Modifying a negative interpretation bias for ambiguous social scenarios that depict the risk of rejection in women with anorexia nervosa

Seeing oneself as an unattractive loser: Similar interpretation and memory biases in adolescents with anorexia nervosa and adolescents with depression or anxiety

OBJECTIVE

Anorexia nervosa (AN) is characterised by dysfunctional cognitive biases but these have rarely been investigated in adolescents with AN. The present study systematically assessed cognitive biases in adolescents with AN and addressed the questions of content-specificity (i.e., do biases occur only for eating disorder-related information?) and disorder-specificity (i.e., are biases unique to individuals with AN?).

METHODS

Cognitive biases on three information processing levels (attention, interpretation, memory) and for two types of information content (eating disorder-related, non-eating disorder-related) were assessed within a single experimental paradigm based on the Scrambled Sentences Task. 12-18-year-old adolescents with AN (n = 40) were compared to a healthy (HC; n = 40) and a clinical (girls with depression and/or anxiety disorders; CC; n = 34) control group.

RESULTS

Both clinical groups (AN and CC) showed pronounced negative interpretation and memory biases compared to the HC group, for both disorder-related and non-disorder-related information. Attention biases could not be analysed.

CONCLUSION

The results support the hypothesis that adolescents with AN show negative cognitive biases but these were not limited to disorder-related information. Adolescents with depression and/or anxiety disorders showed similar biases, suggesting them to be transdiagnostic phenomena. Important implications for cognitive-behavioural theories of AN, subsequent cognitive bias modification studies in AN, as well as clinical practice are discussed.

The effect of training to target cognitive biases towards social rejection in eating disorders

OBJECTIVE

This study examined the effect of cognitive bias modification for interpretation (CBM-I) training in Korean women with eating disorders (EDs).

METHOD

Sixty-three women with EDs participated in the study. Participants were randomly assigned to the intervention group where they received six sessions of CBM-I training (n = 31) in addition to treatment-as-usual or were put on a waiting list (n = 32). Participants' interpretation and attention biases, emotion regulation, affect, and ED psychopathology were assessed at baseline, end-of-intervention (4 weeks), and follow-up (8 weeks).

RESULTS

Participants who completed the CBM-I training displayed greater reductions in negative interpretation bias (Δη2 = 0.107) and emotion dysregulation (Δη2 = 0.085) with medium to large effect sizes compared to the control group, which were maintained from baseline to follow-up. Disengagement from negative faces and a focus on positive faces was found in the intervention group with a moderate effect size at the end-of-intervention (Δη2 = 0.090). Both intervention and control groups showed improvements in ED psychopathology. Baseline neuroticism was positively correlated with CBM-I effect.

DISCUSSION

The results suggest that modifying interpretation bias towards ambiguous social stimuli might be an effective adjuvant treatment to reduce negative expectations of social situations and improve emotion regulation in women with bulimia nervosa and anorexia nervosa.

Implication of Social Rejection in Cognitive Bias Modification Interpretation Training in Adolescents With Eating Disorders

Objectives

Difficulties in interpersonal relationships intensify negative emotions and act as risk and maintenance factors for eating pathology in eating disorders. Rejection sensitivity refers to the tendency to react sensitively to a rejection. Patients with eating disorders experience difficulties in interpersonal relationships because of their high sensitivity to rejection. Cognitive bias modification interpretation (CBM-I) is a treatment developed to correct interpretation bias for social and emotional stimuli. In this review, we searched for research characteristics and trends through a systematic literature analysis of CBM-I for eating disorders.

Methods

Five papers that met the selection and exclusion criteria were included in the final literature review and analyzed according to detailed topics (participant characteristics, design, and results).

Results

The literature supports the efficacy of the CBM-I in reducing negative interpretation bias and eating disorder psychopathology in patients with eating disorders. CBM-I targets emotional dysregulation in adolescent patients with eating disorders and serves as an additional strengthening psychotherapy to alleviate eating disorder symptoms.

Conclusion

The current findings highlight the potential of CBM-I as an individualized adjunctive treatment for adolescents with eating disorders and social functioning problems.

