Cognitive bias modification of interpretations: A viable treatment for child and adolescent anxiety?
Abstract
Anxiety disorders in children and adolescents are common and impairing. As many patients do not benefit from - or have difficulties accessing - frontline treatments, novel, effective and easy-to-deliver interventions are needed. Cognitive Bias Modification of Interpretations (CBM-I) training has been used to treat adult anxiety disorders. CBM-I methods train individuals to endorse benign rather than negative resolutions of ambiguous cues. Developmental extensions of CBM-I are important for several reasons. First, implementing CBM-I in symptomatic children and adolescents may facilitate early preventative gains. Second, as training uses simple learning mechanisms, CBM-I may reflect a developmentally-suitable strategy for shaping adaptive processing styles. Third, as this age range involves protracted neurocognitive maturation and associated plasticity, administering CBM-I early could drive powerful, long-lasting benefits for emotional development. Finally, data from CBM-I studies could inform the cognitive mechanisms involved in the genesis of early-emerging anxiety. This paper provides the first organised review of CBM-I studies conducted in children and adolescents, and contains suggestions for future research that may help realise the therapeutic potential of early CBM-I interventions.
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Both bottom-up and top-down processes may contribute to interpretation bias, which has been targeted by computer-delivered interpretation bias modification (IBM) training.
“Both bottom-up and top-down processes may contribute to this bias, which has been targeted by computer-delivered interpretation bias modification (IBM) training (Lau, 2013;MacLeod & Mathews, 2012).”
From Anxiety and attention to threat: cognitive mechanisms and treatment with attention bias modification (2016) · cites this paper as Lau, 2013
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“…et al., 2010; Hallion and Ruscio, 2011; Beard et al., 2012; Cristea et al., 2015), our data highlight the potential of reward-guided reinforcement learning as a novel method to correct self-negativity bias and to enhance self-positivity bias in depression (cf. Hertel and Mathews, 2011; Lau, 2013).”
Sun, X.-R., Yang, R., Zhang, Q., Xiao, J., Li, C.-L., & Cui, L.-X. (2019) · Journal of Experimental Psychopathology · doi:10.1177/2043808719875274 · Cited by 15 · see citing works
“To date, several studies have found that multisession CBM-I training would yield more robust effects on reduction of social anxiety than single-session training (Lau, 2013; MacLeod & Mathews, 2012; Murphy, Hirsch, Mathews, Smith, & Clark, 2007).”
BackgroundLau, J., & Pile, V. (2015) · Clinical Psychological Science · doi:10.1177/2167702614549596 · Cited by 22 · see citing works
Self-citationSingle-Session Cognitive Bias Modification of Interpretations Training in High-Anxious Adolescents
Fu, X., Du, Y., Au, S., & Lau, J. Y. F. (2015) · Journal of Cognitive Psychotherapy · doi:10.1891/0889-8391.29.3.253 · Cited by 15 · see citing works
“…(Lau, Belli, & Chopra, 2012; Lau, Molyneaux, Telman, & Belli, 2011; Lothmann, Holmes, Chan, & Lau, 2011; Salemink & Wiers, 2011, 2012; Telman, Holmes, & Lau, 2013) with a few studies describing training in clinical samples (Fu, Du, Au, & Lau, 2013; Micco, Henin, & Hirshfeld-Becker, 2014).”
