Shifting Negative Prospection With Online Cognitive Bias Modification: A Randomized Controlled Trial

Objective: Emotional disorders often include negative simulations of the future, termed negative prospection. The present study tested an online cognitive bias modification program designed to train more positive future thinking in community participants. Method: 958 adults (73.3% female, 86.5% White, 83.4% from United States), most (74.1%) with a likely anxiety or depressive disorder, were randomized to one of five conditions: two positive conditions with emotionally ambiguous future scenarios that ended positively 90% of the time after first either negating a negative outcome (n = 147) or not (n = 177), two 50/50 conditions that ended positively (50% of the time) or negatively (50% of the time) in either blocked (n = 146) or random (n = 173) order, and a control condition with emotionally neutral scenarios (n = 315). Outcomes were assessed at baseline, after each of four training sessions, and at 1-month follow-up. Results: As hypothesized (preregistration: osf.io/jrst6), participants in positive training improved in negative and positive expectancy bias, self-efficacy, and optimism more than control participants, ds and 97.5% CIs = -0.57 [-0.87, -0.27], 0.79 [0.42, 1.15], 0.28 [0.02, 0.53], 0.28 [0.04, 0.51], and, for expectancy bias, more than 50/50 participants. Unexpectedly, participants across all conditions improved comparably in anxiety and depression symptoms and growth mindset. Additionally, no superiority emerged between the control and 50/50 conditions, between the two 50/50 conditions, or between the two positive conditions. Conclusions: Targeting transdiagnostic negative prospection with a scalable program may improve bias and outlook; however, further validation of outcome measures is required.

Any published article that follows from this thesis will credit the following authors in this order: Jeremy W. Eberle, Mehdi Boukhechba, Jianhui Sun, Diheng Zhang, Daniel H. Funk, Laura E. Barnes, and Bethany A. Teachman.