Cited by 235Anxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesPsychological Treatments and AssessmentsPsychotherapy Techniques and Applications

The DOI matches its Crossref record; 75 of the 75 references it cites were found in a registry or an index; none of the 50 sources its claims cite is checked for support yet.

How to Boost Positive Interpretations? A Meta-Analysis of the Effectiveness of Cognitive Bias Modification for Interpretation

Open access

Abstract

The current meta-analysis explores the strength of effects of cognitive bias modification training for interpretation bias (CBM-I) on positive (i.e., adaptive) interpretations and mood as well as the training and sample characteristics influencing these effects. Data-bases were searched with the key words "interpret* bias AND training" and "interpret* bias AND modif*". Reference lists of identified articles were checked and authors of identified articles were contacted for further relevant articles and unpublished data. Studies were reviewed for inclusion with eligibility criteria being that the study (a) aimed to target interpretation biases through any kind of training, (b) assessed mood and/or interpretation bias as outcome measures, (c) allocated individuals to training conditions at random, and (d) recruited adult samples. A meta-analytic multilevel mixed-effects model was employed to assess standardized mean changes in interpretation bias, negative mood, and emotional reactivity. In addition, several training and sample characteristics were explored for their potential to enhance benign training effectiveness. On average, benign CBM-I resulted in an increase in positive interpretation bias (p<.01) and a decrease in negative mood state (p<.001), but did not affect emotional reactivity. These effects were not consistently different from control conditions with no or neutral training. However, within benign training conditions imagery instructions and more training sessions were related to larger cognitive and mood effects, whereas feedback about training performance and inclusion of non-benign training items (instead of including benign items only) boosted cognitive effects only. Finally, training was more effective in women (cognitive and mood effects) and presumably samples with symptomatic emotional dysregulation (cognitive effects). Although the effects of emotional dysregulation and number of training sessions could not well be distinguished, there is an indication that when used with imagery instructions and more training sessions, benign CBM-I can be employed as a useful complementary treatment to usual psychotherapies.

Overview

AI snapshot

Written from the paper’s full text.

TL;DR

This meta-analysis of 42 articles (59 studies, 125 samples, 2,526 individuals) found that benign cognitive bias modification for interpretation (CBM-I) increased positive interpretation bias and decreased negative mood, but effects were not consistently different from neutral or no-training controls. Imagery instructions and more training sessions were the most consistent moderators of larger cognitive and mood effects.

Key findings

  • Benign CBM-I produced a large post-training difference favoring positive over negative interpretations (ES = 1.33, 95% CI 1.11–1.55, p < .001), significantly larger than neutral (ES = 0.49), negative (ES = −0.05), and no-training (ES = 0.28) conditions (all pairwise p < .001).
  • Pre- to post-training positive interpretation bias increased significantly only in benign training (ES = 0.43, 95% CI 0.17–0.69, p < .01), differing significantly only from negative training (ES = −0.22; pairwise ES = 0.65, p < .05).
  • Negative mood decreased significantly pre- to post-training in benign training (ES = 0.25, 95% CI 0.14–0.36, p < .001), but this did not differ significantly from neutral (ES = 0.22) or no-training (ES = −0.03) conditions; it did differ from negative training (ES = −0.20; pairwise ES = 0.44, p < .001).
  • Benign CBM-I did not attenuate negative mood reactivity after an emotional challenge: negative mood increased in all conditions (benign ES = −0.79, negative ES = −0.80, neutral ES = −1.03, no training ES = −0.77), with no significant pairwise differences.
  • Moderators: imagery instructions increased post-training positive-vs-negative bias from ES = 0.54 to 1.59 and pre-post positive bias by ES = 0.50; each additional session increased positive bias by ES = 0.08 and mood improvement by ES = 0.07; feedback increased pre-post positive bias by ES = 0.46; non-benign training items (ratio < 1) boosted cognitive effects; effects were larger in women and, for cognitive change, in symptomatic samples.

