Cognitive bias modification of interpretations for anxiety and depression in children and adolescents: A meta-analysis

Gemma Sicouri; Emily K Daniel; Michael J Spoelma; Elske Salemink; Emma A McDermott; Jennifer L Hudson

doi:10.1002/jcv2.12207

Cognitive bias modification of interpretations for anxiety and depression in children and adolescents: A meta-analysis

JCPP Adv. 2023 Nov 16;4(1):e12207. doi: 10.1002/jcv2.12207. eCollection 2024 Mar.

Authors

Gemma Sicouri^{1

2}, Emily K Daniel¹, Michael J Spoelma^{1

3}, Elske Salemink⁴, Emma A McDermott¹, Jennifer L Hudson^{1

2}

Affiliations

¹ Black Dog Institute University of New South Wales Sydney New South Wales Australia.
² School of Psychology University of New South Wales Sydney New South Wales Australia.
³ Discipline of Psychiatry and Mental Health School of Clinical Medicine Faculty of Medicine and Health University of New South Wales Sydney New South Wales Australia.
⁴ Department of Clinical Psychology Utrecht University Utrecht the Netherlands.

Abstract

Background: Evidence suggests that cognitive bias modification of interpretations (CBM-I) is effective in modifying interpretation biases and has a small effect on reducing anxiety in children and adolescents. However, most evidence to date is based on studies which report anxiety or general distress using ad-hoc Likert-type or Visual Analogue Scales, which are useful but do not reliably index symptoms of clinical importance. This meta-analysis aimed to establish the effects of CBM-I for children and adolescents on both anxiety and depression using psychometrically validated symptom measures, as well as state negative affect and negative and positive interpretation bias.

Methods: We identified studies through a systematic search. To be eligible for inclusion, studies needed to target interpretation biases, not combine CBM-I with another intervention, randomly allocate participants to CBM-I or a control condition, assess a mental health outcome (i.e., anxiety or depression symptoms using validated measures or state measures of negative affect) and/or interpretation bias and have a mean age less than 18 years.

Results: We identified 36 studies for inclusion in the meta-analysis. CBM-I had a small and non-significant unadjusted effect on anxiety symptoms (g = 0.16), no effect on depression symptoms (g = -0.03), and small and non-significant unadjusted effects on state negative affect both at post-training (g = 0.16) and following a stressor task (g = 0.23). In line with previous findings, CBM-I had moderate to large unadjusted effects on negative and positive interpretations (g = 0.78 and g = 0.52). No significant moderators were identified.

Conclusions: CBM-I is effective at modifying interpretation bias, however there were no effects on mental health outcomes. The substantial variability across studies and paucity of studies using validated symptom measures highlight the need to establish randomized controlled trial protocols that evaluate CBM-I in clinical youth samples to determine its future as a clinical intervention.

Keywords: adolescent; anxiety; children; depression; interpretation bias modification.