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Cognitive bias modification

Author: Dr Simon Moss


Cognitive bias modification encompasses a series of techniques that can alleviate anxiety or depression. In particular, according to this paradigm, anxiety and depression emanates from biases in the attention, memory, and interpretations of individuals. For example, anxious individuals tend to orient their attention to unpleasant features. Depressed individuals are inclined to remember adverse events. Cognitive bias modification entails a set of practices that reverse these biases and, therefore, ameliorate mood disorders.

Specifically, according to proponents of cognitive bias modification, anxiety and depression can be ascribed to three clusters of biases. The first set of biases relate to attention. That is, if people are anxious in particular, they are more likely to orient their attention to negative words or images. The second set of biases relate to interpretation. When people are anxious or depressed, they are more inclined to misconstrue an ambiguous remark or event: They may, for example, assume the sentence "The doctor measured little Emma's growth" alludes to a tumor instead of her height. The final set of biases relate to memory. When individuals are depressed, they are more inclined to recognize sad faces as well as remember past failures or negative traits.

Various exercises can be undertaken to redress these biases. One set of exercises involves attention training. Typically, participants must locate a positive object, such as a happy face, that is embedded in a series of negative objects, such as angry faces. Another set of exercises involve interpretation training. As one example, participants may need to complete word fragment, such as f-ar, which appear at the end of sentences, such as "After a while, you lose your f-ar". If these word fragments tend to reflect positive outcomes, anxiety tends to diminish. Finally, some exercises involve memory training.

Evidence of biases in mood disorders

Attention bias

Many studies have shown that individuals with anxiety, and to a lesser extent depression, tend to shift their attention to negative features. Furthermore, some research indicates this bias causes these mood disorders.

Some research indicates that attention in anxious people is skewed towards threatening pictures. For example, in one study, conducted by Yiend and Mathews (2001), either threatening or neutral pictures appeared on a screen. Immediately after these pictures appeared, participants needed to identify other items or targets, usually at another location on the screen. If participants reported levels of anxiety, their capacity to identify these targets that appeared at a different location to a threatening picture was impaired. As this study shows, anxious participants, relative to other individuals, cannot as readily disengage their attention from threatening pictures.

Interpretation biases

When people are anxious or depressed, they are more inclined to misconstrue an ambiguous remark or event. A seminal study, designed to demonstrate this possibility, was reported by Eysenck, Mogg, May, Richards, and Mathews (1991). In this study, participants were exposed to many ambiguous sentences, such as "The doctor measured little Emma's growth". They were then asked to decide whether another sentence, such as "The doctor measured little Emma's tumor" or The doctor measured little Emma's growth in height", shared the same meaning. If people reported elevated levels of anxiety, they tended to endorse the negative connotation of the sentence, such as "The doctor measured little Emma's tumor". A similar tendency does emerge in depression (Lawson, MacLeod, & Hammond, 2002) but not in reaction time tasks (for a review, see Hertel & Mathews, 2011).

Several conditions can exacerbate or mitigate this interpretation bias in depressed individuals. For example, as Hertel and El-Messidi (2006) showed, after individuals complete a task that increases their focus or awareness of themselves, rather than other people, this bias magnifies. These findings are consistent with the notion that depressed individuals associate negative concepts with themselves.

Memory biases

Many studies have shown that depressed individuals are more likely than other participants to remember negative information than positive information. If they need to remember a list of positive and negative traits about themselves, for example, depressed individuals will tend to remember the negative characteristics. If exposed to a series of faces, depressed individuals are more likely to recognize the sad or angry faces (for a review, see Mathews & MacLeod, 2005).

Similarly, provided suitable variables are controlled, anxious individuals are also more likely to remember negative information. Admittedly, as the review by MacLeod and Mathews (2005) showed, many studies have also shown that anxiety is unrelated to memory of negative information. Yet, many other complications could explain the findings of these studies: statistical power is sometimes limited because the tasks are too easy, and anxious individuals sometimes divert their attention from threatening information to alleviate their emotions (for another meta-analysis on this topic, with similar conclusions, see Mitte, 2008).

