Cognitive bias modification

Cognitive bias modification (CBM) refers to the process of modifying cognitive biases in healthy people and also refers to a growing area of psychological (non-pharmaceutical) therapies for anxiety, depression and addiction called CBMT. Cognitive bias modification therapy (CBMT) is sub-group of therapies within a growing area of psychological therapies based on modifying cognitive processes with or without accompanying medication and talk therapy, sometimes referred to as Applied Cognitive Processing Therapies (ACPT). Other ACPTs include attention training,[1] interpretation modification,[2] approach/avoid training,[3] imagery modification training,[4] eye movement desensitization and reprocessing therapy[5] for PTSD.

According to Yiend et al. 2013 in an article in the peer reviewed scientific journal Cognitive Therapy Research, "CBM treatments are a more convenient and flexible than other modes of treatment because they do not require meetings with a therapist. They offer the potential for delivery using modern technologies (e.g. internet or mobile phone) and require minimal supervision. They could therefore become highly cost effective and widely accessible. CBM methods are also less demanding and more acceptable to patients than traditional therapies. This is because personal thoughts and beliefs are not directly interrogated, and there is no need for social interaction or stigmatizing visits to outpatient clinics. Similarly, patient insight is not required because CBM seeks to target the underlying maintaining cognitive bias directly; therefore, patient engagement is likely to be easier. In sum, CBM methods offer a high gain, low cost treatment option because they can circumvent many of the practical and psychological requirements that disadvantage competing psychological interventions[6]

CBMT techniques are technology assisted therapies that are delivered via a computer with or without clinician support. CBM combines evidence and theory from the cognitive model of anxiety.[7] cognitive neuroscience[8][9] and attentional models.[10][11][12]

CBM can be seen as one version of attentional retraining. It has been described as a 'cognitive vaccine'.[13]

Efficacy evidence base and other research

CBMT is a growing area of evidence-based psychological therapy,[14][15][16] in which cognitive processes are modified to relieve suffering from serious;

CBM has been found to change brain activity, moving prefrontal cortex activity more to the left side, which is normally associated with more positive and happier thinking.[43]

Description

Some CBM apps ask the user to consistently select 'good' or 'positive' images over 'bad' or 'negative' ones. For CBM applications that are designed to reduce anxiety, the user may be asked to repeatedly select the smiling face amongst a group of faces, to help overcome the tendency to focus on negative or threatening social cues. CBM may also be useful in the treatment of mood and addiction disorders.

A layman's explanation: how does it reduce anxiety?

(From Beard, C., R.B. Weisberg, and N. Amir, Combined cognitive bias modification treatment for social anxiety disorder: a pilot trial. Depression and Anxiety, 2011. 28(11): p. 981-988.[44])

"CBMT changes how you think and mentally respond to everyday things in your life—your mental habits. CBMT changes mental habits in a new way that may be better than past treatments. These mental habits are often hard to control. For example, people with anxiety have a tendency to focus their attention on negative information. They also tend to interpret ambiguous information as negative. This habit is so automatic that it is very difficult to "catch" or change on purpose. However, just like other habits, such as typing or riding a bicycle, with practice we can change these mental habits and have new 'nonanxiety-related' habits become automatic."

Attention bias

"People differ in how they focus their attention. What you pay attention to plays an important role in how safe or unsafe you feel. If you tend to focus your attention on negative aspects of a situation or cues that might signal danger, you will be more likely to become excessively anxious. Also, the more you look for something, the more likely it is that you will find it; so, if you are always looking for signs of danger, you will be more likely to see danger."

Interpretation bias

"People differ in how they interpret ambiguous information in their environment as well. An interpretation bias or a tendency to interpret situations negatively also plays an important role in how safe or unsafe each situation seems to you. If you tend to think of situations as negative, you will be more likely to become excessively anxious. Because, in everyday life, many situations are ambiguous, a negative interpretation bias will lead to most situations being seen as negative. Moreover, by expecting a negative outcome, people with anxiety often create what is called a "self-fulfilling prophecy". For example, if you walk into a party and expect people will not talk to you, you may be cold to them, and as a result, it is more likely that they will not talk to you."

