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Cited by 164Anxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesDigital Mental Health InterventionsPsychological Treatments and Assessments

A comparison of cognitive bias modification for interpretation and computerized cognitive behavior therapy: effects on anxiety, depression, attentional control, and interpretive bias

Open access
Bowler, Jennifer O., Mackintosh, Bundy, Dunn, Barnaby D., Mathews, Andrew, Dalgleish, Tim, Hoppitt, Laura·2012·Journal of Consulting and Clinical Psychology
DOI 10.1037/a0029932PMC PMC3516492
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Abstract

OBJECTIVE: Computerized cognitive behavioral therapy (cCBT) and cognitive bias modification for interpretation (CBM-I) both have demonstrated efficacy in alleviating social anxiety, but how they compare with each other has not been investigated. The present study tested the prediction that both interventions would reduce anxiety relative to a no-intervention comparison condition, but CBM-I would be particularly effective at modifying threat-related cognitive bias under high mental load. METHOD: Sixty-three primarily Caucasian adults (mean age = 22.7, SD = 5.87; 68.3% female) with high social anxiety, randomly allocated to 3 groups: CBM-I (n = 21), cCBT (n = 21), and a no-intervention control group (n = 21) provided complete data for analysis. Pre- and postintervention (4 sessions lasting 2 weeks, control participants only attended the pre-post sessions) self-report measures of anxiety, depression, attentional control, and threat-related interpretive bias were completed. In addition, interpretive bias under high versus low cognitive load was measured using the Scrambled Sentences Test. RESULTS: Both CBM-I and cCBT groups reported significantly reduced levels of social anxiety, trait anxiety, and depression and improved attentional control, relative to the control group, with no clear superiority of either active intervention. Although both active conditions reduced negative bias on the Scrambled Sentences Test completed under mental load, CBM-I was significantly more effective at doing so. CONCLUSIONS: The results suggest that although not differing in therapeutic efficacy, CBM-I and cCBT might differ in the resilience of their effects when under mental load.

AI snapshot

Written from the paper’s full text.

TL;DR

This randomized study compared cognitive bias modification for interpretation (CBM-I) and computerized cognitive behavior therapy (cCBT) against a no-intervention control in 63 high socially anxious adults. Both active interventions reduced anxiety and depression relative to control, but CBM-I was superior at reducing negative interpretive bias under high cognitive load.

Key findings

  • Both CBM-I and cCBT significantly reduced social anxiety (FNE, SPIN), trait anxiety (STAI-T), and depression (BDI-II) relative to the no-intervention control, with no clear superiority of either active intervention. For SPIN, the Time × Group interaction was \(F(2, 60) = 7.55, p = .001, \eta^2 = .20\).
  • Attentional control improved in both active groups relative to control (Group × Time \(F(2, 60) = 4.88, p = .01, \eta^2 = .14\)), and CBM-I and cCBT did not differ significantly on this measure.
  • On the Scrambled Sentences Test under high mental load, both active groups reduced negative bias relative to control, but CBM-I was significantly more effective than cCBT (Load × Group \(F(2, 58) = 3.36, p = .042, \eta^2 = .10\); CBM-I vs. cCBT \(p = .05\)).
  • Clinically reliable SPIN reductions from above to below cutoff occurred in 5/13 CBM-I participants (38.5%), 6/14 cCBT participants (42.9%), and 0/13 control participants.

Methods

  • Randomized controlled trial: 71 recruited, 63 completed (20 men, 43 women; mean age = 22.7, SD = 5.87), screened with FNE ≥ 17 for high social anxiety; completers were allocated to CBM-I (\(n = 21\)), cCBT (\(n = 21\)), or no-intervention control (\(n = 21\)). Active interventions involved four sessions over 2 weeks; control participants attended only pre–post sessions.
  • Measures included FNE, SPIN, STAI-T, BDI-II, Attentional Control Scale, Ambiguous Social Situations Interpretation Questionnaire, and the Scrambled Sentences Test under high versus low cognitive load. CBM-I used ambiguous scenarios resolved positively; cCBT used the e-couch social anxiety program.
  • Main analyses were mixed-model ANOVAs, with complete-case analysis primary and intent-to-treat analyses for symptom outcomes; mediation used Preacher and Hayes’ multiple mediation procedure with bootstrapping.