Negative and positive interpretations of emotionally neutral situations modulate the desire to eat personally craved foods

Emotions play an important role in modulating food craving. Previous studies demonstrated that exposure to negative or positive stimuli can subsequently influence the desire to eat. However, in many daily situations, individuals self-generate their emotions, for example, by interpreting emotionally-neutral situations as positive or negative. So far, no studies have examined if and how positive and negative interpretations of emotionally-neutral situations modulate food craving. In this study, 65 healthy participants were asked to interpret emotionally-neutral images negatively or positively or observe the images naturally. Subsequently, participants rated their state negative/positive affect and their desire to eat their personally craved foods. The results demonstrate a lower desire to eat craved foods after negative interpretations and a higher desire to eat after positive interpretations, compared to an observe-naturally condition. Additionally, the impact of emotional interpretations on the desire to eat was mediated by participants' state negative/positive affect. These findings suggest that self-generated emotion as a result of negative/positive interpretations plays a significant role in modulating food craving. The results highlight the potential of modifying affective interpretations for the treatment of disorders that are characterized by both dysregulated food craving and emotion.

Modification of Body-Related Attentional Bias through Virtual Reality and Eye-Tracking in Healthy Participants: Implications for Anorexia Nervosa Treatments

Cognitive biases have a significant impact on the etiology and treatment of eating disorders (EDs). These biases, including selective attentional bias (AB) to disliked body parts, may reinforce concerns about body shape, fear of gaining weight and body image disturbances and may contribute to dietary restriction and restraint. Decreasing AB could reduce core symptoms in anorexia nervosa (AN). This study represents a preliminary exploration aiming to assess whether AB towards weight-related (WR) and non-weight-related (NW) body parts could be reduced through an AB modification task in a virtual reality (VR) environment in healthy participants. A total of 54 female participants, aged 22.98 ± 1.89, were recruited. The task consisted of directing the participants' attention towards all body parts equally in a VR setting. Eye-tracking (ET) measurements (complete fixation time [CFT] and number of fixations [NF]) were made before and after the task. The results showed a significant reduction of the AB in the two groups with an initial AB towards WR body parts or towards NW body parts. Participants showed a tendency to more balanced (non-biased) attention after the intervention. This study provides evidence of the usefulness of AB modification tasks in a non-clinical sample.

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

OBJECTIVE

This study aimed to investigate whether a computerized cognitive bias modification training delivered remotely would reduce expectations of rejection in adolescents with eating disorders.

METHOD

Sixty-seven adolescents aged 12-18 (99.5% female) with an eating disorder diagnosis (94% anorexia nervosa) and receiving specialist treatment were recruited. Participants were randomized to an intervention condition (n = 37) which included treatment as usual (TAU) supplemented by nine sessions of online cognitive bias modification training for social stimuli (CBMT + TAU), or a control condition (n = 30), which included TAU only. Participants were invited to complete assessments at baseline and post-intervention.

RESULTS

In the intervention condition, 22/37 participants completed six or more training sessions and post-intervention measures, the pre-defined criteria to be considered "completers." In the control condition, 28/30 participants completed the post-intervention measures. Participants who completed the intervention displayed a significantly greater reduction in negative interpretations of ambiguous social scenarios, with a medium effect size (p = .048, ηp2 = .090), and eating disorder psychopathology, with a medium effect size (p = .027, ηp2 = .105), compared to participants in the control condition. No significant between-group differences were found on emotional response to criticism, and anxiety and depression symptoms post-intervention (ps > .05; small effect sizes).

DISCUSSION

Enhancing treatment as usual with CBMT targeting expectations of social rejection might be feasible and effective to reduce expectations of social rejection and eating disorder psychopathology in adolescents with eating disorders. Training adaptations might be necessary to impact on emotional processing and comorbid psychological distress.

PUBLIC SIGNIFICANCE

Adolescents with eating disorders who completed a brief (4-week) online cognitive training intervention, alongside their usual treatment, reported greater reductions in expectations of social rejection and eating disorder psychopathology after the intervention, compared to a separate group of patients who received their usual treatment only. This brief and accessible intervention may be a helpful treatment adjunct for adolescents with eating disorders.

