Cognitive bias modification for attention and interpretation reduces trait and state anxiety in anxious patients referred to an out-patient service: Results from a pilot study

It is well established that anxious individuals show biases in information processing, such that they attend preferentially to threatening stimuli and interpret emotional ambiguity in a threatening way. It has also been established that these biases in attention and interpretation can causally influence anxiety. Recent advances in experimental work have involved the development of a paradigm known as Cognitive Bias Modification (CBM), a constellation of procedures which directly modify bias using computerised tasks. Excitingly, these procedures have been shown to reduce bias in attention to threat (CBM-A), and to promote a positive interpretive bias (CBM-I) in anxious populations; furthermore, these modifications are associated with reductions in anxiety. We believe that these techniques have the potential to create a real clinical impact for people with anxiety. Initial studies involved volunteer participants who reached criteria for clinical diagnoses to be made, but emerging evidence suggests that patients referred for therapy also benefit. For the purposes of experimentation researchers have normally looked at one procedure at a time. In order to try to maximise the potential clinical impact we wished to investigate whether the combination of the procedures would be more effective than either alone. We also wished to investigate whether the procedures could be carried out in routine clinical settings with patients referred to an out-patient psychological treatment service. We therefore carried out a pilot study using a combined approach of CBM-A and CBM-I with a sample of 13 anxious patients referred to an out-patient psychology service for cognitive therapy. The results showed successful reductions in threat related attentional and interpretive bias, as well as reductions in trait and state anxiety. Participant reports describe the procedures as acceptable, with the attentional task experienced as boring, but the interpretive one experienced as helpful. While recognising the methodological problems of the pilot study we believe that these results give indications that the techniques could provide an effective intervention for anxiety, and that further study is well justified.