How to boost positive interpretations? A meta-analysis of the effectiveness of cognitive bias modification for interpretation

Abstract

The current meta-analysis explores the strength of effects of cognitive bias modification training for interpretation bias (CBM-I) on positive (i.e., adaptive) interpretations and mood as well as the training and sample characteristics influencing these effects. Data-bases were searched with the key words "interpret* bias AND training" and "interpret* bias AND modif*". Reference lists of identified articles were checked and authors of identified articles were contacted for further relevant articles and unpublished data. Studies were reviewed for inclusion with eligibility criteria being that the study (a) aimed to target interpretation biases through any kind of training, (b) assessed mood and/or interpretation bias as outcome measures, (c) allocated individuals to training conditions at random, and (d) recruited adult samples. A meta-analytic multilevel mixed-effects model was employed to assess standardized mean changes in interpretation bias, negative mood, and emotional reactivity. In addition, several training and sample characteristics were explored for their potential to enhance benign training effectiveness. On average, benign CBM-I resulted in an increase in positive interpretation bias (p<.01) and a decrease in negative mood state (p<.001), but did not affect emotional reactivity. These effects were not consistently different from control conditions with no or neutral training. However, within benign training conditions imagery instructions and more training sessions were related to larger cognitive and mood effects, whereas feedback about training performance and inclusion of non-benign training items (instead of including benign items only) boosted cognitive effects only. Finally, training was more effective in women (cognitive and mood effects) and presumably samples with symptomatic emotional dysregulation (cognitive effects). Although the effects of emotional dysregulation and number of training sessions could not well be distinguished, there is an indication that when used with imagery instructions and more training sessions, benign CBM-I can be employed as a useful complementary treatment to usual psychotherapies.

Conflict of interest statement

Competing Interests: co-authors Prof. Dr. Jim van Os and Dr. Marieke Wichers of the current meta-analysis are PLOS one editorial members. This does not alter the authors’ adherence to PLOS ONE Editorial policies and criteria.

Figures

Figure 1. PRISMA flow chart of article retrieval and selection.

Note. 1the search in June 2013 was conducted on separate searches of the data-bases as the software to do simultaneous searches was no longer available. In total, 109 hits were identified in June 2013. 2zero records were excluded for the search in 2013. 3ten records were screened for the search in 2013. 4four articles were excluded for the search in 2013. 5three articles were excluded for the search in 2013.

Figure 2. Forest plot of post training difference between positive and negative interpretation bias.

Note. Order of same conditions within one study follow the order of table 1.

Figure 3. Forest plot of change in positive interpretation bias.

Note. Order of same conditions within one study follow the order of table 1.

Figure 4. Forest plot of change in negative mood.

Note. Order of same conditions within one study follow the order of table 1.

Figure 5. Forest plot of change in negative mood in response to an emotional challenge.

Note. Order of same conditions within one study follow the order of table 1. The summary effect size for the no-training condition is not identical to the effect size reported for the sole study in this condition as the model took multiple nesting (within study and within one article) into account and ‘corrected’ for such effects in the summary effect size.