Many barriers prevent individuals suffering from anxiety disorders from receiving the treatment they need.
Besides the obvious monetary cost of attending traditional psychotherapy or psychiatry sessions, there still exists a stigma associated with seeking mental health care, despite the many measures taken to preserve clients’ confidentiality. Finding a nearby therapist with expertise in administering the appropriate evidence-based interventions can be challenging. Transportation can be an additional barrier, making it difficult to access regular therapy sessions. Moreover, sometimes people’s own attitudes and beliefs about mental illness and its care may cause them to forego therapy altogether.
To add to the ‘toolbox’ of options that we can offer individuals who are suffering from anxiety, especially those who may not have access to top-quality in-person care, researchers have been developing new interventions that do not require a mental health professional or coming to a clinic. Cognitive Bias Modification for reducing threat Interpretations (CBM-I) is a family of technology-based interventions designed to shift how people think about situations. Because it can be completed with readily available technologies (e.g. a personal computer) and does not require a licensed professional, it may help reach the many people who do not currently have care or who need a little additional help to complement their current treatment.
What are cognitive biases and why do they need to be modified?
Cognitive biases are habitual ways of processing information that tend to skew what cues are attended to or emphasized (e.g. selective processing of potential threat cues). Examples of cognitive biases include attentional bias (increased attention towards potentially threatening features of the environment) and interpretation bias (being more likely to automatically think ambiguous situations are negative). Anyone can have a cognitive bias, and persons with anxiety are particularly prone to biases that favor the assignment of threatening or dangerous interpretations of situations. For example, imagine that you are presenting at a meeting in front of a few colleagues. As you are speaking, one of them closes his eyes, yawns, and then looks at you again without smiling. What might you think in that situation? Some people may simply think that the colleague is tired because he did not get enough sleep the previous night. However, if you have anxiety difficulties, you are likely to immediately assume the yawn indicates that your presentation is terrible and that the colleague is bored. Thus, instead of assigning a benign or positive meaning to an ambiguous situation, a negative and threatening meaning is assigned. As you might imagine, this threatening interpretation can make you less likely to volunteer to present at a future meeting and you may miss important future opportunities.
What is Cognitive Bias Modification?
CBM-I targets the tendency to make rigid, negative interpretations of ambiguous events by providing anxious individuals with repeated practice processing ambiguous information in new ways so they can think more flexibly. It is technology-based (e.g., administered by computer) and offers another option for those who are unable or do not want to receive more traditional forms of treatment (or for those who want to add an additional strategy to complement their existing care). Because it is typically administered via computer, people can complete the training sessions from home or wherever they choose. It also does not “feel” like typical therapy, because you do not have to disclose difficult personal, emotional information to another person. Finally, CBM-I sessions are brief, and can be done anywhere and anytime. This means that even individuals with the busiest schedules can access the intervention.
How is it like other kinds of treatment?
The current gold standard for anxiety treatment is Cognitive Behavioral Therapy (CBT), which is usually done with the assistance of a therapist (though it is also being tested as an online intervention). Therapists help people with anxiety learn to identify their thoughts, feelings, and behaviors, and how those interact. In particular, CBT for anxiety disorders often involves helping a person re-enter situations that they have been avoiding due to anxiety so they can get used to those situations and learn that they are okay even in situations that make them anxious. A therapist doing CBT also helps someone with anxiety learn how thinking differently can change how they feel and behave. CBM-I is built on similar principles, using brief stories to help people think differently in anxiety-provoking situations – with repeated practice, this new way of thinking is expected to help people feel better and behave differently. Medications are also used routinely in the treatment of anxiety, but do not directly target cognitive biases and building new thinking habits, so while we expect that CBM-I can be used alongside medication treatment they likely operate through different pathways.
Does it really work?
While there have been many research studies showing how effective CBM-I is at shifting thinking styles in a research laboratory or clinic setting1, there are more mixed results when it comes to how effective it is when people use it online, outside of the laboratory. Thus, a very important next step is to examine how to make CBM-I a more helpful online intervention. CBM-I has been shown to be effective for reducing negative thinking styles and/or symptoms of social anxiety2,3, phobic reactions like fear of heights4, anxiety sensitivity5, obsessive beliefs6, contamination fears7, generalized anxiety disorder8, and depression9, among other problem areas.
Editor’s Note: The authors are part of a group of researchers who are building on previous research on CBM-I. They are currently testing different versions of an online intervention called MindTrails – a free, experimental program for high anxiety (e.g., persons with high trait anxiety, social anxiety disorder, or generalized anxiety disorder). The testing is to determine which version works best and for whom. It involves eight 15-20 minute sessions that are spread out over approximately four weeks. Sessions can be done from anywhere with access to a computer and an Internet connection. Participation in the study will help others as the researchers learn more about how to most effectively deliver CBM-I over the Internet. If you are feeling anxious and want to try this private, flexible, and free intervention, you can register at https://mindtrails.virginia.edu.
1. Hallion, L.S. and A.M. Ruscio, A meta-analysis of the effect of cognitive bias modification on anxiety and depression. Psychological Bulletin, 2011. 137(6): p. 940-958.
2. Brettschneider, M., et al., Internet-based interpretation bias modification for social anxiety: A pilot study. Journal of Behavior Therapy and Experimental Psychiatry, 2015. 49, Part A: p. 21-29.
3. Bowler, J.O., et al., A comparison of cognitive bias modification for interpretation and computerized cognitive behavior therapy: effects on anxiety, depression, attentional control, and interpretive bias. J Consult Clin Psychol, 2012. 80(6): p. 1021-33.
4. Steinman, S.A. and B.A. Teachman, Reaching new heights: comparing interpretation bias modification to exposure therapy for extreme height fear. J Consult Clin Psychol, 2014. 82(3): p. 404-17.
5. Steinman, S.A. and B.A. Teachman, Modifying interpretations among individuals high in anxiety sensitivity. Journal of Anxiety Disorders, 2010. 24(1): p. 71-78.
6. Williams, A.D. and J.R. Grisham, Cognitive Bias Modification (CBM) of obsessive compulsive beliefs. BMC Psychiatry, 2013. 13(1): p. 1-9.
7. Beadel, J.R., F.L. Smyth, and B.A. Teachman, Change Processes During Cognitive Bias Modification for Obsessive Compulsive Beliefs. Cognitive Therapy and Research, 2014. 38(2): p. 103-119.
8. Hayes, S., et al., The effects of modifying interpretation bias on worry in generalized anxiety disorder. Behaviour Research and Therapy, 2010. 48(3): p. 171-178.
9. Blackwell, S.E. and E.A. Holmes, Modifying interpretation and imagination in clinical depression: A single case series using cognitive bias modification. Applied Cognitive Psychology, 2010. 24(3): p. 338-350.