Web-based interpretation bias training to reduce anxiety: A sequential, multiple-assignment randomized trial.

Area of Science:

• Psychology
• Clinical Psychology
• Digital Health

Background:

• Web-based cognitive bias modification for interpretation (CBM-I) is a promising intervention for anxiety.
• High dropout rates are a significant challenge for digital mental health interventions like CBM-I.
• The effectiveness of supplemental support, such as telecoaching, in mitigating dropout and enhancing CBM-I efficacy requires further investigation.

Purpose of the Study:

• To evaluate the effectiveness of web-based CBM-I compared to an active psychoeducation control condition.
• To examine the impact of adding low-intensity telecoaching to CBM-I for participants at higher risk of dropout.
• To assess the effects of CBM-I and telecoaching on interpretation biases and anxiety symptoms.

Main Methods:

• A sequential, multiple-assignment randomized trial involving 1,234 anxious adults was conducted.
• Participants were randomly assigned to CBM-I or psychoeducation, with higher-risk CBM-I completers then randomized to receive telecoaching or no coaching.
• Outcomes included interpretation biases (Recognition Ratings, Brief Body Sensations Interpretation Questionnaire) and anxiety symptoms (Overall Anxiety Severity and Impairment Scale, Depression Anxiety Stress Scales-Short Form).

Main Results:

• CBM-I significantly outperformed psychoeducation in improving interpretation biases and anxiety symptoms, with effects maintained at 2-month follow-up.
• Contrary to expectations, CBM-I had significantly higher dropout rates than psychoeducation.
• The addition of telecoaching did not significantly improve efficacy or reduce dropout rates, partly due to low participant engagement with coaches.

Conclusions:

• Web-based CBM-I is an effective intervention for reducing interpretation biases and anxiety symptoms.
• Supplemental low-intensity telecoaching does not appear to effectively mitigate dropout challenges in web-based CBM-I.
• Future research should explore alternative strategies to improve engagement and reduce dropout in digital mental health interventions.