A Cognitive Bias Modification of Interpretations Intervention for Children with Anxiety and Depressive Symptoms

This project aims to evaluate the efficacy of a cognitive bias modification of interpretations (CBM-I) intervention for children aged 8 to 10 years old with anxiety and/or depressive symptoms. We aim to evaluate its effectiveness versus a waitlist control group at post-intervention and after a one month follow up. Participants allocated to the intervention will receive the CBM-I intervention delivered in an online format. Access to the intervention will be password-protected on a website. Participants will complete the intervention on personal devices (e.g. computer, tablet, phone) within their own homes. The intervention has been specifically designed for children by a team of psychologists, researchers, user experience designers and software developers at the Black Dog Institute with co-design input from lived experience children, parents and mental health professionals. The intervention will involve 8, 10-15 minute sequential sessions four times per week over two weeks (up to three weeks). On completion of a session, the next session is only available for completion on the following day. The intervention is designed to encourage positive or benign interpretations of ambiguous situations and is based on similar tasks used by members of the project team. During every trial, children will be presented with a short 2-3 sentence scenario describing an uncertain situation that might happen to them. Children will be asked to imagine the scenario as happening to themselves as vividly as possible. Each scenario will be followed by two options, one describing a positive or benign outcome, and the other presenting a negative outcome. Children will be asked to read the scenario and two possible outcomes and then choose one of the outcomes. The scenario will then disappear from the screen and will be replaced with feedback on their choice that reinforces the positive/benign interpretation. Each session will contain 15 training scenarios (total 120 scenarios). In addition to the training trials, children will be presented with short pieces of narrative in between trials. The inclusion of the narrative is designed to promote engagement in the intervention by providing additional context to the scenarios, which was identified as important during the co-design process. All scenarios, narrative, response options, and feedback will be presented as text. A proportion of the scenarios (approximately 3-4 per session) will be accompanied by an image. The images are not designed to enhance the scenarios or intervention, but rather to increase engagement in the online program. The scenarios used in the intervention are matched to anxiety and depressive concerns commonly experienced by children (e.g., generalised concerns, social concerns, separation concerns and depressive concerns) and adapted from previous materials. To ensure relevance and matching of training content to children’s concerns, 40% of the scenarios will be matched to the child’s primary concern. Primary concerns will be identified based on a basic algorithm of subscale scores on the symptom questionnaire measures. Participants will receive points for “correct” responses (i.e., selection of the positive/benign option) and no points for “incorrect” responses (i.e., negative option). These points can be redeemed for illustrative icons within the digital program (e.g., medals, trophies or ribbons). Participants will also receive rewards as they progress through the program. The rewards will be set up by parents and children at the start of the intervention and delivered by parents. Participants allocated to the intervention will receive a weekly email check in to assist with session scheduling and can opt to receive a phone call with a researcher to answer questions about the program and assist with session scheduling. No additional contact with participants will be made, except if risk management phone calls or technical support for the intervention is required. For participants allocated to the intervention, the study will also collect research data associated with their engagement and use of the intervention. This trial will collect the following usage data from the intervention: number of sessions completed and individual responses to training activities.