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Feeling anxious? There could soon be an app for that

Addressing contrary patterns of thinking, or cognitive biases, could help ameliorate negative feelings. Mira Manns

Cognitive bias modification is a new approach to treating emotional problems. It holds considerable promise for the remote delivery of mental health interventions.

The story of how this new approach came to be starts in the “cognitive revolution” of the 1970s and 1980s. This was a time when psychologists were just beginning to entertain the radical possibility that the way you think about things could actually influence the way you feel.

The old view held that focusing on negativity and danger, common in anxiety and depression, was a symptom of these problems rather than a potential cause.

Flash forward a few decades and it’s now well accepted that constantly having negative thoughts and perceiving danger everywhere might actually cause you to feel pretty ordinary.

We also know these negative thoughts are associated with low-level biases in the way people process information. This is akin to having an unhelpful cognitive “reflex” that skews the information we take in toward more negative and dangerous aspects of the world.

These contrary patterns of thinking are referred to as cognitive biases.

Cognitive bias modification results from the finding that these cognitive biases can successfully be altered. Unlike traditional therapies, it doesn’t require any conscious alteration of thinking and behaviour. Instead, it involves completing simple, computer-based tasks.

How it works

Imagine walking into a large restaurant filled with people hastily eating.

Do you notice smiling faces, laughter and friendly chatter? Or do you find yourself irresistibly drawn to sneers, loud voices, and people looking angrily in your direction?

People with emotional problems are likely to attend to the negative aspects in such situations, and interpret them as being threatening.

The goal of cognitive bias modification is to alter these automatic reflexes by discouraging negative information processing through completing set tasks. To alter biased interpretation, for instance, people are encouraged to impose positive, rather than negative, resolutions on ambiguous situations.

The aim is to change these reflexive patterns and reduce emotional problems, such as anxiety and depression, by helping people to focus more on smiling faces and happy voices, and less on potential sources of stress. And it seems to work.

So far, anxiety has been one of the primary targets of cognitive bias modification research and the results have been encouraging.

Tasks targeting attention have been shown to reduce anxiety reactions to a stressful task, improve performance when completing a speech, and decrease the impact of stressful life events.

Virtually all cognitive bias modification tasks are computer based, so most can easily be translated to an app. Cristiano Betta/Flickr

Perhaps most impressively, among those with clinical anxiety, a few 15-minute sessions of cognitive bias modification over a number of weeks can significantly reduce clinical symptoms of generalised anxiety disorder, and social anxiety disorder.

There’s also some evidence that cognitive bias modification may improve symptoms of depression, and assist in the treatment of substance abuse problems.

There’s an app for that!

To date, most research on cognitive bias modification has been run from university labs or clinics. But some researchers have now successfully started delivering the therapy online.

Although the results of this approach have occasionally been mixed, this delivery mode has the potential to bring the benefits of cognitive bias modification to a greater number of people.

What’s more, because virtually all cognitive bias modification tasks are computer based, most can easily be translated to an application that can run on a smartphone or tablet.

In fact, researchers within our own group have recently completed a study where cognitive bias modification was delivered to people suffering anxiety-related sleep problems via their smartphones.

We found that completing a short cognitive bias modification session immediately before bed over five nights significantly decreased pre-sleep worry and also reduced the time it took to get to sleep, when compared to a control group.

The potential benefits of delivering these tasks on handheld devices are numerous, especially in remote communities where mental health services are not always available.

First, it’s cheap. Compared to traditional talk therapy, which can cost upwards of A$150 per session, an app or program can be provided at little to no cost.

Second, it’s discreet. Taking the step to access traditional mental health services can be a big one that many people want to avoid. But downloading an app is a small step that could be a giant leap towards addressing mental health issues.

Third, it’s convenient. Once an app is installed, it’s not bound by office hours but is accessible anytime, even in the absence of internet access or phone reception.

Cognitive bias modification tasks can typically be completed in five to ten minutes, an ideal pastime for a toilet break.

But even though it’s promising, it is still very early days for cognitive bias modification as an intervention. Enthusiasm about its potential should be tempered with appropriate caution and based on solid research.

That said, it has potential as a treatment for emotional and substance abuse problems, and also as a cognitive vaccine to protect against the development of these problems in people who face future or chronic stress.

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