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Cited by 83Anxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesDigital Mental Health InterventionsChild and Adolescent Psychosocial and Emotional Development

Online attentional bias modification training targeting anxiety and depression in unselected adolescents: short- and long-term effects of a randomized controlled trial

Open access
de Voogd, E.L., Wiers, R.W., Prins, P.J.M., de Jong, P.J., Boendermaker, W.J., Zwitser, R.J., Salemink, E.·2016·Behaviour Research and Therapy
DOI 10.1016/j.brat.2016.08.018
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Abstract

Based on information processing models of anxiety and depression, we investigated the efficacy of multiple sessions of online attentional bias modification training to reduce attentional bias and symptoms of anxiety and depression, and to increase emotional resilience in youth. Unselected adolescents (N = 340, age: 11-18 years) were randomly allocated to eight sessions of a dot-probe, or a visual search-based attentional training, or one of two corresponding placebo control conditions. Cognitive and emotional measures were assessed pre- and post-training; emotional outcome measures also at three, six and twelve months follow-up. Only visual search training enhanced attention for positive information, and this effect was stronger for participants who completed more training sessions. Symptoms of anxiety and depression reduced, whereas emotional resilience improved. However, these effects were not especially pronounced in the active conditions. Thus, this large-scale randomized controlled study provided no support for the efficacy of the current online attentional bias modification training as a preventive intervention to reduce symptoms of anxiety or depression or to increase emotional resilience in unselected adolescents. However, the absence of biased attention related to symptomatology at baseline, and the large drop-out rates at follow-up preclude strong conclusions.

AI snapshot

Written from the paper’s full text.

TL;DR

In a large RCT with 340 unselected adolescents, eight sessions of online visual search (VS) or dot-probe (DP) attentional bias modification did not outperform placebo for reducing anxiety/depression or increasing emotional resilience, although VS training increased attention to positive information. Symptoms and resilience improved over time irrespective of condition, and limitations such as low compliance and high follow-up dropout preclude strong conclusions.

Key findings

  • VS training significantly reduced negative attentional bias on the Emotional Visual Search Task (EVST) (Condition × Type × Time; Exp-VS-T2 B = −1734.98, SE = 276.97, p < .001), and this effect was stronger for participants who completed more sessions (B = −274.78, SE = 96.24, p = .005). DP training did not affect attentional bias on the Dot-Probe Task (DPT).
  • No active training outperformed placebo on anxiety (SCARED), depression (CDI), or secondary resilience measures; only significant Time effects were observed, indicating general improvement: e.g., SCARED T2 B = −2.05, FU3 B = −3.23; CDI T2 B = −0.76, FU3 B = −1.44; RSES T2 B = 0.57, FU3 B = 1.93.
  • At baseline, a significant negative attentional bias was found on the EVST, t(330) = 10.38, p < .001, d = 0.57, but not on the DPT, t(329) = 1.32, p = .188, d = 0.07. Anxiety/depression were not significantly correlated with EVST bias (r = .05, p = .35 and r = .05, p = .36); DPT bias showed a small marginally significant correlation with anxiety (r = .12, p = .03) but not depression (r = .05, p = .37).
  • Participants completed a mean of 5.33 (SD = 2.35) training sessions, and 82 adolescents (24%) completed all eight sessions. Training accuracy rates were 99.1% for VS, 98.7% for VS placebo, 97.5% for DP, and 98.3% for DP placebo.

Methods

  • Multi-center, stratified, double-blind, placebo-controlled, parallel-group RCT in the Netherlands (NTR3950), recruiting from 14 regular high schools; 2312 adolescents were invited, 733 were randomized, and the current CBM-A intention-to-treat sample comprised 340 participants (57.6% female; mean age = 14.41, SD = 1.20): VS n = 126, DP n = 128, VS placebo n = 38, DP placebo n = 48. Participants received eight online sessions over four weeks, with assessments pre- and post-training and at 3, 6, and 12 months follow-up.
  • Cognitive measures included the EVST and DPT attentional bias tasks; primary outcomes were anxiety (SCARED) and depression (CDI); secondary outcomes included self-esteem (RSES), perseverative thinking (PTQ), test anxiety (PMT-K), difficulties (SDQ), attentional control (ACS), and Cyberball stress reactivity. Main analyses used mixed regression with Participant as grouping variable and Time as repeated measures, backward model selection, and Bonferroni-Holm correction.

