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Prescription 2014: Cognitive Bias Modification

June 23, 2014 Written by JP    [Font too small?]

Imagine walking into a party populated by a large group of relative strangers. As you scan the crowd, you detect certain people who seem to be glaring at you, feigning indifference or whispering disapprovingly. You also notice several friendly folks who nod warmly, smile or wave. After processing this information, feelings begin to form. Those who are prone to anxiety, depression and a host of related psychological conditions tend to magnify the number and/or significance of the negative impressions they perceive. On the other hand, those who have a more upbeat disposition have a “protective bias” against such depressing, distressing thoughts and subsequent feelings. If you happen to fall into the more neurotic camp, Cognitive Bias Modification (CBM) may be invaluable to your sanity and well being. Given enough practice and time, CBM can assist you to see and experience the more positive side of life.

Recently, while on a flight from Los Angeles to London, I happened upon “The Truth About Personality”, an entertaining and fascinating documentary produced by the BBC. The program examined why a significant percentage of people view the world in a more pessimistic way than others. Michael Mosley, the charismatic host of the documentary, personally investigated the topic and opened up about his own dour and neurotic mindset. Michael bravely agreed to have several measures of his own mental health scientifically evaluated on camera. He then engaged in Cognitive Bias Modification, a computer-based treatment program, to determine whether his test results and, ultimately, his life could be swayed towards a happier, more optimistic place. I won’t give away any spoilers about what he discovered. But, I highly recommend that you seek out this fascinating short film if this could be an area of interest for you or someone you know.

Cognitive Bias Modification is a seemingly simple computer program which instructs users to identify an accepting or smiling face in a grid of many other faces with negative expressions – anger, apathy, disgust, fear, etc. By playing this “game” on a consistent basis, at least three days a week for ten minutes each session, researchers have discovered profound improvements in mental health. In fact, trials conducted at the Baldwin Social Cognitive Lab at McGill University and elsewhere report that CBM reduces symptoms associated with maladies ranging from social anxiety disorder to unipolar depression. In addition, CBM can likewise assist those striving to improve scholastic and workplace performance by enhancing feelings of calm, concentration and confidence.

The benefits reported in the CBM studies are partially brought about by both long and short-term declines in cortisol, a stress hormone. Also, one experiment noted that altering attentional bias stabilizes the activity of key regions of the brain associated with the processing of emotions and stress – the amygdala and ventrolateral prefrontal cortex. And, for some, what may be most impressive is that these effects can begin to present themselves after just one CBM session – though the benefits tend to increase with time.

I’ve saved the best news about CBM for last. For one thing, it can be practiced in the privacy of your own home and it doesn’t require a prescription. It’s very safe. To date, there have been no reported side effects in the numerous, peer reviewed studies. Okay, okay, but it’s got to be expensive, right? If you’re interested in trying it, you can do so for free. A gratis, Internet-based version of a CBM program can be found here. If you’d rather have access to a CBM program for use on your mobile device, I highly recommend and use PsychMeUp! PRO, a widely available app for Android, iPad and iPhone. Now get out there and find the happy face! 🙂

Note: Please check out the “Comments & Updates” section of this blog – at the bottom of the page. You can find the latest research about this topic there!

To learn more about the studies referenced in today’s column, please click on the following links:

Study 1 – Cognitive Trainings Reduce Implicit Social Rejection Associations (link)

Study 2 – The Buffering Effects of Rejection-Inhibiting Attentional Training (link)

Study 3 – Cutting Stress Off at the Pass: Reducing Vigilance and Responsiveness(link)

Study 4 – The Inhibition of Socially Rejecting Information Among People with (link)

Study 5 – Attentional Biases for Angry Faces in Unipolar Depression (link)

Study 6 – Combined Cognitive Bias Modification Treatment for Social Anxiety (link)

Study 7 – Using Attentional Bias Modification as a Cognitive Vaccine Against (link)

Study 8 – Attention Training Towards Positive Stimuli in Clinically Anxious (link)

Study 9 – Combining Imagination and Reason in the Treatment of Depression (link)

Study 10 – Training-Associated Changes and Stability of Attention Bias in Youth (link)

Face (Cognitive) Bias Modification Improves Depression Symptoms

Source: Biol Psychiatry. Oct 1, 2012; 72(7): 572–579. (link)

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Posted in Alternative Therapies, Mental Health

8 Comments & Updates to “Prescription 2014: Cognitive Bias Modification”

  1. JP Says:

    Update 05/06/15:


    J Abnorm Psychol. 2015 Apr 20.

