Cognitive bias modification (CBM) refers to procedures used in
psychology
Psychology is the scientific study of mind and behavior. Psychology includes the study of conscious and unconscious phenomena, including feelings and thoughts. It is an academic discipline of immense scope, crossing the boundaries betwe ...
that aim to directly change biases in
cognitive processes
Cognition refers to "the mental action or process of acquiring knowledge and understanding through thought, experience, and the senses". It encompasses all aspects of intellectual functions and processes such as: perception, attention, thought, ...
, such as biased
attention
Attention is the behavioral and cognitive process of selectively concentrating on a discrete aspect of information, whether considered subjective or objective, while ignoring other perceivable information. William James (1890) wrote that "Atte ...
toward threat (vs. benign) stimuli and biased
interpretation of ambiguous stimuli as threatening. The procedures are designed to modify
information processing
Information processing is the change (processing) of information in any manner detectable by an observer. As such, it is a process that ''describes'' everything that happens (changes) in the universe, from the falling of a rock (a change in posit ...
via cognitive tasks that use basic learning principles and repeated practice to encourage a healthier thinking style in line with the training contingency.
CBM research emerged as investigators used the same techniques to assess attention bias to the manipulation of attention bias.
[Kuckertz, J. M., & Amir, N. (2017). Cognitive Bias Modification. In S. G. Hoffmann, & G. S.G. Asmundson (Eds.), ''The Science of Cognitive Behavioral Therapy'' (pp. 463-491). Academic Press.] This allowed for tests of the causal relationship between cognitive biases and emotional states (e.g., does selectively attending to threatening information cause greater anxiety). Over time, CBM paradigms were developed to modify biases in other areas of information processing, including interpretation,
memory
Memory is the faculty of the mind by which data or information is encoded, stored, and retrieved when needed. It is the retention of information over time for the purpose of influencing future action. If past events could not be remembered, ...
,
motivation
Motivation is the reason for which humans and other animals initiate, continue, or terminate a behavior at a given time. Motivational states are commonly understood as forces acting within the agent that create a disposition to engage in goal-dire ...
(e.g., approach–avoidance behaviors), and
attributional style
Explanatory style is a psychological attribute that indicates how people explain to themselves why they experience a particular event, either positive or negative.
Aspects Personal
This aspect covers the degree to which a person attributes the ca ...
. The early success of the procedures in inducing change in bias led researchers to see the potential benefit of CBM as an intervention for emotional and behavioral disorders. Given that the maladaptive cognitive processes implicated in models of emotional vulnerability and dysfunction are targeted by CBM, there is considerable interest in the theoretical and applied importance of the techniques. As such, many recent studies of CBM have targeted cognitive biases in people with
anxiety
Anxiety is an emotion which is characterized by an unpleasant state of inner turmoil and includes feelings of dread over anticipated events. Anxiety is different than fear in that the former is defined as the anticipation of a future threat wh ...
and
depressive symptoms.
Research on the effectiveness of CBM in shifting attention and interpretation biases has indicated promising evidence in adult populations, though there are also some null results.
[Jones, E. B., & Sharpe, L. (2017). Cognitive bias modification: A review of meta-analyses. ''Journal of Affective Disorders, 223'', 175–183.] Additionally, CBM can reduce anxiety symptoms and stress vulnerability in some cases though these effects are more mixed. There is also some evidence of CBM’s effectiveness in depression symptomatology. Researchers have pointed to the practical benefits offered by CBM, such as scalability and ease of dissemination, potential for augmentation effects with
cognitive-behavioral therapy
Cognitive behavioral therapy (CBT) is a psycho-social intervention that aims to reduce symptoms of various mental health conditions, primarily depression and anxiety disorders. CBT focuses on challenging and changing cognitive distortions (suc ...
, and cost-effectiveness. Further research on CBM is needed, however, as the evidence for its long-term effects are less clear, including in children.
[Jones, E. B., & Sharpe, L. (2017). Cognitive bias modification: A review of meta-analyses. ''Journal of Affective Disorders, 223'', 175–183.]
Types
![Visual_Probe_Task_on_a_PDA](https://upload.wikimedia.org/wikipedia/commons/a/af/Visual_Probe_Task_on_a_PDA.jpg)
Two common features are used in the majority of CBM methodologies. First, the cognitive bias targeted for change represents a pattern of selective information processing that is known to characterize psychopathology. For example, individuals with anxiety disorders are characterized by an automatic tendency to attend toward threat, while paying less attention to neutral stimuli. Second, the cognitive bias is altered in a manner that does not involve instructing the individual to intentionally change such information-processing selectivity. Rather, change in the cognitive bias is induced by introducing a contingency designed such that successful task performance will be enhanced by adoption of a new pattern of responding.
