Anxiety
Conditions
Keywords
Anxiety, Cognitive bias, Telemedicine
Brief summary
The study aims to develop a web-based Cognitive Bias Modification infrastructure to train interpretations, and evaluate the usability, acceptability, and feasibility of the program to reduce anxiety symptoms.
Detailed description
Approximately half of the U.S. population experiences serious mental health problems during their lifetime, including 29% with anxiety pathology severe enough to qualify for an anxiety disorder diagnosis \[1\]. Critically, more than two thirds of individuals struggling with a mental illness do not receive treatment \[1\]. With this level of mental illness burden, it is clear that treating people one-on-one in an office setting will never meet the existing needs \[2\]. There are many barriers to treatment, including costs \[3\], difficulties accessing evidence-based treatments in many regions \[4\], and associated stigma \[5\]. Thus, there is a pressing need to consider alternative, larger scale approaches to delivering mental health services. Cognitive Bias Modification (CBM) interventions hold considerable promise as a way to meet these needs, especially for anxiety difficulties \[6\]. These computer-based programs are designed to alter biased ways of thinking, such as a tendency toward negative interpretations, which cause and maintain anxiety \[6\]. Because these programs do not require therapist contact and can be administered on any computer with an Internet connection, CBM holds promise as a cost-effective method that can be disseminated widely. However, while CBM for interpretation bias (CBM-I) has established efficacy when administered in-person in the laboratory \[7\], it now needs to be tested with broader populations using a web-based infrastructure to examine: a) whether the program will be effective in a web environment, b) whether the program continues to engage the targeted mechanism (i.e., interpretation bias), c) the feasibility of this delivery method, and d) the modifications needed to adapt the program for the web (in particular, to prime anxiety-linked negative thinking in an online environment, we test the effect of adding a guided anxious imagery exercise to prime feared outcomes prior to each training session). Together, the current proposal will develop an infrastructure to pilot test the effectiveness of web-based CBM-I for anxiety symptoms. CBM-I training will target moderate to severe anxiety symptoms, a widespread problem area with considerable occupational and social impairment \[8\]. Participants will be visitors to Project Implicit Mental Health (PIMH), an existing website directed by the Principal Investigator that allows visitors to assess their cognitive biases tied to mental health concerns. Consistent with the RFA's priorities, this approach encourages efficiencies by capitalizing on the existing PIMH site and its heavy traffic. Further, the site's large number of visitors and use of automated assessments will make it efficient to assess baseline demographic characteristics and interpretation bias as moderators of CBM-I effects that can be tested in future trials. Aim 1: Develop and evaluate usability and acceptability of web-based CBM-I for anxiety symptoms. Aim 1 will build the web-based interpretation bias training program using the PIMH infrastructure. We will pilot the program on a small test group of moderate to highly anxious participants (N=15) who will complete questionnaires and semi-structured interviews to provide feedback on the programs' usability and acceptability. Further, an advisory board (N=8) of anxiety researchers, clinicians, and experts in CBM and web-based research will provide feedback on the program and study protocol. Using a deployment-focused approach, this feedback from experts and end-users will be used to iteratively modify the program for the trial planned for Aims 2 and 3. Thus, even at this initial pilot stage, we will measure the targeted outcome (anxiety symptoms) and mechanism (interpretation bias) to determine whether modifications to enhance target engagement are needed. Note, within Research Domain Criteria (RDoC), this outcome falls under the Potential Threat/Anxiety construct within the Negative Valence System, and the targeted mechanism (interpretation bias) falls under the Response Selection, Inhibition construct within the Cognitive (effortful) control system. Both the outcome and mechanism will be objectively measured using multiple units of analysis (e.g., behavior and self-report). Further, mechanisms underlying the guided anxious imagery prime's effects will be measured by assessing subjective distress, imagery vividness, and activation of feared outcomes following the manipulation. This prime was selected in part because of its potential to be disseminated widely in future trials, given it does not require human contact. Aim 2: Test target engagement, feasibility and effectiveness of web-based CBM-I. Aim 3: Evaluate the impact of an anxious prime on web-based CBM-I for anxiety symptoms. Aims 2 and 3 will test the feasibility of an 8-session web-based interpretation training program among individuals with moderate to severe anxiety symptoms (based on screening at the PIMH site). Participants will be randomly assigned to positive CBM-I (90% positive scenario training), 50% positive/50% negative CBM-I, or a no scenario control condition. Half the participants in each of these 3 conditions will receive an anxious imagery prime prior to each training session, and half will receive a neutral imagery prime, resulting in a 3 training condition x 2 prime design (N=210; target of n=35 per condition). Feasibility will be determined by analyses of recruitment, attrition, acceptance of randomization, adherence to and appropriateness of the measurement model, caseness, extent of missing data, and safety. Additionally, target engagement (change in interpretation bias) and preliminary tests of effectiveness at reducing anxiety symptoms will be evaluated.
Interventions
BEHAVIORALPositive Cognitive Bias Modification - Interpretation
Training involves presenting participants with brief scenarios that introduce an ambiguous potential threat. Critically, the ambiguity regarding how the situation is resolved remains until the last word of the scenario, which is presented as a word fragment that the participant must solve, which will then assign a benign (rather than threatening) meaning to the scenario.
BEHAVIORAL50/50 Cognitive Bias Modification - Interpretation
This condition follows the same design and content as the Positive Training conditions, except the word fragments differ; rather than consistently resolving the scenario in a positive direction, half of the scenarios will end with a negative (anxiety-congruent) word fragment, and half will end with a positive word fragment.
BEHAVIORALAnxious Imagery Prime
We will test whether priming anxious concerns and feared negative outcomes on the web via the addition of a guided anxious imagery prime at the start of each session will enhance effects.
BEHAVIORALNeutral Imagery Prime
At the start of each session, participants will complete a neutral control imagery exercise where they do a guided imagery exercise imagining upcoming mundane tasks, like brushing one's teeth.
Sponsors
University of Virginia
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Investigator)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
The target population will be adults age 18 and over who score in the moderate to extremely severe anxiety range (i.e., 10 or higher) on the Depression, Anxiety, Stress Scales - Short Form: Anxiety Subscale and have regular access to the Internet.
Exclusion criteria
None listed.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in Brief Bodily Sensations Interpretations Questionnaire | Baseline, and after sessions 3 (~2 weeks following baseline), 6 (~10 days after session 3), and 8 (~7 days after session 6) & at 2-month follow-up. Measure will be completed immediately following that day's training session. | The Brief Bodily Sensation Interpretation Questionnaire (BBSIQ; Clark et al., 1997) was administered as a more independent, additional measure of interpretation bias. In the BBSIQ, participants are presented with fourteen ambiguous events related to physical (e.g., feeling lightheaded) or external (e.g., smelling smoke, social situations) concerns, along with three possible explanations for each ambiguous event (one negative, and two neutral or positive explanations). Participants rated the extent to which they believed each explanation for why the ambiguous event occurred on a Likert scale from 0 (not at all likely) to 4 (extremely likely). Typically, the BBSIQ is administered on an eight-point Likert scale, but a 0-4 scale was used to align with other rating scales in the study. Negative interpretation bias score was computed by averaging the likelihood ratings for all negative explanations (following Steinman & Teachman, 2010, 2015). |
| Change in Recognition Ratings (Positive Interpretation Bias) | Baseline, and after sessions 3 (~2 weeks following baseline), 6 (~10 days after session 3), and 8 (~7 days after session 6) & at 2-month follow-up. Measure will be completed immediately following that day's training session. | To measure interpretation bias, participants will read ambiguous scenarios with titles, after which they will see the titles of each scenario, followed by 2 disambiguated interpretations of the scenario: 1 positive and 1 negative. Participants will rate each disambiguated interpretation based on how similar in meaning it is to the original scenario on a 4-point scale ranging from 1 to 4. The mean of the positive, threat-related ratings index positive interpretation bias. Higher scores represent a more positive interpretation bias. |
| Change in Overall Anxiety Severity and Impairment Scale | Baseline, and after sessions 1,2,3,4,5,6,7,8 (sessions will be spaced ~3-4 days apart) & at 2-month follow-up. Measure will be completed immediately following that day's training session. Session 2 is expected to occur within 3-8 days of the baseline. | The Overall Anxiety Severity and Impairment Scale (OASIS; Norman, Hami Cissell, Means-Christensen, & Stein, 2006) assesses anxiety frequency, severity, and associated avoidance, work and social interference. This 5-item measure of anxiety symptom severity and impairment has good psychometric properties, shows treatment sensitivity, and is valid in community and clinical samples. All items are rated on a scale of 0 (lowest impairment/severity) to 4 (highest impairment/severity). Total scores on the OASIS are calculated by summing the scores of each of the 5 questions. The total score on the OASIS ranges from 0 to 20, with higher scores indicating greater anxiety. A cut-score of 8 or higher on the OASIS is considered to indicate probable anxiety disorder. |
| Change in Recognition Ratings (Negative Interpretation Bias) | Baseline, and after sessions 3 (~2 weeks following baseline), 6 (~10 days after session 3), and 8 (~7 days after session 6) & at 2-month follow-up. Measure will be completed immediately following that day's training session. | To measure interpretation bias, participants will read ambiguous scenarios with titles, after which they will see the titles of each scenario, followed by 2 disambiguated interpretations of the scenario: 1 positive and 1 negative. Participants will rate each disambiguated interpretation based on how similar in meaning it is to the original scenario on a 4-point scale ranging from 1 to 4. The mean of the negative, threat-related ratings index negative interpretation bias. Higher scores represent a more negative interpretation bias. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Multi-Session User Experience Questionnaire | At 2-month follow-up | This questionnaire assesses users' opinions about the intervention. Participants could select from options Not at all=0, Slightly=1, Somewhat=2, Mostly=3, Very=4, Decline to answer=5 for questions 1-13 as well as 15 and 16 (examples listed below); question 14 asked This training program was 8 sessions. How many sessions do you think would have been ideal? with an open ended response box, which we will not include in the means and SDs. We will recode Decline to answer=5 as NA. Higher scores on this scale indicate more positive experiences with the program in general across questions, from 0-4. 1. How helpful did you find the web program for reducing your anxiety? 2. How much did the web program improve your overall quality of life? 3. How much did the web program help improve your overall mood (e.g., feeling happier)? 4. How likely would you be to recommend this web program to others with similar anxiety difficulties? 5. How easy was the web program to use? |
| Impact of Anxious Imagery Prime (Change Over Time is Exploratory But Should Show Anxious/Neutral Prime Differences; e.g., in Subjective Distress) | After sessions 1,2,3,4,5,6,7,8 (sessions will be spaced ~3-4 days apart). Measure will be completed following that day's imagery prime (which immediately precedes the training session). | Following the anxious or neutral imagery prime, participants reported on the questions provided. Minimum score = 3; maximum score =115. Higher scores indicate more vividness and anxiety following the anxious imagery prime. How vividly did you imagine the situation? 1=Not at all vivid 2=Somewhat vivid 3=Moderately vivid 4=Very vivid 5=Totally vivid How anxious did you feel (at the highest level of anxiety) as you completed the imagery task? (using a 0-100 slider with the following anchors marked) 0=Not at all anxious, 50= Moderately anxious, 100=Totally anxious How likely is it that this situation will turn out well vs. turn out badly? 1=Very likely to turn out well, 2=Somewhat likely to turn out well, 3=Neutral, 4= Somewhat likely to turn out badly, 5= Very likely to turn out badly If this situation did turn out badly, how well or badly would you be able to handle it? 1=Very well, 2=Somewhat well, 3=Neutral, 4=Somewhat badly, 5=Very badly |
| Change in Depression, Anxiety, Stress Scales-Short Form: Anxiety Subscale | Baseline, after session 8 (~4 weeks after baseline) & at 2-month follow-up. | While we use the OASIS as a primary measure of anxiety symptom severity, we are using the DASS-AS (Lovibond & Lovibond, 1995) as another 7-item measure of anxiety symptoms. Higher scores indicate more severe anxiety symptoms. Minimum score = 0; maximum score = 21. 0 = Did not apply to me at all 1. = Applied to me to some degree, or some of the time 2. = Applied to me to a considerable degree, or a good part of time 3. = Applied to me very much, or most of the time Qs: 1. I was aware of dryness of my mouth. 2. I experienced breathing difficulty (e.g., excessively rapid breathing, breathlessness in the absence of physical exertion). 3. I experienced trembling (e.g., in the hands). 4. I was worried about situations in which I might panic and make a fool of myself. 5. I felt I was close to panic. 6. I was aware of the action of my heart in the absence of physical exertion (e.g., sense of heart rate increase, heart missing a beat). 7. I felt scared without any good reason. |
| Change in Quality of Life Scale | Baseline, and after sessions 3 (~2 weeks following baseline), 6 (~10 days after session 3), and 8 (~7 days after session 6) & at 2-month follow-up. Measure will be completed immediately following that day's training session. | The Quality of Life Scale (Flanagan, 1978) is a 16-item questionnaire chosen to evaluate change in quality of life in five domains: recreation, relationships, well-being, personal fulfillment and development, and social activities. Higher scores indicate more positive feelings about quality of life/more satisfaction. Minimum score = 16; maximum score = 80. The question asks How satisfied are you with... with each of the following options as separate questions: material, health, relationships, children, spouse, friend, helping, participating, learning, understanding, work, expression, socializing, reading, recreation, independence (just providing a key word for purposes of description, but questions include a full statement such as Material comforts home, food, conveniences, financial security for material). Response options range from Completely unsatisfied=1, Somewhat unsatisfied=2, Mixed=3, Somewhat satisfied=4, Completely satisfied=5. |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Positive Training+Anxious Imagery Prime Positive Cognitive Bias Modification - Interpretation training paired with a preceding Anxious Imagery Prime
Positive Cognitive Bias Modification - Interpretation: Training involves presenting participants with brief scenarios that introduce an ambiguous potential threat. Critically, the ambiguity regarding how the situation is resolved remains until the last word of the scenario, which is presented as a word fragment that the participant must solve, which will then assign a benign (rather than threatening) meaning to the scenario.
