Attention and Cognitive Bias Modification Apps: Review of the Literature and of Commercially Available Apps

Abstract

BackgroundAutomatic processes, such as attentional biases or interpretative biases, have been purported to be responsible for several psychiatric disorders. Recent reviews have highlighted that cognitive biases may be modifiable. Advances in eHealth and mHealth have been harnessed for the delivery of cognitive bias modification. While several studies have evaluated mHealth-based bias modification intervention, no review, to our knowledge, has synthesized the evidence for it. In addition, no review has looked at commercial apps and their functionalities and methods of bias modification. A review is essential in determining whether scientifically validated apps are available commercially and the proportion of commercial apps that have been evaluated scientifically.ObjectiveThe objective of this review was primarily to determine the proportion of attention or cognitive bias modification apps that have been evaluated scientifically and secondarily to determine whether the scientifically evaluated apps were commercially available. We also sought to identify commercially available bias modification apps and determine the functionalities of these apps, the methods used for attention or cognitive bias modification, and whether these apps had been evaluated scientifically.MethodsTo identify apps in the published literature, we searched PubMed, MEDLINE, PsycINFO, and Scopus for studies published from 2000 to April 17, 2018. The search terms used were “attention bias” OR “cognitive bias” AND “smartphone” OR “smartphone application” OR “smartphone app” OR “mobile phones” OR “mobile application” OR mobile app” OR “personal digital assistant.” To identify commercial apps, we conducted a manual cross-sectional search between September 15 and 25, 2017 in the Apple iTunes and Google Play app stores. The search terms used to identify the apps were “attention bias” and “cognitive bias.” We also conducted a manual search on the apps with published evaluations.ResultsThe effectiveness of bias modification was reported in 7 of 8 trials that we identified in the published literature. Only 1 of the 8 previously evaluated apps was commercially available. The 17 commercial apps we identified tended to use either an attention visual search or gamified task. Only 1 commercial app had been evaluated in the published literature.ConclusionsThis is perhaps the first review to synthesize the evidence for published mHealth attention bias apps. Our review demonstrated that evidence for mHealth attention bias apps is inconclusive, and quite a few commercial apps have not been validated scientifically.

Evidence Regarding Automatic Processing Computerized Tasks Designed For Health Interventions in Real-World Settings Among Adults: Systematic Scoping Review

“…These tasks can be delivered via a variety of methods, but the most popular in the health domain are dot-probe, visual probe, and visual search tasks. All 3 tasks have been extensively used and reviewed in the literature [ 19 , 47 , 48 ]; however, historically, these tasks have been used in a laboratory setting, particularly in mental health interventions seeking to change anxiety and depression. This review revealed an expansion in the field, both in a real-world setting and in other health fields such as problem drinking, smoking, and suicide.…”

Gamified Cognitive Bias Modification Interventions for Psychiatric Disorders: Review

“…The conditions that gamified cognitive bias modification interventions target are like those targeted by conventional mobile-based cognitive bias modification interventions. The review by Zhang et al [ 23 ] evaluated the published literature and reported that out of 8 identified studies, at least 4 studies used a mobile intervention to target anxiety-related disorders (anxiety and social anxiety disorders). In their review of meta-analyses, Jones et al [ 10 ] included 5 meta-analyses that examined anxiety-related outcomes.…”

“…User perspectives of what makes an app engaging and which strategies result in short and longer term engagement are important to consider in the design of gamified cognitive bias modification interventions. While only 4 studies were identified for this review, Zhang et al [ 23 ] found that there were 17 commercial cognitive bias modification apps in the app stores. It might be helpful to analyze the gamification features in commercial cognitive bias modification apps and see if certain gamification features are associated with higher rates of downloads, a surrogate measure of acceptability.…”

Gamified Cognitive Bias Modification Interventions for Psychiatric Disorders: Review (Preprint)

“…The perspectives of patients and public is important in the design of gamified cognitive bias modification intervention informing us about what they feel might help make the application more engaging and what strategies, when applied, would result in both short and longer-term engagement. While only four studies are identified for this review, Zhang et al (2018) have in their prior review highlighted that there are seventeen cognitive bias modification commercial applications on the application stores. It might be helpful to analyse the gamification features in commercial cognitive bias modification applications and see if certain gamification features are associated with higher rates of downloads, a surrogate measure of acceptability.…”