title: Efficacy of cognitive bias modification interventions in anxiety and depression: meta-analysis.
abstract: BACKGROUND
  Cognitive bias modification (CBM) interventions are strongly advocated in research and clinical practice.
  
  
  OBJECTIVE
  To examine the efficiency of CBM for clinically relevant outcomes, along with study quality, publication bias and potential moderators.
  
  
  METHODS
  We included randomised controlled trials (RCTs) of CBM interventions that reported clinically relevant outcomes assessed with standardised instruments.
  
  
  RESULTS
  We identified 49 trials and grouped outcomes into anxiety and depression. Effect sizes were small considering all the samples, and mostly non-significant for patient samples. Effect sizes became non-significant when outliers were excluded and after adjustment for publication bias. The quality of the RCTs was suboptimal.
  
  
  CONCLUSIONS
  CBM may have small effects on mental health problems, but it is also very well possible that there are no significant clinically relevant effects. Research in this field is hampered by small and low-quality trials, and by risk of publication bias. Many positive outcomes are driven by extreme outliers.
authors.affiliation: Ioana A. Cristea, PhD, Department of Clinical Psychology and Psychotherapy, Babeʂ-Bolyai University, Cluj-Napoca, Romania and Clinical Psychology Branch, Department of Surgical, Medical, Molecular and Critical Pathology, University of Pisa, Pisa, Italy; Robin N. Kok, MSc, Department of Clinical Psychology and the EMGO institute for Health and Care Research, Faculty of Psychology and Education, VU University Amsterdam, Amsterdam, The Netherlands and Centre for Mental Health Research, The Australian National University, Acton, Australia; Pim Cuijpers, PhD, Department of Clinical Psychology, VU University and EMGO Institute for Health and Care Research, VU University and VU University Medical Centre, Amsterdam, The Netherlands and Leuphana University, Lüneburg, Germany.
authors.forename: Ioana A
authors.initials: IA
authors.lastname: Cristea
authors.affiliation: Ioana A. Cristea, PhD, Department of Clinical Psychology and Psychotherapy, Babeʂ-Bolyai University, Cluj-Napoca, Romania and Clinical Psychology Branch, Department of Surgical, Medical, Molecular and Critical Pathology, University of Pisa, Pisa, Italy; Robin N. Kok, MSc, Department of Clinical Psychology and the EMGO institute for Health and Care Research, Faculty of Psychology and Education, VU University Amsterdam, Amsterdam, The Netherlands and Centre for Mental Health Research, The Australian National University, Acton, Australia; Pim Cuijpers, PhD, Department of Clinical Psychology, VU University and EMGO Institute for Health and Care Research, VU University and VU University Medical Centre, Amsterdam, The Netherlands and Leuphana University, Lüneburg, Germany.
authors.forename: Robin N
authors.initials: RN
authors.lastname: Kok
authors.affiliation: Ioana A. Cristea, PhD, Department of Clinical Psychology and Psychotherapy, Babeʂ-Bolyai University, Cluj-Napoca, Romania and Clinical Psychology Branch, Department of Surgical, Medical, Molecular and Critical Pathology, University of Pisa, Pisa, Italy; Robin N. Kok, MSc, Department of Clinical Psychology and the EMGO institute for Health and Care Research, Faculty of Psychology and Education, VU University Amsterdam, Amsterdam, The Netherlands and Centre for Mental Health Research, The Australian National University, Acton, Australia; Pim Cuijpers, PhD, Department of Clinical Psychology, VU University and EMGO Institute for Health and Care Research, VU University and VU University Medical Centre, Amsterdam, The Netherlands and Leuphana University, Lüneburg, Germany.
authors.forename: Pim
authors.initials: P
authors.lastname: Cuijpers
mesh_terms: D001007:Anxiety / Q000628:therapy*; D015928:Cognitive Behavioral Therapy; D003863:Depression / Q000628:therapy*; D006801:Humans; D017594:Publication Bias / Q000706:statistics & numerical data; D016896:Treatment Outcome