Limitations

  • The authors state that response rates were modest, most adolescents did not complete all eight training sessions or all assessments, and low training compliance is a serious problem for implementation; control groups were smaller than originally planned because placebo conditions were analyzed separately, reducing power especially with high follow-up dropout.
  • The authors also state that online training at home was unsupervised and unstandardized, with possible motivation/concentration problems and technical issues; a Flash Player timing issue was discovered after data collection and browser/plugin use was not recorded. They note that the unselected sample had low symptom levels, leaving little room for improvement, and that the absence of biased attention related to symptomatology at baseline plus large follow-up dropout preclude strong conclusions.
  • Evident from the text: there was no transfer between the EVST and DPT attentional bias tasks, and change in bias did not affect training effects on emotional outcomes, suggesting the VS bias change may partly reflect task-specific learning; the VS placebo also lacked exposure to emotional faces, though the authors cite prior evidence that VS training effects were not attributable to mere exposure.

Model-written summary. Check it against the paper before relying on it.

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Registry

Crossref · 10.1016/j.brat.2016.08.018

Cites

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Statistics

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Claims the paper makes

0 of 68 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    The effect of visual search training on attention for positive information was stronger for participants who completed more training sessions.

    “Only visual search training enhanced attention for positive information, and this effect was stronger for participants who completed more training sessions.”
    Quote in the paperNot a substantial claim
  • Findingown data

    There was an absence of biased attention related to symptomatology at baseline.

    “However, the absence of biased attention related to symptomatology at baseline, and the large drop-out rates at follow-up preclude strong conclusions.”
    Quote in the paperSubstantial claim
  • Findingown data

    The effects on symptoms of anxiety and depression and emotional resilience were not especially pronounced in the active conditions.

    “However, these effects were not especially pronounced in the active conditions.”
    Quote in the paperSubstantial claim
  • Findingown data

    Symptoms of anxiety and depression reduced.

    “Symptoms of anxiety and depression reduced, whereas emotional resilience improved.”
    Quote in the paperNot a substantial claim
  • Findingown data

    Only visual search training enhanced attention for positive information.

    “Only visual search training enhanced attention for positive information, and this effect was stronger for participants who completed more training sessions.”
    Quote in the paperNot a substantial claim
  • The quote only partly states this claim. 2
  • Classified as probably not a substantial claim. 49
  • May combine two claims. 48

  • The quote only partly states this claim.

    Findingown data

    Emotional resilience improved.

    “Symptoms of anxiety and depression reduced, whereas emotional resilience improved.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Scores on the EVST and DPT were not significantly correlated with each other.

    “Scores on the EVST and DPT were not significantly correlated with each other, r ¼ .042,p ¼ .45.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    For attentional bias as assessed with the DPT, the expected Condition by Type by Time interaction was not observed, nor any other main effects or interactions.

    “For attentional bias as assessed with the DPT, the expected Condition  Type  Time interaction was not observed, nor any other main effects or interactions.”
    • Also stated in: § 3. Discussion · plain
      “For DP training, no effects were found on attentional bias.”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: Participants with missing data at specific time points were missing at random.

  • May combine two claims.

    Findingown data

    There were no significant changes in positive or negative mood in response to the Cyberball stress task, and mood was not affected by training condition.

    “With regard to stress-reactivity, we did not observe any significant changes in positive or negative mood in response to the Cyberball stress task, nor was mood affected by training condition (no significant main effects of Time and Condition, nor significant interactions).”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: Participants with missing data at specific time points were missing at random.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    On average, participants completed 5.33 training sessions.

    “On average, participants completed 5.33 (SD ¼ 2.35) training sessions”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Eighty-two adolescents, 24% of the sample, completed all eight training sessions.

    “and 82 adolescents (24%) completed all eight sessions.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    On average, participants completed their last training session 6.88 days before the post-training assessment, with no significant difference between groups.

    “On average, participants completed their last training session 6.88 (SD ¼ 6.48) days before the post-training assessment, with no significant difference between groups, F (3, 312) ¼ 0.44, p ¼ .723,h p 2 ¼ .004.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    VS training effects on anxiety or depressive symptoms were not moderated by number of sessions completed, baseline attentional bias, baseline attentional control, or stressful life events.

    “Nor were VS training effects on anxiety or depressive symptoms moderated by number of sessions completed, baseline attentional bias, baseline attentional control, or stressful life events.”
    Quote in the paperNot a substantial claim
    • The authors state this as an assumption: Participants with missing data at specific time points were missing at random.

  • May combine two claims.

    Findingown data

    For attentional bias as assessed with the EVST, there was a significant Condition by Type by Time interaction, indicating a significant reduction in the VS training group only.

    “for attentional bias as assessed with the EVST, a significant Condition  Type  Time interaction was observed (see Table 4), indicating a significant reduction in the VS training group only (see Table 5).”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: Participants with missing data at specific time points were missing at random.

