Change Processes During Cognitive Bias Modification for Obsessive Compulsive Beliefs

Multiple studies have found that cognitive bias modification (CBM) can be an effective intervention to reduce maladaptive, anxiety-linked cognitive biases and symptoms, but little is known about how it achieves its effects. CBM is posited to work by altering contingency learning about potential threat cues, rather than via habituation of fear and arousal (as hypothesized for exposure-based interventions). In the current study, multi-level modeling was used to examine the trajectories of potential change processes over the course of CBM for interpretation bias in a sample high in obsessive–compulsive (OC) symptoms (n = 75). Psychophysiological arousal (heart rate and galvanic skin response), subjective fear, and the development of a learned contingency between ambiguity tied to threat and safe outcomes were measured before, during, and after CBM. Results showed that, compared to a control group, CBM was effective at reducing OC beliefs (though not responses to subsequent OC stressors). Additionally, as expected, only contingency learning significantly changed as a function of training condition, while subjective fear and arousal did not. Moreover, post-training indicators of contingency learning predicted the extent OC beliefs changed from pre- to post-training for the “positive” CBM group only (and not for the control group). This indicates that CBM is likely not operating similarly to habituation, but is instead marked by change in cognitive processing. However, change in contingency learning did not fully mediate the effect of this intervention on change in OC beliefs, suggesting more work is needed to fully understand the mechanisms underlying CBM.