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Change Processes During Cognitive Bias Modification for Obsessive Compulsive Beliefs

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Abstract

Multiple studies have found that cognitive bias modification (CBM) can be an effective intervention to reduce maladaptive, anxiety-linked cognitive biases and symptoms, but little is known about how it achieves its effects. CBM is posited to work by altering contingency learning about potential threat cues, rather than via habituation of fear and arousal (as hypothesized for exposure-based interventions). In the current study, multi-level modeling was used to examine the trajectories of potential change processes over the course of CBM for interpretation bias in a sample high in obsessive–compulsive (OC) symptoms (n = 75). Psychophysiological arousal (heart rate and galvanic skin response), subjective fear, and the development of a learned contingency between ambiguity tied to threat and safe outcomes were measured before, during, and after CBM. Results showed that, compared to a control group, CBM was effective at reducing OC beliefs (though not responses to subsequent OC stressors). Additionally, as expected, only contingency learning significantly changed as a function of training condition, while subjective fear and arousal did not. Moreover, post-training indicators of contingency learning predicted the extent OC beliefs changed from pre- to post-training for the “positive” CBM group only (and not for the control group). This indicates that CBM is likely not operating similarly to habituation, but is instead marked by change in cognitive processing. However, change in contingency learning did not fully mediate the effect of this intervention on change in OC beliefs, suggesting more work is needed to fully understand the mechanisms underlying CBM.

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Notes

  1. The recognition ratings task often also includes disorder-irrelevant interpretations to serve as “foils.” These foil options were not included in the current task to save time given the repeated administration of the recognition ratings task.

  2. All covariates were converted to z-scores in order to apply a constant transformation so that they were all on the same metric.

  3. If the two measures with baseline differences (negative interpretations, and depression) and the six subscale means of the OCI-R are not included as covariates in the analysis, the interaction does not reach significance (F(1, 65) = 1.96, p = .166, η 2 p  = .03).

  4. For the multi-level modeling procedure and the structural regression analyses, a constant of one was added to the EDA variable to obtain non-negative numbers, and EDA was then log-transformed to reduce positive skew in order to maximize a normal distribution.

  5. Only three participants who received the funnel debriefing reported suspicion related to the deceptive components of the tasks. In the interest of maximizing power, all participants were included in the analyses. Additionally, performance on the dichotomous pen-cleaning variable was not included in our analyses because its inclusion prevented convergence of the models.

  6. We thank an anonymous reviewer for this suggestion.

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Acknowledgments

The authors are thankful for the feedback provided by members of the Teachman Program for Anxiety, Cognition and Treatment lab. Writing of this article was facilitated by an AG033033 Grant from the National Institute of Health and a Programmatic Distinguished Visitor award from the University of Western Australia awarded to Bethany Teachman.

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  1. University of Virginia, P.O. Box 400400, Charlottesville, VA, 22904, USA

    Jessica R. Beadel, Frederick L. Smyth & Bethany A. Teachman

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  1. Jessica R. Beadel
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Beadel, J.R., Smyth, F.L. & Teachman, B.A. Change Processes During Cognitive Bias Modification for Obsessive Compulsive Beliefs. Cogn Ther Res 38, 103–119 (2014). https://doi.org/10.1007/s10608-013-9576-6

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