BackgroundSelf-citationSubar, A. R., & Rozenman, M. S. (2021) · Journal of Affective Disorders · doi:10.1016/j.jad.2021.05.020 · Cited by 14 · see citing works
Cognitive Bias Modification Training in Adolescents: Persistence of Training Effects
Belli, S. R., & Lau, J. Y. F. (2014) · Cognitive Therapy and Research · doi:10.1007/s10608-014-9627-7 · Cited by 13 · see citing works
Self-citationRiddleston, L., Bangura, E., Gibson, O., Qualter, P., & Lau, J. Y. F. (2023) · Behaviour Research and Therapy · doi:10.1016/j.brat.2023.104380 · Cited by 12 · see citing works
Self-citationMeissel, E. E. E., Kuckertz, J. M., & Amir, N. (2021) · Volume 1 · doi:10.1016/b978-0-12-803457-6.00019-2 · Cited by 2 · see citing works
Mao, N., Li, T., Li, C., Ding, R., Zhang, Q., & Cui, L. (2023) · Journal of Child and Family Studies · doi:10.1007/s10826-023-02619-8 · Cited by 10 · see citing works
Duque, A., Lopez-Gomez, I., Blanco, I., & Vázquez, C. (2015) · Terapia psicológica · doi:10.4067/s0718-48082015000200005 · Cited by 10 · see citing works
“El uso de procedimientos de aprendizaje asociativo, acompañados cuando sea posible de nuevas tecnologías, puede hacer que esta sea una área fructífera de intervención en el futuro (Lau, 2013).”
BackgroundLo, S. L., Gearhardt, A. N., Fredericks, E. M., Katz, B., Sturza, J. S., Kaciroti, N., Gonzalez, R., Hunter, C. M., Sonneville, K. R., Chaudhry, K., et al. (2021) · Journal of Experimental Child Psychology · doi:10.1016/j.jecp.2021.105157 · Cited by 9 · see citing works
Chen, R., Zheng, J., Li, T., Zhang, Q., Li, C., & Cui, L. (2020) · Current Psychology · doi:10.1007/s12144-020-01094-4 · Cited by 7 · see citing works
Lau, J. Y. F., Belli, S. R., Gregory, A. M., & Eley, T. C. (2014) · Development and Psychopathology · doi:10.1017/s0954579414001011 · Cited by 7 · see citing works
“…factor for emotional symptoms in early childhood (Pass, Arteche, Cooper, Creswell, & Murray, 2012; although see Haller, Cohen Kadosh, & Lau, 2013, for the developmental timecourse of interpretational style), it may be more likely to reflect inherited risk for depressive symptoms from…”
BackgroundSelf-citationBlankers, M., Salemink, E., & Wiers, R. (2016) · Springer eBooks · doi:10.1007/978-3-319-20852-7_10 · Cited by 6 · see citing works
Boselie, J. J. L. M., Goossens, M. E. J. B., Muris, P., & Vancleef, L. M. G. (2019) · European Journal of Pain · doi:10.1002/ejp.1444 · Cited by 6 · see citing works
“…support for the positive effects of cognitive bias modification as a stand‐alone or additive intervention to other interventions (i.e., CBT, treatment as usual) on anxiety symptoms in children and adolescents (Cristea, Mogoas,e, David, & Cuijpers, 2015; Lau, 2013; Salemink, Wolters, & Haan, 2015).”
BackgroundTreatment of Anxiety in Children and Adolescents
Dowell, T. L., Donovan, C. L., Farrell, L. J., & Waters, A. M. (2018) · Current Treatment Options in Psychiatry · doi:10.1007/s40501-018-0136-2 · Cited by 6 · see citing works
Coussement, C., & Heeren, A. (2015) · L’Année psychologique · doi:10.4074/s0003503315000202 · Cited by 6 · see citing works
Cognitive bias modification of interpretation for social anxiety: A “bottom-up” intervention?
Liu, B.-Q., & Li, X. (2018) · Advances in Psychological Science · doi:10.3724/sp.j.1042.2018.00859 · Cited by 1 · see citing works
“…糊的社交情境与非社交情境, 引导被试想象自己 身临其境, 通过有反馈的重复训练增加或减少其 特定的解释偏向。 2.1 模糊情境范式 在对社交焦虑障碍的解释偏向进行矫正训练 时 , 模糊情境范式通过几十个描述性场景进行 , 前几行内容描述模糊情境(社交情境与非社交情 境), 最终行末尾的词汇(积极含义或消极含义)需 要被试进行补笔, 从而使得句意明晰。随后根据 补笔词的含义出现一条理解性问答, 需要被试进 行选择, 选择后根据补笔词的含义出现反馈答案, 强化训练效果(Mathews & Mackintosh, 2000)。除 应用补笔词外 , 此范式还有其他版本 , 例如：…”
InfluentialBennett, E., Gray, P., & Lau, J. Y. F. (2022) · Journal of Child & Adolescent Trauma · doi:10.1007/s40653-022-00469-y · Cited by 4 · see citing works
“As interpretation biases for rejection situations are thought to be modifiable (Lau, 2013), future research tracking interpretation biases from early childhood and across the life span, would provide a more holistic picture of the malleability of cognitive biases within social situations.”