    Attention Bias Modification for Major Depressive Disorder: Effects on Attention Bias, Resting State Connectivity, and Symptom Change.

    Cognitive theories of depression posit that selective attention for negative information contributes to the maintenance of depression. The current study experimentally tested this idea by randomly assigning adults with Major Depressive Disorder (MDD) to 4 weeks of computer-based attention bias modification designed to reduce negative attention bias or 4 weeks of placebo attention training. Findings indicate that compared to placebo training, attention bias modification reduced negative attention bias and increased resting-state connectivity within a neural circuit (i.e., middle frontal gyrus and dorsal anterior cingulate cortex) that supports control over emotional information. Further, pre- to post-training change in negative attention bias was significantly correlated with depression symptom change only in the active training condition. Exploratory analyses indicated that pre- to post-training changes in resting state connectivity within a circuit associated with sustained attention to visual information (i.e., precuenus and middle frontal gyrus) contributed to symptom improvement in the placebo condition. Importantly, depression symptoms did not change differentially between the training groups-overall, a 40% decrease in symptoms was observed across attention training conditions. Findings suggest that negative attention bias is associated with the maintenance of depression; however, deficits in general attentional control may also maintain depression symptoms, as evidenced by resting state connectivity and depression symptom improvement in the placebo training condition.

    Be well!


  2. JP Says:

    Update 05/06/15:


    J Affect Disord. 2015 Jun 1;178:131-41.

    Positive imagery cognitive bias modification (CBM) and internet-based cognitive behavioral therapy (iCBT): A randomized controlled trial.

    BACKGROUND: Accruing evidence suggests that positive imagery-based cognitive bias modification (CBM) could have potential as a standalone targeted intervention for depressive symptoms or as an adjunct to existing treatments. We sought to establish the benefit of this form of CBM when delivered prior to Internet cognitive behavioral therapy (iCBT) for depression

    METHODS: A randomized controlled trial (RCT) of a 1-week Internet-delivered positive CBM vs. an active control condition for participants (N=75, 69% female, mean age=42) meeting diagnostic criteria for major depression; followed by a 10-week iCBT program for both groups.

    RESULTS: Modified intent-to-treat marginal and mixed effect models demonstrated no significant difference between conditions following the CBM intervention or the iCBT program. In both conditions there were significant reductions (Cohen׳s d .57-1.58, 95% CI=.12-2.07) in primary measures of depression and interpretation bias (PHQ9, BDI-II, AST-D). Large effect size reductions (Cohen׳s d .81-1.32, 95% CI=.31-1.79) were observed for secondary measures of distress, disability, anxiety and repetitive negative thinking (K10, WHODAS, STAI, RTQ). Per protocol analyses conducted in the sample of participants who completed all seven sessions of CBM indicated between-group superiority of the positive over control group on depression symptoms (PHQ9, BDI-II) and psychological distress (K10) following CBM (Hedges g .55-.88, 95% CI=-.03-1.46) and following iCBT (PHQ9, K10). The majority (>70%) no longer met diagnostic criteria for depression at 3-month follow-up.

    LIMITATIONS: The control condition contained many active components and therefore may have represented a smaller ‘dose’ of the positive condition.

    CONCLUSIONS: Results provide preliminary support for the successful integration of imagery-based CBM into an existing Internet-based treatment for depression.

    Be well!


  3. JP Says:

    Update 05/06/15:


    Addict Biol. 2015 Jan 13.

    Effects of cognitive bias modification training on neural signatures of alcohol approach tendencies in male alcohol-dependent patients.

