A systematic review with meta-analysis of cognitive bias modification interventions for anger and aggression

Aggression and anger are associated with interpretation and attention biases. Such biases have become treatment targets for anger and aggressive behavior in cognitive bias modification (CBM) interventions. Several studies have evaluated the efficacy of CBM for the treatment of anger and aggressive behavior, with inconsistent results. The present study meta-analytically analyzed 29 randomized controlled trial studies (N = 2334) published in EBSCOhost and PubMed between March 2013 and March 2023 assessing the efficacy of CBM for anger and/or aggression. Included studies delivered CBMs that addressed either attention biases, interpretation biases, or both. Risk of publication bias and potential moderating effects of several participant-, treatment- and study-related factors were assessed. CBM significantly outperformed control conditions in the treatment of aggression (Hedge's G = -0.23, 95% CI [-0.35, -0.11], p < .001) and anger (Hedge's G = -0.18, 95% CI [-0.28, -0.07], p = .001) independent of treatment dose, participant demographic characteristics, and study quality, though overall effects were small. Follow-up analyses demonstrated that only CBMs targeting interpretation bias were efficacious for aggression outcomes, but not when baseline aggression was accounted for. Findings suggest that CBM demonstrates efficacy for the treatment aggressive behavior and to a lesser extent, anger.