Methods

  • Systematic review and meta-analysis following PRISMA; databases searched through June 2013 with terms “interpret* bias AND training” and “interpret* bias AND modif*,” plus reference checks and author contacts.
  • Inclusion criteria: studies targeting interpretation bias through training, random allocation for multi-condition studies, interpretation bias and/or mood as outcomes, adult samples (healthy, subclinical/high-trait, or clinical anxiety/depression), and publication in English, German, or Dutch.
  • Multilevel mixed-effects meta-analytic models estimated standardized mean changes/differences for four contrasts: post-training positive vs negative interpretations, pre-post positive interpretation bias, pre-post negative mood, and pre-post emotional challenge negative mood; moderators were tested separately for benign training.

Limitations

  • The paper states that unpublished data and publication bias were addressed, with no indication of publication bias (funnel-plot asymmetry p-values = .72, .79, .46, .89), but it acknowledges that unpublished studies could still matter.
  • The paper states that it focused only on mood state, not the full symptom spectrum; effects on low mood were small, and effects on guilt, rumination, or other symptoms cannot be answered.
  • The paper states that moderators were tested separately, so their combined effects are unknown; repeated training sessions and symptomatic status were strongly associated (r = .73) and could not be well distinguished for pre-post positive interpretation bias.
  • Evident from the text: paradigm and imagery instructions were almost perfectly confounded (all AS paradigms used imagery; only one homograph paradigm did), so it is impossible to tell whether paradigm or imagery drove those effects; ratio < 1 was based on only three samples; neutral and no-training comparisons had much smaller sample counts than benign training, reducing power.

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Integrity signals

Registry

Crossref · 10.1371/journal.pone.0100925

Cites

75 of 75 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Figures

Figure 1 PRISMA flow chart of article retrieval and selection. Note. 1the search in June 2013 was conducted on separate searches of the data-bases as the software to do simultaneous searches was no longer available. In total, 109 hits were identified in June 2013. 2zero records were excluded for the search in 2013. 3ten records were screened for the search in 2013. 4four articles were excluded for the search in 2013. 5three articles were excluded for the search in 2013.
Figure 1 PRISMA flow chart of article retrieval and selection. Note. 1the search in June 2013 was conducted on separate searches of the data-bases as the software to do simultaneous searches was no longer available. In total, 109 hits were identified in June 2013. 2zero records were excluded for the search in 2013. 3ten records were screened for the search in 2013. 4four articles were excluded for the search in 2013. 5three articles were excluded for the search in 2013.CC BY · PubMed Central
Figure 2 Forest plot of post training difference between positive and negative interpretation bias. Note. Order of same conditions within one study follow the order of table 1.
Figure 2 Forest plot of post training difference between positive and negative interpretation bias. Note. Order of same conditions within one study follow the order of table 1.CC BY · PubMed Central
Figure 3 Forest plot of change in positive interpretation bias. Note. Order of same conditions within one study follow the order of table 1.
Figure 3 Forest plot of change in positive interpretation bias. Note. Order of same conditions within one study follow the order of table 1.CC BY · PubMed Central
Figure 4 Forest plot of change in negative mood. Note. Order of same conditions within one study follow the order of table 1.
Figure 4 Forest plot of change in negative mood. Note. Order of same conditions within one study follow the order of table 1.CC BY · PubMed Central
Figure 5 Forest plot of change in negative mood in response to an emotional challenge. Note. Order of same conditions within one study follow the order of table 1. The summary effect size for the no-training condition is not identical to the effect size reported for the sole study in this condition as the model took multiple nesting (within study and within one article) into account and ‘corrected’ for such effects in the summary effect size.
Figure 5 Forest plot of change in negative mood in response to an emotional challenge. Note. Order of same conditions within one study follow the order of table 1. The summary effect size for the no-training condition is not identical to the effect size reported for the sole study in this condition as the model took multiple nesting (within study and within one article) into account and ‘corrected’ for such effects in the summary effect size.CC BY · PubMed Central

Verification

Claims the paper makes

109 Own result · 39 Not checked yet · 29 Own interpretation · 25 Own method · 15 No basis given

Verify all 50 references — free account

Show all 112 claims

  • It may state two separate claims as one. 77
  • Probably not a substantial claim. 36
  • The quote only partly states this claim. 1
105 of 105
  • The paper relies on this without support.