Attention training

Further information: Attentional retraining

The attentional bias is one of several different cognitive biases. The attentional bias is the tendency of certain salient cues in a person's environment to preferentially draw and/or hold the person's attention. For example, individuals with anxiety disorders demonstrate an automatic attentional bias towards threatening cues in their environment and drug users and addicts demonstrate an automatic attentional bias towards drug related cues in their environment.[45][46]

The rise of research in cognitive bias modification has led to the recent publication of a special issue of the Journal of Abnormal Psychology[47] focusing on the methods and technologies used for cognitive bias modification in psychopathology. Attentional retraining as cognitive bias modification is predicated on the observed attentional bias evident in psychopathology. The most common task used to retrain attention in psychopathologies is the dot-probe task developed originally by Macleod et al. (1986). If attentional biases have a causal role on the maintenance of anxiety or drug addictions then lowering the attentional biases should therefore lower feelings of anxiety amongst the anxious and craving and promote abstinence amongst the drug addicted.

Criticisms and limitations

One concern is whether CBM modification procedures will achieve lasting benefits. This is not yet clear from research.[48]

Another concern is that participants with cognitive vulnerability are not able to maintain their new learning even within a CBM course, with their negative cognitive bias beginning to re-emerge over time.[49]

A recent (January 2015) meta-analysis of 49 trials looking at outcomes for anxiety and depression casts doubt on value of CBM. The paper concluded that 'CBM may have small effects on mental health problems, but it is also possible that there are no significant clinically relevant effects.' It notes that research is hampered by small low quality trials and by risk of publication bias.[50]

Likewise, a recent meta-analysis[51] also casts doubt on the value of Attention Bias Modification (ABM) as a treatment for social anxiety disorder (SAD). In this meta-analysis, the authors assessed the efficacy of ABM for SAD on symptoms, reactivity to speech challenge, attentional bias (AB) toward threat, and secondary symptoms at posttraining as well as SAD symptoms at 4-month follow-up. A systematic search in bibliographical databases uncovered 15 randomized studies involving 1043 individuals that compared ABM to a control training procedure. Data were extracted independently by two raters. All analyses were conducted on intent-to-treat data. Results revealed that ABM produces a small but significant reduction in SAD symptoms (g = 0.27), reactivity to speech challenge (g = 0.46), and AB (g = 0.30). These effects were moderated by characteristics of the ABM procedure, the design of the study, and trait anxiety at baseline. However, effects on secondary symptoms (g = 0.09) and SAD symptoms at 4-month follow-up (g = 0.09) were not significant. Although there was no indication of significant publication bias, the authors identified that quality of the studies was substandard and wedged the effect sizes. From a clinical point of view, these findings imply that ABM is not yet ready for wide-scale dissemination as a treatment for SAD in routine care.