  • May combine two claims.

    Findingown data

    DP training effects on anxiety or depressive symptoms were not moderated by number of sessions completed, baseline attentional bias, baseline attentional control, or stressful life events.

    “Nor were DP training effects on anxiety or depressive symptoms moderated by number of sessions completed, baseline attentional bias, baseline attentional control, or stressful life events.”
    Quote in the paperNot a substantial claim
    • The authors state this as an assumption: Participants with missing data at specific time points were missing at random.

  • May combine two claims.

    Findingown data

    For secondary outcome measures, only significant main effects of Time were observed, indicating increased self-esteem and reductions in perseverative negative thinking, test anxiety, and social-emotional and behavioral problems over time irrespective of condition.

    “Again, only significant main effects of Time were observed, indicating increased self-esteem and reductions in perseverative negative thinking, test anxiety, and social-emotional and behavioral problems over time, irrespective of condition.”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: Participants with missing data at specific time points were missing at random.

  • May combine two claims.

    Findingown data

    A long-term reduction in anxiety and depressive symptoms was observed up to one-year follow-up, but neither VS nor DP training outperformed their respective control conditions.

    “With regard to our primary outcome measures of anxiety and depressive symptoms, a long-term (one-year follow-up) reduction in symptoms was observed, but neither the VS nor the DP training outperformed their respective control conditions.”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: Participants with missing data at specific time points were missing at random.

  • May combine two claims.

    Findingown data

    For anxiety and depressive symptoms, only significant main effects of Time were observed, indicating that symptoms generally reduced over time up to one-year follow-up.

    “Only significant main effects of Time were observed, indicating that anxiety and depressive symptoms generally reduced over time up till one-year follow-up.”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: Participants with missing data at specific time points were missing at random.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    For attentional bias as assessed with the DPT, a small and marginally significant correlation was observed with anxiety symptoms.

    “For attentional bias as assessed with the DPT, a small and marginally significant correlation was observed with anxiety symptoms, r ¼ .12,p ¼ .03”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    DP training effects on attentional bias assessed with the DPT were not moderated by number of sessions completed or baseline attentional control.

    “DP training effects on attentional bias assessed with the DPT were not moderated by number of session completed, or baseline attentional control, as no significant three-way interaction were observed between Condition, Time and these variables.”
    Quote in the paperNot a substantial claim
    • The authors state this as an assumption: Participants with missing data at specific time points were missing at random.

  • May combine two claims.

    Findingown data

    The current results provide no support for the hypothesis of long-term emotional effects, as long-term improvements in anxiety and depressive symptoms and emotional resilience were observed irrespective of training condition, and training effects were not moderated by stressful life events.

    “However, the current results provide no support for this hypothesis, as long-term improvements in term of anxiety and depressive symptoms and emotional resilience were observed irrespective of training condition, and training effects were not moderated by stressful life events.”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: Participants with missing data at specific time points were missing at random.

  • May combine two claims.

    Premisecitation

    Adolescence is a period of increased vulnerability for emotional disorders and also of heightened plasticity and potentially greater opportunities to profit from cognitive training.

    “Also, adolescence is not only a period of increased vulnerability for emotional disorders, but also of heightened plasticity and potentially greater opportunities to profit from cognitive training (Crone, 2009).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Crone, 2009

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Anxiety and depression are among the most prevalent psychiatric disorders and show a considerable increase during adolescence.

    “Anxiety and depression are among the most prevalent psychiatric disorders and show a considerable increase during adolescence (Costello, Mustillo, Erkanli, Keeler, & Angold, 2003).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Costello, Mustillo, Erkanli, Keeler, & Angold, 2003 source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    The study provided no support for the efficacy of the current online attentional bias modification training as a preventive intervention to reduce symptoms of anxiety or depression or to increase emotional resilience in unselected adolescents.

    “Thus, this large-scale randomized controlled study provided no support for the efficacy of the current online attentional bias modification training as a preventive intervention to reduce symptoms of anxiety or depression or to increase emotional resilience in unselected adolescents.”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: The working mechanism of CBM-A is a reduction in attentional bias for negative information.

  • May combine two claims.

    Premisecitation

    A meta-analysis on the first set of youth CBM-A studies showed that although moderate and significant training effects on attentional bias have often been reported, overall training effects on mental health were small and non-significant.

    “A meta-analysis on the first set of youth CBM-A studies (Cristea, Mogoas ¸e, David, & Cuijpers, 2015, K ¼ 9foot_0 ) showed that although moderate and significant training effects on attentional bias have often been reported, overall training effects on mental health were small and non-significant.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Cristea, Mogoas ¸e, David, & Cuijpers, 2015

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S1 (asserted).