Anxious Imagery Prime: We will test whether priming anxious concerns and feared negative outcomes on the web via the addition of a guided anxious imagery prime at the start of each session will enhance effects. | 111 |
| Positive Training+Neutral Imagery Prime Positive Cognitive Bias Modification - Interpretation training paired with a preceding Neutral Imagery Prime
Positive Cognitive Bias Modification - Interpretation: Training involves presenting participants with brief scenarios that introduce an ambiguous potential threat. Critically, the ambiguity regarding how the situation is resolved remains until the last word of the scenario, which is presented as a word fragment that the participant must solve, which will then assign a benign (rather than threatening) meaning to the scenario.
Neutral Imagery Prime: At the start of each session, participants will complete a neutral control imagery exercise where they do a guided imagery exercise imagining upcoming mundane tasks, like brushing one's teeth. | 141 |
| 50/50 Training+Anxious Imagery Prime 50/50 Cognitive Bias Modification - Interpretation (half positive & half negative scenarios) paired with a preceding Anxious Imagery Prime
50/50 Cognitive Bias Modification - Interpretation: This condition follows the same design and content as the Positive Training conditions, except the word fragments differ; rather than consistently resolving the scenario in a positive direction, half of the scenarios will end with a negative (anxiety-congruent) word fragment, and half will end with a positive word fragment.
Anxious Imagery Prime: We will test whether priming anxious concerns and feared negative outcomes on the web via the addition of a guided anxious imagery prime at the start of each session will enhance effects. | 121 |
| 50/50 Training+Neutral Imagery Prime 50/50 Cognitive Bias Modification - Interpretation (half positive & half negative scenarios) paired with a preceding Neutral Imagery Prime
50/50 Cognitive Bias Modification - Interpretation: This condition follows the same design and content as the Positive Training conditions, except the word fragments differ; rather than consistently resolving the scenario in a positive direction, half of the scenarios will end with a negative (anxiety-congruent) word fragment, and half will end with a positive word fragment.
Neutral Imagery Prime: At the start of each session, participants will complete a neutral control imagery exercise where they do a guided imagery exercise imagining upcoming mundane tasks, like brushing one's teeth. | 144 |
| No Scenario+Anxious Imagery Prime No scenarios paired with a preceding Anxious Imagery Prime
Anxious Imagery Prime: We will test whether priming anxious concerns and feared negative outcomes on the web via the addition of a guided anxious imagery prime at the start of each session will enhance effects. | 136 |
| No Scenario+Neutral Imagery Prime No scenarios paired with a preceding Neutral Imagery Prime
Neutral Imagery Prime: At the start of each session, participants will complete a neutral control imagery exercise where they do a guided imagery exercise imagining upcoming mundane tasks, like brushing one's teeth. | 154 |
| Total | 807 |
Baseline characteristics
| Characteristic | Total | Positive Training+Neutral Imagery Prime | 50/50 Training+Anxious Imagery Prime | 50/50 Training+Neutral Imagery Prime | No Scenario+Anxious Imagery Prime | No Scenario+Neutral Imagery Prime | Positive Training+Anxious Imagery Prime |
|---|---|---|---|---|---|---|---|
| Age, Continuous | 33.59 years STANDARD_DEVIATION 13.32 | 32.22 years STANDARD_DEVIATION 12.22 | 32.06 years STANDARD_DEVIATION 12.39 | 34.22 years STANDARD_DEVIATION 14.51 | 33.45 years STANDARD_DEVIATION 13.37 | 35.16 years STANDARD_DEVIATION 14.39 | 34.42 years STANDARD_DEVIATION 13.04 |
| Education Bachelor's degree | 200 Participants | 38 Participants | 27 Participants | 34 Participants | 29 Participants | 39 Participants | 33 Participants |
| Education Graduate school | 236 Participants | 33 Participants | 32 Participants | 46 Participants | 44 Participants | 47 Participants | 34 Participants |
| Education High school or below | 67 Participants | 10 Participants | 15 Participants | 11 Participants | 11 Participants | 12 Participants | 8 Participants |
| Education Not reported | 2 Participants | 1 Participants | 1 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Education Other | 302 Participants | 59 Participants | 46 Participants | 53 Participants | 52 Participants | 56 Participants | 36 Participants |
| Employment Status Not reported | 4 Participants | 1 Participants | 1 Participants | 0 Participants | 2 Participants | 0 Participants | 0 Participants |
| Employment Status Other | 63 Participants | 14 Participants | 9 Participants | 12 Participants | 13 Participants | 11 Participants | 4 Participants |
| Employment Status Retired | 26 Participants | 4 Participants | 2 Participants | 5 Participants | 4 Participants | 9 Participants | 2 Participants |
| Employment Status Student | 229 Participants | 46 Participants | 36 Participants | 41 Participants | 37 Participants | 38 Participants | 31 Participants |
| Employment Status Unemployed or looking for work | 57 Participants | 9 Participants | 7 Participants | 9 Participants | 15 Participants | 11 Participants | 6 Participants |
| Employment Status Working full-time | 337 Participants | 52 Participants | 41 Participants | 62 Participants | 54 Participants | 72 Participants | 56 Participants |
| Employment Status Working part-time | 91 Participants | 15 Participants | 25 Participants | 15 Participants | 11 Participants | 13 Participants | 12 Participants |
| Income > $200,000 | 35 Participants | 5 Participants | 5 Participants | 7 Participants | 9 Participants | 4 Participants | 5 Participants |
| Income < $75,000 | 350 Participants | 66 Participants | 53 Participants | 54 Participants | 56 Participants | 72 Participants | 49 Participants |
| Income Between $75,000 and $200,000 | 243 Participants | 37 Participants | 36 Participants | 47 Participants | 38 Participants | 47 Participants | 38 Participants |
| Income Don't know | 81 Participants | 12 Participants | 12 Participants | 17 Participants | 14 Participants | 16 Participants | 10 Participants |
| Income Not reported | 1 Participants | 1 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Income Prefer not to answer | 97 Participants | 20 Participants | 15 Participants | 19 Participants | 19 Participants | 15 Participants | 9 Participants |
| Marital Status Married | 247 Participants | 40 Participants | 28 Participants | 42 Participants | 45 Participants | 52 Participants | 40 Participants |
| Marital Status Other options | 282 Participants | 51 Participants | 43 Participants | 49 Participants | 49 Participants | 48 Participants | 42 Participants |
| Marital Status Prefer not to answer | 13 Participants | 3 Participants | 3 Participants | 2 Participants | 0 Participants | 4 Participants | 1 Participants |
| Marital Status Single | 265 Participants | 47 Participants | 47 Participants | 51 Participants | 42 Participants | 50 Participants | 28 Participants |
| Race/Ethnicity, Customized American Indian/Alaska Native | 6 Participants | 0 Participants | 2 Participants | 0 Participants | 2 Participants | 0 Participants | 2 Participants |
| Race/Ethnicity, Customized Black/African Origin | 24 Participants | 2 Participants | 3 Participants | 5 Participants | 5 Participants | 4 Participants | 5 Participants |
| Race/Ethnicity, Customized East/South Asian | 63 Participants | 11 Participants | 7 Participants | 15 Participants | 12 Participants | 10 Participants | 8 Participants |
| Race/Ethnicity, Customized Hispanic/Latino | 67 Participants | 11 Participants | 5 Participants | 17 Participants | 13 Participants | 10 Participants | 11 Participants |
| Race/Ethnicity, Customized Native Hawaiian/Pacific Islander | 2 Participants | 0 Participants | 1 Participants | 0 Participants | 0 Participants | 1 Participants | 0 Participants |
| Race/Ethnicity, Customized Not Hispanic/Latino | 667 Participants | 115 Participants | 108 Participants | 108 Participants | 115 Participants | 132 Participants | 89 Participants |
| Race/Ethnicity, Customized Not reported | 2 Participants | 1 Participants | 1 Participants | 0 Participants | 0 Participants | 1 Participants | 0 Participants |
| Race/Ethnicity, Customized Other or Unknown | 54 Participants | 5 Participants | 8 Participants | 10 Participants | 10 Participants | 13 Participants | 8 Participants |
| Race/Ethnicity, Customized Prefer not to answer | 30 Participants | 6 Participants | 7 Participants | 5 Participants | 4 Participants | 5 Participants | 3 Participants |
| Race/Ethnicity, Customized Unknown | 29 Participants | 5 Participants | 2 Participants | 8 Participants | 2 Participants | 5 Participants | 7 Participants |
| Race/Ethnicity, Customized White/European Origin | 626 Participants | 116 Participants | 92 Participants | 109 Participants | 103 Participants | 121 Participants | 85 Participants |
| Sex/Gender, Customized Gender (Female) | 583 Participants | 106 Participants | 87 Participants | 104 Participants | 94 Participants | 113 Participants | 79 Participants |
| Sex/Gender, Customized Male | 203 Participants | 31 Participants | 29 Participants | 38 Participants | 37 Participants | 37 Participants | 31 Participants |
| Sex/Gender, Customized Not reported | 1 Participants | 0 Participants | 1 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Sex/Gender, Customized Other | 8 Participants | 2 Participants | 1 Participants | 1 Participants | 1 Participants | 2 Participants | 1 Participants |
| Sex/Gender, Customized Prefer not to answer | 6 Participants | 1 Participants | 2 Participants | 0 Participants | 2 Participants | 1 Participants | 0 Participants |
| Sex/Gender, Customized Transgender | 6 Participants | 1 Participants | 1 Participants | 1 Participants | 2 Participants | 1 Participants | 0 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk | EG003 affected / at risk | EG004 affected / at risk | EG005 affected / at risk |
|---|---|---|---|---|---|---|
| deaths Total, all-cause mortality | 0 / 111 | 0 / 141 | 0 / 121 | 0 / 144 | 0 / 136 | 0 / 154 |
| other Total, other adverse events | 0 / 111 | 0 / 141 | 0 / 121 | 0 / 144 | 0 / 136 | 0 / 154 |
| serious Total, serious adverse events | 0 / 111 | 0 / 141 | 0 / 121 | 0 / 144 | 0 / 136 | 0 / 154 |
Outcome results
Primary
Change in Brief Bodily Sensations Interpretations Questionnaire
The Brief Bodily Sensation Interpretation Questionnaire (BBSIQ; Clark et al., 1997) was administered as a more independent, additional measure of interpretation bias. In the BBSIQ, participants are presented with fourteen ambiguous events related to physical (e.g., feeling lightheaded) or external (e.g., smelling smoke, social situations) concerns, along with three possible explanations for each ambiguous event (one negative, and two neutral or positive explanations). Participants rated the extent to which they believed each explanation for why the ambiguous event occurred on a Likert scale from 0 (not at all likely) to 4 (extremely likely). Typically, the BBSIQ is administered on an eight-point Likert scale, but a 0-4 scale was used to align with other rating scales in the study. Negative interpretation bias score was computed by averaging the likelihood ratings for all negative explanations (following Steinman & Teachman, 2010, 2015).
