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Mental imagery abilities in different modalities moderate the efficacy of cognitive bias modification for interpretation bias in social anxiety

DOI: 10.1016/j.jbtep.2025.102031
Lam, C. L., Hin, A. S., Lau, L. N., Zhang, Z., & Leung, C. J. (2025). Mental imagery abilities in different modalities moderate the efficacy of cognitive bias modification for interpretation bias in social anxiety. Journal of Behavior Therapy and Experimental Psychiatry, 88, 102031. doi:10.1016/j.jbtep.2025.102031

Abstract

Cognitive bias modification for interpretation bias (CBM-I) is an effective low-intensity intervention that targets interpretation biases associated with the development and maintenance of social anxiety. Few studies to-date have examined the extent to which individual mental imagery ability affects the efficacy of CBM-I. A total of 666 individuals were screened. Seventy-two participants with high levels of social anxiety and elevated baseline interpretation bias were randomly assigned to either CBM-I (n = 36) or control groups (n = 36). They completed 5-day internet-delivered training in modifying their interpretation bias associated with ambiguous social scenarios (CBM-I) or reading neutral text passages (control). Intent-to-treat analyses revealed that participants in the CBM-I group had a significant reduction in their interpretation bias compared to the controls. They had a reduction of 11 %-18 % on the social anxiety measures. Participants' mental imagery ability was significantly associated with the reduction of interpretation bias and social anxiety symptoms in the CBM-I group. Specifically, participants with higher mental imagery ability in emotional feelings benefited the most from the intervention. CBM-I is an efficacious intervention for modulating social anxiety-related biases and symptoms. Mental imagery ability facilitated the efficacy of CBM-I.

Authors

  • Charlene L.M. Lam1
  • Andy S. Hin1
  • Luciana N.S. Lau1
  • Zhiqi Zhang1
  • Chantel J. Leung1

Understanding the Impact of Mental Imagery on Social Anxiety Treatment

Overview/Introduction

Social anxiety can significantly impact daily life, making social interactions challenging for many individuals. A promising treatment approach called Cognitive Bias Modification for Interpretation Bias (CBM-I) aims to help people with social anxiety by altering their negative interpretations of ambiguous social situations. This study explores how an individual's ability to create mental images influences the effectiveness of CBM-I.

Methodology

  • Participants: Out of 666 screened individuals, 72 with high social anxiety were selected and divided into two groups: CBM-I (36 participants) and a control group (36 participants).
  • Intervention: Over five days, the CBM-I group received online training to modify their interpretation biases, while the control group read neutral text.
  • Measurements: Interpretation bias was assessed using the Similarity Rating Task, and social anxiety levels were measured with established scales. Mental imagery ability was evaluated through various sensory modalities.

Key Findings

  • Reduction in Bias and Anxiety: The CBM-I group showed a significant reduction in negative interpretation bias and a decrease of 11%-18% in social anxiety symptoms compared to the control group.
  • Role of Mental Imagery: Participants with a higher ability to imagine emotional feelings experienced the most significant improvements. Mental imagery in modalities like smell, touch, and emotional feelings contributed to better outcomes, while visual, sound, and taste imagery did not show a significant impact.

Implications

  • Personalized Treatment: Assessing mental imagery ability could help tailor CBM-I interventions for individuals, potentially enhancing treatment efficacy.
  • Alternative Therapy: CBM-I offers a low-intensity, internet-delivered option for managing social anxiety, which could be particularly beneficial for those who prefer or require remote therapy.

Limitations

  • Long-term Effects: The study did not assess the long-term benefits of CBM-I, such as effects after three or six months.
  • Real-world Application: The study did not include real-world stressor tasks, like public speaking, to evaluate the intervention's effectiveness in practical scenarios.
In summary, this research highlights the importance of mental imagery in enhancing CBM-I's effectiveness for social anxiety. Future studies could explore long-term outcomes and incorporate real-world testing to further validate these findings.