See also

References

  1. ↑ Klumpp, H.; Amir, N. (2010). "Preliminary Study of Attention Training to Threat and Neutral Faces on Anxious Reactivity to a Social Stressor in Social Anxiety". Cognitive Therapy and Research. 34 (3): 263–271. doi:10.1007/s10608-009-9251-0.
  2. ↑ Mathews, A.; Ridgeway, V.; Cook, E.; Yiend, J. (2007). "Inducing a benign interpretational bias reduces trait anxiety". J Behav Ther Exp Psychiatry. 38 (2): 225–236. doi:10.1016/j.jbtep.2006.10.011.
  3. ↑ Eberl, C.; Wiers, R. W.; Pawelczack, S.; Rinck, M.; Becker, E. S.; Lindenmeyer, J. (2013). "Approach bias modification in alcohol dependence: Do clinical effects replicate and for whom does it work best?". Developmental Cognitive Neuroscience. 4 (0): 38–51. doi:10.1016/j.dcn.2012.11.002.
  4. ↑ Mathews, A.; MacLeod, C. (2002). "Induced processing biases have causal effects on anxiety". Cognition & Emotion. 16 (3): 331–354. doi:10.1080/02699930143000518.
  5. ↑ Shapiro, Francine. "EMDR and the adaptive information processing model: Integrative treatment and case conceptualization". Clinical Social Work Journal. 39: 191–200. doi:10.1007/s10615-010-0300-7.
  6. ↑ Yiend, J.; Lee, J. S.; Tekes, S.; Atkins, L.; Mathews, A.; Vrinten, M.; Shergill, S. (2013). "Modifying Interpretation in a Clinically Depressed Sample Using 'Cognitive Bias Modification-Errors': A Double Blind Randomized Controlled Trial". Cognitive Therapy and Research. 38: 146–159. doi:10.1007/s10608-013-9571-y.
  7. ↑ Clark, D. A., & Beck, A. T. (2009). Cognitive Therapy of Anxiety Disorders: Science and Practice. London: Guildford.
  8. ↑ Browning, M.; Holmes, E. A.; Murphy, S. E.; Goodwin, G. M.; Harmer, C. J. (2010). "Lateral Prefrontal Cortex Mediates the Cognitive Modification of Attentional Bias". Biological Psychiatry. 67 (10): 919–925. doi:10.1016/j.biopsych.2009.10.031. PMC 2866253Freely accessible. PMID 20034617.
  9. ↑ Eldar, S.; Bar-Haim, Y. (2010). "Neural plasticity in response to attention training in anxiety". Psychological Medicine. 40 (4): 667–677. doi:10.1017/s0033291709990766.
  10. ↑ Koster, E. H.; De Lissnyder, E.; Derakshan, N.; De Raedt, R. (2011). "Understanding depressive rumination from a cognitive science perspective: the impaired disengagement hypothesis". Clin Psychol Rev. 31 (1): 138–145. doi:10.1016/j.cpr.2010.08.005.
  11. ↑ Eysenck, M. W.; Derakshan, N.; Santos, R.; Calvo, M. G. (2007). "Anxiety and cognitive performance: Attentional control theory". Emotion. 7 (2): 336–353. doi:10.1037/1528-3542.7.2.336.
  12. ↑ De Lissnyder, E.; Koster, E. H. W.; Derakshan, N.; De Raedt, R. (2010). "The association between depressive symptoms and executive control impairments in response to emotional and non-emotional information". Cognition & Emotion. 24 (2): 264–280. doi:10.1080/02699930903378354.
  13. ↑ http://www.economist.com/node/18276234
  14. ↑ MacLeod, C.; Mathews, A. (2012). "Cognitive Bias Modification Approaches to Anxiety". Annu Rev Clin Psychol. 8: 189–217. doi:10.1146/annurev-clinpsy-032511-143052.
  15. ↑ Koster, E. H. W.; Fox, E.; MacLeod, C. (2009). "Introduction to the special section on cognitive bias modification in emotional disorders". Journal of Abnormal Psychology. 118 (1): 1–4. doi:10.1037/a0014379.
  16. ↑ Beard, C (2011). "Cognitive bias modification for anxiety: current evidence and future directions". Expert Review of Neurotherapeutics. 11 (2): 299–311. doi:10.1586/ern.10.194. PMC 3092585Freely accessible. PMID 21306216.
  17. ↑ Holmes, E. A.; Lang, T. J.; Shah, D. M. (2009). "Developing interpretation bias modification as a "cognitive vaccine" for depressed mood: imagining positive events makes you feel better than thinking about them verbally". J Abnorm Psychol. 118 (1): 76–88. doi:10.1037/a0012590.
  18. ↑ See, J.; MacLeod, C.; Bridle, R. (2009). "The Reduction of Anxiety Vulnerability Through the Modification of Attentional Bias: A Real-World Study Using a Home-Based Cognitive Bias Modification Procedure". Journal of Abnormal Psychology. 118 (1): 65–75. doi:10.1037/a0014377.
