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The effects of modifying interpretation bias on worry in generalized anxiety disorder
Abstract
This study investigated whether facilitating a benign interpretive bias decreases negative thought intrusions in generalized anxiety disorder (GAD). Clients were randomly allocated to an interpretation modification condition in which they repeatedly accessed benign meanings of emotionally ambiguous homographs and scenarios, or to a control condition in which they accessed threat and benign meanings with equal frequency. Worry frequency was assessed using a breathing focus task that involved categorising the valence of thought intrusions before and after an instructed worry period. Interpretation bias was assessed during the modification tasks, and on a different measure of interpretation bias (sentence completion) following a period of worry. The experimental procedure modified interpretations made during training, and in the later sentence completion task. Furthermore, compared to the control group, the benign group showed fewer negative thought intrusions during breathing focus (as rated by both participants and an assessor). These findings show that it is possible to induce a more benign interpretive bias in GAD clients and that this reduces negative thought intrusions.
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“Sample size was calculated a priori to detect effects similar to those observed in previous studies that have used this self-referential worry task (e.g. Hayes et al., 2010: between-group difference on negative thought intrusions at post-test, f2 = 0.43).”
From Testing the differential effects of acceptance and attention-based psychological interventions on intrusive thoughts and worry (2017) · cites this paper as Hayes et al., 2010
In the citing paper
“This task has been widely used to examine thought intrusions and worry in non-clinical groups (Krebs, Hirsch, & Mathews, 2010), individuals with elevated worry, and generalized anxiety disorder (Hayes et al., 2010, Hirsch et al., 2009) and associated conditions (i.e. insomnia symptoms, Baker, Baldwin, & Garner, 2015).”
From Testing the differential effects of acceptance and attention-based psychological interventions on intrusive thoughts and worry (2017) · cites this paper as Hayes et al., 2010
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MethodSelf-citationNew treatment approaches for severe and enduring eating disorders
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“In recent years, Cognitive Bias Modification (CBM) procedures have been developed with the purpose of modifying negative cognitive biases in interpretations and attention in a range of clinical populations including: affective disorders [73] (Yang et al.”
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Characteristics of worry in Generalized Anxiety Disorder
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Self-citationEffects of modifying interpretation bias on transdiagnostic repetitive negative thinking.
Hirsch, C., Krahé, C., Whyte, J., Bridge, L., Loizou, S., Norton, S., & Mathews, A. (2020) · Journal of Consulting and Clinical Psychology · doi:10.1037/ccp0000455 · Cited by 56
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Efficacy of Interpretation Bias Modification in Depressed Adolescents and Young Adults
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“…to CBM studies of other clinical samples, which largely found reductions in anxiety symptoms or disorders (Amir and Taylor 2012; Beard et al. 2011; Hayes et al. 2010; see also Lang et al. 2012, which used a modified CBM-I paradigm for depression), but similar to a few other studies (mainly using…”
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Krahé, C., Whyte, J., Bridge, L., Loizou, S., & Hirsch, C. R. (2019) · Clinical Psychological Science · doi:10.1177/2167702619851808 · Cited by 46
“However, research using “cognitive bias modification” paradigms to train a certain interpretive style has found that changing interpretation bias may lead to corresponding changes in worry (Hayes et al., 2010; Hirsch et al., 2009) and rumination (Hertel et al.”
BackgroundMethodSelf-citationWorry as an adaptive avoidance strategy in healthy controls but not in pathological worriers.
Ottaviani, C., Borlimi, R., Brighetti, G., Caselli, G., Favaretto, E., Giardini, I., Marzocchi, C., Nucifora, V., Rebecchi, D., Ruggiero, G. M., et al. (2014) · International Journal of Psychophysiology · doi:10.1016/j.ijpsycho.2014.05.010 · Cited by 41
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“Positive training using the same approach was later demonstrated to be effective in reducing worry in participants with GAD on a behavioral task assessing intrusive thoughts, and showed that this effect was mediated by change in interpretive bias (50).”
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Cognitive bias modification training in adolescents reduces anxiety to a psychological challenge
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“In a related clinical study, the same training was successful in reducing negative thought intrusions in patients suffering from Generalised Anxiety Disorder (Hayes et al., 2010).”