As several studies reveal, memory biases can often be ascribed to attention biases. To illustrate, in one study, conducted by Wells, Beevers, Robison, and Ellis (2010), participants were exposed to a series of angry, sad, happy, and neutral expressions. Later, they received an unexpected memory task, gauging whether they recognize these faces. If participants reported elevated levels of dysphoria--in essence, mild depression--they were more likely to remember the angry faces. Interestingly, this relationship between dysphoria and memory of angry faces was mediated by the amount of time they gazed at each angry face. Biases in attention, therefore, may underpin many of the biases in memory (for similar results, see Koster, De Raedt, Leyman, & De Lissnyder, 2010).

Modification techniques

Many studies have been conducted to manipulate biases in attention, interpretation, and memory. When attention, interpretation, and memory are diverted from negative features, anxiety and depression tend to diminish. These studies demonstrate that such biases actually cause increases in anxiety or depression as well as offer insights on how to alleviate these disorders (e.g., Wilson, MacLeod, Mathews, & Rutherford, 2006).

Attention training

An excellent example of attention training was reported by Dandeneau, Baldwin, Baccus, Sakellaropoulo, and Pruessner (2007). In their study, participants completed a computer task in which they receive sets of 16 faces on a computer screen. Their task was to identify the person who is smiling rather than frowning. After undertaking this task for 10 or so minutes, measures of social anxiety dissipated, and cortisol levels diminished as well (for neurological underpinnings, especially with reference to lateral regions of the prefrontal cortex, see Browning, Holmes, Murphy, Goodwin, & Harmer, 2010).

Another effective paradigm was developed by MacLeod, Rutherford, Campbell, Ebsworth, and Holker (2002). In this study, participants needed to respond as rapidly as possible to the presentation of a dot. Immediately before the dot appeared, a benign word and a threatening word appeared simultaneously. If the dot tended to appear in the same location as the benign word, participants exhibited less distress on a subsequent task. Other studies also show this task can increase resilience to other challenges in life, such as relocating to another nation (e.g., See, MacLeod, & Bridle, 2009).

In general, participants are unaware of these biases in attention. In a few studies, however, some of the participants were told that a target will tend to appear at the same location as positive stimuli rather than threatening stimulus. These explicit instructions, interestingly, have been shown to enhance the effects of attention training (Krebs, Hirsch, & Mathews, 2010).

Attention training and the vigilance-avoidance pattern

According to the vigilance-avoidance pattern of attentional bias (Mogg & Bradley, 1999), anxious individuals are initially very sensitive to threats. Their attention is oriented, almost unduly, to upsetting or hazardous features, called vigilance. But after some delay, such as a second or so, anxious individuals are less sensitive to threats than most people, implying a tendency to avoid these upsetting features.

The question, then, is whether attentional training curbs the vigilance or only magnifies the subsequent avoidance. This matter was investigated by Koster, Baert, Bockstaele, and De Raedt (2010). In the attentional training task, on each trial, a dot appeared one either the left or right side of a screen Participants, all of whom exhibited anxiety, needed to indicate on which side the dot appeared. Between 50 and 250 ms before this dot appeared, however, two pictures were also presented on one each side of the screen. Typically, one of the pictures was upsetting or disturbing and the other picture was neutral. The upsetting or disturbing picture appeared on the opposite side of the dot. Therefore, after several hours of this task over one week, participants learnt to shift their attention away from these negative picture. In the control condition, the upsetting or disturbing picture did not always appear on the opposite side of the dot.

Later, to assess the attentional distribution of individuals, participants again performed a similar task, except the upsetting or disturbing picture, if presented, did not always appear on the opposite side of the dot. In addition, the time between the pictures and the dot was 50, 100, or 1500 ms.

Training did not influence the pattern of results when the pictures appeared 50 or 100 ms before the dot. However, training did influence the pattern of results when the pictures appeared 1500 ms before the dot. Specifically, if participants had completed the attentional training, their attention was not as likely to be biased towards the upsetting or disturbing picture. These individuals did not respond faster when the dot appeared on the same location as the upsetting or disturbing picture. Accordingly, attentional training seems to amplify the avoidance of threats. The procedure may be helpful when the threats are modest and should be avoided but could exacerbate phobias and other examples of unhelpful avoidance.