Time frame: Baseline, and after sessions 3 (~2 weeks following baseline), 6 (~10 days after session 3), and 8 (~7 days after session 6) & at 2-month follow-up. Measure will be completed immediately following that day's training session.
Population: Due to attrition, the number of participants differs at each session.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Positive Training+Anxious Imagery Prime | Change in Brief Bodily Sensations Interpretations Questionnaire | Session 8 | 1.58 units on a scale | Standard Deviation 1.14 |
| Positive Training+Anxious Imagery Prime | Change in Brief Bodily Sensations Interpretations Questionnaire | Session 3 | 1.82 units on a scale | Standard Deviation 1.16 |
| Positive Training+Anxious Imagery Prime | Change in Brief Bodily Sensations Interpretations Questionnaire | Baseline | 1.81 units on a scale | Standard Deviation 1.15 |
| Positive Training+Anxious Imagery Prime | Change in Brief Bodily Sensations Interpretations Questionnaire | 2-month Follow-up | 1.68 units on a scale | Standard Deviation 1.33 |
| Positive Training+Anxious Imagery Prime | Change in Brief Bodily Sensations Interpretations Questionnaire | Session 6 | 1.66 units on a scale | Standard Deviation 1.09 |
| Positive Training+Neutral Imagery Prime | Change in Brief Bodily Sensations Interpretations Questionnaire | Session 3 | 1.82 units on a scale | Standard Deviation 1.17 |
| Positive Training+Neutral Imagery Prime | Change in Brief Bodily Sensations Interpretations Questionnaire | Session 8 | 1.78 units on a scale | Standard Deviation 1.16 |
| Positive Training+Neutral Imagery Prime | Change in Brief Bodily Sensations Interpretations Questionnaire | Baseline | 1.83 units on a scale | Standard Deviation 1.16 |
| Positive Training+Neutral Imagery Prime | Change in Brief Bodily Sensations Interpretations Questionnaire | 2-month Follow-up | 1.59 units on a scale | Standard Deviation 0.8 |
| Positive Training+Neutral Imagery Prime | Change in Brief Bodily Sensations Interpretations Questionnaire | Session 6 | 1.85 units on a scale | Standard Deviation 1.16 |
| 50/50 Training+Anxious Imagery Prime | Change in Brief Bodily Sensations Interpretations Questionnaire | Session 3 | 1.80 units on a scale | Standard Deviation 1.04 |
| 50/50 Training+Anxious Imagery Prime | Change in Brief Bodily Sensations Interpretations Questionnaire | Session 8 | 1.90 units on a scale | Standard Deviation 1.15 |
| 50/50 Training+Anxious Imagery Prime | Change in Brief Bodily Sensations Interpretations Questionnaire | 2-month Follow-up | 2.04 units on a scale | Standard Deviation 1.06 |
| 50/50 Training+Anxious Imagery Prime | Change in Brief Bodily Sensations Interpretations Questionnaire | Session 6 | 1.94 units on a scale | Standard Deviation 1.13 |
| 50/50 Training+Anxious Imagery Prime | Change in Brief Bodily Sensations Interpretations Questionnaire | Baseline | 1.93 units on a scale | Standard Deviation 1.17 |
| 50/50 Training+Neutral Imagery Prime | Change in Brief Bodily Sensations Interpretations Questionnaire | Session 6 | 1.94 units on a scale | Standard Deviation 1.27 |
| 50/50 Training+Neutral Imagery Prime | Change in Brief Bodily Sensations Interpretations Questionnaire | Baseline | 1.91 units on a scale | Standard Deviation 1.16 |
| 50/50 Training+Neutral Imagery Prime | Change in Brief Bodily Sensations Interpretations Questionnaire | Session 3 | 1.94 units on a scale | Standard Deviation 1.14 |
| 50/50 Training+Neutral Imagery Prime | Change in Brief Bodily Sensations Interpretations Questionnaire | Session 8 | 1.85 units on a scale | Standard Deviation 1.24 |
| 50/50 Training+Neutral Imagery Prime | Change in Brief Bodily Sensations Interpretations Questionnaire | 2-month Follow-up | 1.98 units on a scale | Standard Deviation 1.3 |
| No Scenario+Anxious Imagery Prime | Change in Brief Bodily Sensations Interpretations Questionnaire | Session 8 | 1.87 units on a scale | Standard Deviation 1.07 |
| No Scenario+Anxious Imagery Prime | Change in Brief Bodily Sensations Interpretations Questionnaire | Baseline | 1.90 units on a scale | Standard Deviation 1.13 |
| No Scenario+Anxious Imagery Prime | Change in Brief Bodily Sensations Interpretations Questionnaire | 2-month Follow-up | 2.13 units on a scale | Standard Deviation 1.22 |
| No Scenario+Anxious Imagery Prime | Change in Brief Bodily Sensations Interpretations Questionnaire | Session 3 | 1.86 units on a scale | Standard Deviation 1.11 |
| No Scenario+Anxious Imagery Prime | Change in Brief Bodily Sensations Interpretations Questionnaire | Session 6 | 1.92 units on a scale | Standard Deviation 1.22 |
| No Scenario+Neutral Imagery Prime | Change in Brief Bodily Sensations Interpretations Questionnaire | Baseline | 1.85 units on a scale | Standard Deviation 1.12 |
| No Scenario+Neutral Imagery Prime | Change in Brief Bodily Sensations Interpretations Questionnaire | Session 8 | 1.82 units on a scale | Standard Deviation 1.17 |
| No Scenario+Neutral Imagery Prime | Change in Brief Bodily Sensations Interpretations Questionnaire | Session 3 | 1.77 units on a scale | Standard Deviation 1.03 |
| No Scenario+Neutral Imagery Prime | Change in Brief Bodily Sensations Interpretations Questionnaire | 2-month Follow-up | 1.25 units on a scale | Standard Deviation 1.04 |
| No Scenario+Neutral Imagery Prime | Change in Brief Bodily Sensations Interpretations Questionnaire | Session 6 | 1.90 units on a scale | Standard Deviation 1.08 |
Comparison: Effect of CBM-I condition: The main effect of CBM-I was represented by three binary variables in the main effect models (Positive vs. No-training control; 50/50 vs. No- training control; Positive vs. 50/50). Due to high attrition, latent growth curve modeling was used instead of the planned approach (mixed effects models with multiple imputation of missing values) to minimize bias due to missing data estimation. Because omnibus tests were not run, results for all comparisons are listed below.p-value: <0.001Likelihood Ratio Tests
Comparison: Effect of Imagery Prime Type: The main effect of imagery prime was represented by one binary variable (neutral vs. anxiety imagery). Due to high attrition, latent growth curve modeling was used instead of the planned approach (mixed effects models with multiple imputation of missing values) to minimize bias due to missing data estimation. Because omnibus tests were not run, results for all comparisons are listed below.p-value: 0.135Likelihood Ratio Tests
Comparison: Effect of CBM-I condition and Imagery Prime Type interaction: Each cell of the interaction was represented by one of 5 binary variables, set to 1 if a participant was in that group, and 0 otherwise; the sixth group (No-training + neutral prime) was considered a reference group, and was represented by all variables being 0. Due to high attrition, latent growth curve modeling was used instead of the planned approach. Because omnibus tests were not run, results for all comparisons are listed below.p-value: 0.009Likelihood Ratio Tests
Primary
Change in Overall Anxiety Severity and Impairment Scale
The Overall Anxiety Severity and Impairment Scale (OASIS; Norman, Hami Cissell, Means-Christensen, & Stein, 2006) assesses anxiety frequency, severity, and associated avoidance, work and social interference. This 5-item measure of anxiety symptom severity and impairment has good psychometric properties, shows treatment sensitivity, and is valid in community and clinical samples. All items are rated on a scale of 0 (lowest impairment/severity) to 4 (highest impairment/severity). Total scores on the OASIS are calculated by summing the scores of each of the 5 questions. The total score on the OASIS ranges from 0 to 20, with higher scores indicating greater anxiety. A cut-score of 8 or higher on the OASIS is considered to indicate probable anxiety disorder.
Time frame: Baseline, and after sessions 1,2,3,4,5,6,7,8 (sessions will be spaced ~3-4 days apart) & at 2-month follow-up. Measure will be completed immediately following that day's training session. Session 2 is expected to occur within 3-8 days of the baseline.
