Cognitive bias modification: Is it time to move on?

Ioana Cristea

• CBM for adults• CBM for children and adolescents• CBM for addictions

Objective:• To examine the efficiency of CBM for clinically relevant outcomes for adults, along with study quality, publication bias and potential moderators

Summary of findings (I)

• Many small trials with high and uncertain risk of bias

• Small significant effects, marked by a high degree of heterogeneity, extreme positive outliers, and risk of publication bias; effects largely reduced with adjustment for these factors

• For clinical samples: mostly non-significant effects; all rendered non-significant after adjustment for publication bias

Summary of findings (II)

• Outcomes were better in earlier studies, in studies with high or uncertain risk of bias, when the intervention was delivered in the laboratory or when participants were compensated.

Objective•To examine the utility of CBM procedures for mental health outcomes in children and adolescents

Summary of findings

• Most of the included trials had uncertain or high risk of bias

• Small and non-significant effects for mental health outcomes, anxiety and depression

• Moderate and significant effects for bias measures, but marked by significant heterogeneity.

• More sessions or clinical samples were not associated with better outcomes

Implications

• Any clinically meaningful effects?- Maybe it just isn’t there.- Why continue to invest in CBM? (other

efficient therapies already exist)• Demand characteristics/ “Experimenter bias”• Hype- Positive early studies (small, high risk of bias) +

laudatory reviews in top-tier journals

Other recent meta-analysesCorroborated our findings Did find clinically relevant effects

Mogoase et al, 2014, JCP (ABM for symptoms & distress)-Overall ESs ; some of the moderator analyses (laboratory vs home; clinical samples vs subclinical or unselected)

Linetzky at al., 2014, Depr Anx (ABM for clinical anxiety)-ESs significant for ABM only for clinician-rated outcomes- 11 studies; not reported I2; only fail-safe N for publication bias; no assessment of RoB- Within group ESs also show a significant effect for the control group

Heeren et al., CPR, 2015 (ABM for social anxiety)- Overall ESs; most moderator analysis (“-” relationship between the pooled ES and study quality &publication year; “+”relationship between ES and journal IF ; laboratory vs home/Internet based)

And to close…

“Cognitive-bias modification may put the psychiatrist’s couch out of business”

People who reported having learnt about the trial from the Economist piece all responded well, whether they were getting the ABM treatment or the no-contingency Placebo, as if, “the article itself had some power of suggestion”.

Described an ongoing, recruiting ABM trial.

Trial began to be flooded with participants.

CBM for addiction (manuscript under review)

• No clinical benefits for CBM at post-test, neither for addiction outcomes, nor for craving.

• Similar results for alcohol or smoking-related outcomes separately.

• There was no indication whatsoever that CBM might prove more efficient for certain types of applications (multiple sessions) or participants

CBM for addiction