Experimental studies applying cognitive bias modification of attention (CBM-A) and interpretation (CBM-I) to reduce aggression have examined the effect of modifying each cognitive bias in isolation. In order to maximise the potential impact on both biases and symptom reduction, we examined whether a combined bias training procedure targeting both attention and interpretation biases (CBM-AI) in combination would be more effective than targeting interpretation bias (CBM-I) alone. University students (17–35 years) were randomly assigned to either a single session of CBM-AI training (n = 40), CBM-I training (n = 40), or a control condition (n = 40). Contrary to our expectations, participants showed an increase in adaptive attention and pro-social interpretation bias in all training conditions. Additionally, in none of the conditions, we found a significant change on self-reported or behavioural aggression. These findings suggest: (1) that the combined training did not have added effect over single interpretation bias training, (2) that training interpretation bias may lead to changes in attention bias, (3) that elements of the control condition unexpectedly, but interestingly, also affected attention and interpretation biases, and (4) single-session CBM procedures do not produce robust effects on self-report or behavioural measures of aggression in unselected samples.

Background: Previous research suggests that computerized interpretation bias modification (IBM) techniques may be useful for modifying thoughts and behaviours relevant to eating pathology; however, little is known about the utility of IBM for decreasing specific eating disorder (ED) symptoms (e.g. bulimia, drive for thinness). Aims: The current study sought to further examine the utility of IBM for ED symptoms via secondary analyses of an examination of IBM for individuals with elevated body dysmorphic disorder (BDD) symptoms (see Summers and Cougle, 2016), as these disorders are both characterized by threat interpretation biases of ambiguous appearance-related information. Method: We recruited 41 participants for a randomized trial comparing four sessions of IBM aimed at modifying problematic social and appearance-related threat interpretation biases with a placebo control training (PC). Results: At 1-week post-treatment, and relative to the PC, the IBM group reported greater reductions in negative/threat interpretations of ambiguous information in favour of positive/benign biases. Furthermore, among individuals with high pre-treatment bulimia symptoms, IBM yielded greater reductions in bulimia symptoms compared with PC at post-treatment. No treatment effects were observed on drive for thinness symptoms. Conclusions: The current study suggests that cognitive interventions for individuals with primary BDD symptoms may improve co-occurring ED symptoms such as bulimia.

While control conditions are vitally important in research, selecting the optimal control condition can be challenging. Problems are likely to arise when the choice of control condition is not tightly guided by the specific question that a given study aims to address. Such problems have become increasingly apparent in experimental psychopathology research investigating the experimental modification of cognitive biases, particularly as the focus of this research has shifted from theoretical questions concerning mechanistic aspects of the association between cognitive bias and emotional vulnerability, to questions that instead concern the clinical efficacy of ‘cognitive bias modification’ (CBM) procedures. We discuss the kinds of control conditions that have typically been employed in CBM research, illustrating how difficulties can arise when changes in the types of research questions asked are not accompanied by changes in the control conditions employed. Crucially, claims made on the basis of comparing active and control conditions within CBM studies should be restricted to those conclusions allowed by the specific control condition employed. CBM studies aiming to establish clinical utility are likely to require quite different control conditions from CBM studies aiming to illuminate mechanisms. Further, conclusions concerning the clinical utility of CBM interventions cannot necessarily be drawn from studies in which the control condition has been chosen to answer questions concerning mechanisms. Appreciating the need to appropriately alter control conditions in the transition from basic mechanisms-focussed investigations to applied clinical research could greatly facilitate the translational process.

Background: Research suggests that aggressive children are prone to over-attribute hostile intentions to peers. Aims: The current study investigated whether this attributional style can be altered using a Cognitive Bias Modification of Interpretations (CBM-I) procedure. Method: A sample of 10–12-year-olds selected for displaying aggressive behaviours was trained over three sessions to endorse benign rather than hostile attributions in response to ambiguous social scenarios. Results: Compared to a test-retest control group (n = 18), children receiving CBM-I (n = 16) were less likely to endorse hostile attributions and more likely to endorse benign attributions in response to a new set of ambiguous social situations. Furthermore, aggressive behaviour scores reduced more in the trained group than in the untrained controls. Children who received attribution training also reported less perceived anger and showed a trend to report more self-control than those in the control group. Conclusions: Implications of these findings are discussed.