    CBM-I was first introduced in 2000.

    “To the authors’ knowledge, CBM-I was first introduced in 2000; additional searches for the years 1992 through 1999 were conducted to ensure that no earlier and possibly less popular accounts were missed.”
  • The paper relies on this without support.

    It is currently unclear whether one of the various CBM-I paradigms used is more effective than others.

    “It is currently unclear whether one of the various CBM-I paradigms used (i.e., homograph, AS, and WSAT) is more effective than others.”
  • The paper relies on this without support.

    The administration of feedback about response accuracy has not yet been systematically tested.

    “However, to the best of the authors’ knowledge, this has not yet been systematically tested.”
  • The paper relies on this without support.

    Additional training characteristics such as mode of stimuli presentation and ratio of training items have not yet been systematically investigated.

    “Additional training characteristics, such as the mode of stimuli presentation (visual or auditory), and the ratio of training items in the benign training direction to the total number of presented items (i.e., does the fraction of benign items matter?) also frequently vary between CBM-I studies but have not yet been systematically investigated.”
  • The paper relies on this without support.

    Questions remain on the degree to which CBM can actually ‘correct’ biases and reduce symptomatology.

    “While recent individual studies appear promising, questions remain on the degree to which CBM can actually ‘correct’ biases and reduce symptomatology.”
  • The paper relies on this without support.

    The emotional challenges used in the included studies were universally stressful and not under the direct influence of interpretation biases.

    “For example, watching stressful videos [39], trying to solve an unsolvable anagram task under time pressure ‘knowing’ that ‘most people have no problems solving it in time’, e.g., see [9] or giving a speech, e.g. see [55] should be stressful for most individuals.”
  • The authors state this as an assumption.

    Individuals are confronted with ambiguous situations repeatedly in their daily lives.

    “assuming that individuals are confronted with ambiguous situations repeatedly in their daily lives”
  • The paper relies on this without support.

    Interpretation biases only start to play a role in reducing mood when people are confronted with ambiguous situations in their own life.

    “First, interpretation biases only start to play a role in reducing mood when people are confronted with ambiguous situations in their own life.”
  • The paper relies on this without support.

    Women are more vulnerable to develop mood symptoms.

    “particularly women (who are more vulnerable to develop mood symptoms)”
  • The paper relies on this without support.

    Healthy populations already possess a substantial positive interpretation bias to begin with.

    “as they already possess a substantial positive interpretation bias to begin with”
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Metadata

Authors
Menne-Lothmann, C., Viechtbauer, W., Höhn, P., Kasanova, Z., Haller, S. P., Drukker, M., van Os, J., Wichers, M., & Lau, J. Y. F.
Affiliations
  • Maastricht University (NL)
  • University of Oxford (GB)
  • King's College London (GB)
Venue
PLoS ONE
Published
2014-06-26
Volume
9
Issue
6
Pages
e100925
ISSN
1932-6203 (ISSN-L)
OpenAlex
W2036630076
Cited by
235
References
75
Citations by year
2026: 14 · 2025: 10 · 2024: 13 · 2023: 26 · 2022: 14 · 2021: 30 · 2020: 27 · 2019: 24 · 2018: 16 · 2017: 19 · 2016: 16 · 2015: 21 · 2014: 5
FWCI
2.75
Type
journal article
Language
en
Open access
Locations
  • PLoS ONE (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Research Publications (Maastricht University) (publishedVersion, cc-by)
  • RePEc: Research Papers in Economics (submittedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
  • Figshare (submittedVersion, cc-by)
  • Research Portal (King's College London) (submittedVersion, cc-by)
  • Research Publications (Maastricht University) (submittedVersion, other-oa)
Funders
Universiteit Maastricht
Topics
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
  • Social Sciences › Psychology › Clinical Psychology › Psychological Treatments and Assessments
  • Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
Keywords
cognitive bias modification for interpretation, interpretation bias, negative mood, emotional reactivity, imagery instructions, gender differences, emotional dysregulation
MeSH terms
Affect, Humans, Cognitive Behavioral Therapy, Outcome Assessment, Health Care

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