BackgroundSelf-citationSudhesh, N. T., Sreenath, K., Gupta, S., Nair, D., & Avnit (2020) · Institutionalised Children Explorations and Beyond · doi:10.1177/2349300320960272 · Cited by 4 · see citing works
“The more serious mental health needs of the ALWH are addressed via group and individual counselling sessions providing them with a therapeutic environment for communication of personal difficulties (Lau, 2013; PlataniaSolazzo et al., 1992).”
BackgroundStewart, S., Houghton, S. J., & Macqueen, L. (2025) · Pediatric Reports · doi:10.3390/pediatric17020028 · Cited by 3 · see citing works
“Research shows that cognitive biases (that promote negative thinking) are involved in the onset and maintenance of psychopathology [74–76] and loneliness [77,78].”
Reducing Pediatric Anxiety through Training: an Integrative Neurocognitive Approach
Britton, J. C., Dellarco, D. V., & Evans, T. C. (2017) · Current Behavioral Neuroscience Reports · doi:10.1007/s40473-017-0118-5 · Cited by 3 · see citing works
Dhakal, S., Gupta, S., Sharma, N. P., Upadhyay, A., Oliver, A., Sumich, A. L., Kumari, V., Niraula, S., Pandey, R., & Lau, J. Y. F. (2023) · Behaviour Research and Therapy · doi:10.1016/j.brat.2023.104267 · Cited by 3 · see citing works
Self-citationBai, S., Chen, L.-L., Liu, P., & Zhou, R.-L. (2025) · Psychology in the schools (Print) · doi:10.1002/pits.23570 · Cited by 2 · see citing works
“I) is an effective intervention for test anxiety (de Hullu et al. 2017; Krebs et al. 2018; Lau 2013; Martinelli et al. 2022; Salemink and Wiers 2011), by increasing the positive automatic associations related to threat (Sportel et al. 2013) regardless of whether they are content ‐ specific to the…”
The Interactive Regulation of Negative Emotions by Anticipation and Cognitive Strategies
Jiemin, Y. A. N. G., ZHANG, S., Yuan, J., & Liu, G. (2015) · Advances in Psychological Science · doi:10.3724/sp.j.1042.2015.01312 · Cited by 2 · see citing works
Mogoaşe, C., Podina, I. R., Sucala, M. L., & Dobrean, A. (2013) · Journal of Evidence-Based Psychotherapies · Cited by 2 · see citing works
Frommelt, T., Bäumler, L., Rohleder, N., Schulte‐Körne, G., & Platt, B. (2023) · BMC Psychiatry · doi:10.1186/s12888-023-04803-y · Cited by 2 · see citing works
“on handheld devices) they represent a potentially useful resource for universal or selected prevention [67, 117].”
BackgroundMental Health Problems in Adolescence and the Interpretation of Unambiguous Threat
Henry, J. D., Moses, E., Castellini, J., & Scott, J. G. (2015) · PLoS ONE · doi:10.1371/journal.pone.0127167 · Cited by 2 · see citing works
Cognitive Training and Technology in the Treatment of Children and Adolescents
Lazarov, A., Segal, A., & Bar‐Haim, Y. (2018) · Oxford University Press eBooks · doi:10.1093/oxfordhb/9780190634841.013.47 · Cited by 2 · see citing works
College students' depression and body image: Unraveling the Link
Cheng, Z.-J., Tao, H., Huan, H.-G., Wu, C., Wang, Q., & Hao, M. (2025) · World Journal of Psychiatry · doi:10.5498/wjp.v15.i9.109611 · Cited by 1 · see citing works
Vies is niet gevaarlijk : Werk in uitvoering
Wolters, L. H., Salemink, E., de Beek, V. O., & de Haan, E. (2016) · Kind & Adolescent Praktijk · doi:10.1007/s12454-016-0011-5 · Cited by 1 · see citing works
Sicouri, G., Daniel, E. K., Salemink, E., Mackinnon, A. J., Allsop, A., & Hudson, J. L. (2024) · BMJ Open · doi:10.1136/bmjopen-2023-078652 · Cited by 1 · see citing works
“22 A handful of studies have attempted to modify the training to make it relevant to children, such as the Space Odyssey programme, which contextu-alises training within a journey through space.”