    Premisecitation

    Increased attentional control might mediate the effects of CBM-A on emotional vulnerability.

    “It has also been suggested that increased attentional control might mediate the effects of CBM-A on emotional vulnerability (e.g., Klumpp & Amir, 2010).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Klumpp & Amir, 2010

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The role of attentional bias in non-clinical samples is less clear, with recent studies in adolescent community samples reporting either the presence or absence of a relation between attentional bias and anxiety and/or depressive symptoms.

    “The role of attentional bias in non-clinical samples is less clear, with recent studies in adolescent community samples reporting either the presence (Platt, Murphy, & Lau, 2015) or absence (O' Leary-Barrett et al., 2015) of a relation between attentional bias and anxiety and/or depressive symptoms.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Platt, Murphy, & Lau, 2015

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    • cites O' Leary-Barrett et al., 2015 source

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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Various training paradigms have been developed that specifically target attentional bias (CBM-A), with promising effects on cognitive and emotional functioning.

    “Various training paradigms have been developed that specifically target attentional bias, so-called Cognitive Bias Modification of Attention (CBM-A), with promising effects on cognitive and emotional functioning (for a review see: Kuckertz & Amir, 2015).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Kuckertz & Amir, 2015

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  • May combine two claims.

    Premisecitation

    It might take time to generalize a newly acquired information processing style to daily life and the experience of stressful life events, so emotional effects might only become apparent at a later time point.

    “As it might take time to generalize a newly acquired information processing style to daily life and the experience of stressful life events, emotional effects might only become apparent at a later time point (cf.Harmer, Goodwin, & Cowen, 2009).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Harmer, Goodwin, & Cowen, 2009 source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    A change in emotional functioning would only be expected if attentional bias reduction is obtained.

    “Therefore, a change in emotional functioning would only be expected if such an attentional bias reduction is obtained (MacLeod & Clarke, 2015).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites MacLeod & Clarke, 2015

      Not checked in the free run.

    • The authors state this as an assumption: The working mechanism of CBM-A is a reduction in attentional bias for negative information.

  • May combine two claims.

    Premisenone given

    CBM-A meta-analyses report large heterogeneity in effect sizes as well as in tasks, samples and outcome measures.

    “Although these meta-analytic results suggest that CBM-A might not be suitable for preventive or clinical application in youth, it is important to note that CBM-A meta-analyses report large heterogeneity in effect sizes as well as in tasks, samples and outcome measures.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    In the adult literature, many positive effects have been observed in clinical samples, mainly social anxiety patients.

    “In the adult literature, many of the positive effects have been observed in clinical samples, mainly social anxiety patients (Linetzky et al., 2015;Mogoas ¸e et al., 2014).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Linetzky et al., 2015 source

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    • cites Mogoas ¸e et al., 2014

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Most of the CBM-A studies included in Cristea, Mogoas ̧e, et al. (2015) used the dot-probe training and (sub-)clinical samples.

    “For example, most of the CBM-A studies included in Cristea, Mogoas ¸e, et al. (2015) used the dotprobe training and (sub-)clinical samples, so more research is needed to increase insight into the effectiveness of specific training paradigms in various subgroups in youth, including non-clinical samples.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Cristea, Mogoas ¸e, et al. (2015)

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  • May combine two claims.

    Premisecitation

    Most studies on the efficacy of CBM-A as an intervention to reduce stress-reactivity, anxiety, or depression have focused on adult (mostly clinical) samples, and have provided mixed results.

    “Thus far most studies on the efficacy of CBM-A as an intervention to reduce stress-reactivity, anxiety, or depression have focused on adult (mostly clinical) samples, and have provided mixed results (for meta-analyses see Cristea, Kok, & Cuijpers, 2015;Heeren et al., 2015;Linetzky, Pergamin-Hight, Pine, & Bar-Haim, 2015;Mogoas ¸e, David, & Koster, 2014).”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites Cristea, Kok, & Cuijpers, 2015

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    • cites Heeren et al., 2015 source

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    • cites Linetzky, Pergamin-Hight, Pine, & Bar-Haim, 2015

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  • May combine two claims.

    Premisenone given

    Earlier studies employed only one or two training sessions and did not include any follow-up assessments.

    “However, these earlier studies employed only one or two training sessions and did not include any follow-up assessments.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Recent meta-analyses of CBM-A for social anxiety disorders in adults reported conflicting findings regarding long-term effects (up to four months); Linetzky et al. (2015) found some small effects, while effects were nonsignificant in Heeren et al. (2015).

