also in high level cases of social inhibition, other social disorders can emerge through development, such as social anxiety disorder and social phobia.

<span class="mw-page-title-main">Worry</span> Thoughts, images, emotions, and actions of a pessimistic nature

Worry refers to the thoughts, images, emotions, and actions of a negative nature in a repetitive, uncontrollable manner that results from a proactive cognitive risk analysis made to avoid or solve anticipated potential threats and their potential consequences.

The dot-probe paradigm is a test used by cognitive psychologists to assess selective attention.

Attentional bias refers to how a person's perception is affected by selective factors in their attention. Attentional biases may explain an individual's failure to consider alternative possibilities when occupied with an existing train of thought. For example, cigarette smokers have been shown to possess an attentional bias for smoking-related cues around them, due to their brain's altered reward sensitivity. Attentional bias has also been associated with clinically relevant symptoms such as anxiety and depression.

Test anxiety is a combination of physiological over-arousal, tension and somatic symptoms, along with worry, dread, fear of failure, and catastrophizing, that occur before or during test situations. It is a psychological condition in which people experience extreme stress, anxiety, and discomfort during and/or before taking a test. This anxiety creates significant barriers to learning and performance. Research suggests that high levels of emotional distress have a direct correlation to reduced academic performance and higher overall student drop-out rates. Test anxiety can have broader consequences, negatively affecting a student's social, emotional and behavioural development, as well as their feelings about themselves and school.

Social anxiety is the anxiety and fear specifically linked to being in social settings. Some categories of disorders associated with social anxiety include anxiety disorders, mood disorders, autism spectrum disorders, eating disorders, and substance use disorders. Individuals with higher levels of social anxiety often avert their gazes, show fewer facial expressions, and show difficulty with initiating and maintaining a conversation. Social anxiety commonly manifests itself in the teenage years and can be persistent throughout life; however, people who experience problems in their daily functioning for an extended period of time can develop social anxiety disorder. Trait social anxiety, the stable tendency to experience this anxiety, can be distinguished from state anxiety, the momentary response to a particular social stimulus. Half of the individuals with any social fears meet the criteria for social anxiety disorder. Age, culture, and gender impact the severity of this disorder. The function of social anxiety is to increase arousal and attention to social interactions, inhibit unwanted social behavior, and motivate preparation for future social situations.

<span class="mw-page-title-main">Attentional retraining</span> Retraining of automatic attentional processes

Attentional retraining is the retraining of automatic attentional processes. The method of retraining varies but has typically employed computerized training programs. The term originally indicated retraining of attention to rehabilitate individuals after a brain injury who had neurological disorders of attention including hemineglect, perseveration, limited attention span, and even ADHD. However, in more recent research and clinical applications attentional retraining has also been applied as a type of cognitive bias modification. In this application, attentional retraining refers to the retraining of automatic attentional biases that have been observed in high levels of anxiety.

Reinforcement sensitivity theory (RST) proposes three brain-behavioral systems that underlie individual differences in sensitivity to reward, punishment, and motivation. While not originally defined as a theory of personality, the RST has been used to study and predict anxiety, impulsivity, and extraversion. The theory evolved from Gray's biopsychological theory of personality to incorporate findings from a number of areas in psychology and neuroscience, culminating in a major revision in 2000. The revised theory distinguishes between fear and anxiety and proposes functionally related subsystems. Measures of RST have not been widely adapted to reflect the revised theory due to disagreement over related versus independent subsystems. Despite this controversy, RST informed the study of anxiety disorders in clinical settings and continues to be used today to study and predict work performance. RST, built upon Gray's behavioral inhibition system (BIS) and behavioral activation system (BAS) understanding, also may help to suggest predispositions to and predict alcohol and drug abuse. RST, a continuously evolving paradigm, is the subject of multiple areas of contemporary psychological enquiry.

<span class="mw-page-title-main">Attentional control</span> Individuals capacity to choose what they pay attention to and what they ignore

Attentional control, colloquially referred to as concentration, refers to an individual's capacity to choose what they pay attention to and what they ignore. It is also known as endogenous attention or executive attention. In lay terms, attentional control can be described as an individual's ability to concentrate. Primarily mediated by the frontal areas of the brain including the anterior cingulate cortex, attentional control is thought to be closely related to other executive functions such as working memory.

A cognitive vulnerability in cognitive psychology is an erroneous belief, cognitive bias, or pattern of thought that predisposes an individual to psychological problems. The vulnerability exists before the symptoms of a psychological disorder appear. After the individual encounters a stressful experience, the cognitive vulnerability shapes a maladaptive response that increases the likelihood of a psychological disorder.

Emotion perception refers to the capacities and abilities of recognizing and identifying emotions in others, in addition to biological and physiological processes involved. Emotions are typically viewed as having three components: subjective experience, physical changes, and cognitive appraisal; emotion perception is the ability to make accurate decisions about another's subjective experience by interpreting their physical changes through sensory systems responsible for converting these observed changes into mental representations. The ability to perceive emotion is believed to be both innate and subject to environmental influence and is also a critical component in social interactions. How emotion is experienced and interpreted depends on how it is perceived. Likewise, how emotion is perceived is dependent on past experiences and interpretations. Emotion can be accurately perceived in humans. Emotions can be perceived visually, audibly, through smell and also through bodily sensations and this process is believed to be different from the perception of non-emotional material.

Interpretive bias or interpretation bias is an information-processing bias, the tendency to inappropriately analyze ambiguous stimuli, scenarios and events. One type of interpretive bias is hostile attribution bias, wherein individuals perceive benign or ambiguous behaviors as hostile. For example, a situation in which one friend walks past another without acknowledgement. The individual may interpret this behavior to mean that their friend is angry with them.

<span class="mw-page-title-main">Dual representation theory</span>

Dual representation theory (DRT) is a psychological theory of post-traumatic stress disorder (PTSD) developed by Chris Brewin, Tim Dalgleish, and Stephen Joseph in 1996. This theory proposes that certain symptoms of PTSD - such as nightmares, flashbacks, and emotional disturbance - may be attributed to memory processes that occur after exposure to a traumatic event. DRT proposes the existence of two separate memory systems that run in parallel during memory formation: the verbally accessible memory system (VAM) and situationally accessible memory system (SAM). The VAM system contains information that was consciously processed and thus can be voluntarily recalled or described. In contrast, the SAM system contains unconsciously processed sensory information that cannot be voluntarily recalled. This theory suggests that the VAM system is impaired during a traumatic event because conscious attention is narrowly drawn to threat-related information. Therefore, memory of the trauma is heavily focused on fear, which affects information processing. This gives rise to PTSD symptoms such as trauma-related cognitions, appraisals, and emotions. The SAM system captures vivid sensory information during the traumatic event, which is automatically recalled through exposure to trauma-related triggers. This system is thought to be responsible for the presence of flashbacks and nightmares in PTSD symptomatology.

<span class="mw-page-title-main">Tracy Dennis-Tiwary</span> American Female Clinical Psychologist

Tracy Dennis-Tiwary is an American clinical psychologist, author, health technology entrepreneur, and professor of psychology and neuroscience at Hunter College and the Graduate Center of The City University of New York. Her research explores emotion regulation and its role in mental health and illness, with a particular focus on anxiety and anxiety-related attention biases, as well as child emotional development. She is known for her nuanced view of the impact of digital technology and social media on psychological well-being in youth and adults, including adjustment, relationship quality, anxiety, and emotion regulation.

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