Two of the most common types of CBM target attention and interpretation biases.
[Kuckertz, J. M., & Amir, N. (2017). Cognitive Bias Modification. In S. G. Hoffmann, & G. S.G. Asmundson (Eds.), ''The Science of Cognitive Behavioral Therapy'' (pp. 463-491). Academic Press.] Another type of CBM, approach–avoidance training, targets motivation biases associated with approach and avoidance behaviors.
Attention bias modification
Cognitive bias modification for attention (CBM-A) or attention bias modification (ABM) cognitive tasks are typically designed to draw attention to neutral or positive stimuli, and avoid negative or threatening stimuli. The cognitive tasks utilized in ABM were originally designed for the assessment of attentional bias and later adapted as training tasks.
[Kuckertz, J. M., & Amir, N. (2017). Cognitive Bias Modification. In S. G. Hoffmann, & G. S.G. Asmundson (Eds.), ''The Science of Cognitive Behavioral Therapy'' (pp. 463-491). Academic Press.]
Common paradigms to manipulate visual attention include the ''
spatial cueing task'' and ''visual search task'', in addition to the ''
visual probe task''. In a typical visual probe trial, a central fixation cross is presented, followed by the brief appearance of a threat and non-threat cue, such as a face with an angry expression and a face with a neutral expression. One of the cues is replaced by a probe, such as a small dot, letter or arrow. The aim is to respond as quickly as possible to identify the probe with a button-press response, for example, to indicate the letter shown or direction of the arrow presented. By having the probe occur routinely in the location where the neutral (rather than negative or threatening) face appeared, the individual learns though practice that attending to the neutral stimulus will enhance their performance on the task because they will be faster to identify the probe.
The logic guiding this training task follows from the assessment version of the task in which the probe appears equally and randomly following the neutral and threat stimuli. In this case, attention bias for threat is inferred from response times to probes. If an individual has a bias to direct attention to the spatial location of the threat stimuli, this should be reflected by faster response times to probes that appear in the same location as threat cues (threat-congruent trials) than non-threat cues (threat-incongruent trials). Conversely, if an individual has a bias to direct attention away from threat stimuli, this should be reflected by slower response times to probes replacing threat than non-threat cues.
Interpretation bias modification
Cognitive bias modification for interpretation (CBM-I) or interpretation bias modification (IBM) involves cognitive tasks that disambiguate an otherwise ambiguous sentence, paragraph, or picture to be either positively or negatively valenced. Interpretation bias tasks typically aim to increase the extent individuals interpret ambiguous situations in benign ways to encourage more flexible thinking that is less rigidly negative.
The ''ambiguous situations paradigm'' is one of the most commonly-used protocols used to manipulate interpretation bias. In this task, individuals are typically presented with short paragraphs describing an ambiguous situation. The emotional resolution of the paragraph is not revealed until the end of the paragraph—for example, "You ask a friend to look over some work you have done. You wonder what he will think about what you've written. He comes back with some comments, which are all very ''positi_e''
ord fragment in italics" The resolution often features a word fragment that the individual is asked to solve. By repeatedly practicing assigning non-threatening meanings to the ambiguous situations, the individual is thought to learn that uncertainty is more likely to be resolved in a benign, rather than negative, way. The resolution of the ambiguity is typically reinforced through a brief question following the word fragment completion that requires the individual to respond in a way that matches the situation's ending as determined by the word fragment.
To see whether the ambiguous situations paradigm is successful in modifying interpretation bias, a "recognition" task that consists of a series of ambiguous scenarios is typically used as an outcome measure. In this task, the scenarios remain ambiguous even after solving the word fragment—for example, "You ask a friend to look over some work you have done. You wonder what he will think about what you've written. He comes back with some comments on a ''Thur_day''
ord fragment in italics" In the second part of the recognition task, the titles of the ambiguous scenarios are displayed, together with four sentences per scenario that reflect different ways of understanding what occurred in the scenario that weren't actually stated. These sentences represent: a) a possible positive interpretation tied to the key emotional meaning of the scenario, b) a possible negative interpretation tied to the key emotional meaning of the scenario, c) a positive sentence that is not tied to the key emotional meaning of the scenario, and d) a negative sentence that is not tied to the key emotional meaning of the scenario. Individuals rate each sentence for its similarity in meaning to the original scenario. Higher similarity ratings for the positive (vs. negative) interpretation tied to the key emotional meaning of the scenario are thought to reflect a more positive interpretation.