Limitations

  • Stated by the authors: the sample was primarily Caucasian and young (mean age = 22.7), limiting generalizability; replication is needed in a suitably powered RCT, preferably with a clinical sample and other cCBT versions. The e-couch website had not yet been formally evaluated; attentional control and symptom outcomes were self-report; demand effects were possible; and outcomes were assessed only pre- and postintervention, with no follow-up.
  • Evident from the text: group sizes were small (\(n = 21\) completers per condition), cCBT compliance was not measured comparably to CBM-I task compliance, and there was no clinician-administered or objective behavioral assessment of clinical change.

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

Integrity signals

Registry

Crossref · 10.1037/a0029932

Cites

64 of 64 references verified0 citation errors · 0 not checkable

Statistics

38 tests recomputed · 0 with the reported and recomputed p on opposite sides of .05

Claims the paper makes

0 of 47 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    In complete-case analysis, 5 CBM-I participants (38.5%), 6 cCBT participants (42.9%), and 0 control participants displayed a reliable reduction on the SPIN from above to below the cutoff.

    “Of these, five CBM-I participants (38.5%), six cCBT participants (42.9%), and zero control participants displayed a reliable reduction in scores (RCI > 1.96) from above to below the cutoff value.”
    Quote in the paperSubstantial claim
  • Findingown data

    There was no significant difference between CBM-I and cCBT in reducing depression.

    “but there was no interaction between time and group: STAI, F(1, 40) = 1.63, p = .21, η2 = .04; BDI-II, F < 1, indicating that the interventions did not significantly differ in reducing trait anxiety and depression.”
    Quote in the paperSubstantial claim
  • Findingown data

    ITT analyses showed no significant difference between CBM-I and cCBT.

    “However, there was no significant difference in efficacy on any measure in a comparison of CBM-I and cCBT (all Fs < 2.11, all ps > .15, all ηp2s < .05).”
    Quote in the paperSubstantial claim
  • Findingown data

    There was no significant difference between CBM-I and cCBT in reducing social anxiety.

    “When comparing the two intervention groups (CBM-I vs. cCBT), there was no significant Time × Group interaction for FNE (F < 1) or SPIN, F(1, 40) = 1.05, p = .31, η2 = .03, suggesting that the two interventions did not significantly differ in reducing social anxiety.”
    Quote in the paperSubstantial claim
  • Findingown data

    A significant Group × Time interaction was revealed for attentional control scale scores, F(2, 60) = 4.88, p = .01, η2 = .14.

    “As predicted, a significant Group × Time interaction was revealed, F(2, 60) = 4.88, p = .01, η2 = .14.”
    Quote in the paperSubstantial claim
  • May combine two claims. 29
  • Classified as probably not a substantial claim. 25

  • May combine two claims.

    Findingown data

    Both CBM-I and cCBT reduced depression relative to the control group.

    “the predicted Time × Group interactions were evident when comparing CBM-I with the control group: STAI, F(1, 40) = 5.64, p = .02, η2 = .12; BDI-II, F(1, 40) = 4.50, p = .04, η2 = .10, and cCBT with the control group: STAI, F(1, 40) = 11.93, p = .001, η2 = .23; BDI-II, F(1, 39) = 7.22, p = .01, η2 = .16, indicating relatively greater reductions in trait anxiety and depression in the intervention”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Both CBM-I and cCBT reduced trait anxiety relative to the control group.

    “the predicted Time × Group interactions were evident when comparing CBM-I with the control group: STAI, F(1, 40) = 5.64, p = .02, η2 = .12; BDI-II, F(1, 40) = 4.50, p = .04, η2 = .10, and cCBT with the control group: STAI, F(1, 40) = 11.93, p = .001, η2 = .23; BDI-II, F(1, 39) = 7.22, p = .01, η2 = .16, indicating relatively greater reductions in trait anxiety and depression in the intervention”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    ITT analyses showed that both CBM-I and cCBT were more efficacious than the control condition.

    “Follow-up analyses revealed that both CBM-I and cCBT, analysed separately, were more efficacious than the control condition (all Fs > 4.23, all ps < .05, all ηp2s > .08).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Changes in attentional control significantly mediate symptom improvement in cCBT but not in CBM-I.

    “changes in attentional control significantly mediate symptom improvement in cCBT but not in CBM-I”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The mediation analysis assumes no unmeasured confounding of the mediator–outcome relationship.