    Alcohol-dependent patients have been shown to faster approach than avoid alcohol stimuli on the Approach Avoidance Task (AAT). This so-called alcohol approach bias has been associated with increased brain activation in the medial prefrontal cortex and nucleus accumbens. Cognitive bias modification (CBM) has been used to retrain the approach bias with the clinically relevant effect of decreasing relapse rates one year later. The effects of CBM on neural signatures of approach/avoidance tendencies remain hitherto unknown. In a double-blind placebo-controlled design, 26 alcohol-dependent in-patients were assigned to a CBM or a placebo training group. Both groups performed the AAT for three weeks: in CBM training, patients pushed away 90 percent of alcohol cues; this rate was 50 percent in placebo training. Before and after training, patients performed the AAT offline, and in a 3 T magnetic resonance imaging scanner. The relevant neuroimaging contrast for the alcohol approach bias was the difference between approaching versus avoiding alcohol cues relative to soft drink cues: [(alcohol pull > alcohol push)  > (soft drink pull > soft drink push)]. Before training, both groups showed significant alcohol approach bias-related activation in the medial prefrontal cortex. After training, patients in the CBM group showed stronger reductions in medial prefrontal cortex activation compared with the placebo group. Moreover, these reductions correlated with reductions in approach bias scores in the CBM group only. This suggests that CBM affects neural mechanisms involved in the automatic alcohol approach bias, which may be important for the clinical effectiveness of CBM.

    Be well!


  4. JP Says:

    Updated 09/02/15:


    Psychiatry Res. 2015 Jul 21.

    Imagining a brighter future: The effect of positive imagery training on mood, prospective mental imagery and emotional bias in older adults.

    Positive affect and optimism play an important role in healthy ageing and are associated with improved physical and cognitive health outcomes. This study investigated whether it is possible to boost positive affect and associated positive biases in this age group using cognitive training. The effect of computerised imagery-based cognitive bias modification on positive affect, vividness of positive prospective imagery and interpretation biases in older adults was measured. 77 older adults received 4 weeks (12 sessions) of imagery cognitive bias modification or a control condition. They were assessed at baseline, post-training and at a one-month follow-up. Both groups reported decreased negative affect and trait anxiety, and increased optimism across the three assessments. Imagery cognitive bias modification significantly increased the vividness of positive prospective imagery post-training, compared with the control training. Contrary to our hypothesis, there was no difference between the training groups in negative interpretation bias. This is a useful demonstration that it is possible to successfully engage older adults in computer-based cognitive training and to enhance the vividness of positive imagery about the future in this group. Future studies are needed to assess the longer-term consequences of such training and the impact on affect and wellbeing in more vulnerable groups.

    Be well!


  5. JP Says:

    Updated 09/02/15:


    Am J Drug Alcohol Abuse. 2015 Jul 17:1-8.

    Re-training automatic action tendencies to approach cigarettes among adolescent smokers: a pilot study.

    BACKGROUND: This pilot study conducted a preliminary examination of whether Cognitive Bias Modification (CBM), a computerized task to retrain cognitive-approach biases towards smoking stimuli (a) changed approach bias for cigarettes, and (b) improved smoking cessation outcomes in adolescent smokers.

    METHODS: Sixty adolescent smokers received four weeks of Cognitive Behavioral Therapy (CBT) for smoking cessation, with CBM (90% avoidance/10% approach for smoking stimuli and 10% avoidance/90% approach for neutral stimuli) or sham (50% avoidance/50% approach for smoking and neutral stimuli) training in the Netherlands (n = 42) and the United States (n = 18).

    RESULTS: While we did not observe changes in action tendencies related to CBM, adolescents with higher smoking approach biases at baseline had greater decreases in approach biases at follow-up, compared to adolescents with smoking avoidance biases, regardless of treatment condition (p = 0.01). Intent-to-treat (ITT) analyses showed that CBM, when compared with sham trended toward higher end-of-treatment, biochemically-confirmed, seven-day point prevalence abstinence, (17.2% vs. 3.2%, p = 0.071). ITT analysis also showed that regardless of treatment condition, cotinine level (p = 0.045) and average number of cigarette smoked (p ≤ 0.001) significantly decreased over the course of treatment.

    CONCLUSIONS: The findings from this pilot study suggests that re-training approach biases toward cigarettes shows promise for smoking cessation among adolescent smokers. Future research should utilize larger samples and increased distinction between CBM and sham conditions, and examine mechanisms underlying the CBM approach.

    Be well!


  6. JP Says:

    Updated 10/12/15:


    Cognit Ther Res. 2015 Aug;39(4):424-440.

    Preliminary Evidence for the Enhancement of Self-Conducted Exposures for OCD using Cognitive Bias Modification.