    “Recent meta-analyses of CBM-A for social anxiety disorders in adults reported conflicting findings regarding long-term effects (up to four months); Linetzky et al. (2015) found some small effects, while effects were nonsignificant in Heeren et al. (2015).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Linetzky et al. (2015) source

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    • cites Heeren et al. (2015) source

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Changes in attentional bias were not observed when visual search training effects were measured with a dot-probe assessment task.

    “Changes in attentional bias have been observed in healthy children (Eldar, Ricon, & Bar-Haim, 2008) and unselected adolescents (de Voogd, Wiers, Prins, & Salemink, 2014), but not when visual search training effects were measured with a dot-probe assessment task (Platt et al., 2015).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Platt et al., 2015 source

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  • May combine two claims.

    Interpretationown data

    VS attentional training led to an increased bias for positive information, as assessed with the EVST, but not with the DPT.

    “Consistent with earlier research in youth (Waters, Pittaway, Mogg, Bradley, & Pine, 2013;de Voogd et al., 2014), VS attentional training led to an increased bias for positive information, as assessed with the closely matched EVST, but not with the DPT.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Waters, Pittaway, Mogg, Bradley, & Pine, 2013

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    • cites de Voogd et al., 2014 source

      Not checked in the free run.

    • The authors state this as an assumption: Participants with missing data at specific time points were missing at random.

  • May combine two claims.

    Interpretationown data

    Because symptoms of anxiety and depression were not correlated with EVST scores and only weakly correlated with DPT scores, the relevance of these attentional bias indices to symptomology in the current sample of unselected adolescents can be questioned.

    “As symptoms of anxiety and depression were not correlated with EVST scores and only a weak correlation was observed between anxiety and DPT scores, one might also question the relevance of these attentional bias indices to symptomology in the current sample of unselected adolescents.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    Anticipating a drop-out rate of 20%, the study aimed to include 566 participants.

    “Anticipating a drop-out rate of 20%, we aimed to include 566 participants.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The study was registered in the Dutch trial register with number NTR3950.

    “The current study was part of a large scale multi-center, stratified, double-blind, placebo-controlled, parallel-group study conducted in The Netherlands (registered in the Dutch trial register with number NTR3950; http://www.trialregister.nl/trialreg/admin/ rctview.asp?TC¼3950).”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductown data

    Test-assistants present during assessments were blind to allocation.

    “Test-assistants present during the first training session were aware of allocation, but test-assistants present during assessments were blind to allocation.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Premisecitation

    Universal prevention might effectively target many adolescents who might otherwise remain unnoticed.

    “Although not all adolescents are at risk for anxiety or depression, given the high prevalence of these disorders and potential stigma associated with indicated programs, universal prevention might effectively target many adolescents who might otherwise remain unnoticed (Farrell & Barrett, 2007).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Farrell & Barrett, 2007

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The randomization procedure was written by an independent programmer.

    “The randomization procedure was written by an independent programmer.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The PTQ had Cronbach's alpha .95 in the current sample.

    “Cronbach's alpha a ¼ .95 in the current sample.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The PMT-K negative test anxiety subscale had Cronbach's alpha .81 in the current sample.

    “Cronbach's alpha a ¼ .81 in the current sample.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    The study was a multi-center, stratified, double-blind, placebo-controlled, parallel-group study.

    “The current study was part of a large scale multi-center, stratified, double-blind, placebo-controlled, parallel-group study conducted in The Netherlands (registered in the Dutch trial register with number NTR3950; http://www.trialregister.nl/trialreg/admin/ rctview.asp?TC¼3950).”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    The positive and negative mood scales had Cronbach's alpha .72 and .65, respectively, in the current sample.

    “In the current sample, Cronbach's alpha a ¼ .72 and a ¼ .65 for positive and negative mood, respectively.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    At baseline, the four training groups did not significantly differ on demographic characteristics or outcome measures, except for self-esteem scores, which were higher in the DP and DP placebo groups than in the VS placebo group.

    “At baseline (T1), groups did not significantly differ on demographic characteristics (see Table 1) nor outcome measures (see Tables 2 and 3), except for self-esteem scores, F (3, 338) ¼ 2.84, p ¼ .038,h p 2 ¼ .025,with higher self-esteem for the DP and DP placebo group compared to the VS placebo group.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Randomization was stratified by school, gender, and age group (under/above 15 years) and occurred after registration.

    “Randomization was stratified by school, gender, and age group (under/above 15 years) and occurred after registration.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    The study was approved by the ethics committee of the psychology department of the University of Amsterdam and carried out in accordance with the Declaration of Helsinki.

    “The study was approved by the ethics committee of the psychology department of the University of Amsterdam and carried out in accordance with the provisions of the World Medical Association Declaration of Helsinki.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). The quote only partly states this claim.