  • May combine two claims.

    Findingcitation

    On the clinically recommended SPIN, both intervention groups dropped over 7 points from a start point of moderate social anxiety, representing a clinically significant reduction in anxiety-related symptoms (Connor et al., 2000).

    “both intervention groups dropped over 7 points from a start point of moderate social anxiety, representing a clinically significant reduction in anxiety-related symptoms (Connor et al., 2000)”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Connor et al., 2000

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  • May combine two claims.

    Findingown data

    Both CBM-I and cCBT produced significant reductions in symptoms of social anxiety, trait anxiety, and depression, relative to the control group.

    “both CBM-I and cCBT produced significant reductions in symptoms of social anxiety, trait anxiety, and depression, relative to the control group”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Blackwell & Holmes, 2010

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    • cites Proudfoot et al., 2004

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    • Rests on an assumption: The e-couch program is a valid and adequate form of cCBT.

  • May combine two claims.

    Findingown data

    The two approaches do not differ significantly in their ability to reduce symptoms of anxiety and depression or to increase perceived attentional control, and both were superior to a no-intervention comparison condition.

    “The two approaches do not differ significantly in their ability to reduce symptoms of anxiety and depression or to increase perceived attentional control, and both were superior to a no-intervention comparison condition.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The e-couch program is a valid and adequate form of cCBT.

  • May combine two claims.

    Findingown data

    Although both CBM-I and cCBT were effective at reducing negative bias under load as compared with the control group, CBM-I was significantly more effective than cCBT.

    “although both CBM-I and cCBT were effective at reducing negative bias under load as compared with the control group, CBM-I was significantly more effective than cCBT”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingcitation

    Participants began the study with high self-reported fear of negative evaluation, and upon completion of either the CBM-I or the cCBT programs, this had dropped to within the range of average scorers (Watson & Friend, 1969).

    “Participants began the study with high self-reported fear of negative evaluation, and upon completion of either the CBM-I or the cCBT programs, this had dropped to within the range of average scorers (Watson & Friend, 1969).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Watson & Friend, 1969

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  • May combine two claims.

    Findingown data

    CBM-I and cCBT resulted in increases in perceived attentional control as compared with the control group (with no significant differences between CBM-I and cCBT).

    “CBM-I and cCBT resulted in increases in perceived attentional control as compared with the control group (with no significant differences between CBM-I and cCBT)”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Where the two active interventions do differ is in how well the effects of positive bias modification endure when generating outcomes of emotionally ambiguous scenarios, and under conditions of high cognitive load, with CBM-I showing superior performance.

    “Where the two active interventions do differ is in how well the effects of positive bias modification endure when generating outcomes of emotionally ambiguous scenarios, and under conditions of high cognitive load, with CBM-I showing superior performance.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    Combined cognitive bias modification for interpretation and attention led to reductions in state and trait anxiety over four sessions in a diagnosed clinical sample of individuals with social phobia/generalized anxiety disorder.

    “Similarly, Brosan, Hoppitt, Shelfer, Sillence, and Mackintosh (2011) found combined CBM-I and CBM-A led to reductions in state and trait anxiety over four sessions in a diagnosed, clinical sample of individuals with social phobia/generalized anxiety disorder.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Brosan et al., 2011

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

    Study design and conductown data

    Participants were randomly allocated to three conditions (CBM-I, cCBT, control) with approximately equal group sizes.

    “The 71 participants were randomly allocated to one of three conditions—interpretation bias modification (CBM-I; n = 25), cCBT (n = 24), or a control condition not involving any intervention (n = 22). Randomization was subject to the restriction that group sizes were approximately equal.”
    Quote in the paperSubstantial claim

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

    Study design and conductnone given

    All 21 cCBT participants attended all four cCBT sessions.

    “We did not have a comparable measure of cCBT compliance, although all 21 participants attended all four cCBT sessions.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    The results suggest that although not differing in therapeutic efficacy, CBM-I and cCBT might differ in the resilience of their effects when under mental load.

    “The results suggest that although not differing in therapeutic efficacy, CBM-I and cCBT might differ in the resilience of their effects when under mental load.”
    Quote in the paperSubstantial claim

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

    Study design and conductown data

    SST scoring had high inter-judge reliability at baseline and follow-up.