Population: Due to attrition, the number of participants differs at each session.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Positive Training+Anxious Imagery Prime | Change in Overall Anxiety Severity and Impairment Scale | Session 3 | 7.782609 score on a scale | Standard Deviation 0.47 |
| Positive Training+Anxious Imagery Prime | Change in Overall Anxiety Severity and Impairment Scale | Session 2 | 8.725490 score on a scale | Standard Deviation 0.57 |
| Positive Training+Anxious Imagery Prime | Change in Overall Anxiety Severity and Impairment Scale | 2-month Follow-up | 3.000000 score on a scale | Standard Deviation 0.55 |
| Positive Training+Anxious Imagery Prime | Change in Overall Anxiety Severity and Impairment Scale | Session 8 | 9.200000 score on a scale | Standard Deviation 0.3 |
| Positive Training+Anxious Imagery Prime | Change in Overall Anxiety Severity and Impairment Scale | Session 7 | 7.222222 score on a scale | Standard Deviation 0.54 |
| Positive Training+Anxious Imagery Prime | Change in Overall Anxiety Severity and Impairment Scale | Session 6 | 7.928571 score on a scale | Standard Deviation 0.43 |
| Positive Training+Anxious Imagery Prime | Change in Overall Anxiety Severity and Impairment Scale | Session 1 | 10.152778 score on a scale | Standard Deviation 0.55 |
| Positive Training+Anxious Imagery Prime | Change in Overall Anxiety Severity and Impairment Scale | Baseline | 10.367925 score on a scale | Standard Deviation 0.65 |
| Positive Training+Anxious Imagery Prime | Change in Overall Anxiety Severity and Impairment Scale | Session 5 | 9.066667 score on a scale | Standard Deviation 0.45 |
| Positive Training+Anxious Imagery Prime | Change in Overall Anxiety Severity and Impairment Scale | Session 4 | 8.750000 score on a scale | Standard Deviation 0.48 |
| Positive Training+Neutral Imagery Prime | Change in Overall Anxiety Severity and Impairment Scale | Session 1 | 10.458333 score on a scale | Standard Deviation 0.6 |
| Positive Training+Neutral Imagery Prime | Change in Overall Anxiety Severity and Impairment Scale | Baseline | 11.066667 score on a scale | Standard Deviation 0.63 |
| Positive Training+Neutral Imagery Prime | Change in Overall Anxiety Severity and Impairment Scale | Session 2 | 9.587302 score on a scale | Standard Deviation 0.62 |
| Positive Training+Neutral Imagery Prime | Change in Overall Anxiety Severity and Impairment Scale | Session 3 | 9.292683 score on a scale | Standard Deviation 0.6 |
| Positive Training+Neutral Imagery Prime | Change in Overall Anxiety Severity and Impairment Scale | Session 4 | 8.514286 score on a scale | Standard Deviation 0.57 |
| Positive Training+Neutral Imagery Prime | Change in Overall Anxiety Severity and Impairment Scale | Session 5 | 8.535714 score on a scale | Standard Deviation 0.59 |
| Positive Training+Neutral Imagery Prime | Change in Overall Anxiety Severity and Impairment Scale | Session 6 | 8.407407 score on a scale | Standard Deviation 0.53 |
| Positive Training+Neutral Imagery Prime | Change in Overall Anxiety Severity and Impairment Scale | Session 7 | 8.285714 score on a scale | Standard Deviation 0.54 |
| Positive Training+Neutral Imagery Prime | Change in Overall Anxiety Severity and Impairment Scale | Session 8 | 9.521739 score on a scale | Standard Deviation 0.57 |
| Positive Training+Neutral Imagery Prime | Change in Overall Anxiety Severity and Impairment Scale | 2-month Follow-up | 7.400000 score on a scale | Standard Deviation 0.53 |
| 50/50 Training+Anxious Imagery Prime | Change in Overall Anxiety Severity and Impairment Scale | Session 3 | 10.285714 score on a scale | Standard Deviation 0.57 |
| 50/50 Training+Anxious Imagery Prime | Change in Overall Anxiety Severity and Impairment Scale | Session 4 | 10.600000 score on a scale | Standard Deviation 0.47 |
| 50/50 Training+Anxious Imagery Prime | Change in Overall Anxiety Severity and Impairment Scale | Session 1 | 11.168675 score on a scale | Standard Deviation 0.58 |
| 50/50 Training+Anxious Imagery Prime | Change in Overall Anxiety Severity and Impairment Scale | Session 5 | 10.058824 score on a scale | Standard Deviation 0.64 |
| 50/50 Training+Anxious Imagery Prime | Change in Overall Anxiety Severity and Impairment Scale | 2-month Follow-up | 11.333333 score on a scale | Standard Deviation 0.45 |
| 50/50 Training+Anxious Imagery Prime | Change in Overall Anxiety Severity and Impairment Scale | Session 6 | 9.200000 score on a scale | Standard Deviation 0.58 |
| 50/50 Training+Anxious Imagery Prime | Change in Overall Anxiety Severity and Impairment Scale | Session 7 | 8.818182 score on a scale | Standard Deviation 0.49 |
| 50/50 Training+Anxious Imagery Prime | Change in Overall Anxiety Severity and Impairment Scale | Session 8 | 11.454545 score on a scale | Standard Deviation 0.68 |
| 50/50 Training+Anxious Imagery Prime | Change in Overall Anxiety Severity and Impairment Scale | Session 2 | 10.433962 score on a scale | Standard Deviation 0.68 |
| 50/50 Training+Anxious Imagery Prime | Change in Overall Anxiety Severity and Impairment Scale | Baseline | 11.470085 score on a scale | Standard Deviation 0.62 |
| 50/50 Training+Neutral Imagery Prime | Change in Overall Anxiety Severity and Impairment Scale | Session 1 | 10.011111 score on a scale | Standard Deviation 0.58 |
| 50/50 Training+Neutral Imagery Prime | Change in Overall Anxiety Severity and Impairment Scale | Session 2 | 9.571429 score on a scale | Standard Deviation 0.57 |
| 50/50 Training+Neutral Imagery Prime | Change in Overall Anxiety Severity and Impairment Scale | Session 8 | 8.041667 score on a scale | Standard Deviation 0.42 |
| 50/50 Training+Neutral Imagery Prime | Change in Overall Anxiety Severity and Impairment Scale | 2-month Follow-up | 8.333333 score on a scale | Standard Deviation 0.58 |
| 50/50 Training+Neutral Imagery Prime | Change in Overall Anxiety Severity and Impairment Scale | Session 4 | 7.771429 score on a scale | Standard Deviation 0.62 |
| 50/50 Training+Neutral Imagery Prime | Change in Overall Anxiety Severity and Impairment Scale | Session 7 | 7.681818 score on a scale | Standard Deviation 0.73 |
| 50/50 Training+Neutral Imagery Prime | Change in Overall Anxiety Severity and Impairment Scale | Session 3 | 8.526316 score on a scale | Standard Deviation 0.53 |
| 50/50 Training+Neutral Imagery Prime | Change in Overall Anxiety Severity and Impairment Scale | Session 6 | 8.391304 score on a scale | Standard Deviation 0.45 |
| 50/50 Training+Neutral Imagery Prime | Change in Overall Anxiety Severity and Impairment Scale | Baseline | 10.544118 score on a scale | Standard Deviation 0.69 |
| 50/50 Training+Neutral Imagery Prime | Change in Overall Anxiety Severity and Impairment Scale | Session 5 | 7.666667 score on a scale | Standard Deviation 0.53 |
| No Scenario+Anxious Imagery Prime | Change in Overall Anxiety Severity and Impairment Scale | 2-month Follow-up | 8.000000 score on a scale | Standard Deviation 0.5 |
| No Scenario+Anxious Imagery Prime | Change in Overall Anxiety Severity and Impairment Scale | Session 3 | 10.171429 score on a scale | Standard Deviation 0.58 |
| No Scenario+Anxious Imagery Prime | Change in Overall Anxiety Severity and Impairment Scale | Session 1 | 10.836957 score on a scale | Standard Deviation 0.55 |
| No Scenario+Anxious Imagery Prime | Change in Overall Anxiety Severity and Impairment Scale | Session 4 | 10.142857 score on a scale | Standard Deviation 0.49 |
| No Scenario+Anxious Imagery Prime | Change in Overall Anxiety Severity and Impairment Scale | Session 6 | 8.714286 score on a scale | Standard Deviation 0.5 |
| No Scenario+Anxious Imagery Prime | Change in Overall Anxiety Severity and Impairment Scale | Session 5 | 8.071429 score on a scale | Standard Deviation 0.57 |
| No Scenario+Anxious Imagery Prime | Change in Overall Anxiety Severity and Impairment Scale | Baseline | 11.131783 score on a scale | Standard Deviation 0.6 |
| No Scenario+Anxious Imagery Prime | Change in Overall Anxiety Severity and Impairment Scale | Session 2 | 10.592593 score on a scale | Standard Deviation 0.61 |
| No Scenario+Anxious Imagery Prime | Change in Overall Anxiety Severity and Impairment Scale | Session 7 | 8.384615 score on a scale | Standard Deviation 0.46 |
| No Scenario+Anxious Imagery Prime | Change in Overall Anxiety Severity and Impairment Scale | Session 8 | 7.400000 score on a scale | Standard Deviation 0.47 |
| No Scenario+Neutral Imagery Prime | Change in Overall Anxiety Severity and Impairment Scale | Session 4 | 8.406250 score on a scale | Standard Deviation 0.5 |
| No Scenario+Neutral Imagery Prime | Change in Overall Anxiety Severity and Impairment Scale | 2-month Follow-up | 6.000000 score on a scale | Standard Deviation 0.63 |
| No Scenario+Neutral Imagery Prime | Change in Overall Anxiety Severity and Impairment Scale | Session 5 | 8.115385 score on a scale | Standard Deviation 0.52 |
| No Scenario+Neutral Imagery Prime | Change in Overall Anxiety Severity and Impairment Scale | Baseline | 10.486111 score on a scale | Standard Deviation 0.67 |
| No Scenario+Neutral Imagery Prime | Change in Overall Anxiety Severity and Impairment Scale | Session 6 | 8.500000 score on a scale | Standard Deviation 0.58 |
| No Scenario+Neutral Imagery Prime | Change in Overall Anxiety Severity and Impairment Scale | Session 7 | 7.631579 score on a scale | Standard Deviation 0.52 |
| No Scenario+Neutral Imagery Prime | Change in Overall Anxiety Severity and Impairment Scale | Session 2 | 9.760417 score on a scale | Standard Deviation 0.63 |
| No Scenario+Neutral Imagery Prime | Change in Overall Anxiety Severity and Impairment Scale | Session 3 | 8.745098 score on a scale | Standard Deviation 0.65 |
| No Scenario+Neutral Imagery Prime | Change in Overall Anxiety Severity and Impairment Scale | Session 8 | 7.357143 score on a scale | Standard Deviation 0.5 |
| No Scenario+Neutral Imagery Prime | Change in Overall Anxiety Severity and Impairment Scale | Session 1 | 10.271845 score on a scale | Standard Deviation 0.63 |
Comparison: Effect of CBM-I condition: The main effect of CBM-I was represented by three binary variables in the main effect models (Positive vs. No-training control; 50/50 vs. No- training control; Positive vs. 50/50). Due to high attrition, latent growth curve modeling was used instead of the planned approach (mixed effects models with multiple imputation of missing values) to minimize bias due to missing data estimation. Because omnibus tests were not run, results for all comparisons are listed below.p-value: 0.003Likelihood Ratio Tests
Comparison: Effect of Imagery Prime Type: The main effect of imagery prime was represented by one binary variable (neutral vs. anxiety imagery). Due to high attrition, latent growth curve modeling was used instead of the planned approach (mixed effects models with multiple imputation of missing values) to minimize bias due to missing data estimation. Because omnibus tests were not run, results for all comparisons are listed below.p-value: 0.14Likelihood Ratio Tests
Comparison: Effect of CBM-I condition and Imagery Prime Type interaction: Each cell of the interaction was represented by one of 5 binary variables, set to 1 if a participant was in that group, and 0 otherwise; the sixth group (No-training + neutral prime) was considered a reference group, and was represented by all variables being 0. Due to high attrition, latent growth curve modeling was used instead of the planned approach. Because omnibus tests were not run, results for all comparisons are listed below.p-value: 0.049Likelihood Ratio Tests
Primary
Change in Recognition Ratings (Negative Interpretation Bias)
To measure interpretation bias, participants will read ambiguous scenarios with titles, after which they will see the titles of each scenario, followed by 2 disambiguated interpretations of the scenario: 1 positive and 1 negative. Participants will rate each disambiguated interpretation based on how similar in meaning it is to the original scenario on a 4-point scale ranging from 1 to 4. The mean of the negative, threat-related ratings index negative interpretation bias. Higher scores represent a more negative interpretation bias.