  19. ↑ Amir, N.; Bomyea, J.; Beard, C. (2010). "The effect of single-session interpretation modification on attention bias in socially anxious individuals". J Anxiety Disord. 24 (2): 178–182. doi:10.1016/j.janxdis.2009.10.005.
  20. ↑ Carlbring, P.; Apelstrand, M.; Sehlin, H.; Amir, N.; Rousseau, A.; Hofmann, S. G.; Andersson, G. (2012). "Internet-delivered attention bias modification training in individuals with social anxiety disorder - a double blind randomized controlled trial". Bmc Psychiatry. 12: 66. doi:10.1186/1471-244x-12-66.
  21. ↑ Beard, C.; Weisberg, R. B.; Amir, N. (2011). "Combined cognitive bias modification treatment for social anxiety disorder: a pilot trial". Depression and Anxiety. 28 (11): 981–988. doi:10.1002/da.20873.
  22. ↑ Amir, N.; Beard, C.; Burns, M.; Bomyea, J. (2009). "Attention modification program in individuals with generalized anxiety disorder". Journal of Abnormal Psychology. 118 (1): 28–33. doi:10.1037/a0012589.
  23. ↑ Boettcher J, Leek L, Matson L, Holmes, E. A., Browning M, MacLeod C, . . . P, C. Internet-based attention modification for social anxiety: a randomised controlled comparison of training towards negative and training towards positive cues (SUBMITTED).
  24. ↑ Boettcher, J.; Andersson, G.; Carlbring, P. (2013). "Combining attention training with cognitive-behavior therapy in Internet-based self-help for social anxiety: study protocol for a randomized controlled trial". Trials. 14: 68. doi:10.1186/1745-6215-14-68.
  25. ↑ Amir, N.; Taylor, C.; Donohue, M. (2011). "Predictors of response to an attention modification program in generalized social phobia". J Consult Clin Psychol. 79 (4): 533–541. doi:10.1037/a0023808.
  26. ↑ Amir, N.; Taylor, C. T. (2012). "Combining Computerized Home-Based Treatments for Generalized Anxiety Disorder: An Attention Modification Program and Cognitive Behavioral Therapy". Behav Ther. 43 (3): 546–559. doi:10.1016/j.beth.2010.12.008.
  27. ↑ Boettcher, J.; Berger, T.; Renneberg, B. (2012). "Internet-Based Attention Training for Social Anxiety: A Randomized Controlled Trial". Cognitive Therapy and Research. 36 (5): 522–536. doi:10.1007/s10608-011-9374-y.
  28. ↑ Beard, C.; Weisberg, R. B.; Primack, J. (2012). "Socially Anxious Primary Care Patients' Attitudes Toward Cognitive Bias Modification (CBM): A Qualitative Study". Behavioural and Cognitive Psychotherapy. 40 (5): 618–633. doi:10.1017/s1352465811000671.
  29. ↑ Amir, N.; Beard, C.; Burns, M.; Bomyea, J. (2009). "Attention modification program in individuals with generalized anxiety disorder". Journal of Abnormal Psychology. 118 (1): 28–33. doi:10.1037/a0012589.
  30. ↑ Amir, N.; Weber, G.; Beard, C.; Bomyea, J.; Taylor, C. T. (2008). "The effect of a single-session attention modification program on response to a public-speaking challenge in socially anxious individuals". Journal of Abnormal Psychology. 117 (4): 860–868. doi:10.1037/a0013445.
  31. ↑ Beard, C.; Sawyer, A. T.; Hofmann, S. G. (2012). "Efficacy of Attention Bias Modification Using Threat and Appetitive Stimuli: A Meta-Analytic Review". Behav Ther. 43: 724–740. doi:10.1016/j.beth.2012.01.002.
  32. ↑ Macleod, C.; Soong, L.; Rutherford, E. M.; Campbell, L. W. (2007). "Internet-delivered assessment and manipulation of anxiety-linked attentional bias: Validation of a free-access attentional probe software package". Behaviour Research Methods. 39 (3): 533–538.
  33. ↑ Hakamata, Y.; Lissek, S.; Bar-Haim, Y.; Britton, J. C.; Fox, N. A.; Leibenluft, E.; Pine, D. S. (2010). "Attention bias modification treatment: a meta-analysis toward the establishment of novel treatment for anxiety". Biol Psychiatry. 68 (11): 982–990. doi:10.1016/j.biopsych.2010.07.021.