    Study design and conductown data

    The ACS had Cronbach's alpha .86 in the current sample.

    “Cronbach's alpha a ¼ .86 in the current sample.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Only the first author could access information on allocation during data collection.

    “Only the first author could access information on allocation during data collection.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The RSES had Cronbach's alpha .86 in the current sample.

    “Cronbach's alpha a ¼ .86 in the current sample.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    In non-clinical samples, attentional bias might not be as strongly related to anxiety and depression as in clinical samples, which would reduce the potential of CBM-A in this population.

    “In non-clinical samples, attentional bias might not be as strongly related to anxiety and depression as in clinical samples (O' Leary-Barrett et al., 2015), which would reduce the potential of CBM-A in this population.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites O' Leary-Barrett et al., 2015 source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    Allocation was concealed to participants until the end of the study.

    “Allocation was concealed to participants until the end of the study.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Premisenone given

    The associated costs and time investments of CBM-A are relatively low.

    “Furthermore, as the associated costs and time investments of CBM-A are relatively low, providing this training to unselected samples might be worthwhile.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Adding self-esteem as a covariate to the models did not affect relative model fit or the significance of any relevant parameters.

    “Adding selfesteem as a covariate to our models did not affect relative model fit or the significance of any relevant parameters.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Participants were randomized by a fully computerized procedure over eight parallel conditions, in 4:4:4:4:1:1:1:1 ratio.

    “Participants were randomized by a fully computerized procedure over eight parallel conditions, in 4:4:4:4:1:1:1:1 ratio, with four experimental and four placebo conditions respectively (DP training, VS training, interpretation bias training, emotional working memory training, and their placebo versions).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    The SDQ had Cronbach's alpha .71 for self-report and .71 for parent-report in the current sample.

    “Cronbach's alpha a ¼ .71for self-report and a ¼ .71for parent-report in the current sample.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The CDI had Cronbach's alpha .86 in the current sample.

    “Cronbach's alpha a ¼ .86 in the current sample.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisenone given

    The number of studies including follow-up assessments is still limited, especially in youth, and none of these earlier studies focused on non-clinical samples.

    “Note that the number of studies including follow-up assessments is still limited, especially in youth, and none of these earlier studies focused on non-clinical samples.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Accuracy rates during training were 99.1% for VS training, 98.7% for VS placebo, 97.5% for DP training, and 98.3% for DP placebo.

    “Accuracy rates during training were 99.1% for VS training, 98.7% for VS placebo, 97.5% for DP training, and 98.3% for DP placebo.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The SCARED had Cronbach's alpha .92 in the current sample.

    “Cronbach's alpha a ¼ .92 in the current sample.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    For the current study on CBM-A, 340 participants remained for intention-to-treat analyses.

    “For the current study on CBM-A, 340 participants (57.6% female, mean age ¼ 14.41, SD ¼ 1.20) remained for intention-to-treat analysesfoot_2 (VS ¼ 126, DP ¼ 128, VS Placebo ¼ 38, DP Placebo ¼ 48).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Interpretationcitation

    Although accuracy rates suggest that performance was not compromised, lack of motivation and concentration, as well as technical issues, could all have played a role in the absence of expected training effects.

    “Although accuracy rates (99% for VS training and 96% for dot-probe training) suggest that performance was not compromised, a lack of motivation and concentration (cf.Booth, Mackintosh, Mobini, Oztop, & Nunn, 2014 on the potential negative effects of distraction), as well as technical issues,foot_5 could all have played a role in the absence of expected training effects.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Booth, Mackintosh, Mobini, Oztop, & Nunn, 2014

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Long-term emotional effects might be observed, as newly acquired information processing styles could be applied in situations encountered after the training period.

    “Also, longterm emotional effects might be observed, as newly acquired information processing styles could be applied in situations encountered after the training period (Harmer et al., 2009).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Harmer et al., 2009 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationcitation

    Stronger training effects might be obtained in subclinical samples of adolescents, as research in clinically anxious children with variants of VS training also suggests.

    “Stronger training effects might be obtained in (sub)clinical samples of adolescents, as research in clinically anxious children with variants of VS training also suggests (Waters et al., 2013;2015).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Waters et al., 2013 source

      Not checked in the free run.

    • cites [2015]

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data

    The meta-analysis included studies on CBM for interpretation (CBM-I, K = 14), which limits the ability to draw conclusions about the efficacy and moderators of CBM-A specifically.

    “Note that this meta-analysis also included studies on CBM for interpretation (CBM-I, K ¼ 14), which limits the possibility to draw conclusions on efficacy and moderators of CBM-A specifically.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The funding bodies were not involved in the study apart from providing financial support.