Time frame: Baseline, and after sessions 3 (~2 weeks following baseline), 6 (~10 days after session 3), and 8 (~7 days after session 6) & at 2-month follow-up. Measure will be completed immediately following that day's training session.
Population: Due to attrition, the number of participants differs at each session.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Positive Training+Anxious Imagery Prime | Change in Recognition Ratings (Negative Interpretation Bias) | Session 8 | 1.20 score on a scale | Standard Deviation 0.73 |
| Positive Training+Anxious Imagery Prime | Change in Recognition Ratings (Negative Interpretation Bias) | Session 3 | 1.21 score on a scale | Standard Deviation 0.83 |
| Positive Training+Anxious Imagery Prime | Change in Recognition Ratings (Negative Interpretation Bias) | Baseline | 1.66 score on a scale | Standard Deviation 0.94 |
| Positive Training+Anxious Imagery Prime | Change in Recognition Ratings (Negative Interpretation Bias) | 2-month Follow-up | 1.17 score on a scale | Standard Deviation 0.97 |
| Positive Training+Anxious Imagery Prime | Change in Recognition Ratings (Negative Interpretation Bias) | Session 6 | 1.04 score on a scale | Standard Deviation 0.73 |
| Positive Training+Neutral Imagery Prime | Change in Recognition Ratings (Negative Interpretation Bias) | Session 3 | 1.38 score on a scale | Standard Deviation 0.79 |
| Positive Training+Neutral Imagery Prime | Change in Recognition Ratings (Negative Interpretation Bias) | Session 8 | 1.30 score on a scale | Standard Deviation 0.72 |
| Positive Training+Neutral Imagery Prime | Change in Recognition Ratings (Negative Interpretation Bias) | Baseline | 1.70 score on a scale | Standard Deviation 0.89 |
| Positive Training+Neutral Imagery Prime | Change in Recognition Ratings (Negative Interpretation Bias) | 2-month Follow-up | 1.25 score on a scale | Standard Deviation 0.7 |
| Positive Training+Neutral Imagery Prime | Change in Recognition Ratings (Negative Interpretation Bias) | Session 6 | 1.18 score on a scale | Standard Deviation 0.76 |
| 50/50 Training+Anxious Imagery Prime | Change in Recognition Ratings (Negative Interpretation Bias) | Session 3 | 1.74 score on a scale | Standard Deviation 0.85 |
| 50/50 Training+Anxious Imagery Prime | Change in Recognition Ratings (Negative Interpretation Bias) | Session 8 | 1.51 score on a scale | Standard Deviation 0.99 |
| 50/50 Training+Anxious Imagery Prime | Change in Recognition Ratings (Negative Interpretation Bias) | 2-month Follow-up | 1.67 score on a scale | Standard Deviation 0.59 |
| 50/50 Training+Anxious Imagery Prime | Change in Recognition Ratings (Negative Interpretation Bias) | Session 6 | 1.88 score on a scale | Standard Deviation 0.86 |
| 50/50 Training+Anxious Imagery Prime | Change in Recognition Ratings (Negative Interpretation Bias) | Baseline | 1.75 score on a scale | Standard Deviation 0.87 |
| 50/50 Training+Neutral Imagery Prime | Change in Recognition Ratings (Negative Interpretation Bias) | Session 6 | 1.67 score on a scale | Standard Deviation 0.9 |
| 50/50 Training+Neutral Imagery Prime | Change in Recognition Ratings (Negative Interpretation Bias) | Baseline | 1.74 score on a scale | Standard Deviation 0.92 |
| 50/50 Training+Neutral Imagery Prime | Change in Recognition Ratings (Negative Interpretation Bias) | Session 3 | 1.68 score on a scale | Standard Deviation 0.92 |
| 50/50 Training+Neutral Imagery Prime | Change in Recognition Ratings (Negative Interpretation Bias) | Session 8 | 1.58 score on a scale | Standard Deviation 0.9 |
| 50/50 Training+Neutral Imagery Prime | Change in Recognition Ratings (Negative Interpretation Bias) | 2-month Follow-up | 1.78 score on a scale | Standard Deviation 0.71 |
| No Scenario+Anxious Imagery Prime | Change in Recognition Ratings (Negative Interpretation Bias) | Session 8 | 1.83 score on a scale | Standard Deviation 0.68 |
| No Scenario+Anxious Imagery Prime | Change in Recognition Ratings (Negative Interpretation Bias) | Baseline | 1.77 score on a scale | Standard Deviation 0.84 |
| No Scenario+Anxious Imagery Prime | Change in Recognition Ratings (Negative Interpretation Bias) | 2-month Follow-up | 1.73 score on a scale | Standard Deviation 0.67 |
| No Scenario+Anxious Imagery Prime | Change in Recognition Ratings (Negative Interpretation Bias) | Session 3 | 1.85 score on a scale | Standard Deviation 0.86 |
| No Scenario+Anxious Imagery Prime | Change in Recognition Ratings (Negative Interpretation Bias) | Session 6 | 1.78 score on a scale | Standard Deviation 0.76 |
| No Scenario+Neutral Imagery Prime | Change in Recognition Ratings (Negative Interpretation Bias) | Baseline | 1.77 score on a scale | Standard Deviation 0.88 |
| No Scenario+Neutral Imagery Prime | Change in Recognition Ratings (Negative Interpretation Bias) | Session 8 | 1.50 score on a scale | Standard Deviation 0.77 |
| No Scenario+Neutral Imagery Prime | Change in Recognition Ratings (Negative Interpretation Bias) | Session 3 | 1.54 score on a scale | Standard Deviation 0.84 |
| No Scenario+Neutral Imagery Prime | Change in Recognition Ratings (Negative Interpretation Bias) | 2-month Follow-up | 0.78 score on a scale | Standard Deviation 0.26 |
| No Scenario+Neutral Imagery Prime | Change in Recognition Ratings (Negative Interpretation Bias) | Session 6 | 1.52 score on a scale | Standard Deviation 0.83 |
Comparison: Effect of CBM-I condition: The main effect of CBM-I was represented by three binary variables in the main effect models (Positive vs. No-training control; 50/50 vs. No- training control; Positive vs. 50/50). Due to high attrition, latent growth curve modeling was used instead of the planned approach (mixed effects models with multiple imputation of missing values) to minimize bias due to missing data estimation. Because omnibus tests were not run, results for all comparisons are listed below.p-value: <0.001Likelihood Ratio Tests
Comparison: Effect of Imagery Prime Type: The main effect of imagery prime was represented by one binary variable (neutral vs. anxiety imagery). Due to high attrition, latent growth curve modeling was used instead of the planned approach (mixed effects models with multiple imputation of missing values) to minimize bias due to missing data estimation. Because omnibus tests were not run, results for all comparisons are listed below.p-value: 0.728Likelihood Ratio Tests
Comparison: Effect of CBM-I condition and Imagery Prime Type interaction: Each cell of the interaction was represented by one of 5 binary variables, set to 1 if a participant was in that group, and 0 otherwise; the sixth group (No-training + neutral prime) was considered a reference group, and was represented by all variables being 0. Due to high attrition, latent growth curve modeling was used instead of the planned approach. Because omnibus tests were not run, results for all comparisons are listed below.p-value: <0.001Likelihood Ratio Tests
Primary
Change in Recognition Ratings (Positive Interpretation Bias)
To measure interpretation bias, participants will read ambiguous scenarios with titles, after which they will see the titles of each scenario, followed by 2 disambiguated interpretations of the scenario: 1 positive and 1 negative. Participants will rate each disambiguated interpretation based on how similar in meaning it is to the original scenario on a 4-point scale ranging from 1 to 4. The mean of the positive, threat-related ratings index positive interpretation bias. Higher scores represent a more positive interpretation bias.
Time frame: Baseline, and after sessions 3 (~2 weeks following baseline), 6 (~10 days after session 3), and 8 (~7 days after session 6) & at 2-month follow-up. Measure will be completed immediately following that day's training session.
