Online Cognitive Bias Modification for Interpretation to Reduce Anxious Thinking During COVID-19

Anxiety disorders are highly prevalent and rates increased during the COVID-19 pandemic. However, most individuals with elevated anxiety do not access treatment due to barriers such as stigma, cost, and availability. Internet-based programs, such as cognitive bias modification for interpretation (CBM-I), hold promise as a tool to increase access to care. Before widely disseminating CBM-I, we must rigorously test its effectiveness, and determine whom it is best positioned to benefit. The present study compared CBM-I against a psychoeducation active comparison condition offered through the public website MindTrails, and also tested whether anxiety tied to COVID-19 moderated the effectiveness of these interventions. Adults with moderate-to-severe anxiety (N = 609) were randomly assigned to receive five sessions of CBM-I or psychoeducation. As predicted (https://osf.io/2dyzr), CBM-I was superior to psychoeducation at reducing anxiety symptoms (on our primary but not secondary anxiety measure: d = -0.30), reducing negative interpretation bias (d range= -0.34 to -0.47), and increasing positive interpretation bias (d = 0.83). Gains were maintained at 2- and 6-month follow-up assessments for all outcomes except positive interpretation bias. Results also indicated that individuals higher (vs. lower) in baseline COVID-19 anxiety experienced stronger decreases in anxiety symptoms while receiving CBM-I and stronger increases in anxiety while receiving psychoeducation (increases within the psychoeducation condition occurred only on one anxiety measure). These findings suggest that CBM-I may be a useful anxiety-reduction tool for individuals experiencing higher (vs. lower) anxiety tied to COVID-19. Future work is needed to further evaluate whether CBM-I is ready to be disseminated on a wider scale, and who may benefit most.

Funding: Grants awarded to Bethany A. Teachman from the National Institute of Mental Health (NIMH R01 MH113752) and the UVA GIDI Emergency Response Grant funded this work.

Acknowledgements: We would like to thank our collaborators and research assistants in the Teachman psychology lab and the Barnes and Boukhechba engineering labs. We would also like to thank the Teachman Program for Anxiety, Cognition, and Treatment (PACT) laboratory and for their feedback on an earlier draft of this manuscript.