BackgroundInfluentialSelf-citationHotton, M., Derakshan, N., & Fox, E. (2017) · Behaviour Research and Therapy · doi:10.1016/j.brat.2017.10.011 · Cited by 42
“…an interaction between “top-down” and “bottom-up” processes (Hirsch & Mathews, 2012), future research may benefit from investigation of the combination of WMT with interventions which aim to reduce “bottom-up” biases, such as interpretation bias modification (Hayes, Hirsch, Krebs, & Mathews, 2010).”
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The Plasticity of Adolescent Cognitions: Data from a Novel Cognitive Bias Modification Training Task
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“high trait anxiety/depression) has yielded similar beneficial effects on mood [19], negative thought intrusions [20, 21] and anxiety [22–27], presumably through modification of cognitive biases.”
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“After the anger induction, we expected a significant increase in the number of negative interpretations and a decrease in the number of positive interpretations relative to the control state (Barazzone & Davey, 2009; Hayes et al., 2010).”
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“From these catch items we calculated a positivity index reflecting the ratio of positively interpreted catch items on the total number of catch items (Hayes et al., 2010).”
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Self-citationInterpretation bias characterizes trait rumination.
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Cognitive bias modification of interpretation in children with social anxiety disorder
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“There was not a significant interaction between group and time for negative interpretation where the effect was small ( V = 0.01, F (1,53) = 0.32, p = 0.58; d = 0.15).”
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Semantic ambiguity norms for 530 Spanish words
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“Within CBM-I studies participants in active training tend to be exclusively exposed to scenarios that are consistently resolved in a positive manner while those in non-training conditions receive half positive and half negative scenarios (e.g. Hayes et al. 2010).”
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tDCS increases anxiety reactivity to intentional worry
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Self-citationThe influence of social comparison on cognitive bias modification and emotional vulnerability.
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“In addition, previous studies (Hayes et al., 2010; Hirsch et al., 2009) have shown that high worriers who were given consistently benign interpretations had fewer negative intrusions on a worry measure compared to controls after a single-session CBM-I program.”
Self-citationImpact of imagery-enhanced interpretation training on offline and online interpretations in worry
Feng, Y.-C., Krahé, C., Meeten, F., Sumich, A. L., Mok, C. L. M., & Hirsch, C. R. (2019) · Behaviour Research and Therapy · doi:10.1016/j.brat.2019.103497 · Cited by 27
“For example, participants with GAD who were trained in to generate more positive interpretations reported fewer negative thought intrusions during a lab-based worry task following a single session of training, than control participants (Hayes et al. 2010).”
Self-citationThe Impact of Worry on Attention to Threat
Oathes, D. J., Squillante, C. M., Ray, W. J., & Nitschke, J. B. (2010) · PLoS ONE · doi:10.1371/journal.pone.0013411 · Cited by 26
“Similarly, focusing on benign meanings of potentially aversive information reduces negative thought intrusions and anxiety in high worriers [67,68].”
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Effects of interpretation bias modification on unregulated and regulated emotional reactivity
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“Although there are several studies with similar results (e.g., see Hayes, Hirsch, Krebs, & Mathews, 2010; Lang, Moulds, & Holmes, 2009; Mackintosh, Mathews, Yiend, Ridgeway, & Cook, 2006; Tran, Siemer, & Joormann, 2011), these positive effects have not been replicated consistently.”
Malivoire, B. L., Marcos, M., Pawluk, E. J., Tallon, K., Kusec, A., & Koerner, N. (2018) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2018.1508247 · Cited by 21
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Self-citationCognitive-behavior therapy resolves implicit fear associations in generalized anxiety disorder
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Repetitive negative thinking and interpretation bias in pregnancy
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“For example, training individuals with GAD to interpret ambiguous information as benign (rather than nega‐ tive) reduced worry frequency (Hayes et al., 2010).”