Population: Due to attrition, the number of participants differs at each session.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Positive Training+Anxious Imagery Prime | Change in Recognition Ratings (Positive Interpretation Bias) | Session 8 | 1.58 score on a scale | Standard Deviation 0.78 |
| Positive Training+Anxious Imagery Prime | Change in Recognition Ratings (Positive Interpretation Bias) | Session 3 | 1.63 score on a scale | Standard Deviation 0.9 |
| Positive Training+Anxious Imagery Prime | Change in Recognition Ratings (Positive Interpretation Bias) | Baseline | 1.23 score on a scale | Standard Deviation 0.87 |
| Positive Training+Anxious Imagery Prime | Change in Recognition Ratings (Positive Interpretation Bias) | 2-month Follow-up | 1.50 score on a scale | Standard Deviation 1.16 |
| Positive Training+Anxious Imagery Prime | Change in Recognition Ratings (Positive Interpretation Bias) | Session 6 | 1.67 score on a scale | Standard Deviation 0.78 |
| Positive Training+Neutral Imagery Prime | Change in Recognition Ratings (Positive Interpretation Bias) | Session 3 | 1.57 score on a scale | Standard Deviation 0.83 |
| Positive Training+Neutral Imagery Prime | Change in Recognition Ratings (Positive Interpretation Bias) | Session 8 | 1.38 score on a scale | Standard Deviation 0.74 |
| Positive Training+Neutral Imagery Prime | Change in Recognition Ratings (Positive Interpretation Bias) | Baseline | 1.19 score on a scale | Standard Deviation 0.82 |
| Positive Training+Neutral Imagery Prime | Change in Recognition Ratings (Positive Interpretation Bias) | 2-month Follow-up | 1.64 score on a scale | Standard Deviation 0.51 |
| Positive Training+Neutral Imagery Prime | Change in Recognition Ratings (Positive Interpretation Bias) | Session 6 | 1.47 score on a scale | Standard Deviation 0.79 |
| 50/50 Training+Anxious Imagery Prime | Change in Recognition Ratings (Positive Interpretation Bias) | Session 3 | 1.47 score on a scale | Standard Deviation 0.7 |
| 50/50 Training+Anxious Imagery Prime | Change in Recognition Ratings (Positive Interpretation Bias) | Session 8 | 1.72 score on a scale | Standard Deviation 0.76 |
| 50/50 Training+Anxious Imagery Prime | Change in Recognition Ratings (Positive Interpretation Bias) | 2-month Follow-up | 1.47 score on a scale | Standard Deviation 0.81 |
| 50/50 Training+Anxious Imagery Prime | Change in Recognition Ratings (Positive Interpretation Bias) | Session 6 | 1.50 score on a scale | Standard Deviation 0.85 |
| 50/50 Training+Anxious Imagery Prime | Change in Recognition Ratings (Positive Interpretation Bias) | Baseline | 1.22 score on a scale | Standard Deviation 0.83 |
| 50/50 Training+Neutral Imagery Prime | Change in Recognition Ratings (Positive Interpretation Bias) | Session 6 | 1.30 score on a scale | Standard Deviation 0.98 |
| 50/50 Training+Neutral Imagery Prime | Change in Recognition Ratings (Positive Interpretation Bias) | Baseline | 1.16 score on a scale | Standard Deviation 0.88 |
| 50/50 Training+Neutral Imagery Prime | Change in Recognition Ratings (Positive Interpretation Bias) | Session 3 | 1.38 score on a scale | Standard Deviation 0.94 |
| 50/50 Training+Neutral Imagery Prime | Change in Recognition Ratings (Positive Interpretation Bias) | Session 8 | 1.43 score on a scale | Standard Deviation 0.97 |
| 50/50 Training+Neutral Imagery Prime | Change in Recognition Ratings (Positive Interpretation Bias) | 2-month Follow-up | 1.24 score on a scale | Standard Deviation 0.73 |
| No Scenario+Anxious Imagery Prime | Change in Recognition Ratings (Positive Interpretation Bias) | Session 8 | 1.42 score on a scale | Standard Deviation 0.63 |
| No Scenario+Anxious Imagery Prime | Change in Recognition Ratings (Positive Interpretation Bias) | Baseline | 1.17 score on a scale | Standard Deviation 0.83 |
| No Scenario+Anxious Imagery Prime | Change in Recognition Ratings (Positive Interpretation Bias) | 2-month Follow-up | 1.62 score on a scale | Standard Deviation 0.68 |
| No Scenario+Anxious Imagery Prime | Change in Recognition Ratings (Positive Interpretation Bias) | Session 3 | 1.20 score on a scale | Standard Deviation 0.77 |
| No Scenario+Anxious Imagery Prime | Change in Recognition Ratings (Positive Interpretation Bias) | Session 6 | 1.33 score on a scale | Standard Deviation 0.82 |
| No Scenario+Neutral Imagery Prime | Change in Recognition Ratings (Positive Interpretation Bias) | Baseline | 1.22 score on a scale | Standard Deviation 0.83 |
| No Scenario+Neutral Imagery Prime | Change in Recognition Ratings (Positive Interpretation Bias) | Session 8 | 1.38 score on a scale | Standard Deviation 0.66 |
| No Scenario+Neutral Imagery Prime | Change in Recognition Ratings (Positive Interpretation Bias) | Session 3 | 1.43 score on a scale | Standard Deviation 0.71 |
| No Scenario+Neutral Imagery Prime | Change in Recognition Ratings (Positive Interpretation Bias) | 2-month Follow-up | 2.05 score on a scale | Standard Deviation 0.79 |
| No Scenario+Neutral Imagery Prime | Change in Recognition Ratings (Positive Interpretation Bias) | Session 6 | 1.51 score on a scale | Standard Deviation 0.71 |
Comparison: Effect of CBM-I condition: The main effect of CBM-I was represented by three binary variables in the main effect models (Positive vs. No-training control; 50/50 vs. No- training control; Positive vs. 50/50). Due to high attrition, latent growth curve modeling was used instead of the planned approach (mixed effects models with multiple imputation of missing values) to minimize bias due to missing data estimation. Because omnibus tests were not run, results for all comparisons are listed below.p-value: 0.005Likelihood Ratio Tests
Comparison: Effect of Imagery Prime Type: The main effect of imagery prime was represented by one binary variable (neutral vs. anxiety imagery). Due to high attrition, latent growth curve modeling was used instead of the planned approach (mixed effects models with multiple imputation of missing values) to minimize bias due to missing data estimation. Because omnibus tests were not run, results for all comparisons are listed below.p-value: 0.799Likelihood Ratio Tests
Comparison: Effect of CBM-I condition and Imagery Prime Type interaction: Each cell of the interaction was represented by one of 5 binary variables, set to 1 if a participant was in that group, and 0 otherwise; the sixth group (No-training + neutral prime) was considered a reference group, and was represented by all variables being 0. Due to high attrition, latent growth curve modeling was used instead of the planned approach. Because omnibus tests were not run, results for all comparisons are listed below.p-value: 0.011Likelihood Ratio Tests
Secondary
Change in Depression, Anxiety, Stress Scales-Short Form: Anxiety Subscale
While we use the OASIS as a primary measure of anxiety symptom severity, we are using the DASS-AS (Lovibond & Lovibond, 1995) as another 7-item measure of anxiety symptoms. Higher scores indicate more severe anxiety symptoms. Minimum score = 0; maximum score = 21. 0 = Did not apply to me at all 1. = Applied to me to some degree, or some of the time 2. = Applied to me to a considerable degree, or a good part of time 3. = Applied to me very much, or most of the time Qs: 1. I was aware of dryness of my mouth. 2. I experienced breathing difficulty (e.g., excessively rapid breathing, breathlessness in the absence of physical exertion). 3. I experienced trembling (e.g., in the hands). 4. I was worried about situations in which I might panic and make a fool of myself. 5. I felt I was close to panic. 6. I was aware of the action of my heart in the absence of physical exertion (e.g., sense of heart rate increase, heart missing a beat). 7. I felt scared without any good reason.
Time frame: Baseline, after session 8 (~4 weeks after baseline) & at 2-month follow-up.
Population: Due to attrition, the number of participants differs at each session.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Positive Training+Anxious Imagery Prime | Change in Depression, Anxiety, Stress Scales-Short Form: Anxiety Subscale | Session 8 | 14.4 score on a scale | Standard Deviation 9.11 |
| Positive Training+Anxious Imagery Prime | Change in Depression, Anxiety, Stress Scales-Short Form: Anxiety Subscale | Baseline | 22.4 score on a scale | Standard Deviation 7.92 |
| Positive Training+Anxious Imagery Prime | Change in Depression, Anxiety, Stress Scales-Short Form: Anxiety Subscale | 2-month Follow-up | 13 score on a scale | Standard Deviation 9.72 |
| Positive Training+Neutral Imagery Prime | Change in Depression, Anxiety, Stress Scales-Short Form: Anxiety Subscale | Session 8 | 14.3 score on a scale | Standard Deviation 9.07 |
| Positive Training+Neutral Imagery Prime | Change in Depression, Anxiety, Stress Scales-Short Form: Anxiety Subscale | Baseline | 22.64 score on a scale | Standard Deviation 7.91 |
| Positive Training+Neutral Imagery Prime | Change in Depression, Anxiety, Stress Scales-Short Form: Anxiety Subscale | 2-month Follow-up | 15.6 score on a scale | Standard Deviation 9.54 |
| 50/50 Training+Anxious Imagery Prime | Change in Depression, Anxiety, Stress Scales-Short Form: Anxiety Subscale | Session 8 | 19.8 score on a scale | Standard Deviation 9.2 |
| 50/50 Training+Anxious Imagery Prime | Change in Depression, Anxiety, Stress Scales-Short Form: Anxiety Subscale | Baseline | 24.7 score on a scale | Standard Deviation 8 |
| 50/50 Training+Anxious Imagery Prime | Change in Depression, Anxiety, Stress Scales-Short Form: Anxiety Subscale | 2-month Follow-up | 19.0 score on a scale | Standard Deviation 9.6 |
| 50/50 Training+Neutral Imagery Prime | Change in Depression, Anxiety, Stress Scales-Short Form: Anxiety Subscale | Session 8 | 11.37 score on a scale | Standard Deviation 9.17 |
| 50/50 Training+Neutral Imagery Prime | Change in Depression, Anxiety, Stress Scales-Short Form: Anxiety Subscale | Baseline | 22.7 score on a scale | Standard Deviation 7.93 |
| 50/50 Training+Neutral Imagery Prime | Change in Depression, Anxiety, Stress Scales-Short Form: Anxiety Subscale | 2-month Follow-up | 10.67 score on a scale | Standard Deviation 9.6 |
| No Scenario+Anxious Imagery Prime | Change in Depression, Anxiety, Stress Scales-Short Form: Anxiety Subscale | Session 8 | 16.36 score on a scale | Standard Deviation 9.1 |
| No Scenario+Anxious Imagery Prime | Change in Depression, Anxiety, Stress Scales-Short Form: Anxiety Subscale | Baseline | 23.84 score on a scale | Standard Deviation 9.8 |
| No Scenario+Anxious Imagery Prime | Change in Depression, Anxiety, Stress Scales-Short Form: Anxiety Subscale | 2-month Follow-up | 9.67 score on a scale | Standard Deviation 9.29 |
| No Scenario+Neutral Imagery Prime | Change in Depression, Anxiety, Stress Scales-Short Form: Anxiety Subscale | Baseline | 22.48 score on a scale | Standard Deviation 7.94 |
| No Scenario+Neutral Imagery Prime | Change in Depression, Anxiety, Stress Scales-Short Form: Anxiety Subscale | 2-month Follow-up | 14 score on a scale | Standard Deviation 9.29 |
| No Scenario+Neutral Imagery Prime | Change in Depression, Anxiety, Stress Scales-Short Form: Anxiety Subscale | Session 8 | 14.17 score on a scale | Standard Deviation 9.1 |
Secondary
Change in Quality of Life Scale
The Quality of Life Scale (Flanagan, 1978) is a 16-item questionnaire chosen to evaluate change in quality of life in five domains: recreation, relationships, well-being, personal fulfillment and development, and social activities. Higher scores indicate more positive feelings about quality of life/more satisfaction. Minimum score = 16; maximum score = 80. The question asks How satisfied are you with... with each of the following options as separate questions: material, health, relationships, children, spouse, friend, helping, participating, learning, understanding, work, expression, socializing, reading, recreation, independence (just providing a key word for purposes of description, but questions include a full statement such as Material comforts home, food, conveniences, financial security for material). Response options range from Completely unsatisfied=1, Somewhat unsatisfied=2, Mixed=3, Somewhat satisfied=4, Completely satisfied=5.
