Evaluation of a Tailored Cognitive Bias Modification of Interpretations Intervention for Adolescents with Anxiety

This project aims to evaluate user engagement, acceptability, and efficacy of a cognitive bias modification of interpretations (CBM-I) intervention for adolescents aged 14 to 17 years old with anxiety symptoms. The trial is a single-arm pilot trial design – all participants will receive the intervention. We aim to evaluate efficacy by comparing baseline and post-intervention outcomes. The study will also collect data associated with user engagement (e.g., attrition) and use of the intervention (e.g., number of sessions completed). Participants will receive CBM-I intervention delivered in an online format via the Qualtrics platform. It will involve reading through brief psychoeducation information on unhealthy and healthy thinking habits, before moving on to complete 8, 10-15 minute sequential sessions four times per week over two to four weeks. Each session will comprise of 3 practice scenarios, followed by maximum 30 intervention scenarios, drawn from a larger bank of scenarios. The entire intervention will comprise maximum 240 intervention scenarios in total. On completion of a session, the next session is only available for completion on the following day. Scenario content will be relevant to domains of generalised anxiety, social anxiety, and panic disorder. The intervention is designed to encourage positive or benign interpretations of ambiguous situations and is based on the word fragment paradigm used in previous CBM-I studies and members of the project team. Participants will be asked to imagine scenarios as happening to themselves as vividly as possible. During every trial, participants will be presented with a short 2-3 sentence scenario describing an uncertain situation that might happen to them, with the final word of each scenario missing to create ambiguity (e.g., “You messaged your friend yesterday asking about their day. Your friend has “seen” the message but hasn’t replied.”). This is followed by a word fragment that would disambiguate the sentence in a neutral or positive manner (“They must be b_sy”). Participants are required to input the correct letter to complete the word fragment, and this is followed by a simple yes/no comprehension question (“Is your friend ignoring you because they’re upset with you?”). The ratio of yes/no responses to the comprehension question will be equal across the intervention. Non-negative interpretations are positively reinforced (“That’s right! Your friend is really busy and hasn’t had time to respond to your text yet.”). Unique to this study, scenarios will be tailored to participants concerns in both relevancy and content-specificity ( to GAD/SAD/Panic Disorder). At the start of each CBM-I session, adolescents will be provided a list of topics to choose from (e.g., ‘Academics/School, ‘Health, Injury, Illness’, ‘Future Planning’, ‘Performance in social situations’). Session content will be comprised of scenarios designed to target biases specific to anxiety subtypes of participants (i.e., generalised anxiety, social anxiety, and panic disorder). Participants will be shown a random selection of unique scenarios based on their selection of module/topic. Participants will receive a weekly reminder email to complete their sessions for that week.