Shifting Episodic Prediction With Online Cognitive Bias Modification: A Randomized Controlled Trial

Abstract

Negative future thinking pervades emotional disorders. This hybrid efficacy–effectiveness trial tested a four-session, scalable online cognitive-bias-modification program for training more positive episodic prediction. Nine hundred fifty-eight adults (73.3% female, 86.5% White, 83.4% from United States) were randomly assigned to positive conditions with ambiguous future scenarios that ended positively, 50/50 conditions that ended positively or negatively, or a control condition with neutral scenarios. As hypothesized (preregistration: https://osf.io/jrst6 ), positive-training participants improved more than control participants in negative expectancy bias ( d = −0.58), positive expectancy bias ( d = 0.80), and self-efficacy ( d = 0.29). Positive training was also superior to 50/50 training for expectancy bias and optimism ( d = 0.31). Training gains attenuated yet remained by 1-month follow-up. Unexpectedly, participants across conditions improved comparably in anxiety and depression symptoms and growth mindset. Targeting a transdiagnostic process with a scalable program may improve bias and outlook; however, further validation of outcome measures is required.

Web-based interpretation bias training to reduce anxiety: A sequential, multiple-assignment randomized trial.

“…Although the mean differences favoring CBM-I over psychoeducation remained significant at the 2-month follow-up in the present trial, the CBM-I group lost some treatment gains, whereas the psychoeducation group continued to improve. This follow-up period is longer than that of a prior MindTrails trial in which adults with negative future thinking in positive CBM-I did not significantly change on most outcomes (except on positive expectancy bias, for which they lost some treatment gains) during 1-month follow-up (Eberle et al, 2023). The loss of some gains in CBM-I by 2-month follow-up may reflect some loss in the skill of flexible thinking when the practice of this skill is no longer provided, whereas psychoeducation, which is more knowledge-based, may have a more lasting effect.…”

Web-Based Interpretation Bias Training to Reduce Anxiety: A Sequential, Multiple-Assignment Randomized Trial

“…Although the mean differences favoring CBM-I over psychoeducation remained significant at 2-month follow-up in the present trial, the CBM-I group lost some treatment gains, whereas the psychoeducation group continued to improve. This follow-up period is longer than that of a prior MindTrails trial in which adults with negative future thinking in positive CBM-I did not significantly change on most outcomes (except on positive expectancy bias, for which they lost some treatment gains) during 1-month follow-up (Eberle et al, 2023). The loss of some gains in CBM-I by 2-month follow-up may reflect some loss in the skill of flexible thinking when practice of this skill is no longer provided, whereas psychoeducation, which is more knowledge based, may have a more lasting effect.…”

“…We used a random forest machine learning model (developed by Lewis, 2019) to predict the probability that CBM-I participants will not complete Session 2 training and assessment based on a combination of self-reported (i.e., selected demographic variables, state anxiety) and passively detected (e.g., time spent on selected measures) features from pretreatment and Session 1 assessment data. The model was trained on data from a prior MindTrails study (Future Thinking; Eberle et al, 2023). If the participant's probability of not completing Session 2 was below a threshold, which was adjusted over the course of the study, they were deemed at lower risk of dropout; if the probability was above the threshold, they were deemed at higher risk.…”