Time frame: Baseline, and after sessions 3 (~2 weeks following baseline), 6 (~10 days after session 3), and 8 (~7 days after session 6) & at 2-month follow-up. Measure will be completed immediately following that day's training session.
Population: Number of participants varies by session due to attrition.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Positive Training+Anxious Imagery Prime | Change in Quality of Life Scale | Session 8 | 2.957341 score on a scale | Standard Deviation 0.988957 |
| Positive Training+Anxious Imagery Prime | Change in Quality of Life Scale | Session 3 | 3.182143 score on a scale | Standard Deviation 0.898759 |
| Positive Training+Anxious Imagery Prime | Change in Quality of Life Scale | Baseline | 3.196459 score on a scale | Standard Deviation 1.0354441 |
| Positive Training+Anxious Imagery Prime | Change in Quality of Life Scale | 2-month Follow-up | 3.625000 score on a scale | Standard Deviation 0.9350209 |
| Positive Training+Anxious Imagery Prime | Change in Quality of Life Scale | 2Session 6 | 2.975962 score on a scale | Standard Deviation 0.8749633 |
| Positive Training+Neutral Imagery Prime | Change in Quality of Life Scale | Session 3 | 3.088767 score on a scale | Standard Deviation 0.9424159 |
| Positive Training+Neutral Imagery Prime | Change in Quality of Life Scale | Session 8 | 2.939854 score on a scale | Standard Deviation 0.9254448 |
| Positive Training+Neutral Imagery Prime | Change in Quality of Life Scale | Baseline | 3.106346 score on a scale | Standard Deviation 1.0543742 |
| Positive Training+Neutral Imagery Prime | Change in Quality of Life Scale | 2-month Follow-up | 3.775000 score on a scale | Standard Deviation 0.6580935 |
| Positive Training+Neutral Imagery Prime | Change in Quality of Life Scale | 2Session 6 | 3.089638 score on a scale | Standard Deviation 0.9243989 |
| 50/50 Training+Anxious Imagery Prime | Change in Quality of Life Scale | Session 3 | 3.123667 score on a scale | Standard Deviation 1.0305259 |
| 50/50 Training+Anxious Imagery Prime | Change in Quality of Life Scale | Session 8 | 3.006250 score on a scale | Standard Deviation 1.0276903 |
| 50/50 Training+Anxious Imagery Prime | Change in Quality of Life Scale | 2-month Follow-up | 3.232292 score on a scale | Standard Deviation 0.9395024 |
| 50/50 Training+Anxious Imagery Prime | Change in Quality of Life Scale | 2Session 6 | 3.166667 score on a scale | Standard Deviation 1.0418765 |
| 50/50 Training+Anxious Imagery Prime | Change in Quality of Life Scale | Baseline | 3.081101 score on a scale | Standard Deviation 1.0750755 |
| 50/50 Training+Neutral Imagery Prime | Change in Quality of Life Scale | 2Session 6 | 3.409006 score on a scale | Standard Deviation 0.9131546 |
| 50/50 Training+Neutral Imagery Prime | Change in Quality of Life Scale | Baseline | 3.169298 score on a scale | Standard Deviation 1.0052069 |
| 50/50 Training+Neutral Imagery Prime | Change in Quality of Life Scale | Session 3 | 3.314192 score on a scale | Standard Deviation 0.9043169 |
| 50/50 Training+Neutral Imagery Prime | Change in Quality of Life Scale | Session 8 | 3.479613 score on a scale | Standard Deviation 0.9089624 |
| 50/50 Training+Neutral Imagery Prime | Change in Quality of Life Scale | 2-month Follow-up | 3.675000 score on a scale | Standard Deviation 0.862517 |
| No Scenario+Anxious Imagery Prime | Change in Quality of Life Scale | Session 8 | 3.114583 score on a scale | Standard Deviation 1.0242228 |
| No Scenario+Anxious Imagery Prime | Change in Quality of Life Scale | Baseline | 3.157229 score on a scale | Standard Deviation 1.0582803 |
| No Scenario+Anxious Imagery Prime | Change in Quality of Life Scale | 2-month Follow-up | 2.899150 score on a scale | Standard Deviation 0.9038532 |
| No Scenario+Anxious Imagery Prime | Change in Quality of Life Scale | Session 3 | 2.985270 score on a scale | Standard Deviation 1.0139484 |
| No Scenario+Anxious Imagery Prime | Change in Quality of Life Scale | 2Session 6 | 2.955463 score on a scale | Standard Deviation 0.993999 |
| No Scenario+Neutral Imagery Prime | Change in Quality of Life Scale | Baseline | 3.283237 score on a scale | Standard Deviation 1.0084809 |
| No Scenario+Neutral Imagery Prime | Change in Quality of Life Scale | Session 8 | 3.515278 score on a scale | Standard Deviation 0.7620035 |
| No Scenario+Neutral Imagery Prime | Change in Quality of Life Scale | Session 3 | 3.275440 score on a scale | Standard Deviation 0.8989526 |
| No Scenario+Neutral Imagery Prime | Change in Quality of Life Scale | 2-month Follow-up | 4.080357 score on a scale | Standard Deviation 0.6680277 |
| No Scenario+Neutral Imagery Prime | Change in Quality of Life Scale | 2Session 6 | 3.443031 score on a scale | Standard Deviation 0.8065981 |
Secondary
Impact of Anxious Imagery Prime (Change Over Time is Exploratory But Should Show Anxious/Neutral Prime Differences; e.g., in Subjective Distress)
Following the anxious or neutral imagery prime, participants reported on the questions provided. Minimum score = 3; maximum score =115. Higher scores indicate more vividness and anxiety following the anxious imagery prime. How vividly did you imagine the situation? 1=Not at all vivid 2=Somewhat vivid 3=Moderately vivid 4=Very vivid 5=Totally vivid How anxious did you feel (at the highest level of anxiety) as you completed the imagery task? (using a 0-100 slider with the following anchors marked) 0=Not at all anxious, 50= Moderately anxious, 100=Totally anxious How likely is it that this situation will turn out well vs. turn out badly? 1=Very likely to turn out well, 2=Somewhat likely to turn out well, 3=Neutral, 4= Somewhat likely to turn out badly, 5= Very likely to turn out badly If this situation did turn out badly, how well or badly would you be able to handle it? 1=Very well, 2=Somewhat well, 3=Neutral, 4=Somewhat badly, 5=Very badly
Time frame: After sessions 1,2,3,4,5,6,7,8 (sessions will be spaced ~3-4 days apart). Measure will be completed following that day's imagery prime (which immediately precedes the training session).
Population: Due to attrition, the number of participants differs at each session.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Positive Training+Anxious Imagery Prime | Impact of Anxious Imagery Prime (Change Over Time is Exploratory But Should Show Anxious/Neutral Prime Differences; e.g., in Subjective Distress) | Session 5 | 19.16667 score on a scale | Standard Deviation 30.67189 |
| Positive Training+Anxious Imagery Prime | Impact of Anxious Imagery Prime (Change Over Time is Exploratory But Should Show Anxious/Neutral Prime Differences; e.g., in Subjective Distress) | Session 6 | 21.00000 score on a scale | Standard Deviation 34.45232 |
| Positive Training+Anxious Imagery Prime | Impact of Anxious Imagery Prime (Change Over Time is Exploratory But Should Show Anxious/Neutral Prime Differences; e.g., in Subjective Distress) | Session 4 | 18.55556 score on a scale | Standard Deviation 30.30694 |
| Positive Training+Anxious Imagery Prime | Impact of Anxious Imagery Prime (Change Over Time is Exploratory But Should Show Anxious/Neutral Prime Differences; e.g., in Subjective Distress) | Session 8 | 18.00000 score on a scale | Standard Deviation 28.50996 |
| Positive Training+Anxious Imagery Prime | Impact of Anxious Imagery Prime (Change Over Time is Exploratory But Should Show Anxious/Neutral Prime Differences; e.g., in Subjective Distress) | Session 3 | 17.76786 score on a scale | Standard Deviation 28.40848 |
| Positive Training+Anxious Imagery Prime | Impact of Anxious Imagery Prime (Change Over Time is Exploratory But Should Show Anxious/Neutral Prime Differences; e.g., in Subjective Distress) | Session 7 | 16.75000 score on a scale | Standard Deviation 27.00975 |
| Positive Training+Anxious Imagery Prime | Impact of Anxious Imagery Prime (Change Over Time is Exploratory But Should Show Anxious/Neutral Prime Differences; e.g., in Subjective Distress) | Session 1 | 18.73311 score on a scale | Standard Deviation 30.59704 |
| Positive Training+Anxious Imagery Prime | Impact of Anxious Imagery Prime (Change Over Time is Exploratory But Should Show Anxious/Neutral Prime Differences; e.g., in Subjective Distress) | Session 2 | 18.17045 score on a scale | Standard Deviation 29.3872 |
| Positive Training+Neutral Imagery Prime | Impact of Anxious Imagery Prime (Change Over Time is Exploratory But Should Show Anxious/Neutral Prime Differences; e.g., in Subjective Distress) | Session 2 | 7.154762 score on a scale | Standard Deviation 10.01027 |
| Positive Training+Neutral Imagery Prime | Impact of Anxious Imagery Prime (Change Over Time is Exploratory But Should Show Anxious/Neutral Prime Differences; e.g., in Subjective Distress) | Session 4 | 7.879630 score on a scale | Standard Deviation 11.37995 |
| Positive Training+Neutral Imagery Prime | Impact of Anxious Imagery Prime (Change Over Time is Exploratory But Should Show Anxious/Neutral Prime Differences; e.g., in Subjective Distress) | Session 7 | 8.308824 score on a scale | Standard Deviation 12.36007 |
| Positive Training+Neutral Imagery Prime | Impact of Anxious Imagery Prime (Change Over Time is Exploratory But Should Show Anxious/Neutral Prime Differences; e.g., in Subjective Distress) | Session 1 | 7.899425 score on a scale | Standard Deviation 11.26371 |
| Positive Training+Neutral Imagery Prime | Impact of Anxious Imagery Prime (Change Over Time is Exploratory But Should Show Anxious/Neutral Prime Differences; e.g., in Subjective Distress) | Session 3 | 8.500000 score on a scale | Standard Deviation 12.48014 |
| Positive Training+Neutral Imagery Prime | Impact of Anxious Imagery Prime (Change Over Time is Exploratory But Should Show Anxious/Neutral Prime Differences; e.g., in Subjective Distress) | Session 8 | 10.017857 score on a scale | Standard Deviation 15.63498 |
| Positive Training+Neutral Imagery Prime | Impact of Anxious Imagery Prime (Change Over Time is Exploratory But Should Show Anxious/Neutral Prime Differences; e.g., in Subjective Distress) | Session 5 | 7.784091 score on a scale | Standard Deviation 11.31204 |
| Positive Training+Neutral Imagery Prime | Impact of Anxious Imagery Prime (Change Over Time is Exploratory But Should Show Anxious/Neutral Prime Differences; e.g., in Subjective Distress) | Session 6 | 7.637500 score on a scale | Standard Deviation 11.05529 |