    “The funding bodies were not involved in the study apart from providing financial support.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    Based on diathesis-stress theory, changes in information processing primarily affect emotional functioning in interaction with stressful experiences.

    “Based on diathesis-stress theory (Beck, 1967), one would expect that changes in information processing primarily affect emotional functioning in interaction with stressful experiences (cf.Hallion & Ruscio, 2011;Mogoas ¸e et al., 2014).”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites Beck, 1967

      Not checked in the free run.

    • cites Hallion & Ruscio, 2011 source

      Not checked in the free run.

    • cites Mogoas ¸e et al., 2014

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Such a general improvement in emotional functioning is in line with previous findings on the development of anxiety and depressive symptoms.

    “Such a general improvement in emotional functioning is in line with previous findings on the development of anxiety and depressive symptoms (e.g., Sportel et al., 2013;de Voogd et al., 2016;de Voogd et al., in press).”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites Sportel et al., 2013 source

      Not checked in the free run.

    • cites de Voogd et al., 2016

      Not checked in the free run.

    • cites de Voogd et al., in press

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationcitation

    The absence of social stress with online training at home compared to lab studies might explain recent null findings.

    “The absence of (social) stress with online training at home compared to lab studies might explain recent null findings (Boettcher, Berger, & Renneberg, 2012;Boettcher et al., 2013;Kuckertz et al., 2014).”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites Boettcher, Berger, & Renneberg, 2012 source

      Not checked in the free run.

    • cites Boettcher et al., 2013 source

      Not checked in the free run.

    • cites Kuckertz et al., 2014 source

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data

    The current findings indicate that CBM-A in its current form is ineffective in reducing anxiety or depressive symptoms or increasing emotional resilience in unselected adolescents.

    “Although the attentional bias change obtained with online VS training performed at home seems promising, the current findings indicate that CBM-A in its current form is ineffective in reducing anxiety or depressive symptoms or increasing emotional resilience in unselected adolescents.”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: Participants with missing data at specific time points were missing at random.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The authors declare that there are no conflicts of interest.

    “The authors declare that there are no conflicts of interest.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    Although the sample size was very large compared to previous research, response rates to the invitation were modest and most adolescents did not complete all eight intended training sessions and all assessments.

    “First, although our sample size was very large compared to previous research, response rates to our invitation for the study were modest and most adolescents did not complete all eight intended training sessions and all assessments.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    Technical problems related to a Flash Player plugin (PepperFlash) in Google Chrome were discovered after data collection and might have resulted in small timing differences during training and assessment tasks.

    “After completing data collection, technical problems related to a Flash Player plugin (PepperFlash) in Google Chrome were discovered, that might have resulted in small timing differences during training and assessments tasks.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Specifications of the DP training and the DP assessment task were prespecified and identical at all participating sites.

    “Specifications of this training and the DP assessment task were prespecified and are identical at all participating sites.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductreasoning

    Because the DP training specifications were prespecified and identical across sites, feedback or a progress bar could not be included as in the VS training.

    “Therefore, we could not include feedback or a progress bar as in the VS training.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The covariance structure between time points was verified based on AIC and BIC criteria as compound symmetry, first-order autoregressive, or unstructured.

    “With regard to the covariance between time points, we have verified (based on AIC and BIC criteria) whether these were structured according to compound symmetry, or first order autoregressive, or whether these were unstructured.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductreasoning

    Training sessions were completed at home, without any supervision or standardization of training circumstances.

    “A third limitation is related to the online nature of the training.While it has important advantages, the disadvantage is that training sessions were completed at home, without any supervision or standardization of training circumstances.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    For all analyses, Bonferroni-Holm correction was applied to control for Type I errors related to multiple comparisons.

    “For all analyses, Bonferroni-Holm correction was applied to control for Type I errors related to multiple comparisons.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Interpretationcitation

    It might be that the EVST better taps into relevant attentional processes of an unselected adolescent sample, and that enhancing a bias for positive information is more effective here.

    “It might be that the EVST better taps into relevant attentional processes of an unselected adolescent sample, and that enhancing a bias for positive information is more effective here (cf.Grafton, Ang, & MacLeod, 2012)”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Grafton, Ang, & MacLeod, 2012

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    Motivation for online training appears to be low in unselected adolescents, which is not surprising given the low levels of distress and the repetitive nature of the training tasks.

    “Motivation for online training appears to be low in unselected adolescents, which is not surprising given the low levels of distress and the repetitive nature of the training tasks (Beard et al., 2011).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Beard et al., 2011 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    School was not included as another grouping variable because preliminary analyses indicated that this did not improve model fit and intra-class correlations were very small.