BackgroundSelf-citationWhen We Should Worry More: Using Cognitive Bias Modification to Drive Adaptive Health Behaviour
Notebaert, L., Chrystal, J., Clarke, P., Holmes, E. A., & MacLeod, C. (2014) · PLoS ONE · doi:10.1371/journal.pone.0085092 · Cited by 17
“Since it has been shown that a negative interpretation bias causally contributes to worry symptoms [10,11], the aim of the current study was to investigate whether adopting a negative interpretation bias, as compared to a positive interpretation bias, can increase worry elicited by a health campaign video, and consequ…”
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Ainsworth, B., Bolderston, H., & Garner, M. (2017) · Behaviour Research and Therapy · doi:10.1016/j.brat.2017.01.012 · Cited by 16
An exploration of Intolerance of Uncertainty and memory bias
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Cowden Hindash, A. H., & Rottenberg, J. A. (2017) · Behaviour Research and Therapy · doi:10.1016/j.brat.2017.09.005 · Cited by 15
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Self-citationWorry and Generalized Anxiety Disorder: A Review
Newman, M. G., Cho, S.-I. T., & Kim, H. (2017) · Elsevier eBooks · doi:10.1016/b978-0-12-809324-5.05108-7 · Cited by 14
“repeated accessing of benign meanings led to worry reduction in high worriers (Hayes et al., 2010; Hirsch et al., 2009).”
BackgroundCognitive Bias Modification: A New Frontier in Cognition and Emotion Research
MacLeod, C., & Clarke, P. (2013) · UWA Profiles and Research Repository (UWA) · Cited by 13
Attentional Bias for Threat and Anxiety: The Role of Loneliness
Wei, M., Roodenrys, S. J., & Miller, L. M. (2020) · Psychiatry · doi:10.1080/00332747.2020.1762400 · Cited by 13
“…broad range of topics, a defining feature of anxiety (Hirsch et al., 2013), has been associated with extended decision-making times (Masi et al., 2004), heightened needs for reassurance (Beesdo-Baum et al., 2012), and a tendency to interpret events in the worst possible light (Hayes et al., 2010).”
BackgroundFrench, N. J., Eberle, J. W., & Teachman, B. A. (2021) · Anxiety Stress & Coping · doi:10.1080/10615806.2021.1977797 · Cited by 12
“Negative interpretation bias is associated with more severe symptoms in social anxiety (Chen et al., 2020), panic disorder (Teachman et al., 2007), and generalized anxiety disorder (Hayes et al., 2010).”
BackgroundKuckertz, J. M., & Amir, N. (2017) · Elsevier eBooks · doi:10.1016/b978-0-12-803457-6.00019-2 · Cited by 16
Evidence for distinct genetic and environmental influences on fear acquisition and extinction
Purves, K. L., Krebs, G., McGregor, T., Constantinou, E., Lester, K. J., Barry, T. J., Craske, M. G., Young, K. S., Breen, G. D., & Eley, T. C. (2021) · Psychological Medicine · doi:10.1017/s0033291721002580 · Cited by 15
Self-citationWhite, L. K., Suway, J. G., Pine, D. S., Field, A. P., Lester, K. J., Muris, P., Bar‐Haim, Y., & Fox, N. A. (2016) · Journal of Experimental Psychopathology · doi:10.5127/jep.053615 · Cited by 12
van der Ploeg, M. M., BROSSCHOT, J. F., Verkuil, B., Gillie, B. L., Williams, D. P., Koenig, J., Vasey, M. W., & Thayer, J. F. (2017) · Psychophysiology · doi:10.1111/psyp.12891 · Cited by 11
Lubbers, J., Geurts, D. E. M., Spinhoven, P., Cladder-Micus, M. B., Ennen, D., Speckens, A. E. M., & Spijker, J. (2024) · Depression and Anxiety · doi:10.1155/da/3511703 · Cited by 10
Modifying interpretation bias leads to congruent changes in gratitude
Watkins, P. C., Munger, P., Hutton, B. R., Elliot, K., & Mathews, A. (2021) · The Journal of Positive Psychology · doi:10.1080/17439760.2021.1940249 · Cited by 10
“From previous research (Hayes et al., 2010; Mathews & Mackintosh, 2000) we expected a medium to large effect size for interpretation bias.”
MethodSelf-citationYang, Z., Han, S., Zhang, L., Sun, M., Hu, Q., Hu, Y., & Wu, B. (2024) · AIDS and Behavior · doi:10.1007/s10461-024-04290-6 · Cited by 9
“From these two perspectives, anxiety symptoms were considered “choice”, whereas depression symptoms were considered “how to achieve better results” [46, 47].”
