Approximately half of the U.S. population will experience a significant mental health problem during their lifetime, including 29% with anxiety pathology severe enough to qualify for an anxiety disorder diagnosis. Critically, the majority will not receive treatment, creating a serious need to consider alternative approaches to delivering mental health services that can meet needs on a larger scale. Cognitive Bias Modification (CBM) interventions for anxiety hold considerable promise as a way to meet these needs. These computer-based training programs are designed to alter biased ways of thinking, such as selective assignment of threat interpretations, which are known to cause and maintain anxiety. CBM programs have shown efficacy in the laboratory, and now have the potential to be tested and implemented on a broader scale using a web- based infrastructure. The current proposal aims to develop a web-based CBM infrastructure to train interpretations, and to evaluate and maximize the usability, acceptability, and feasibility of web-based CBM for anxiety symptoms.
In Aim 1, a web-based interpretation bias training program will be built using the Project Implicit Mental Health (PIMH) infrastructure, an existing website directed by the Principal Investigator. This approach encourages efficiencies by capitalizing on the existing site and its heavy traffic. The training program will be piloted on a small test group of anxious participants (N=15) and an advisory board (N=8) of anxiety researchers, clinicians, and experts in CBM to obtain feedback on the programs' usability and acceptability.
Aims 2 and 3 will evaluate target engagement, feasibility, and effectiveness of the web-based CBM program among individuals with moderate to severe anxiety symptoms, and will assess the inclusion of an anxious imagery prime to enhance CBM's effectiveness on the web. Participants will be randomly assigned to either 8 sessions of active CBM (100% positive scenario training) or a 50% positive/50% negative standard control condition, or a neutral, non-valenced 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=300; target of n=50 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), mechanisms underlying the prime's effects, and preliminary tests of effectiveness at reducing anxiety symptoms will be evaluated via assessments at baseline, and following sessions 3, 6, and 8, and at a 2-month follow-up. This research fits directly within the priorities of NIMH, given the proposal's focus on evaluating feasibility and effectiveness of a psychosocial intervention for a prevalent and impairing mental health problem that has strong potential for dissemination to large, diverse populations.

Public Health Relevance

Untreated mental illness is related to many deleterious outcomes, including higher mortality rates, more social service utilization, and lowered quality of life. Yet, more than half of all people struggling with disabling anxiety symptoms or disorders are not receiving treatment. The development of web-based interventions, such as the Cognitive Bias Modification training program proposed for this grant, can offer a solution to some of these issues, because it presents an economical, efficient, and private option for disseminating evidence-based treatments on a large scale to people who might otherwise not receive help.

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Planning Grant (R34)
Project #
1R34MH106770-01
Application #
8874600
Study Section
Special Emphasis Panel (ZMH1)
Program Officer
Sherrill, Joel
Project Start
2015-05-01
Project End
2017-04-30
Budget Start
2015-05-01
Budget End
2016-04-30
Support Year
1
Fiscal Year
2015
Total Cost
Indirect Cost
Name
University of Virginia
Department
Psychology
Type
Schools of Arts and Sciences
DUNS #
065391526
City
Charlottesville
State
VA
Country
United States
Zip Code
22904
Gorlin, Eugenia I; Werntz, Alexandra J; Fua, Karl C et al. (2018) Remembering or knowing how we felt: Depression and anxiety symptoms predict retrieval processes during emotional self-report. Emotion :
Millner, Alexander J; Coppersmith, Daniel D L; Teachman, Bethany A et al. (2018) The Brief Death Implicit Association Test: Scoring recommendations, reliability, validity, and comparisons with the Death Implicit Association Test. Psychol Assess 30:1356-1366
Chow, Philip I; Portnow, Sam; Zhang, Diheng et al. (2018) Comorbid interpretation and expectancy bias in social anxiety and alcohol use. Anxiety Stress Coping 31:669-685
Narr, Rachel K; Teachman, Bethany A (2017) Using Advances From Cognitive Behavioral Models of Anxiety to Guide Treatment for Social Anxiety Disorder. J Clin Psychol 73:524-535
Roberson-Nay, Roxann; Gorlin, Eugenia I; Beadel, Jessica R et al. (2017) Temporal stability of multiple response systems to 7.5% carbon dioxide challenge. Biol Psychol 124:111-118
Glenn, Jeffrey J; Werntz, Alexandra J; Slama, S J Katarina et al. (2017) Suicide and self-injury-related implicit cognition: A large-scale examination and replication. J Abnorm Psychol 126:199-211
Lindgren, Kristen P; Ramirez, Jason J; Namaky, Nauder et al. (2016) Evaluating the Relationship between Explicit and Implicit Drinking Identity Centrality and Hazardous Drinking. Addict Behav Rep 4:87-96
Kulesza, Magdalena; Matsuda, Mauri; Ramirez, Jason J et al. (2016) Towards greater understanding of addiction stigma: Intersectionality with race/ethnicity and gender. Drug Alcohol Depend 169:85-91
Werntz, Alexandra J; Steinman, Shari A; Glenn, Jeffrey J et al. (2016) Characterizing implicit mental health associations across clinical domains. J Behav Ther Exp Psychiatry 52:17-28
Lindgren, Kristen P; Gasser, Melissa L; Werntz, Alexandra et al. (2016) Moderators of implicit and explicit drinking identity in a large US adult sample. Addict Behav 60:177-83