A Critical Review of Studies Assessing Interpretation Bias Towards Social Stimuli in People With Eating Disorders and the Development and Pilot Testing of Novel Stimuli for a Cognitive Bias Modification Training

Abstract

People with eating disorders display a negative interpretation bias towards ambiguous social stimuli. This bias may be particularly relevant to young people with the illness due to the developmental salience of social acceptance and rejection. The overall aim of this study was to systematically develop and validate stimuli for a cognitive bias modification training to reduce a social rejection-related negative interpretation bias in young people with eating disorders. A mixed-methods design was used to achieve this aim. A review of the literature was conducted using EMBASE, MEDLINE, PsycINFO, Web of Science, and PubMed. Six studies were included in the review. Focus groups were held with patients with eating disorders, carers and healthcare professionals. Content analysis was used to identify key themes from the qualitative data. Based on these themes, a total of 339 scenarios were generated by the researchers. Salient themes identified from the focus group data included virtual rejection/exclusion, rejection associated with an aspect of the eating disorder, rejection triggered by ambiguous/benign comments or behaviors of others and rejection perceived when confiding in others. Patients rated these scenarios in terms of their age-relevance and emotional salience and 301 scenarios were included in the final stimulus set. These materials may be used by researchers conducting future experimental research into the potential benefits of interpretation bias training for young people with eating disorders.

Cognitive bias modification training of attention and interpretation to reduce expectations of social rejection in adolescents with eating disorders: A small efficacy randomized controlled trial

“…A strength of the study was that the stimuli for the interpretation bias training modules were developed in collaboration with people with eating disorders, carers and professionals. This has rarely been the case in previous studies in this population (Rowlands et al, 2020). It is likely that the rigorous process undergone to develop the scenarios for the interpretation bias training played a role in reducing negative interpretations and eating disorder symptoms in the participants in this study, emphasizing the need to develop CBM-I trainings in collaboration with the population of interest (Hughes et al, 2016;Lau et al, 2021).…”

“…The reduction in eating disorder in participants who completed the CBM training is encouraging, given that the training protocol was developed following recommendations for producing symptom change. These considerations included the use of multiple training sessions (Hallion & Ruscio, 2011;Hang et al, 2021), and the development of interpretation bias module materials for the specific population of interest (Hughes et al, 2016;Rowlands et al, 2020).…”

“…2.3.9 | Cognitive bias modification of interpretation (CBM-I): Ambiguous scenarios training task (Hirsch et al, 2009) An adapted version of the ambiguous scenarios training task (Hirsch et al, 2009) was used to train benign or neutral interpretations of ambiguous social scenarios. The scenarios included in the training were developed based on feedback from young people with eating disorders, carers and professionals (see: Rowlands et al, 2020 for details on the process of stimuli development). In each session, participants were presented with 50 of the hypothetical social scenarios (as text on the screen and via audio clips using headphones).…”

Evaluation of film stimuli for the assessment of social-emotional processing: a pilot study

“…This is unexpected considering that there is a wealth of previous work indicating that people with depression and eating disorders show reduced facial reactivity to emotionally provoking stimuli ( Panaite, Whittington & Hindash, 2018 ; Davies et al, 2016 ; Dapelo et al, 2016 ; Leppanen et al, 2017 ). Similarly, several studies have also documented that negative interpretation bias is a key feature in depression and social anxiety ( Everaert, Podina & Koster, 2017 ; Chen, Short & Kemps, 2020 ) and it has recently also been documented in eating disorders ( Rowlands et al., 2020 ; Dapelo et al, 2016 ). On one hand, this may be because performance on interpretation of the ambiguous films and reactivity to the emotionally provoking films bear no association with depression, anxiety or eating disorder psychopathology.…”

“…Both top-down and bottom-up emotion generation are relevant in the context of psychiatric disorders. Interpretation bias, particularly negative interpretation bias, has been widely researched in psychiatric disorders, including mood, anxiety, and eating disorders, and negative biases have been associated with low mood and worse psychopathology ( Rowlands et al., 2020 ; Everaert, Podina & Koster, 2017 ; Hirsch et al, 2016 ). Similarly, alterations in bottom-up emotional reactivity, particularly reduced facial expression of emotions, have been documented in mood and eating disorders ( e.g.…”