    “Judges' correlations were high at baseline (r = .99, p < .001) and follow-up (r = .96, p < .001).”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    Combined cognitive bias modification for attention plus interpretation can reduce self-reported symptoms of social anxiety in a highly socially anxious population compared with a control group.

    “Beard, Weisberg, and Amir (2011) provided preliminary indication that combined training can reduce self-reported symptoms of social anxiety in a highly socially anxious population compared with a control group.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Beard et al., 2011

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  • May combine two claims.

    Premisecitation

    Cognitive bias modification for attention reduces symptoms of social phobia over the time of training, with effects maintained at 4-month follow-up.

    “For example, CBM-A has been shown to reduce symptoms of social phobia over the time of training (50% vs. 14% in the trained vs. control condition no longer meeting diagnosis), with effects maintained at a 4-month follow-up (Amir et al., 2009).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Amir et al., 2009

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  • May combine two claims.

    Premisecitation

    Multiple sessions of cognitive bias modification for interpretation reduce trait anxiety, state anxiety, and general psychopathology.

    “similarly, Salemink, van den Hout, and Kindt (2009) demonstrated reductions in trait anxiety, state anxiety, and general psychopathology through multiple CBM-I sessions.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Salemink et al., 2009

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

    Premisecitation

    Highly socially anxious individuals can be trained to interpret novel stimuli benignly, interpret new situations less negatively, and self-report less anxiety about upcoming social events compared with a control group.

    “Murphy, Hirsch, Mathews, Smith, and Clark (2007) reported that highly socially anxious individuals were trained to interpret novel stimuli benignly, interpreted new situations less negatively, and self-reported less anxiety about upcoming social events, compared with a control group.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Murphy et al., 2007

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    Premisecitation

    Cognitive behavioral therapy can be efficacious in reducing symptoms of anxiety and threat-related bias.

    “Randomized controlled trials (RCTs) have shown that CBT can be efficacious in reducing symptoms of anxiety (Hofmann & Smits, 2008) and threat-related bias (e.g., Tobon, Ouimet, & Dozois, 2011).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Hofmann & Smits, 2008

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    • cites Tobon et al., 2011

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

    Study design and conductown data

    All participants who completed interpretation bias training fell within three standard deviations of the mean accuracy on comprehension question input, indicating good task compliance.

    “All participants who completed interpretation bias training (n = 21) fell within three standard deviations of the mean accuracy on comprehension question input, indicating good task compliance.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    A single session of avoid-threat cognitive bias modification for attention leads to greater activation in prefrontal areas associated with control mechanisms when participants attend to threat-relevant stimuli.

    “Browning, Holmes, Murphy, Goodwin, and Harmer (2010) demonstrated that following a single session of avoid-threat CBM-A, there was greater activation in prefrontal areas associated with control mechanisms when participants were required to attend to threat-relevant stimuli.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Browning et al., 2010

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

    Premisecitation

    Cognitive behavioral therapy works on the premise that maladaptive information processing has a causal role in anxiety and that correcting this thinking attenuates anxiety.

    “cognitive behavioral therapy (CBT) works on the premise that maladaptive information processing (e.g., attention and interpretation biases) has a causal role in anxiety and that when this thinking is corrected, anxiety will be attenuated (Beck & Clark, 1997; DeRubeis, Siegle, & Hollon, 2008).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Beck & Clark, 1997

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    • cites DeRubeis et al., 2008

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    Premisecitation

    Eight sessions of cognitive bias modification for attention reduces social and trait anxiety in individuals with generalized social anxiety disorder, with effects maintained at 4-month follow-up.

    “Consistent with this, Schmidt, Richey, Buckner, and Timpano (2009) demonstrated that eight sessions of CBM-A reduces social and trait anxiety in individuals with generalized social anxiety disorder (72% vs. 11% in the CBM-A vs. control condition no longer meeting DSM–IV diagnosis criteria), with effects maintained at 4-month follow-up.”
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    • cites Schmidt et al., 2009

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    Premisecitation

    Cognitive bias modification for interpretation might influence highly socially anxious participants' ability to disengage their attention from threat.

    “To date, one study has indicated that CBM for interpretation might influence highly socially anxious participants' ability to disengage their attention from threat (Amir, Bomyea, & Beard, 2010).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Amir et al., 2010

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    Premisecitation

    Internet-delivered self-help can lead to large posttreatment within-group reductions in social phobia symptoms, with improvements maintained at 6-month and 30-month follow-up.