Social network sites as learning environments and their implications for mental health

Social network sites (SNSs) have become ubiquitous around the globe and interwoven with all aspects of life. In this article, I will argue that the communicative infrastructure of SNSs, i.e., all SNS-elements that allow users to communicate, is a key element for understanding their impact as it creates environments in which users, their behaviors, and social interactions are embedded. These digital environments facilitate and encourage fundamental mechanisms of implicit learning from feedback as well as observation in an unprecedented way. I will discuss how these technology-based learning environments impact the mental health of their users, e.g., by linking negative online feedback to depression and following influencers to disturbed eating. The article ends with a conclusion that emphasizes the advantages of understanding SNSs as environments in order to reflect the complexity, relevance, and ubiquitousness of the phenomenon.

Biased and inflexible interpretations of ambiguous social situations: Associations with eating disorder symptoms and socioemotional functioning

BACKGROUND

Research indicates that difficulties across multiple socioemotional functioning domains (e.g., social emotion expression/regulation, response to social elicitors of emotion) and negatively biased interpretations of ambiguous social situations may affect eating disorder symptoms. The impact of inflexible interpretations of social situations on eating disorder symptoms is less clear. The present study therefore examined relations between inflexible and biased social interpretations, socioemotional functioning, and eating disorder symptoms.

METHOD

A total of 310 participants from the general population, recruited from an online crowdsourcing platform, completed measures of socioemotional functioning (e.g., rejection sensitivity, negative social exchange), eating disorder symptoms, and positive and negative interpretation bias and inflexibility on a single measurement occasion.

RESULTS

Socioemotional functioning impairments (Pillai's trace = 0.11, p < .001), but not negative (β = .07, p = .162) or positive (β = -.01, p = .804) interpretation bias or inflexible interpretations (β = .04, p = .446), were associated with eating disorder symptoms in multiple regression models. In network analyses controlling statistically for multiple markers of socioemotional functioning, eating disorder symptoms were directly associated with negative (but not positive) interpretation bias. Inflexible interpretations were indirectly linked to symptoms via co-dampening of positive emotions. Exploratory causal discovery analyses suggested that several socioemotional functioning variables (social anxiety, depression, negative social exchange) may cause eating disorder symptoms.

CONCLUSIONS

Consistent with cognitive-interpersonal models of disordered eating, our results suggest that less accurate (biased, inflexible) interpretations of social information contribute to patterns of cognition (anxious anticipation of rejection) and emotion regulation (down-regulation of positive social emotion) thought to encourage disordered eating.

PUBLIC SIGNIFICANCE

This study suggests that less accurate interpretations of ambiguous social information encourage anxious anticipation of rejection and downregulation of positive social emotions, both of which are thought to promote eating disorder symptoms. Knowledge provided by this study about the likely relations between interpretive processes, social/emotional functioning, and eating disorder symptoms may help inform treatments for eating disorders, particularly those that attempt to modify patterns of interpretation.

The KOALA-study: study protocol for a comprehensive study of cognitive biases in adolescent anorexia nervosa patients compared to healthy and clinical controls

BACKGROUND

Anorexia nervosa (AN) is characterized by dysfunctional cognitions including cognitive biases at various levels of information processing. However, less is known about the specificity of these biases, i.e., if they occur for eating-disorder-related information alone or also for non-eating-disorder-related emotional information in AN patients (content-specificity) and if they are unique to individuals with AN or are also shown by individuals with other mental disorders (disorder-specificity).

METHODS

The present study systematically assesses cognitive biases in 12-18-year-old female adolescents with AN on three levels of information processing (attention, interpretation, and memory) and with regard to two types of information content (eating-disorder-related, i.e., stimuli related to body weight and shape, and non-eating-disorder-related). To address not only content- but also disorder-specificity, adolescents with AN will be compared not only to a healthy control group but also to a clinical control group (adolescents with major depression or particular anxiety disorders). Cognitive biases are assessed within a single experimental paradigm based on the Scrambled Sentences Task. During the task eye movements are recorded in order to assess attention biases while interpretation biases are derived from the behavioural outcome. An incidental free recall test afterwards assesses memory biases. We expect adolescents with AN to show more pronounced negative cognitive biases on all three levels of information processing and for both types of content compared to healthy adolescents. In addition, we expect the specificity of biases to translate into differential results for the two types of content: AN patients are expected to show stronger biases for disorder-related stimuli but similar or less pronounced biases for non-disorder-related stimuli compared to the clinical control group.