  34. ↑ Schmidt, N. B.; Richey, J. A.; Buckner, J. D.; Timpano, K. R. (2009). "Attention training for generalized social anxiety disorder". J Abnorm Psychol. 118 (1): 5–14. doi:10.1037/a0013643.
  35. ↑ Hazen, R. A.; Vasey, M. W.; Schmidt, N. B. (2009). "Attentional retraining: a randomized clinical trial for pathological worry". J Psychiatr Res. 43 (6): 627–633. doi:10.1016/j.jpsychires.2008.07.004.
  36. ↑ Amir, N.; Beard, C.; Taylor, C. T.; Klumpp, H.; Elias, J.; Burns, M.; Chen, X. (2009). "Attention training in individuals with generalized social phobia: A randomized controlled trial". J Consult Clin Psychol. 77 (5): 961–973. doi:10.1037/a0016685.
  37. ↑ Beard, C.; Amir, N. (2008). "A multi-session interpretation modification program: changes in interpretation and social anxiety symptoms". Behav Res Ther. 46 (10): 1135–1141. doi:10.1016/j.brat.2008.05.012.
  38. ↑ Bar-Haim, Y.; Lamy, D.; Pergamin, L.; Bakermans-Kranenburg, M. J. (2007). "Threat-related attentional bias in anxious and nonanxious individuals: a meta-analytic study". Psychol Bull. 133 (1): 1–24. doi:10.1037/0033-2909.133.1.1.
  39. ↑ Wiers, R. W.; Eberl, C.; Rinck, M.; Becker, E. S.; Lindenmeyer, J. (2011). "Retraining Automatic Action Tendencies Changes Alcoholic Patients' Approach Bias for Alcohol and Improves Treatment Outcome". Psychological Science. 22 (4): 490–497. doi:10.1177/0956797611400615.
  40. ↑ Eberl, C.; Wiers, R. W.; Pawelczack, S.; Rinck, M.; Becker, E. S.; Lindenmeyer, J. (2013). "Approach bias modification in alcohol dependence: Do clinical effects replicate and for whom does it work best?". Developmental Cognitive Neuroscience. 4 (0): 38–51. doi:10.1016/j.dcn.2012.11.002.
  41. ↑ Wiers, R. W.; Rinck, M.; Kordts, R.; Houben, K.; Strack, F. (2010). "Retraining automatic action-tendencies to approach alcohol in hazardous drinkers". Addiction. 105 (2): 279–287. doi:10.1111/j.1360-0443.2009.02775.x.
  42. ↑ Schoenmakers, T. M.; de Bruin, M.; Lux, I. F. M.; Goertz, A. G.; Van Kerkhof, D.; Wiers, R. W. (2010). "Clinical effectiveness of attentional bias modification training in abstinent alcoholic patients". Drug and Alcohol Dependence. 109 (1-3): 30–36. doi:10.1016/j.drugalcdep.2009.11.022.
  43. ↑ Browning, M; Holmes, EA; Murphy, SE; Goodwin, GM; Harmer, CJ (2010). "Lateral prefrontal cortex mediates the cognitive modification of attentional bias". Biol. Psychiatry. 67: 919–25. doi:10.1016/j.biopsych.2009.10.031. PMC 2866253Freely accessible. PMID 20034617.
  44. ↑ Beard, C.; Weisberg, R.B.; Amir, N. (2011). "Combined cognitive bias modification treatment for social anxiety disorder: a pilot trial". Depression and Anxiety. 28 (11): 981–988. doi:10.1002/da.20873. PMC 3215809Freely accessible. PMID 21898705.
  45. ↑ Waters, A. J.; Shiffman, S.; Bradley, B. P.; Mogg, K. (2003a). "Attentional shifts to smoking cues in smokers". Addiction. 98 (10): 1409–1417. doi:10.1046/j.1360-0443.2003.00465.x.
  46. ↑ MacLeod, C.; Mathews, A.; Tata, P. (1986). "Attentional bias in emotional disorders". Journal of Abnormal Psychology. 95 (1): 15–20. doi:10.1037/0021-843x.95.1.15. PMID 3700842.
  47. ↑ Koster, E. H. W.; Fox, E.; MacLeod, C. (2009). "Introduction to the special section on cognitive bias modification in emotional disorders". Journal of Abnormal Psychology. 118 (1): 1–4. doi:10.1037/a0014379.
  48. ↑ http://digitalcommons.trinity.edu/cgi/viewcontent.cgi?article=1013&context=psych_faculty
  49. ↑ http://www3.nd.edu/~ghaeffel/Resources/Haeffeletal2012.pdf
  50. ↑ Cristea, Kok, Cuijpers BJP sych (2015) 206,7-16.
  51. ↑ Heeren, A; Mogoaşe C; Philippot P; McNally RJ (2015). "Attention bias modification for social anxiety: A systematic review and meta-analysis". Clinical Psychology Review. 4 (2): 76–90. doi:10.1016/j.cpr.2015.06.001.

External links

This article is issued from Wikipedia - version of the 12/3/2016. The text is available under the Creative Commons Attribution/Share Alike but additional terms may apply for the media files.