    “Such Internet-delivered self-help can lead to large posttreatment within group reductions in social phobia symptoms (Cohen's d = 1.38–1.64), with improvements maintained at both 6-month (ds = 1.35–1.65) and 30-month follow-up (ds = 1.10–1.71; Berger et al., 2011; Carlbring, Nordgren, Furmack, & Andersson, 2009).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Berger et al., 2011

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    • cites Carlbring et al., 2009

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    Study design and conductreasoning

    Complete-case analysis was the primary approach used to analyze the data.

    “A complete-case analysis approach, where only participants with all data points complete are included, was the primary approach used to analyze the data due to the small number of cases who dropped out (see Figure 1) and because it was reasonable to assume that the data were missing at random (Little & Rubin, 1987).”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: The data were missing at random.

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    Premisecitation

    Cognitive behavioral therapy is thought to increase inhibitory executive control and improve functions of the prefrontal cortex that are impaired in anxiety.

    “CBT is thought to increase inhibitory executive control and appears to improve functions of the prefrontal cortex that are impaired in anxiety, such as directing attention away from threat distractors, volitional regulation of emotional responses, and reappraisal of meaning (DeRubeis et al., 2008).”
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    • cites DeRubeis et al., 2008

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    Premisecitation

    Anxious participants trained to disengage their attention from threat images displayed increased N2 amplitude.

    “In addition, Eldar and Bar-Haim (2010) found that anxious participants trained to disengage their attention from threat images displayed increased N2 amplitude (an event-related potential component that is associated with increases in attentional control).”
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    • cites Eldar & Bar-Haim, 2010

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    Premisecitation

    In Europe, only one quarter of those affected by mental illness are in any form of treatment.

    “In Europe, only one quarter of those affected by mental illness are in any form of treatment, indicating considerable unmet need (Wittchen & Jacobi, 2005).”
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    • cites Wittchen & Jacobi, 2005

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    Premisecitation

    Socially anxious individuals preferentially attend to negative social cues and perceive emotionally aversive meanings in ambiguous social situations.

    “Numerous studies have supported cognitive models of social anxiety, demonstrating that socially anxious individuals preferentially attend to negative social cues, such as angry faces (attention bias; e.g., for a review, see Bar-Haim, Lamy, Pergamin, Bakermans-Kranenburg, & van IJzendoorn, 2007) and perceive emotionally aversive meanings in ambiguous social situations (interpretation bias; e.g., St”
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    • cites Bar-Haim et al., 2007

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    • cites Stopa & Clark, 2000

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    Premisecitation

    In a recovered depressed sample, generation of more negative sentences in the load condition indicated that negative depressogenic constructs remained accessible, suggesting their activation was being effortfully down-regulated in the no-load condition.

    “The generation of more negative sentences in the load condition indicated that negative depressogenic constructs remained accessible in this recovered depressed sample, suggesting that their activation was being effortfully down-regulated in the no-load condition.”
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    • cites Watkins & Moulds, 2007

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    Premisecitation

    Threat-related information-processing biases are an important maintaining factor within social anxiety disorder.

    “Cognitive theories (e.g., Beck & Clark, 1997; Mathews & Mackintosh, 1998) suggest that threat-related information-processing biases are an important maintaining factor within the disorder.”
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    • cites Beck & Clark, 1997

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    • cites Mathews & Mackintosh, 1998

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    Premisecitation

    A potential complicating factor of the SST paradigm would occur if the groups differed in the effort they applied in remembering the six-digit number in the load condition.

    “As noted by Wenzlaff, Rude, Taylor, Stultz, and Sweatt (2001), a potential complicating factor of the SST paradigm would occur if the groups differed in the effort they applied in remembering the six-digit number in the load condition.”
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    • cites Wenzlaff, Rude, Taylor, Stultz, and Sweatt (2001)

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    Study design and conductnone given

    We only assessed outcomes at pre- and postintervention.

    “we only assessed outcomes at pre- and postintervention”
    Quote in the paperSubstantial claim

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

    Interpretationreasoning

    The self-report nature of the measure of attentional control leaves open the possibility that, rather than improving actual attentional control, we have instead increased individual perception of, or optimism related to, attentional control.

