Imagine the bright side of life: a randomized controlled trial of two types of interpretation bias modification procedure targeting adolescent anxiety and depression

Research output: Contribution to journalArticlepeer-review


  • E. L. de Voogd
  • E. de Hullu
  • S.E. Blackwell
  • R.W. Wiers
  • E. Salemink

Colleges, School and Institutes

External organisations

  • Department of Developmental Psychology, University of Amsterdam, The Netherlands
  • Department of Psychology and Educational Sciences, Open University, The Netherlands
  • MRC Cognition & Brain Sciences Unit, Cambridge, United Kingdom



Anxiety and depression are highly prevalent during adolescence and characterized by negative interpretation biases. Cognitive bias modification of interpretations (CBM-I) may reduce such biases and improve emotional functioning. However, as findings have been mixed and the traditional scenario training is experienced as relatively boring, a picture-based type of training might be more engaging and effective.


The current study investigated short- and long-term effects (up to 6 months) and users’ experience of two types of CBM-I procedure in adolescents with heightened symptoms of anxiety or depression (N = 119, aged 12–18 year). Participants were randomized to eight online sessions of text-based scenario training, picture-word imagery training, or neutral control training.


No significant group differences were observed on primary or secondary emotional outcomes. A decrease in anxiety and depressive symptoms, and improvements in emotional resilience were observed, irrespective of condition. Scenario training marginally reduced negative interpretation bias on a closely matched assessment task, while no such effects were found on a different task, nor for the picture-word or control group. Subjective evaluations of all training paradigms were relatively negative and the imagery component appeared particularly difficult for adolescents with higher symptom levels.


The current results question the preventive efficacy and feasibility of both CBM-I procedures as implemented here in adolescents.


Original languageEnglish
JournalPLoS ONE
Publication statusPublished - 17 Jul 2017