BackgroundCognitive Bias Modification in Mental
Reuland, M. M., Steinman, S. A., & Teachman, B. A. (2015) · Emerging Trends in the Social and Behavioral Sciences · doi:10.1002/9781118900772.etrds0045 · Cited by 1 · see citing works
Bryce, L. (2017) · doi:10.26686/wgtn.17067755 · Cited by 1 · see citing works
“Memories for the novel vignettes 56 contained intrusions that reflected the valence of the CBM-I training group; participants made more benign intrusions when trained to interpret ambiguity in a benign way, and participants had more negative intrusions when trained to interpret ambiguity in a negative way.”
BackgroundMethodInfluentialde Haan, E., Wolters, L. H., & Salemink, E. (2015) · Kind en adolescent · doi:10.1007/s12453-015-0100-5
Cognitive Bias Modification Approaches for Adolescents with Anxiety
Trennepohl, C. (2016)
Pittner, K., Kadosh, K. C., & Lau, J. Y. F. (2016) · doi:10.1002/9781118650813.ch18
Self-citationA Situational Context Training for Socially Anxious Children
Schwab, D., & Schienle, A. (2019) · Cognitive Therapy and Research · doi:10.1007/s10608-019-10060-9
“2015; Lau 2013; Vassilopoulos et al.”
Fliek (2020) · doi:10.26481/dis.20200124lf
Detecting and Avoiding Cognitive Biases
(2018) · Advances in psychology, mental health, and behavioral studies (APMHBS) book series · doi:10.4018/978-1-5225-2978-1.ch009
de Haan, E., Wolters, L. H., & Salemink, E. (2016) · Bohn Stafleu van Loghum eBooks · doi:10.1007/978-90-368-1495-9_8
Youth social anxiety disorder treatment
Chong, L. J., & Silverman, W. K. (2025) · Elsevier eBooks · doi:10.1016/b978-0-443-14146-1.00015-2
- Authors
- Lau, J. Y. F.
- Affiliations
- University of Oxford (GB)
- Corresponding author
- Lau, Jennifer Y.F.
- ORCID
- Lau, Jennifer Y.F.
- Venue
- Behaviour Research and Therapy
- Publisher
- Elsevier BV
- Published
- 2013-10
- Volume
- 51
- Issue
- 10
- Pages
- 614-622
- ISSN
- 0005-7967 (ISSN-L)
- OpenAlex
- W2078800226
- Semantic Scholar
- 4757dc628efc9dcbff7e5b546b56dea37c4322dd
- Cited by
- 71
- References
- 70
- Citations by year
- 2025: 4 · 2024: 1 · 2023: 5 · 2022: 2 · 2021: 3 · 2020: 4 · 2019: 3 · 2018: 7 · 2017: 9 · 2016: 9 · 2015: 15 · 2014: 8 · 2013: 1
- FWCI
- 1.82
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Behaviour Research and Therapy (publishedVersion)
- PubMed (publishedVersion)
- Research Portal (King's College London) (submittedVersion)
- Funders
- British Academy
- Nuffield Trust
- Calleva Research Centre for Evolution and Human Sciences
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
- Social Sciences › Psychology › Clinical Psychology › Psychological Treatments and Assessments
- Keywords
- child and adolescent anxiety, anxiety disorders, cognitive bias modification, early intervention, cognitive development
- MeSH terms
- Adolescent, Adolescent Behavior, Anxiety, Child, Child Behavior Disorders, Humans, Cognitive Behavioral Therapy
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