1. Impact of Training Difficulty and Symptom Severity Internet-based Cognitive Bias Modification: Shari A. Steinman & Bethany A. Teachman (Steinman & Teachman, in press, Journal of Behavior Therapy & Experimental Psychiatry)

2. Cognitive Bias Modification for Interpretations  Brief computerized interventions designed to shift the way individuals interpret information  Series of ambiguous scenarios, that end positively  In contrast to typical psychotherapy…  No therapist  No verbal mediation  No activation of fear network (see Beck & Clark, 1997; Foa & Kozak, 1986)

3. CBM Success Stories (see meta-analysis by Hallion & Ruscio, 2011)

4. …and not so successful stories  No change in bias  No change in anxiety  Particularly mixed results for internet studies  How do we strengthen effects of CBM? (see meta-analysis by Hallion & Ruscio, 2011)

5. Desirable Difficulty  Memory can be increased if a task is made more difficult (but not too difficult that the task cannot be completed) (Bjork, 1994)

6. CBM will lead to more positive interpretation bias Strength of CBM effects will increase as difficulty increases Will baseline anxiety moderate training? Hypotheses

7. Participants  N = 350  64.9% female  Mean Age = 35.44 (SD = 12.28, range = 18 - 64)  Baseline measures: interpretation bias and social anxiety

8. Proof of Principle Study  36 Scenarios 4 Positive Conditions All end positively. Control Condition ½ end positively, ½ end negatively

9. Your boss asks to see you following the recent submission of a paper you wrote. He tells you that he wants to talk to you because your work was ______. Positive:Control: exc_ptional. unc_ear. OR exc_ptional. Are you going to get a bad review from your boss? (modified from Mathews & Mackintosh, 2000)

10. Conditions CBM-0 exceptional CBM-1 exc_ptional CBM-2 exc_pt_onal CBM-3 exc_pt_o_al Control exc_ptional OR unc_ear

11. Recognition Ratings (Evidence for Training Interpretation Bias) THE LOCAL CLUB: You are invited to attend a social event at a local club, although you don't know any of the members very well. As you approach the door you can hear conversation and loud music, but as you enter the room it stops for a mo_ent. Do you know most of the club members very well? (modified from Mathews & Mackintosh, 2000)

12. Recognition Ratings (Evidence for Training Interpretation Bias) THE LOCAL CLUB As you enter the room… Positive Social: conversation stops so club members can greet you. Negative Social: conversation stops and club members glare at you Positive Non-Social: you realize your favorite song was just playing. Negative Non-Social: you realize you forgot your wallet at home. Recognition Ratings = Positive Social Ratings – Negative Social Ratings

13. Full Sample No effect on other outcome measures No effect on other outcome measures

14. Moderation by baseline anxiety  High social anxiety: only CBM-0 and CBM-1 shifted bias  Low social anxiety: all positive conditions shifted bias  Highly Anxious Subsample: only CBM-0, CBM-1, and CBM-2 shifted bias.

15. Discussion  CBM  more positive/less negative bias.  No impact on other measures  brevity?  online administration?  Impact of desirable difficulty  more frustrating or anxiety provoking?  focus on lexical aspects vs. contingency?

16. Thank you!  Andrew Mathews & Bundy Mackinosh  Fred Smyth, Emily Umansky, & Sriram Natarajan  Members of the Teachman Program for Anxiety, Cognition, and Treatment (PACT) Lab  This study was supported by an NIA R01AG033033 grant awarded to Bethany Teachman