Evaluating the effects of visual character-based enhancements in cognitive bias modification for depression: A...

Clinical depression is highly prevalent worldwide, yet many patients remain inadequately treated. Cognitive Bias Modification for Interpretation (CBMI) is a promising, cost-effective digital intervention that targets negative thinking patterns by repeatedly resolving ambiguous scenarios in neutral or positive ways. This study examined whether enhancing CBM-I for depression with graphics and character-based cognitive embodiment could improve presence, immersion, and therapeutic effects.

A total of 138 participants were randomized into four groups: traditional CBM-I (Text-Only), enhanced CBM-I with pictures but no main character (No Character), enhanced CBM-I with pictures and character embodiment (Character), or Control. Procedures were identical across groups apart from the CBM-I version delivered.

All three training groups significantly improved interpretation bias compared to Control, with no significant differences between training conditions. There were significant differences in the sense of presence but there were no significant differences in the sense of immersion among groups. Objective and subjective performance assessed by Anagram task showed no significant differences among groups. European participants exhibited significantly lower negative interpretation bias than non-European participants.

The study lacked preregistration and may be underpowered for between-group comparisons. Visuals may not have been sufficiently realistic and some measures were not assessed at pre-post training.

All active CBM-I conditions significantly reduced negative interpretation bias; however, no incremental benefit was detected for character-based cognitive embodiment or visual enhancements. Future studies should refine visual realism, adapt or develop cognitive embodiment measures, and utilize larger, preregistered samples to more rigorously evaluate the potential of character-based embodiment in CBM-I.