Training Less Threatening Interpretations Over the Internet: Impact of Priming Anxious Imagery and Using a Neutral Control Condition
- 89 Downloads
Cognitive Bias Modification to reduce threat interpretations (CBM-I) is a computer-based paradigm designed to train a less negative interpretation bias that has shown some success in the lab, but results for web-based CBM-I are often mixed. To test possible explanations for the poorer results online, participants high in social anxiety (N = 379) were recruited from Amazon’s Mechanical Turk to complete a single-session, proof-of-principle study to investigate: (1) whether web-based CBM-I can shift interpretations of social situations to be less negative and reduce anticipatory social anxiety, (2) whether a common “control” condition used in CBM-I studies is in fact inert by incorporating an alternate control condition, and (2) whether priming anxious imagery prior to training moderates CBM-I’s effects. Participants were randomly assigned to one of three training conditions: all positive, half positive/half negative, or neutral unemotional scenarios. Participants also received an anxious or neutral imagery prime before training. Although results were somewhat mixed across outcome measures, findings generally suggested that participants exhibited less negative interpretations of ambiguous social scenarios following positive training with an anxious imagery prime. There was also some evidence that the neutral training condition was associated with less negative interpretations, and evidence that the half positive/half negative training condition led to the least anticipatory anxiety, especially when paired with anxious imagery. Findings are discussed in light of different training effects for near- and far-transfer outcomes.
KeywordsSocial anxiety Cognitive bias Interpretations Fear of negative evaluation Internet
We are thankful to Emily Holmes, Simon Blackwell, Andrew Mathews, Bundy Mackintosh and their research teams for sharing some of their training materials. Some of their scenarios were included, typically in a modified form, as part of our training materials. We would also like to thank Shari Steinman and Alexandra Werntz for creating scenarios for the training task. Also, thanks to members of the Teachman Program for Anxiety, Cognition, and Treatment (PACT) Lab for their feedback and suggestions on this study. This research was supported in part by an NIMH grant (NIMH R34MH106770), as well as a Templeton Science of Prospection Award, to B. Teachman. Note, Teachman has a significant financial interest in Project Implicit, Inc., which provided services in support of this project under contract with the University of Virginia.
This study was funded by National Institute of Mental Health grants R34MH106770 and R01MH113752.
Compliance with Ethical Standards
Conflict of Interest
B. Teachman has a significant financial interest in Project Implicit, Inc., which provided services for hosting data collection for this project. C. Edwards, S. Portnow and N. Namaky declares that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
Animal Rights Statements
No animal studies were carried out by the authors for this article.
- Brosan, L., Hoppitt, L., Shelfer, L., Sillence, A., & Mackintosh, B. (2011). Cognitive bias modification for attention and interpretation reduces trait and state anxiety in anxious patients referred to an out-patient service: Results from a pilot study. Journal of Behavior Therapy and Experimental Psychiatry, 42(3), 258–264. https://doi.org/10.1016/j.jbtep.2010.12.006.CrossRefPubMedGoogle Scholar
- Carlbring, P., Apelstrand, M., Sehlin, H., Amir, N., Rousseau, A., Hofmann, S. G., & Andersson, G. (2012). Internet-delivered attention bias modification training in individuals with social anxiety disorder—a double blind randomized controlled trial. BMC Psychiatry. https://doi.org/10.1186/1471-244X-12-66.CrossRefPubMedPubMedCentralGoogle Scholar
- Clark, D. M., Salkovskis, P. M., Öst, L.-G., Breitholtz, E., & Koehler, K. A., Westling, B. E., Jeavons, A., & Gelder, M. (1997). Misinterpretation of body sensations in panic disorder. Journal of Consulting and Clinical Psychology, 65(2), 203–213. https://doi.org/10.1037/0022-006X.65.2.203 CrossRefPubMedGoogle Scholar
- de Boer, M. R., Waterlander, W. E., Kuijper, L. D., Steenhuis, I. H., & Twisk, J. W. (2015). Testing for baseline differences in randomized controlled trials: An unhealthy research behavior that is hard to eradicate. International Journal of Behavioral Nutrition and Physical Activity, 12(4), 1–8. https://doi.org/10.1186/s12966-015-0162-z.CrossRefGoogle Scholar
- First, M. B., Spitzer, R. L., Gibbon, M., & Williams, J. B. W. (1995). Structured clinical interview for DSM-IV axis I disorders. New York: New York State Psychiatric Institute.Google Scholar
- Heimberg, R. G., Brozovich, F. A., & Rapee, R. M. (2010). A cognitive-behavioral model of social anxiety disorder: Update and extension. In S. G. Hofmann & P. M. DiBartolo (Eds.), Social anxiety: Clinical, developmental, and social perspectives, Amsterdam: Elsevier, pp. 395–422.CrossRefGoogle Scholar
- Heimberg, R. G., Mueller, G. P., Holt, C. S., Hope, D. A., & Liebowitz, M. R. (1992). Assessment of anxiety in social interaction and being observed by others: The social interaction anxiety scale and the social phobia scale. Behavior Therapy, 23(1), 53–73. https://doi.org/10.1016/S0005-7894(05)80308-9.CrossRefGoogle Scholar
- Kessler, R. C., Petukhova, M., Sampson, N. A., Zaslavsky, A. M., & Wittchen, H. R. (2012). Twelve-month and lifetime prevalence and lifetime morbid risk of anxiety and mood disorders in the United States. International Journal of Methods in Psychiatric Research, 21(3), 169–184. https://doi.org/10.1002/mpr.1359.CrossRefPubMedPubMedCentralGoogle Scholar
- Kuckertz, J. M., Gildebrant, E., Liliequist, B., Karlström, P., Väppling, C., Bodlund, O., Stenlund, T., Hofmann, S. G., Andersson, G., Amir, N., & Carlbrin, P. (2014). Moderation and mediation of the effect of attention training in social anxiety disorder. Behaviour Research and Therapy, 53, 30–40. https://doi.org/10.1016/j.brat.2013.12.003.CrossRefPubMedGoogle Scholar
- MacLeod, C., & Mathews, A. (2012). Cognitive bias modification approaches to anxiety. Annual Review of Clinical Psychology, 8(1), 189–217. https://doi.org/10.1146/annurev-clinpsy-032511-143052.CrossRefPubMedGoogle Scholar
- Menne-Lothmann, C., Viechtbauer, W., Höhn, P., Kasanova, Z., Haller, S. P., Drukker, M., van Os, J., Wichers, M., & Lau, J. Y. F. (2014). How to boost positive interpretations? A meta-analysis of the effectiveness of cognitive bias modification for interpretation. PLoS ONE, 9(6), e100925. https://doi.org/10.1371/journal.pone.0100925.CrossRefPubMedPubMedCentralGoogle Scholar
- Pearson, D. G., Deeprose, C., Wallace-Hadrill, S. M., Heyes, S. B., & Holmes, E. A. (2013). Assessing mental imagery in clinical psychology: A review of imagery measures and a guiding framework. Clinical Psychology Review, 33(1), 1–23. https://doi.org/10.1016/j.cpr.2012.09.001.CrossRefPubMedPubMedCentralGoogle Scholar
- Salemink, E., Kindt, M., Rienties, H., & van den Hout, M. (2014). Internet-based cognitive bias modification of interpretations in patients with anxiety disorders: A randomised controlled trial. Journal of Behavior Therapy and Experimental Psychiatry, 45(1), 186–195. https://doi.org/10.1016/j.jbtep.2013.10.005.CrossRefPubMedGoogle Scholar