Interpretation training

Several studies have examined the benefits that emanate after individuals participate in interpretation training. One of these methods was developed by Grey and Matthews (2000). On each trial, an ambiguous word, such as sink, is presented. Next, a word fragment appears. The fragment might represent a positive word that is related to the first term, such as "wa-h", corresponding to "wash". Alternatively, the fragment might represent a negative word that is related to the first term, such as "dro-n", corresponding to drown. Theoretically, if participants are exposed to the positive words instead of the negative words, over time, they become more inclined to construe ambiguous concepts positively.

Indeed, studies confirm this possibility. If exposed to the positive connotations of these ambiguous words, this task reduces the likelihood that people will experience negative emotions after watching an accident on video. Likewise, performance on this task at one time biases interpretations of words later. These benefits persist even if the initial training and subsequent performance are conducted in separate locations with different experimenters (e.g., Mackintosh, Mathews, Yiend, Ridgeway, & Cook, 2006) even when the mood of participants changes between these two phases (Salemink & van den Hout, 2010).

Several instructions or procedures can amplify the benefits of interpretation training. As Hoppitt, Mathews, Yiend, and Mackintosh (2010a, 2010b) showed, for example, if individuals are explicitly instructed to choose the benign, rather than threatening, interpretation of ambiguous words, the benefits of interpretation training are especially pronounced.

One alternative explanation is that individuals who practice the positive interpretations may experience a positive mood, and individuals who practice the negative interpretations may experience a negative mood. Mood may then affect performance on subsequent tasks. The benefits of interpretation training, therefore, could be reduced to a transient improvement in mood rather than a genuine reduction in biases. Standage, Ashwin, and Fox (2010) undertook a study that challenges this alternative explanation. They showed that positive moods, induced by music, did not affect the interpretations and, therefore, cannot explain the benefits of interpretation training.

Memory training

Some techniques have been developed to diminish the likelihood that specific memories are recalled. In one study, on each trial during the learning phase, participants read a neutral word, such as carpet, followed by a positive word or negative word, such as flower or coffin respectively. In particular, they were exposed to 43 of these pairs. They were also granted a recall test to learn these pairs as effectively as possible.

Next, during the forgetting phase, the neutral words were presented again. On some trials, participants again attempted to recall the corresponding positive or negative word. On other trials, they were instructed to confine their attention and thoughts to the neutral word and neither articulate nor contemplate the positive or negative word. Finally, during the final recall phase, they performed one more test in which they attempted to remember which positive or negative words were coupled with the neutral words.

If participants had attempted to suppress a negative word during the forgetting phase, they were not as likely to remember this word in the final recall phase. In essence, they successfully forgot the negative words.

However, depressed patients did not as readily forget these words. Instead, they forget these words only if they were also exposed to additional instructions to remember a substitute positive word. These findings show that depressed individuals, while striving to forget negative information, may not control their cognitions as effectively. These individuals need other provisions or support. Yet, if these provisions are offered, depressed individuals are able to forget negative information.

Applications to other disorders


Cognitive bias modification, although primarily conducted to alleviate anxiety and depression, has also been applied to ameliorate other disorders, such as alcoholism (Wiers, Eberl, Rinck, Becker, & Lindenmeyer, 2011). In the study conducted by Wiers, Eberl, Rinck, Becker, and Lindenmeyer (2011), 214 alcoholic inpatients participated in an experiment. If assigned to the experimental condition, individuals undertook tasks in which they needed to push a joystick away whenever they saw a picture that epitomizes alcohol. Pushing a joystick away epitomizes avoidance. These participants, therefore, learnt to associate avoidance with alcohol. That is, they tended to associate alcoholic words with avoidance rather than approach words, as determined by the implicit association test.

Features of training that magnify the benefits of cognitive bias modification

As Hertel and Mathews (2011) emphasize, cognitive bias modification is more effective whenever practitioners apply the key principle, promulgated by Bjork (1994), called desirable difficulty. Specifically, to ensure the training is effective, the task needs to be difficult enough to mobilize effort. For example, practice should be distributed over time. Similarly, variable conditions during practice can also increase difficulty to an acceptable level.


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Last Update: 7/19/2016