Cognitive bias modification of interpretations: A viable treatment for child and adolescent anxiety?
Section snippets
CBM-I principles and study designs
Cognitive Bias Modification of Interpretations (CBM-I) training was first developed to test the causal relationship between negative interpretational style and anxiety (Mathews & Mackintosh, 2000), as hypothesised by early cognitive theories of anxiety (Beck, Emery, & Greenberg, 1985). Extant data had already implicated the tendency to select negative interpretations of ambiguous cues in anxious individuals (Eysenck, Mogg, May, Richards, & Mathews, 1991). However, as the majority of these
CBM-I studies of symptomatic adults
Using this basic methodological set-up, a number of studies have assessed the effectiveness of CBM-I at training benign interpretational styles and boosting anxiety responses in individuals who meet criteria for clinically-significant anxiety problems or those selected on high levels of anxiety symptoms or trait anxiety (Table 1). Most of these studies have assessed the effectiveness of a single session of CBM-I (in comparison to neutral or no training conditions) with a few studies assessing
Developmental considerations
Perhaps the most obvious reason why one would extend CBM-I interventions to non-adult samples is for prevention. Extensive data implicate early-life as a period of onset for many anxiety disorders (Gregory et al., 2007, Kessler et al., 2007). Intervening when conditions first emerge may therefore attenuate lifelong problems such as persistent anxiety (Sahakian, Malloch, & Kennard, 2010). But why adopt CBM-I as an early intervention when there are other options? There is now ample data to
CBM-I studies of children and adolescents
There are now at least 15 studies that have implemented CBM-I methods in children and adolescents (Table 2). Most of these have focussed on children and adolescents recruited through the community, with a few targeting participants selected for high levels of anxiety and/or those with a clinical diagnosis. Developmental differences in the capacity to engage with CBM-I have warranted the creation of a range of training tasks, deviating in their interface to adult paradigms. For most adolescent
Outstanding questions
Developmental extensions of CBM-I have so far yielded promising results: adaptive interpretational styles can be trained in non-adult samples using simple tasks. However, before these tools are implemented in clinical settings, there are several remaining issues that need to be addressed. First, although data from Table 2 are encouraging, as with adult data, it is unclear whether training effects on interpretational style emerge through demand effects. This may be particularly likely if the
Conclusions
Cognitive Bias Modification of Interpretations (CBM-I) training has emerged as a potential clinical tool for treating adult anxiety disorders. Although data attesting to its effectiveness in adults continues to be debated, and its underlying assumptions sometimes challenged (e.g. Longmore and Worrell, 2007), its' potential as an early interventive tool in children and adolescents is just becoming apparent. However, ‘basic’ questions need to be addressed over the generalizability and persistence
Acknowledgements
I have received funding from the British Academy, Nuffield Trust and the Calleva Research Centre for Evolution and Human Sciences for work in this area.
References (67)
- et al.
The effect of single-session interpretation modification on attention bias in socially anxious individuals
Journal of Anxiety Disorders
(2010) - et al.
A multi-session interpretation modification program: changes in interpretation and social anxiety symptoms
Behaviour Research and Therapy
(2008) - et al.
Training interpretation biases among individuals with symptoms of obsessive compulsive disorder
Journal of Behavior Therapy and Experimental
(2011) - et al.
Reducing negative interpretations in adolescents with anxiety disorders: a preliminary study investigating the effects of a single session of cognitive bias modification training
Developmental Cognitive Neuroscience
(2013) The teen brain: insights from neuroimaging
Journal of Adolescent Health
(2008)- et al.
The effects of modifying interpretation bias on worry in generalized anxiety disorder
Behaviour Research and Therapy
(2010) - et al.
Attention training toward and away from threat in social phobia: effects on subjective, behavioral, and physiological measures of anxiety
Behaviour Research and Therapy
(2012) - et al.
Boosting positive cognitions reduces children's social anxiety: a novel bedtime story intervention
Behaviour Research and Therapy
(2013) - et al.
Anxiety-related biases in children's avoidant responses to a masked angry face
Behaviour Research and Therapy
(2007) - et al.
Do we need to challenge thoughts in cognitive behavior therapy?
Clinical Psychology Review
(2007)
On the malleability of emotional encoding
Behaviour Research and Therapy
Inducing a benign interpretational bias reduces trait anxiety
Journal of Behavior Therapy and Experimental Psychiatry
Ground control to Major Tom: experimental manipulation of anxiety-related interpretation bias by means of the “space odyssey” paradigm and effects on avoidance tendencies in children
Journal of Anxiety Disorders
Facilitating a benign interpretation bias in a high socially anxious population
Behaviour Research and Therapy
A UK strategy for mental health and wellbeing
Lancet
Effects of positive interpretive bias modification in highly anxious individuals
Journal of Anxiety Disorders
Adolescent threat-related interpretive bias and its modification: the moderating role of regulatory control
Behaviour Research and Therapy
Comparing visual and auditory presentation for the modification of interpretation bias
Journal of Behavior Therapy and Experimental Psychiatry
Can we harness computerised cognitive bias modification to treat anxiety in schizophrenia? A first step highlighting the role of mental imagery
Psychiatry Research
The impact of anxiety disorders on educational achievement
Journal of Anxiety Disorders
Experimental modification of interpretation bias in socially anxious children: changes in interpretation, anticipated interpersonal anxiety, and social anxiety symptoms
Behaviour Research and Therapy
Comparing imagery and verbal instructions for the experimental modification of interpretation and judgmental bias in children
Journal of Behavior Therapy and Experimental Psychiatry
Life course outcomes of young people with anxiety disorders in adolescence
Journal of the American Academy of Child & Adolescent Psychiatry
Interpretation training in individuals with generalized social anxiety disorder: a randomized controlled trial
Journal of Consulting and Clinical Psychology
The effects of attentional training on physiological stress recovery after induced social threat
Anxiety Stress Coping
Research review: attention bias modification (ABM): a novel treatment for anxiety disorders
Journal of Child Psychology and Psychiatry
Cognitive bias modification for anxiety: current evidence and future directions
Expert Review of Neurotherapeutics
Anxiety disorders and phobias. A cognitive perspective
Chronic childhood adversity and onset of psychopathology during three life stages: childhood, adolescence and adulthood
Journal of Psychiatric Research
Clinical course of Tourette syndrome
Journal of Psychosomatic Research
Child anxiety in primary care: prevalent but untreated
Depression and Anxiety
Bias in interpretation of ambiguous sentences related to threat in anxiety
Journal of Abnormal Psychology
A preliminary investigation of the effectiveness of single session cognitive bias modification of interpretations training in high-anxious adolescents
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