    Exposure and Response Prevention (ERP) is the most effective treatment for OCD but it is not accessible to most patients. Attempts to increase the accessibility of ERP via self-directed ERP (sERP) programs such as computerized delivery and bibliotherapy have met with noncompliance, presumably because patients find the exposure exercises unacceptable. Previous research suggests that Cognitive Bias Modification (CBM) interventions may help individuals approach feared situations. The goal of the current study was to test the efficacy of a treatment program for OCD that integrates sERP with CBM. Twenty-two individuals meeting diagnostic criteria for OCD enrolled in our 7-week treatment program. Results suggest that sERP with CBM led to significant reduction of OCD symptoms and functional impairment. Indeed, the magnitude of the effect of this novel treatment, that requires only an initial session with a clinician trained in ERP for OCD, was comparable to that of the gold standard clinician-administered ERP. Moreover, preliminary evidence suggests that CBM interventions targeting interpretation bias may be most effective, whereas those targeting attention and working memory bias may not be so.

    Be well!


  7. JP Says:


    Appetite. 2015 Sep 12;96:219-224.

    Bias modification training can alter approach bias and chocolate consumption.

    Recent evidence has demonstrated that bias modification training has potential to reduce cognitive biases for attractive targets and affect health behaviours. The present study investigated whether cognitive bias modification training could be applied to reduce approach bias for chocolate and affect subsequent chocolate consumption. A sample of 120 women (18-27 years) were randomly assigned to an approach-chocolate condition or avoid-chocolate condition, in which they were trained to approach or avoid pictorial chocolate stimuli, respectively. Training had the predicted effect on approach bias, such that participants trained to approach chocolate demonstrated an increased approach bias to chocolate stimuli whereas participants trained to avoid such stimuli showed a reduced bias. Further, participants trained to avoid chocolate ate significantly less of a chocolate muffin in a subsequent taste test than participants trained to approach chocolate. Theoretically, results provide support for the dual process model’s conceptualisation of consumption as being driven by implicit processes such as approach bias. In practice, approach bias modification may be a useful component of interventions designed to curb the consumption of unhealthy foods.

    Be well!


  8. JP Says:

    Updated 09/14/16:


    Alcohol Clin Exp Res. 2016 Sep;40(9):2011-9.

    Cognitive Bias Modification Training During Inpatient Alcohol Detoxification Reduces Early Relapse: A Randomized Controlled Trial.

    BACKGROUND: Relapse is common in alcohol-dependent individuals and can be triggered by alcohol-related cues in the environment. It has been suggested that these individuals develop cognitive biases, in which cues automatically capture attention and elicit an approach action tendency that promotes alcohol seeking. The study aim was to examine whether cognitive bias modification (CBM) training targeting approach bias could be delivered during residential alcohol detoxification and improve treatment outcomes.

    METHODS: Using a 2-group parallel-block (ratio 1:1) randomized controlled trial with allocation concealed to the outcome assessor, 83 alcohol-dependent inpatients received either 4 sessions of CBM training where participants were implicitly trained to make avoidance movements in response to pictures of alcoholic beverages and approach movements in response to pictures of nonalcoholic beverages, or 4 sessions of sham training (controls) delivered over 4 consecutive days during the 7-day detoxification program. The primary outcome measure was continuous abstinence at 2 weeks postdischarge. Secondary outcomes included time to relapse, frequency and quantity of alcohol consumption, and craving. Outcomes were assessed in a telephonic follow-up interview.

    RESULTS: Seventy-one (85%) participants were successfully followed up, of whom 61 completed all 4 training sessions. With an intention-to-treat approach, there was a trend for higher abstinence rates in the CBM group relative to controls (69 vs. 47%, p = 0.07); however, a per-protocol analysis revealed significantly higher abstinence rates among participants completing 4 sessions of CBM relative to controls (75 vs. 45%, p = 0.02). Craving score, time to relapse, mean drinking days, and mean standard drinks per drinking day did not differ significantly between the groups.

    CONCLUSIONS: This is the first trial demonstrating the feasibility of CBM delivered during alcohol detoxification and supports earlier research suggesting it may be a useful, low-cost adjunctive treatment to improve treatment outcomes for alcohol-dependent patients.

    Be well!


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