    “the self-report nature of the measure of attentional control leaves open the possibility that, rather than improving actual attentional control, we have instead increased individual perception of, or optimism related to, attentional control”
    Quote in the paperNot a substantial claim

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    Interpretationown data

    This mechanism also appears to be active in cCBT, and in addition changes in perceived attentional control contributed to symptom improvement following cCBT.

    “This mechanism also appears to be active in cCBT, and in addition changes in perceived attentional control contributed to symptom improvement following cCBT.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The mediation analysis assumes no unmeasured confounding of the mediator–outcome relationship.

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

    Interpretationown data

    This finding fits with prior studies and models that have claimed cognitive bias modification techniques could be more data driven and automated (e.g., Mathews & Mackintosh, 2000) and that participants are not necessarily conscious of resultant changes (Hertel & Mathews, 2011).

    “This finding fits with prior studies and models that have claimed cognitive bias modification techniques could be more data driven and automated (e.g., Mathews & Mackintosh, 2000) and that participants are not necessarily conscious of resultant changes (Hertel & Mathews, 2011).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Mathews & Mackintosh, 2000

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    • cites Hertel & Mathews, 2011

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    Interpretationown data

    Our sample is primarily Caucasian and relatively young (mean age = 22.7), and so our results may not be generalizable to the broader population.

    “our sample is primarily Caucasian and relatively young (mean age = 22.7), and so our results may not be generalizable to the broader population”
    Quote in the paperNot a substantial claim

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

    Study design and conductown data

    Five participants could not be included in the analysis of rankings data because they failed to rank outcomes.

    “Five participants could not be included in the analysis of rankings data because they failed to rank outcomes.”
    Quote in the paperNot a substantial claim

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

    Study design and conductown data

    Five participants could not be included in the analysis because they failed to produce belief ratings.

    “Five participants could not be included in the analysis because they failed to produce belief ratings.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    We conclude that these two approaches could be used as alternative or complementary interventions to reduce anxiety.

    “We conclude that these two approaches could be used as alternative or complementary interventions to reduce anxiety.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    The present population reflects the people who are likely to use low-intensity computerized interventions, for which diagnosis is not routine.

    “the present population reflects the people who are likely to use low-intensity computerized interventions, for which diagnosis is not routine”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    A chi-square analysis of recall scores at baseline indicated no reliable differences among the three groups of participants (χ2 < 1), and all participants were included in the final analyses.

    “A chi-square analysis of recall scores at baseline indicated no reliable differences among the three groups of participants (χ2 < 1), and all participants were included in the final analyses.”
    Quote in the paperSubstantial claim

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

    Premisecitation

    The e-couch website has not yet been formally evaluated, although an RCT is presently assessing its efficacy (Christensen et al., 2010).

    “the e-couch website has not yet been formally evaluated, although an RCT is presently assessing its efficacy (Christensen et al., 2010)”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Christensen et al., 2010

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    Study design and conductnone given

    Two participants (one in the cCBT group and one in the control group) were excluded from the analysis because they did not follow instructions correctly.

    “Two participants (one in the cCBT group and one in the control group) were excluded from the analysis because they did not follow instructions correctly.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    The present improvement in attentional control in the CBM-I condition suggests that, following CBM-I, individuals also feel better able to control their attention but that this may not be a key active ingredient of the intervention.

    “The present improvement in attentional control in the CBM-I condition suggests that, following CBM-I, individuals also feel better able to control their attention but that this may not be a key active ingredient of the intervention”
    Quote in the paperSubstantial claim
48 of 48

  • The authors state this as an assumption.

    The data were missing at random.

    “because it was reasonable to assume that the data were missing at random (Little & Rubin, 1987).”

  • The paper relies on this without support.

    The e-couch program is a valid and adequate form of cCBT.

    “the e-couch website has not yet been formally evaluated, although an RCT is presently assessing its efficacy (Christensen et al., 2010)”

  • The paper relies on this without support.

    The mediation analysis assumes no unmeasured confounding of the mediator–outcome relationship.

    “We used the multiple mediation procedure developed by Preacher and Hayes (2008) to examine whether change in symptoms in the two active interventions was driven by change in interpretive bias or attentional control.”
3 of 3

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?

Statistics that don’t add up

Each reported p-value recomputed from its test statistic and degrees of freedom.