Approach–avoidance training
Approach–avoidance training involves cognitive tasks that are designed to induce approach or avoidance behaviors towards specific stimuli. In the ''approach–avoidance task'', a commonly used training protocol, individuals are shown images with a certain distinguishing feature on a computer screen, to which they should react as fast as possible using a joystick.
[Rinck, M., & Becker, E. S. (2007). Approach and avoidance in fear of spiders. ''Journal of Behavior Therapy and Experimental Psychiatry, 38''(2), 105-120.] For example, all images tilted to the left are pulled and become larger, while all images tilted to the right are pushed away and shrink in size. This zooming effect creates the visual impression that the pictures are coming closer upon pulling of the joystick, and that they move away upon pushing it.
Training involves selectively inducing avoidance of one type of stimulus and/or approach of another—for example, training avoidance behavior to alcohol-related stimuli for individuals with an
alcohol use disorder
Alcoholism is, broadly, any drinking of alcohol that results in significant mental or physical health problems. Because there is disagreement on the definition of the word ''alcoholism'', it is not a recognized diagnostic entity. Predomin ...
by repeatedly practicing pushing the joystick when alcohol stimuli appear (and pulling the joystick for comparison stimuli), or training approach behavior to spider stimuli for individuals with
arachnophobia
Arachnophobia is a specific phobia brought about by the irrational fear of spiders and other arachnids such as scorpions.
Signs and symptoms
People with arachnophobia tend to feel uneasy in any area they believe could harbour spiders or that h ...
by repeatedly practicing pulling the joystick when spider pictures appear (and pushing the joystick for comparison stimuli).
[Rinck, M., & Becker, E. S. (2007). Approach and avoidance in fear of spiders. ''Journal of Behavior Therapy and Experimental Psychiatry, 38''(2), 105-120.]
To see whether the training paradigm was successful in modifying approach–avoidance bias, the reaction time when participants are instructed to push away the target stimuli (e.g., alcohol or spider cues) compared to when participants are instructed to push away the comparison stimuli are contrasted, along with the analogous contrast for pulling the target vs. comparison stimuli.
Criticisms and limitations
One concern is whether CBM modification procedures will reliably change symptoms and achieve lasting benefits. This is not yet clear from research.
A 2015
meta-analysis
A meta-analysis is a statistical analysis that combines the results of multiple scientific studies. Meta-analyses can be performed when there are multiple scientific studies addressing the same question, with each individual study reporting me ...
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
Mental health encompasses emotional, psychological, and social well-being, influencing cognition, perception, and behavior. It likewise determines how an individual handles stress, interpersonal relationships, and decision-making. 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
In published academic research, publication bias occurs when the outcome of an experiment or research study biases the decision to publish or otherwise distribute it. Publishing only results that show a significant finding disturbs the balance o ...
.
Likewise, a recent meta-analysis
has found that although attention bias modification (ABM) can be used as a treatment for several primary characteristics of
social anxiety disorder
Social anxiety disorder (SAD), also known as social phobia, is an anxiety disorder characterized by sentiments of fear and anxiety in social situations, causing considerable distress and impaired ability to function in at least some aspects ...
(SAD), the durability of treatment and inability to treat secondary symptoms has been raised as potential issues. 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
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Cognitive bias mitigation
Cognitive bias mitigation is the prevention and reduction of the negative effects of cognitive biases – unconscious, automatic influences on human judgment and decision making that reliably produce reasoning errors.
Coherent, comprehensive th ...
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Cognitive vulnerability A cognitive vulnerability in cognitive psychology is an erroneous belief, cognitive bias, or pattern of thought that predisposes an individual to psychological problems. The vulnerability exists before the symptoms of a psychological disorder appea ...
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Debiasing
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Unconscious bias training
Implicit bias training (or unconscious bias training) programs purport to expose people to their implicit biases, provide tools to adjust automatic patterns of thinking, and ultimately eliminate discriminatory behaviors. Some researchers say that ...
References
{{reflist, 30em
Behavior modification
Behavior therapy