DISCUSSION

This is the first study to comprehensively assess cognitive biases in adolescents with AN. It will have essential implications not only for cognitive-behavioural models of AN but also for subsequent studies aiming to modify cognitive biases in this population, thereby addressing important maintaining factors already at an early stage of the disorder.

Looking on the Bright Side Reduces Worry in Pregnancy: Training Interpretations in Pregnant Women

Background

Recent evidence suggests that anxiety is more common than depression in the perinatal period, however there are few interventions available to treat perinatal anxiety. Targeting specific processes that maintain anxiety, such as worry, may be one potentially promising way to reduce anxiety in this period. Given evidence that negative interpretation bias maintains worry, we tested whether interpretation bias could be modified, and whether this in turn would lead to less negative thought (i.e., worry) intrusions, in pregnant women with high levels of worry.

Method

Participants (N = 49, at least 16 weeks gestation) were randomly assigned to either an interpretation modification condition (CBM-I) which involved training in accessing positive meanings of emotionally ambiguous scenarios, or an active control condition in which the scenarios remained ambiguous and unresolved.

Results

Relative to the control condition, participants in the CBM-I condition generated significantly more positive interpretations and experienced significantly less negative thought intrusions.

Conclusions

Our findings indicate that worry is a modifiable risk factor during pregnancy, and that it is possible to induce a positive interpretation bias in pregnant women experiencing high levels of worry. Although preliminary, our findings speak to exciting clinical possibilities for the treatment of worry and the prevention of perinatal anxiety.

Critical incidents in anorexia nervosa: perspectives of those with a lived experience

BACKGROUND

Although social-emotional difficulties are believed play a key role in anorexia nervosa (AN), there is uncertainty regarding what these difficulties might look like. Previous research has largely focused on a "disease model" of social-emotional processing in AN with little attention paid to positive emotions and experiences. Therefore, the aim of the present study was to obtain a fuller picture of critical life events as identified by those with lived AN experience.

METHODS

Thirty-four participants aged 16-48 with current or past AN completed an online survey describing self-defined positive and difficult critical events. Thematic analysis was used to assess patterns in participants narrative responses.

RESULTS

Two major themes were identified in the descriptions of positive critical events: Moments of celebration and Unexpected positive outcomes. These major themes revealed increased external focus and some corrective experiences that challenged the participants pre-existing expectations leading to new positive outcomes. Difficult events clustered into life events that were identified as Eating disorder (ED) related and Non-ED related and included the dimensions of relational conflict and feeling unsupported.

DISCUSSION

The findings suggest that although negative emotionality was identified in the accounts of those with lived experience of AN capacity for "big-picture" thinking with and explicit focus on others was also identified. Moreover, an openness to corrective experiences that worked to challenge negative expectations was evident for some participants. Together these findings have scope as targets for further clinical research and treatment interventions.

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

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.

Interpretation bias modification to reduce body dissatisfaction - a randomized controlled pilot study in women with elevated weight and shape concerns

BACKGROUND

Recent research has identified several cognitive biases in patients with eating disorders, such as a tendency to interpret ambiguous information about one's own body in a negative way. The so-called "negative interpretation bias" is considered to be a key factor in maintaining maladaptive cognitions and behaviors in eating disorders. Studies on modification of the negative interpretation bias in eating disorders have yielded mixed results. This randomized controlled pilot study examined whether a specially adapted, computerized version of the Scrambled Sentences Task modifies negative interpretation bias in women with elevated body dissatisfaction.