  • p-value fits an unstated one-tailed test: F(1, 40) = 12.18, p < .001

    Minor

    The paper reports p < .001 here; recomputing from the test statistic and its degrees of freedom gives p = .001. The reported value is what a one-tailed test gives, but the paper does not say near this result that a one-tailed test was used.

    Reported p < .001 · recomputed p = .001

  • Inconsistent p-value: F(2, 59) = 3.95, p = .03

    Minor

    The paper reports p = .03 here; recomputing from the test statistic and its degrees of freedom gives p = .025. The check cannot tell whether the statistic or the p-value is the misprint.

    Reported p = .03 · recomputed p = .025

2 of 2

Statistics recomputed

Every reported test result, recomputed from its test statistic and degrees of freedom. A result shows as not adding up only once an independent check has confirmed it.

  • Doesn’t add upF(2, 59) = 3.95reported p = .03 · recomputed p = .025

    “F(2, 59) = 3.95, p = .03”

  • Doesn’t add upF(1, 40) = 12.18reported p < .001 · recomputed p = .001

    “F(1, 40) = 12.18, p < .001”

  • ConsistentF(2, 60) = 3.84reported p = .03 · recomputed p = .027

    “F(2, 60) = 3.84, p = .03”

  • ConsistentF(2, 60) = 7.55reported p = .001 · recomputed p = .001

    “F(2, 60) = 7.55, p = .001”

  • ConsistentF(2, 60) = 6.71reported p = .002 · recomputed p = .002

    “F(2, 60) = 6.71, p = .002”

  • ConsistentF(1, 40) = 6.1reported p = .02 · recomputed p = .018

    “F(1, 40) = 6.10, p = .02”

  • ConsistentF(1, 40) = 8.13reported p = .007 · recomputed p = .007

    “F(1, 40) = 8.13, p = .007”

  • ConsistentF(1, 40) = 6.69reported p = .01 · recomputed p = .013

    “F(1, 40) = 6.69, p = .01”

  • ConsistentF(1, 40) = 18.09reported p < .001 · recomputed p < .001

    “F(1, 40) = 18.09, p < .001”

  • ConsistentF(1, 40) = 1.05reported p = .31 · recomputed p = .312

    “F(1, 40) = 1.05, p = .31”

  • ConsistentF(1, 40) = 5.64reported p = .02 · recomputed p = .022

    “F(1, 40) = 5.64, p = .02”

  • ConsistentF(1, 40) = 4.5reported p = .04 · recomputed p = .040

    “F(1, 40) = 4.50, p = .04”

  • ConsistentF(1, 40) = 11.93reported p = .001 · recomputed p = .001

    “F(1, 40) = 11.93, p = .001”

  • ConsistentF(1, 39) = 7.22reported p = .01 · recomputed p = .011

    “F(1, 39) = 7.22, p = .01”

  • ConsistentF(1, 40) = 21.24reported p < .001 · recomputed p < .001

    “F(1, 40) = 21.24, p < .001”

  • ConsistentF(1, 39) = 13.96reported p = .001 · recomputed p < .001

    “F(1, 39) = 13.96, p = .001”

  • ConsistentF(1, 40) = 1.63reported p = .21 · recomputed p = .209

    “F(1, 40) = 1.63, p = .21”

  • ConsistentF(2, 60) = 4.88reported p = .01 · recomputed p = .011

    “F(2, 60) = 4.88, p = .01”

  • ConsistentF(1, 40) = 2.27reported p = .14 · recomputed p = .140

    “F(1, 40) = 2.27, p = .14”

  • ConsistentF(1, 40) = 8.11reported p = .007 · recomputed p = .007

    “F(1, 40) = 8.11, p = .007”

  • ConsistentF(1, 40) = 5.79reported p = .02 · recomputed p = .021

    “F(1, 40) = 5.79, p = .02”

  • ConsistentF(1, 59) = 27.41reported p < .001 · recomputed p < .001

    “F(1, 59) = 27.41, p < .001”

  • ConsistentF(1, 55) = 11.56reported p = .001 · recomputed p = .001

    “F(1, 55) = 11.56, p = .001”

  • ConsistentF(2, 59) = 7.08reported p = .002 · recomputed p = .002

    “F(2, 59) = 7.08, p = .002”