Background: Interpretation training programs, in which individuals are trained to interpret ambiguous scenarios in either a negative or benign way, have proven effective in altering anxiety-related cognitive biases in both children and adults. Aims: The current study investigated whether the effects of the interpretation training procedure in children are differentiated according to the mode of presentation of the training. Method: Ninety-four primary school children (aged 10–12 years) scoring above the mean on a social anxiety scale were randomly allocated to four groups, in which they were trained using written or spoken presentation of training materials in either the negative or benign direction. Results: For the negative training, children who heard the training material spoken aloud (spoken presentation) made more negative interpretations of ambiguous social events, compared to children who read the training material (written presentation). However, for the benign training, there was less clear evidence for a differentiation of the effects between the two modes of presentation, although children in the spoken presentation group performed better in a stressful task and showed a trend to rate their mood as more positive after the task than children in the written presentation group. Conclusions: These results not only forward our understanding of the mechanism of the genesis of cognitive bias in children, but also highlight the need for further investigation of how to optimize the effectiveness of interpretation training in children.

Background: Past research suggests that socially anxious individuals display a tendency to interpret ambiguous and clearly valenced information in a threatening way. Interpretation training programs, in which individuals are trained to endorse benign rather than negative interpretations of ambiguous social scenarios, have proven effective for reducing anxiety-related cognitive biases. However, it is not clear whether the same paradigms are effective in modifying interpretation biases for clearly valenced social information. Method: In this experiment, a group of unselected children (aged 10–13 years) was trained to endorse the more positive of two possible interpretations of mildly negative and positive social events. Results: Data revealed that this group (n = 77) showed a decrease in catastrophic interpretations and an increase in neutral interpretations of mildly negative events compared to children in a no-training control group (n = 76). Furthermore, participants in the training condition showed an increase in positive interpretations and a trend for a decrease in discounting interpretations of positive events. However, training did not affect emotional ratings of mildly negative and positive events or trait social anxiety. Conclusions: Notwithstanding certain limitations of this pilot study, we believe that the results are promising with regard to modifying interpretative biases for clearly valenced vignettes, and that further study regarding the effects of training on mood is warranted.

Background: Cognitive bias modification (CBM) is a novel treatment for anxiety disorders that utilizes computerized tasks to train attention and interpretation biases away from threat. To date, attitudes toward and acceptability of CBM have not been systematically examined. Method: We conducted qualitative interviews with 10 anxious primary care patients to examine attitudes toward and initial impressions of CBM. Interviews explored general impressions, as well as reactions to the treatment rationale and two computer programs, one targeting attention bias and one targeting interpretation bias. Three clinical psychologists independently coded transcripts and collaboratively developed categories and themes guided by grounded theory. Results: A number of facilitators and barriers emerged related to engaging in treatment in general, computerized treatment, and CBM specifically. Participants stated that the written rationale for CBM seemed relevant and helpful. However, after interacting with the attention modification program, participants frequently expressed a lack of understanding about how the program would help with anxiety. Participants reported greater understanding and engagement with the interpretation modification program. Conclusions: Participants reported a number of positive characteristics of CBM, but it may need improvements regarding its treatment rationale and credibility. Future qualitative studies with individuals who complete a CBM treatment are warranted. Implications for future CBM development and dissemination are discussed.

Background: There is overwhelming evidence that anxiety is associated with the tendency to interpret information negatively. The causal relationship between this interpretive bias and anxiety has been examined by modifying interpretive bias and examining effects on anxiety. A crucial assumption is that the effect of the procedure on anxiety is mediated by change in interpretive bias rather than being a direct effect of the procedure. Surprisingly, this had not previously been tested. Aim: The aim is to test whether altered interpretive bias, following Cognitive Bias Modification of Interpretations (CBM-I), affected anxiety. Method: Mediational path analyses were conducted to test the hypothesis that changes in anxiety are due to changes in interpretive bias. A separate experiment was conducted to test which elements of the procedure could be responsible for a direct mood effect. Results: Results from mediation analyses suggested that changes in trait anxiety, after performing CBM-I, were indeed caused by an altered interpretive bias, whilst changes in state anxiety appear to be caused by the procedure itself. The subsequent experiment showed that state anxiety effects could be due to exposure to valenced materials. Conclusions: Changed state anxiety observed after CBM-I is not a valid indicator of a causal relationship. The finding that CBM-I affected interpretive bias, which in turn affected trait anxiety, supports the assumption of a causal relationship between interpretive bias and trait anxiety. This is promising in light of possible clinical implications.