Lubbers, J., Geurts, D. E. M., Hanssen, I., Huijbers, M. J., Spijker, J., Speckens, A. E. M., & Cladder-Micus, M. B. (2022) · International Journal of Bipolar Disorders · doi:10.1186/s40345-022-00269-1 · Cited by 9
Horton, A. B., Pring, A. M., Rudaizky, D., & Clarke, P. (2024) · Anxiety Stress & Coping · doi:10.1080/10615806.2024.2308673 · Cited by 9
“This method of worry induction has been shown to be highly e ff ective in inducing a brief worry state across a number of studies (Hayes et al., 2010; Hirsch et al., 2011).”
Interpretive Bias Modification for Disgust
Whitton, A. E., Grisham, J. R., Henry, J. D., & Palada, H. (2013) · Journal of Experimental Psychopathology · doi:10.5127/jep.030812 · Cited by 8
Facilitating Episodic Simulation in Anxiety: Role of Sensory Scaffolding and Scenario Modality
Ji, J., Meyer, M., & Teachman, B. (2020) · International Journal of Cognitive Therapy · doi:10.1007/s41811-020-00070-x · Cited by 7
“Though some studies have presented scenarios aurally (Hayes et al. 2010; Murphy et al. 2007), the majority of CBM-I training use visually presented scenarios (see Menne-Lothmann et al.”
BackgroundPathological Worry in Children: What is Currently Known?
Wilson, C. E. (2010) · Journal of Experimental Psychopathology · doi:10.5127/jep.008110 · Cited by 8
Biased interpretation in perfectionistic concerns: an experimental investigation
Howell, J. A., McEvoy, P. M., Grafton, B., Macleod, C., Kane, R. T., Anderson, R. A., & Egan, S. J. (2019) · Anxiety, Stress, & Coping · doi:10.1080/10615806.2019.1586888 · Cited by 7
Modifying insecure attachment style with cognitive bias modification
Doolan, E. L., & Bryant, R. A. (2021) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2021.101664 · Cited by 8
Looking on the bright side reduces worry in pregnancy: Training interpretations in pregnant women
Hirsch, C. R., Meeten, F., Newby, J. M., O’Halloran, S., Gordon, C., Krzyzanowski, H., & Moulds, M. L. (2021) · Clinical Psychology in Europe · doi:10.32872/cpe.3781 · Cited by 6
“Worry is a form of RNT that is predominantly verbal, difficult to control and involves entertaining potential negative outcomes of future situations (Borkovec 1994; Hayes et al., 2010).”
BackgroundInfluentialSelf-citationModifying thought-action fusion via a single-session computerized interpretation training
Siwiec, S. G., Davine, T. P., Kresser, R. C., Rohde, M. M., & Lee, H. (2016) · Journal of Obsessive-Compulsive and Related Disorders · doi:10.1016/j.jocrd.2016.11.005 · Cited by 8
Metadata
- Authors
- Hayes, S., Hirsch, C. R., Krebs, G., & Mathews, A.
- Affiliations
- King's College London (GB)
- The University of Western Australia (AU)
- University of California, Davis (US)
- Corresponding author
- Hayes, Sarra
- Venue
- Behaviour Research and Therapy
- Publisher
- Elsevier BV
- Published
- 2010-03
- Volume
- 48
- Issue
- 3
- Pages
- 171-178
- ISSN
- 0005-7967 (ISSN-L)
- OpenAlex
- W2092460488
- Cited by
- 167
- References
- 34
- Citations by year
- 2026: 8 · 2025: 4 · 2024: 10 · 2023: 5 · 2022: 7 · 2021: 13 · 2020: 12 · 2019: 13 · 2018: 7 · 2017: 11 · 2016: 17 · 2015: 10 · 2014: 9 · 2013: 15 · 2012: 12
- FWCI
- 10.98
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Behaviour Research and Therapy (publishedVersion)
- PubMed (publishedVersion)
- Research Portal (King's College London) (submittedVersion)
- Funders
- Medical Research Council
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Psychological Treatments and Assessments
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Keywords
- generalized anxiety disorder, interpretation bias modification, worry, homographs, sentence completion, cognitive bias modification
- MeSH terms
- Adult, Analysis of Variance, Anxiety Disorders, Emotions, Female, Humans, Interviews as Topic, Male, Perception, Psychological Tests, Surveys and Questionnaires, Thinking, Cognitive Behavioral Therapy, Treatment Outcome
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