Efficacy of a smartphone-based Cognitive Bias Modification program for emotion regulation: A randomized-controlled crossover trial.

Previous research has identified maladaptive emotion regulation as a key factor in psychopathology. Thus, addressing emotion regulation via scalable, low-threshold digital interventions - such as smartphone-based Cognitive Bias Modification (CBM) - holds important therapeutic potential. Using a randomized-controlled crossover trial, we tested the efficacy of an integrated CBM module within the Affect Regulation Training (ART, i.e., CBM-ART) that targeted emotion regulation through elements of appraisal-based and approach avoidance training. Undergraduate students reporting elevated stress were randomized to a one-week active intervention (Mindgames; including psychoeducation, a quiz, and CBM-ART; n = 40), active control training (Emo Shape; including placebo psychoeducation, a quiz, and a placebo swiping task; n = 36) or waitlist (n = 25). Before and after the intervention, we assessed emotion regulation, interpretation bias, stress and depression. We further tested post-training stress reactivity using an anagram task. Results indicated that the active intervention improved negative (OR = 0.35) and positive (OR = 2.40) interpretation biases and symptom measures (d = 0.52-0.87). However, active control training showed attenuated concurrent pre-post changes on interpretation biases (i.e., OR = 0.53 for negative, and OR = 1.49 for positive interpretations) and symptom measures (d = 0.26-0.91). The active intervention was rated positively in terms of acceptability and usability. These findings provide initial evidence for the efficacy and acceptability of an integrated app-based CBM intervention for emotion regulation in reducing interpretation biases and psychopathological symptoms, including stress. However, future studies should disentangle specific mechanisms underlying interventional effects.

Association between engagement with appearance and eating related TikTok content and eating disorder symptoms via recommended content and appearance comparisons.

OBJECTIVE: It is well-established that the use of appearance-focused social media is associated with eating disorder (ED) symptoms, due to the presence of idealized imagery. Of concern, social media exposure is increasingly influenced by algorithms, which recommend content based on an analysis of the users' previous patterns of engagement. However, the relationships between users' engagement with social media content based upon its centering of appearance and eating, the presence of these themes in content suggested to them, and their ED symptoms remains unknown. The current study aimed to examine these relationships in the context of TikTok, a video- and algorithm-based platform. METHOD: Undergraduate students (N = 230; 78% female) completed self-report measures of ED symptoms, upwards social media appearance comparisons, as well as a novel measure of TikTok activity. RESULTS: Serial mediation analyses provided support for indirect relationships between engagement with appearance/eating-related content and ED symptoms via higher proportions of appearance/eating-related recommended content and higher levels of upwards social media appearance comparisons, respectively. There was no association between average screen time, nor general tendency to actively engage with content, and either ED symptoms or upwards social media appearance comparisons. DISCUSSION: Findings provide preliminary support for how engagement on TikTok is related to targeted exposure in ways that may contribute to perpetuating and exacerbating ED symptoms. PUBLIC SIGNIFICANCE: Social media use has been consistently associated with greater eating disorder symptoms. However, the ways in which users' engagement with social media content may be related to targeted social media exposure, and in turn eating disorder symptoms, remains unknown. This research provided preliminary evidence for associations between users' engagement with, and targeted exposure to, TikTok content related to appearance and eating, and their eating disorder symptoms.

A smartphone app for the prevention and early intervention of body dysmorphic disorder: Development and evaluation of the content, usability, and aesthetics.

Body dysmorphic disorder (BDD) is an impairing condition characterized by excessive appearance concerns that frequently begin in adolescence, thus making this phase an eminent target for prevention and early intervention. We developed a cognitive-behavioral app-based program (AINA) intended for prevention and early intervention of BDD. As part of the iterative development process, perceptions of usability, aesthetics, and content were investigated. A sample of 38 adolescents and young adults aged between 14 and 21 years tested the app in a laboratory setting and completed a survey of diagnostic and user experience questionnaires. Overall, usability, aesthetics, and content of the app received positive evaluations. Regression analyses did not point to any large effects of age, gender, years of education, self-esteem, or BDD symptom severity on user evaluations. On average, participants had no concerns about privacy or data security of the app, indicating that these aspects will presumably not act as barriers to usage. Altogether, the present results are encouraging. Future research needs to examine whether AINA is an efficacious measure for prevention and early intervention of BDD.

The role of biases in the judgement processing of (un)attractive faces in body dysmorphic symptomatology.

