Systematic Review and Meta-Analysis of Cognitive Bias Modification for Interpretation in Obsessive-Compulsive Disorder
Abstract
Objective: Cognitive bias modification for interpretation directly modifies maladaptive interpretation biases, central to the development and maintenance of obsessive-compulsive disorder. Although it has been examined across a range of disorders, its efficacy for Obsessive-Compulsive Disorder (OCD) has not been synthesized.
Methods: A systematic search of Embase, PubMed, and PsycInfo (last search 5 May 2026) identified randomized controlled studies targeted OCD-relevant interpretation biases. The synthesis combines a narrative mapping of design and training parameters, followed by three random-effects meta-analyses for interpretation biases, OCD-relevant beliefs, and OCD symptom severity. Prespecified moderators were training dosage, targeted domain, control condition, and study sample. Risk of bias was assessed with RoB 2 and certainty of evidence with GRADE. The review was preregistered (https://osf.io/n3hbk).
Results: Across 19 studies (N = 1,294), single-session designs predominated in analogue samples and multi-session protocols in the few clinical studies. Cognitive bias modification for interpretation showed a large effect on interpretation biases (g = -0.92 [-1.18, -0.65]), a moderate effect on OCD-relevant beliefs (g = -0.40 [-0.57, -0.22]), and a small effect on OCD symptom severity (g = -0.19 [-0.34, -0.04]). General or mixed training protocols outperformed domain-specific protocols, and symptom reductions were larger in clinical than in subclinical samples. All studies raised some concerns on RoB 2, and certainty of evidence ranged from low to moderate.
Conclusions: We present empirical evidence that cognitive bias modification for interpretation reliably modifies post-intervention interpretation biases, with moderate transfer to OCD-relevant beliefs and small transfer effects on OCD symptom severity, supporting its potential as an adjunctive intervention. The larger effects observed for broader training protocols and in clinical samples highlight that future trials should prioritize clinical samples, multi-session designs, preregistration, and outcome measures that are independent of the training paradigm. Given the few studies per subgroup these findings require replication.
Related
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- Concentrated Exposure Therapy vs Internet-Based Cognitive Behavioral Therapy for Obsessive-Compulsive Disorder: A Randomized Clinical Trial.
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BibTeX
@misc{tonsing2026systematic,
title = {{Systematic Review and Meta-Analysis of Cognitive Bias Modification for Interpretation in Obsessive-Compulsive Disorder}},
author = {Daniel Tönsing and Marcel Miché and Johannes Massell and Roselind Lieb and Karina Wahl},
howpublished = {PsyArXiv},
year = {2026},
month = oct,
doi = {10.31234/osf.io/wsdet_v2},
url = {https://osf.io/preprints/psyarxiv/wsdet_v2/},
note = {CC BY 4.0},
}
RIS
TY - UNPB
TI - Systematic Review and Meta-Analysis of Cognitive Bias Modification for Interpretation in Obsessive-Compulsive Disorder
AU - Daniel Tönsing
AU - Marcel Miché
AU - Johannes Massell
AU - Roselind Lieb
AU - Karina Wahl
PY - 2026
DA - 2026/10/26
PB - PsyArXiv
DO - 10.31234/osf.io/wsdet_v2
UR - https://osf.io/preprints/psyarxiv/wsdet_v2/
AB - Objective: Cognitive bias modification for interpretation directly modifies maladaptive interpretation biases, central to the development and maintenance of obsessive-compulsive disorder. Although it has been examined across a range of disorders, its efficacy for Obsessive-Compulsive Disorder (OCD) has not been synthesized. Methods: A systematic search of Embase, PubMed, and PsycInfo (last search 5 May 2026) identified randomized controlled studies targeted OCD-relevant interpretation biases. The synthesis combines a narrative mapping of design and training parameters, followed by three random-effects meta-analyses for interpretation biases, OCD-relevant beliefs, and OCD symptom severity. Prespecified moderators were training dosage, targeted domain, control condition, and study sample. Risk of bias was assessed with RoB 2 and certainty of evidence with GRADE. The review was preregistered (https://osf.io/n3hbk). Results: Across 19 studies (N = 1,294), single-session designs predominated in analogue samples and multi-session protocols in the few clinical studies. Cognitive bias modification for interpretation showed a large effect on interpretation biases (g = -0.92 [-1.18, -0.65]), a moderate effect on OCD-relevant beliefs (g = -0.40 [-0.57, -0.22]), and a small effect on OCD symptom severity (g = -0.19 [-0.34, -0.04]). General or mixed training protocols outperformed domain-specific protocols, and symptom reductions were larger in clinical than in subclinical samples. All studies raised some concerns on RoB 2, and certainty of evidence ranged from low to moderate. Conclusions: We present empirical evidence that cognitive bias modification for interpretation reliably modifies post-intervention interpretation biases, with moderate transfer to OCD-relevant beliefs and small transfer effects on OCD symptom severity, supporting its potential as an adjunctive intervention. The larger effects observed for broader training protocols and in clinical samples highlight that future trials should prioritize clinical samples, multi-session designs, preregistration, and outcome measures that are independent of the training paradigm. Given the few studies per subgroup these findings require replication.
ER -