  • ConsistentF(2, 55) = 3.43reported p = .039 · recomputed p = .039

    “F(2, 55) = 3.43, p = .039”

  • ConsistentF(2, 59) = 6.65reported p = .002 · recomputed p = .002

    “F(2, 59) = 6.65, p = .002”

  • ConsistentF(2, 55) = 4.96reported p = .01 · recomputed p = .010

    “F(2, 55) = 4.96, p = .01”

  • ConsistentF(2, 59) = 7.21reported p = .002 · recomputed p = .002

    “F(2, 59) = 7.21, p = .002”

  • ConsistentF(2, 55) = 5.05reported p = .01 · recomputed p = .010

    “F(2, 55) = 5.05, p = .01”

  • ConsistentF(1, 55) = 3.86reported p = .054 · recomputed p = .055

    “F(1, 55) = 3.86, p = .054”

  • ConsistentF(1, 55) = 14.23reported p < .001 · recomputed p < .001

    “F(1, 55) = 14.23, p < .001”

  • ConsistentF(2, 55) = 4.96reported p = .01 · recomputed p = .010

    “F(2, 55) = 4.96, p = .010”

  • ConsistentF(2, 56) = 3.8reported p = .028 · recomputed p = .028

    “F(2, 56) = 3.80, p = .028”

  • ConsistentF(1, 58) = 5.95reported p = .02 · recomputed p = .018

    “F(1, 58) = 5.95, p = .02”

  • ConsistentF(2, 58) = 6.34reported p = .003 · recomputed p = .003

    “F(2, 58) = 6.34, p = .003”

  • ConsistentF(2, 58) = 3.36reported p = .042 · recomputed p = .042

    “F(2, 58) = 3.36, p = .042”

  • ConsistentF(2, 58) = 1.99reported p = .15 · recomputed p = .146

    “F(2, 58) = 1.99, p = .15”

  • ConsistentF(2, 58) = 10.81reported p < .001 · recomputed p < .001

    “F(2, 58) = 10.81, p < .001”

38 of 38

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.

  • Claimed superiority conflicts with the reported confidence interval

    Major

    The reported 95% confidence interval for the CBM-I versus cCBT difference under load includes zero. It therefore does not support the paper's conclusion that CBM-I was significantly more effective on this comparison.

1 of 1

Cites

Flagged first, then by citations

1 of the 65 references couldn’t be matched to a known paper.

Cited by

Sorted by citations

Related

Authors
Bowler, J. O., Mackintosh, B., Dunn, B. D., Mathews, A., Dalgleish, T., & Hoppitt, L.
Affiliations
  • University of East Anglia (GB)
  • MRC Cognition and Brain Sciences Unit (GB)
  • King's College London (GB)
ORCID
Venue
Journal of Consulting and Clinical Psychology
Publisher
American Psychological Association (APA)
Published
2012-12
Volume
80
Issue
6
Pages
1021-1033
ISSN
  • 0022-006X (ISSN-L)
  • 1939-2117
DOI
10.1037/a0029932
PMC
PMC3516492
OpenAlex
W2165245261
Semantic Scholar
6829c16cefbd6dbb0815588b130429f4914fc83b
Cited by
164
References
65
Citations by year
2026: 11 · 2025: 11 · 2024: 9 · 2023: 26 · 2022: 9 · 2021: 14 · 2020: 13 · 2019: 5 · 2018: 7 · 2017: 10 · 2016: 11 · 2015: 15 · 2014: 17 · 2013: 5 · 2012: 1
FWCI
16.28
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of Consulting and Clinical Psychology (publishedVersion, other-oa)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • Open Access at Essex (University of Essex) (submittedVersion)
  • UEA Digital Repository (University of East Anglia) (submittedVersion)
Funders
  • Wellcome Trust (083475)
  • Medical Research Council (U U1055.02.002.00001.01)
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 › Psychological Treatments and Assessments
Keywords
cognitive bias modification for interpretation, computerized cognitive behavioral therapy, social anxiety, interpretation bias, attentional control, mental workload, cognitive bias modification, depression, trait anxiety, treatment efficacy comparison
MeSH terms
Adolescent, Adult, Anxiety, Attention, Depression, Female, Humans, Male, Phobic Disorders, Therapy, Computer-Assisted, Cognitive Behavioral Therapy, Treatment Outcome, Comprehension

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.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

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