    “School was not included as another grouping variable, as preliminary analyses indicated that this did not improve model fit and intra-class correlations were very small.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    The use of specific browsers and plugins was not recorded during the study, so the impact of the technical problems could not be tested.

    “As the use of specific browsers and plugins was not recorded during the study, we were unable to test the impact of this issue.”
    Quote in the paperNot a substantial claim
81 of 81

  • The authors state this as an assumption.

    The working mechanism of CBM-A is a reduction in attentional bias for negative information.

    “Based on the hypothesized causal role of attentional bias in anxiety and depression, the assumed working mechanism of CBM-A is a reduction in attentional bias for negative information.”

  • The authors state this as an assumption.

    Participants with missing data at specific time points were missing at random.

    “without excluding participants with missing data at specific time points (which we assumed to be missing at random).”
2 of 2

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Evidence for therapeutic efficacy of alternative ABM training methods is limited.

    “Evidence for the therapeutic efficacy of alternative ABM training methods is limited.”

    From Anxiety and Threat-Related Attention: Cognitive-Motivational Framework and Treatment (2018) · cites this paper as [73]

  • Lack of consensus about why conventional ABM has inconsistent effects has encouraged development of alternative methods with preliminary efficacy data.

    “Lack of consensus regarding why conventional ABM threat-avoidance training has inconsistent effects (discussed earlier) has encouraged the development of various alternative methods which have preliminary data suggesting efficacy”

    From Anxiety and Threat-Related Attention: Cognitive-Motivational Framework and Treatment (2018) · cites this paper as [73]

  • Multi-session emotional face visual search training has mixed effects on nonclinical adolescent anxiety, with poor compliance possibly due to insufficient goal engagement.

    “Multi-session emotional face visual search training has mixed effects on nonclinical adolescent anxiety, with problems of poor compliance possibly owing to insufficient goal engagement [71,73,74].”

    From Anxiety and Threat-Related Attention: Cognitive-Motivational Framework and Treatment (2018) · cites this paper as [73]

  • In most ABM training methods, nonthreat targets are more likely to appear in different locations from threat cues, encouraging attention-orienting away from threat.

    “In most ABM training methods, nonthreat targets are more likely to appear in different locations [ 5 0 8 _ T D $ D I F F ] from threat cues, which encourages attention-orienting away from threat.”

    From Anxiety and Threat-Related Attention: Cognitive-Motivational Framework and Treatment (2018) · cites this paper as [73]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Dot-probe training accuracy differs between Results and Discussion

    Minor

    The Discussion gives dot-probe training accuracy as 96%, whereas the Results report 97.5%. Rounding 97.5% to a whole percent would not produce 96%.

1 of 1

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Authors
de Voogd, E. L., Wiers, R. W., Prins, P. J. M., de Jong, P. J., Boendermaker, W. J., Zwitser, R. J., & Salemink, E.
Affiliations
  • University of Amsterdam (NL)
  • Utrecht University (NL)
ORCID
Venue
Behaviour Research and Therapy
Publisher
Elsevier BV
Published
2016-12
Volume
87
Pages
11-22
ISSN
0005-7967 (ISSN-L)
DOI
10.1016/j.brat.2016.08.018
OpenAlex
W2514166927
Cited by
83
References
72
Citations by year
2026: 4 · 2025: 8 · 2024: 5 · 2023: 10 · 2022: 9 · 2021: 12 · 2020: 6 · 2019: 8 · 2018: 12 · 2017: 8 · 2016: 1
FWCI
13.76
Type
journal article
Language
en
Open access
Licence
Locations
  • Behaviour Research and Therapy (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
  • UvA-DARE (University of Amsterdam) (acceptedVersion, cc-by-nc-nd)
  • Utrecht University Repository (Utrecht University) (submittedVersion, other-oa)
  • University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion, cc-by-nc-nd)
  • Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
Funders
  • National Science Foundation
  • ZonMw (200210010)
  • Nederlandse Organisatie voor Wetenschappelijk Onderzoek (453‐08‐001, 451-10-029, VENI 451-10-029, VICI 453-08-001)
Topics
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
  • Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
  • Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
Keywords
attentional bias modification, adolescents, anxiety, depression, psychological resilience, dot-probe task, visual search training, online training, preventive interventions, attentional bias, placebo effect
MeSH terms
Attentional Bias, Adolescent, Adolescent Behavior, Anxiety, Child, Cognition, Depression, Emotions, Female, Humans, Male, Teaching, Internet, Resilience, Psychological

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-09.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-09.

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