METHODS

The sample consisted of 40 normal-weight women with elevated body dissatisfaction, randomly assigned either to an intervention or a no-intervention control group (each n = 20). The intervention group received six sessions (within two weeks) of a newly-developed interpretation bias modification training that involved unscrambling positively valenced, body image-related sentences. The control group received no intervention. In both groups, body image-related negative interpretation bias (main outcome), trait body dissatisfaction and thin-ideal cue reactivity were assessed at baseline and two weeks later. Additionally, in the intervention condition, the trajectory of expected reductions in the thin-ideal internalization was measured during each training session.

RESULTS

In both conditions, body image-related negative interpretation bias and trait body dissatisfaction decreased significantly from pre- to post-assessment; however, a specific effect imparted by the interpretation bias modification training was not found. Groups did not differ in thin-ideal cue reactivity. In the intervention group, thin-ideal internalization decreased significantly over the training sessions.

CONCLUSIONS

The findings do not support use of body image-related interpretation bias modification in its current form in the treatment of body dissatisfaction. Further research involving different versions of the training and clinical samples is warranted.

Utilising cognitive bias modification to remedy appearance and self-worth biases in eating disorder psychopathology: A systematic review

BACKGROUND AND OBJECTIVES

This study systematically reviewed the impact of Cognitive Bias Modification (CBM) on biases related to attention (CBM-A) and interpretation (CBM-I) for appearance and self-worth stimuli and the subsequent impact on eating disorder (ED) psychopathology.

METHOD

The current review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), with 12 studies meeting inclusion criteria (CBM-A n = 5; CBM-I n = 7).

RESULTS

The literature provides preliminary support for CBM-A and CBM-I efficacy in eliciting bias change in varying degrees of psychopathology (Cohen's d ranging between -1.67 and 1.34; 9 studies reflected improved bias, and 3 reflected no change or did not assess), while highlighting the less robust effects associated with improving ED psychopathology (d ranging between -1.30 and 0.61; 5 studies reflected symptom improvement, and 7 reflected no change or did not assess).

LIMITATIONS

The review only considered peer reviewed research and did not report on the findings of unpublished data; thus, the current findings may not provide an accurate representation of CBM in EDs.

CONCLUSIONS

The current findings highlight the potential of CBM as an adjunct intervention for EDs; however the limited number of investigations and high degree of heterogeneity across the included studies impedes on the generalisability of the findings.

The vulnerability to interpersonal stress in eating disorders: The role of insecure attachment in the emotional and cortisol responses to the trier social stress test

BACKGROUND

Vulnerability to interpersonal stress is an important risk factor for Eating Disorders (EDs). Adult insecure attachment involves different emotional, biological and behavioural strategies to cope with social stressors. However, although attachment has proved to play a pivotal role in EDs, no study has yet explored the effects of attachment on the emotional and hypothalamic-pituitary-adrenal (HPA) axis responses to a psychosocial stressor in EDs.

METHODS

Fifty-two ED women (29 with anorexia nervosa, 23 with bulimia nervosa) underwent the Trier Social Stress Test (TSST). Their emotional response was measured by means of the State-Trait Anxiety Inventory state scale while saliva samples were collected to measure cortisol secretion.

RESULTS

According to the Experience in Close Relationship questionnaire scores, 21 ED patients had high attachment anxiety and 31 low attachment anxiety, whilst 34 had high attachment avoidance and 18 low attachment avoidance. Patients with high attachment anxiety or avoidance displayed heightened TSST-induced cortisol secretion and anxiety feelings, in comparison to those with low insecure attachment scores. Anxiety perception was associated with cortisol recovery after the test exposure but not with the HPA axis reactivity in insecure attached patients.

CONCLUSIONS

The present findings corroborate the hypothesis that attachment modulates the biological and emotional reactivities to an acute social threat in ED patients. The role of these attachment-mediated changes in vulnerability to interpersonal stress in EDs needs to be clarified in future studies.