| 50/50 Training+Anxious Imagery Prime | Impact of Anxious Imagery Prime (Change Over Time is Exploratory But Should Show Anxious/Neutral Prime Differences; e.g., in Subjective Distress) | Session 1 | 18.77632 score on a scale | Standard Deviation 30.67108 |
| 50/50 Training+Anxious Imagery Prime | Impact of Anxious Imagery Prime (Change Over Time is Exploratory But Should Show Anxious/Neutral Prime Differences; e.g., in Subjective Distress) | Session 2 | 18.62903 score on a scale | Standard Deviation 30.21894 |
| 50/50 Training+Anxious Imagery Prime | Impact of Anxious Imagery Prime (Change Over Time is Exploratory But Should Show Anxious/Neutral Prime Differences; e.g., in Subjective Distress) | Session 8 | 18.96875 score on a scale | Standard Deviation 31.28617 |
| 50/50 Training+Anxious Imagery Prime | Impact of Anxious Imagery Prime (Change Over Time is Exploratory But Should Show Anxious/Neutral Prime Differences; e.g., in Subjective Distress) | Session 5 | 17.87500 score on a scale | Standard Deviation 28.95789 |
| 50/50 Training+Anxious Imagery Prime | Impact of Anxious Imagery Prime (Change Over Time is Exploratory But Should Show Anxious/Neutral Prime Differences; e.g., in Subjective Distress) | Session 7 | 17.79545 score on a scale | Standard Deviation 28.39446 |
| 50/50 Training+Anxious Imagery Prime | Impact of Anxious Imagery Prime (Change Over Time is Exploratory But Should Show Anxious/Neutral Prime Differences; e.g., in Subjective Distress) | Session 4 | 16.55000 score on a scale | Standard Deviation 26.40416 |
| 50/50 Training+Anxious Imagery Prime | Impact of Anxious Imagery Prime (Change Over Time is Exploratory But Should Show Anxious/Neutral Prime Differences; e.g., in Subjective Distress) | Session 6 | 18.76923 score on a scale | Standard Deviation 30.67833 |
| 50/50 Training+Anxious Imagery Prime | Impact of Anxious Imagery Prime (Change Over Time is Exploratory But Should Show Anxious/Neutral Prime Differences; e.g., in Subjective Distress) | Session 3 | 18.68750 score on a scale | Standard Deviation 30.42976 |
| 50/50 Training+Neutral Imagery Prime | Impact of Anxious Imagery Prime (Change Over Time is Exploratory But Should Show Anxious/Neutral Prime Differences; e.g., in Subjective Distress) | Session 7 | 7.250000 score on a scale | Standard Deviation 10.811497 |
| 50/50 Training+Neutral Imagery Prime | Impact of Anxious Imagery Prime (Change Over Time is Exploratory But Should Show Anxious/Neutral Prime Differences; e.g., in Subjective Distress) | Session 8 | 5.725000 score on a scale | Standard Deviation 8.042796 |
| 50/50 Training+Neutral Imagery Prime | Impact of Anxious Imagery Prime (Change Over Time is Exploratory But Should Show Anxious/Neutral Prime Differences; e.g., in Subjective Distress) | Session 2 | 6.808140 score on a scale | Standard Deviation 9.38342 |
| 50/50 Training+Neutral Imagery Prime | Impact of Anxious Imagery Prime (Change Over Time is Exploratory But Should Show Anxious/Neutral Prime Differences; e.g., in Subjective Distress) | Session 3 | 8.821429 score on a scale | Standard Deviation 13.216355 |
| 50/50 Training+Neutral Imagery Prime | Impact of Anxious Imagery Prime (Change Over Time is Exploratory But Should Show Anxious/Neutral Prime Differences; e.g., in Subjective Distress) | Session 4 | 8.375000 score on a scale | Standard Deviation 12.900746 |
| 50/50 Training+Neutral Imagery Prime | Impact of Anxious Imagery Prime (Change Over Time is Exploratory But Should Show Anxious/Neutral Prime Differences; e.g., in Subjective Distress) | Session 1 | 7.927326 score on a scale | Standard Deviation 11.675453 |
| 50/50 Training+Neutral Imagery Prime | Impact of Anxious Imagery Prime (Change Over Time is Exploratory But Should Show Anxious/Neutral Prime Differences; e.g., in Subjective Distress) | Session 5 | 8.050000 score on a scale | Standard Deviation 12.239715 |
| 50/50 Training+Neutral Imagery Prime | Impact of Anxious Imagery Prime (Change Over Time is Exploratory But Should Show Anxious/Neutral Prime Differences; e.g., in Subjective Distress) | Session 6 | 8.307692 score on a scale | Standard Deviation 12.367694 |
| No Scenario+Anxious Imagery Prime | Impact of Anxious Imagery Prime (Change Over Time is Exploratory But Should Show Anxious/Neutral Prime Differences; e.g., in Subjective Distress) | Session 5 | 14.39583 score on a scale | Standard Deviation 22.7105 |
| No Scenario+Anxious Imagery Prime | Impact of Anxious Imagery Prime (Change Over Time is Exploratory But Should Show Anxious/Neutral Prime Differences; e.g., in Subjective Distress) | Session 7 | 17.27500 score on a scale | Standard Deviation 27.77881 |
| No Scenario+Anxious Imagery Prime | Impact of Anxious Imagery Prime (Change Over Time is Exploratory But Should Show Anxious/Neutral Prime Differences; e.g., in Subjective Distress) | Session 6 | 17.75000 score on a scale | Standard Deviation 28.83588 |
| No Scenario+Anxious Imagery Prime | Impact of Anxious Imagery Prime (Change Over Time is Exploratory But Should Show Anxious/Neutral Prime Differences; e.g., in Subjective Distress) | Session 4 | 16.89062 score on a scale | Standard Deviation 27.09552 |
| No Scenario+Anxious Imagery Prime | Impact of Anxious Imagery Prime (Change Over Time is Exploratory But Should Show Anxious/Neutral Prime Differences; e.g., in Subjective Distress) | Session 3 | 19.04167 score on a scale | Standard Deviation 31.10353 |
| No Scenario+Anxious Imagery Prime | Impact of Anxious Imagery Prime (Change Over Time is Exploratory But Should Show Anxious/Neutral Prime Differences; e.g., in Subjective Distress) | Session 2 | 19.16111 score on a scale | Standard Deviation 31.42217 |
| No Scenario+Anxious Imagery Prime | Impact of Anxious Imagery Prime (Change Over Time is Exploratory But Should Show Anxious/Neutral Prime Differences; e.g., in Subjective Distress) | Session 8 | 14.61111 score on a scale | Standard Deviation 23.71496 |
| No Scenario+Anxious Imagery Prime | Impact of Anxious Imagery Prime (Change Over Time is Exploratory But Should Show Anxious/Neutral Prime Differences; e.g., in Subjective Distress) | Session 1 | 18.57796 score on a scale | Standard Deviation 30.46432 |
| No Scenario+Neutral Imagery Prime | Impact of Anxious Imagery Prime (Change Over Time is Exploratory But Should Show Anxious/Neutral Prime Differences; e.g., in Subjective Distress) | Session 8 | 7.083333 score on a scale | Standard Deviation 10.676861 |
| No Scenario+Neutral Imagery Prime | Impact of Anxious Imagery Prime (Change Over Time is Exploratory But Should Show Anxious/Neutral Prime Differences; e.g., in Subjective Distress) | Session 1 | 8.783981 score on a scale | Standard Deviation 13.011083 |
| No Scenario+Neutral Imagery Prime | Impact of Anxious Imagery Prime (Change Over Time is Exploratory But Should Show Anxious/Neutral Prime Differences; e.g., in Subjective Distress) | Session 2 | 6.867925 score on a scale | Standard Deviation 9.533016 |
| No Scenario+Neutral Imagery Prime | Impact of Anxious Imagery Prime (Change Over Time is Exploratory But Should Show Anxious/Neutral Prime Differences; e.g., in Subjective Distress) | Session 3 | 7.986842 score on a scale | Standard Deviation 11.633403 |
| No Scenario+Neutral Imagery Prime | Impact of Anxious Imagery Prime (Change Over Time is Exploratory But Should Show Anxious/Neutral Prime Differences; e.g., in Subjective Distress) | Session 4 | 8.556818 score on a scale | Standard Deviation 12.628915 |
| No Scenario+Neutral Imagery Prime | Impact of Anxious Imagery Prime (Change Over Time is Exploratory But Should Show Anxious/Neutral Prime Differences; e.g., in Subjective Distress) | Session 5 | 7.411765 score on a scale | Standard Deviation 10.369064 |
| No Scenario+Neutral Imagery Prime | Impact of Anxious Imagery Prime (Change Over Time is Exploratory But Should Show Anxious/Neutral Prime Differences; e.g., in Subjective Distress) | Session 6 | 8.050000 score on a scale | Standard Deviation 11.665366 |
| No Scenario+Neutral Imagery Prime | Impact of Anxious Imagery Prime (Change Over Time is Exploratory But Should Show Anxious/Neutral Prime Differences; e.g., in Subjective Distress) | Session 7 | 7.437500 score on a scale | Standard Deviation 10.966967 |
Secondary
Multi-Session User Experience Questionnaire
This questionnaire assesses users' opinions about the intervention. Participants could select from options Not at all=0, Slightly=1, Somewhat=2, Mostly=3, Very=4, Decline to answer=5 for questions 1-13 as well as 15 and 16 (examples listed below); question 14 asked This training program was 8 sessions. How many sessions do you think would have been ideal? with an open ended response box, which we will not include in the means and SDs. We will recode Decline to answer=5 as NA. Higher scores on this scale indicate more positive experiences with the program in general across questions, from 0-4. 1. How helpful did you find the web program for reducing your anxiety? 2. How much did the web program improve your overall quality of life? 3. How much did the web program help improve your overall mood (e.g., feeling happier)? 4. How likely would you be to recommend this web program to others with similar anxiety difficulties? 5. How easy was the web program to use?
Time frame: At 2-month follow-up
Population: Due to attrition, the number of participants differs at from the overall number in the participant flow, as user experience was only assessed at follow-up, during which we did not receive responses from a majority of participants.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Positive Training+Anxious Imagery Prime | Multi-Session User Experience Questionnaire | 2.54 score on a scale | Standard Deviation 1.05 |
| Positive Training+Neutral Imagery Prime | Multi-Session User Experience Questionnaire | 2.31 score on a scale | Standard Deviation 1.36 |
| 50/50 Training+Anxious Imagery Prime | Multi-Session User Experience Questionnaire | 2.66 score on a scale | Standard Deviation 1.05 |
| 50/50 Training+Neutral Imagery Prime | Multi-Session User Experience Questionnaire | 2.74 score on a scale | Standard Deviation 1.03 |
| No Scenario+Anxious Imagery Prime | Multi-Session User Experience Questionnaire | 2.81 score on a scale | Standard Deviation 1.33 |
| No Scenario+Neutral Imagery Prime | Multi-Session User Experience Questionnaire | 2.21 score on a scale | Standard Deviation 1.09 |