Interpretation Bias Training for Anxiety

There are a range of cognitive biases that are common when people experience anxiety, such as attention biases, where people preferentially attend to potentially threatening cues by rapidly detecting these cues and then staying stuck on them. This could mean, for example, that a socially anxious person giving a presentation quickly notices the one person in the audience with a slightly bored expression while ignoring the 99 other people who are engaged and responding positively. We also know that people with anxiety tend to interpret situations in negative, often catastrophic ways, so when a situation is ambiguous or somewhat uncertain (as most situations are!), they will assign a negative meaning. Returning to the presentation example, if an audience member has a facial expression that is hard to read, the socially anxious presenter is likely to assume the audience member is evaluating them negatively and thinking they are doing a terrible job. We see anxiety-linked biases across many different stages and components of cognitive processing, including memory, imagery, implicit associations, perceptual biases, etc.

The type of cognitive bias modification that our team does is interpretation bias training. We present people with a broad range of short stories that raise a potentially threatening situation but leave it ambiguous whether that situation resolves in a threatening or benign way (following Mathews & Macintosh, 2000). The emotional ambiguity is resolved by presenting a word fragment that the individual has to complete, typically to assign a non-threatening meaning. By completing lots of these stories, we give people practice thinking more flexibly by realizing that uncertain situations can turn out in many different ways, so people don’t automatically jump to the worst-case scenario. To learn more about interpretation bias training and try it out, please visit mindtrails.virginia.edu.

We know that people have some thoughts that are more automatic in that they may occur outside conscious awareness or be difficult to consciously control, while other thoughts will be more available to conscious introspection and more readily controlled. Research from our and others’ labs shows that individuals with anxiety disorders experience biases in their thought patterns at different levels of consciousness, and they regularly interact. So, individuals with anxiety may detect a potential threat cue even without being aware that this detection has occurred. In turn, they may also have thoughts about the dangerousness of a situation that they can reflect and explicitly report on.

Cognitive biases, including memory and attention, and anxious behaviors, including escape and avoidance, are often connected. For example, if a spider phobic person’s attention is drawn to and ‘stuck’ on a small spider across the room, they are likely to try to escape that room. Relatedly, if a socially anxious person misremembers prior attendance at parties as going badly (e.g., that no one wanted to talk to them), they are likely to avoid going to future parties. We can intervene at different points to change the anxious patterns (e.g., by directly changing the cognitive biases and/or by reducing the avoidance behaviors).

Yes, we encourage people to visit mindtrails.virginia.edu to try our online interpretation bias training program.

There is a growing body of research examining interpretation bias modification related to intolerance of uncertainty that has shown some promising results, including change in intolerance of uncertainty that lasted at least one month following the training (see Oglesby et al., 2016).

The main benefits are ease of access and low cost, so the digital interventions can be used from anywhere at any time, whereas in-person treatments often have long waitlists and can be very expensive. That said, if a person has the opportunity and resources to access in-person treatment, this is a great option given there is a rigorous and deep body of research (https://div12.org/psychological-treatments/) supporting in-person care for anxiety, such as cognitive behavior therapies (e.g., exposure therapy). For some people, combining the different intervention options can be helpful.

Yes, there is evidence for interpretation bias training to help address a range of problem areas, such as depression and body image or eating disorder concerns. More research is needed though, to strengthen the effects of interpretation bias training across disorders and increase the reliability of the effects.

We know that it will take some people a little more time, even once they are vaccinated, to feel comfortable returning to in-person classes. This is natural given people are out of practice, and there has been so much uncertainty and anxiety over the past 2 years. It can be helpful to remind children and teens that feeling anxiety is normal and not a sign that they are doing something wrong in this case. It can also be helpful to remind them that they are taking reasonable safety precautions, such as wearing a mask; this can help the person feel they have some control over the situation. It is also useful to recognize that it will be hardest at the beginning, but being in class will become more comfortable over time as they get used to the situation. Finally, any time someone takes on a big challenge that generates a lot of anxiety, it can be helpful to plan some rewards to help motivate the person, so perhaps planning a special dinner or shopping trip to celebrate getting through that first tough day or week.