Eye-tracking research in eating disorders: A systematic review

OBJECTIVE

Those with eating disorders (EDs) show attentional biases to disorder-relevant stimuli, such as food and body shape information. However, attentional bias research in EDs largely relies on reaction time based measures, which are limited in their ability to assess different components and the time course of attention. Eye-tracking paradigms have therefore been utilized to provide greater ecological validity, and directly capture the detailed sequence of processes in perception and attention. While numerous studies have examined eye movements in the mood, anxiety, and psychotic disorders, there has been a lack of studies in EDs. The purpose of this qualitative review is to provide a summary of eye-tracking studies in clinical ED populations.

METHOD

The review was conducted using the PRISMA guidelines. Electronic databases were systematically searched to identify studies examining gaze parameters in ED compared to healthy controls (HCs). Thirty-one studies met inclusion criteria.

RESULTS

Across ED diagnoses, there was evidence of attentional biases towards food and body stimuli. In addition, differential patterns of attention to social information, and differences in smooth pursuit and saccadic eye movements were found in anorexia nervosa (AN).

DISCUSSION

Findings are discussed in relation to research in other psychiatric disorders, and recommendations for future studies using eye-tracking in EDs are given. The findings add to the wider literature on attentional biases in EDs, and provide potential avenues for treatment. IJED-18-0331.R1. Investigación de seguimiento ocular en trastornos de la conducta alimentaria: una revisión sistemática.

Deranged emotional and cortisol responses to a psychosocial stressor in anorexia nervosa women with childhood trauma exposure: Evidence for a "maltreated ecophenotype"?

Exposure to trauma in the childhood and abnormal interpersonal stress reactivity are believed to contribute to the pathophysiology of anorexia nervosa (AN), which suggests a possible role of the hypothalamus-pituitary adrenal (HPA) axis. Although an effect of early traumatic experiences on the cortisol awakening response has been proved in patients with AN, the consequences of childhood trauma exposure on HPA axis reactivity to psychosocial stressors has been never investigated in such individuals. Therefore, we have assessed emotional and cortisol responses to an acute psycho-social stress in AN patients with a history of childhood trauma exposure. Twenty-four AN women and 17 healthy women were enrolled in the study. Patients were classified as maltreated (Mal) or non-maltreated (noMal) according to their Childhood Trauma Questionnaire scores. Participants underwent the Trier Social Stress Test (TSST) and their emotional responses were measured through the state scale of the State-Trait Anxiety Inventory. Saliva samples were collected to measure cortisol production. Compared to both healthy subjects and noMal AN patients, Mal AN women exhibited a blunted cortisol response to TSST. With respect to healthy controls, pre-TSST anxiety levels were enhanced in both AN groups; moreover, Mal AN patients displayed a reduced anxiety increase after TSST as compared to both noMal patients and healthy women. Our findings for the first time provide the evidence of deranged biological and emotional responses to an acute social stress in AN patients with childhood trauma exposure, corroborating the idea of a maltreated ecophenotype in AN as in other psychiatric disorders.

A new cognitive bias modification technique to influence risk factors for eating disorders

OBJECTIVE

Eating disorder psychopathology is associated with a propensity to interpret ambiguous stimuli to be negatively related to one's appearance and self-worth. The relative impact of modifying interpretation bias for these respective stimuli is unknown. Hence the main aim of the current study was to compare two cognitive bias modification protocols targeting interpretation bias (CBM-I), one focused on appearance and the other on self-worth, in terms of impacting interpretation bias, body dissatisfaction and negative affect. The appearance-based CBM-I protocol was developed for the current study.

METHOD

Female university students (N = 123) were randomized into one of three CBM-I conditions: appearance, self-worth or control. Immediately following a negative induction that significantly increased body dissatisfaction and negative affect, participants underwent their respective CBM-I training.

RESULTS

The CBM-I for appearance produced significant changes in the targeted bias, as well as significant improvements (moderate effect sizes) in appearance satisfaction, relative to the CBM-I for self-worth and control conditions.

DISCUSSION

The results support the usefulness of the CBM-I for appearance protocol, and suggests that this technique warrants further investigation with respect to modifying interpretation bias and risk factors associated with eating disorder psychopathology. Null effects of CBM-I for self-worth should be interpreted in light of study limitations, including the potential unsuitability of training material for young women. CBM-I for both types of interpretation bias should be evaluated in future research.