The current study tested the novel hypothesis that elevated facial appearance concern reflects a heightened tendency to judge facial appearance in terms of attractiveness, rather than in terms of attractiveness-irrelevant dimensions. Seventy-three females, reporting either high or low facial appearance concerns, were exposed to an individualised stimulus development protocol which involved a photoshoot and the subsequent selection of photographs perceived to be most and least attractive. Participants were then required to judge photographs in terms of either attractiveness or the eye gaze direction of the individual in the photograph. Results revealed that when judging attractiveness, low facial concern participants were faster to classify photographs as belonging to the attractive category rather than the unattractive category. We termed this potentially protective bias the General Attractiveness Recognition Advantage. Moreover, regardless of judgement required, high facial concern participants were faster to make responses to unattractive relative to attractive photographs of themselves. We termed this potential vulnerability bias the Efficient Processing of Unattractive Self. Further analyses revealed that the former bias associated with broader body dysmorphic symptomatology. The current findings, although inconsistent with the hypothesis under test, were novel in revealing two distinct mechanisms which distinguished high and low facial appearance concern individuals.

Internet-based interpretation bias modification for body dissatisfaction: A three-armed randomized controlled trial.

OBJECTIVE: Appearance-related interpretation bias is postulated to play a role in the maintenance of body dissatisfaction (BD), a risk factor for body dysmorphic disorder (BDD), and eating disorders (ED). Cognitive bias modification for interpretation (CBM-I) has been shown to reduce maladaptive interpretation bias and symptoms in various emotional disorders. This study investigated the acceptability and efficacy of an easily disseminable, web-based CBM-I program for BD. METHODS: Individuals with high BD (N = 318) were randomized to a multi-session CBM-I (Sentence Word Association Paradigm [SWAP] with feedback) vs. control (SWAP without feedback) versus waitlist condition. Interpretation bias, BD and associated symptoms were assessed at baseline and post-intervention. Symptoms were monitored up to 1-week and 4-week follow-up. We further investigated transference effects to stress reactivity, as predicted by cognitive-behavioral models, at post-intervention. RESULTS: Appearance-related CBM-I led to a differential pre-post increase in adaptive interpretation patterns, particularly for appearance-related and social situations (d = 0.65-1.18). Both CBM-I and control training reduced BD, BDD symptom severity, and depression. However, CBM-I (vs. control and waitlist) improved appearance-related quality of life (d = 0.51), self-esteem (d = 0.52), and maladaptive appearance-related beliefs (d = 0.47). State stress reactivity was overall reduced in the CBM-I condition (vs. waitlist). Intervention effects largely held stable up to follow-ups. Treatment satisfaction was comparable to other CBM-I studies, with low rates of adverse reactions. DISCUSSION: These findings support assumptions of cognitive-behavioral models for BD, BDD, and ED, and suggest that web-based CBM-I is an efficacious and acceptable intervention option.

Effects of induced appearance-related interpretation bias: A test of the cognitive-behavioral model of body dysmorphic disorder.

BACKGROUND AND OBJECTIVES: Interpretation biases are hypothesized to maintain body dysmorphic disorder (BDD). Although their existence and malleability have been investigated in clinical studies, their causal status in the maintenance of BDD remains unclear. This study examined the effects of a single-session appearance-related interpretation bias training (CBM-I) on bias indices and stress reactivity (i.e., distress, appearance dissatisfaction, self-esteem, perceived physical attractiveness), exploring the causality predicted in cognitive-behavioral models. METHODS: We used a modified version of the Word Sentence Association Paradigm (WSAP), assessing explicit (i.e., decision rates) and more implicit interpretation bias components (i.e., reaction times). Mentally healthy students (N = 112) were randomized to training conditions enhancing positive interpretation patterns (PT) vs. negative interpretation patterns (NT) vs. a no-feedback control condition (CC). Stress reactivity was assessed during the Cyberball Paradigm. RESULTS: The PT showed a pre-post increase in adaptive bias patterns regarding decision and a differential pre-post decrease in reaction times for the rejection of negative interpretations, compared to the other groups. There were no condition-congruent post-training differences in stress reactivity. However, residual interpretation bias change was significantly correlated with state distress, self-esteem and appearance dissatisfaction during stressor exposure. LIMITATIONS: Limitations pertaining to sample characteristics, training and assessment overlap, and stressor task design are discussed. CONCLUSIONS: Findings suggest that appearance-related interpretation bias is modifiable both explicitly and more implicitly via CBM-I in a mentally healthy sample. The causal status of interpretation bias in BDD maintenance warrants further investigation.