A systematic review of treatments targeting cognitive biases in socially anxious adolescents: Special Section on “Translational and Neuroscience Studies in Affective Disorders” Section Editor, Maria Nobile MD, PhD

Background: Adolescence is a period of brain plasticity that is affected by social and affective stimuli. Adaptive neurodevelopmental changes in the context of complex social situations may precipitate or exacerbate cognitive biases (i.e., attention and/or interpretation biases) and predispose at-risk individuals to symptoms of social anxiety. Methods: This systematic review followed the PRISMA guidelines. Nine adolescent studies were examined including 3 studies using Cognitive Bias Modification Training (CBMT) to target attention biases (CBMT-A), 3 studies using CBMT to target interpretation biases (CBMT-I), and 3 aimed at reducing both attention and interpretation biases. Results: The studies of CBMT-A alone did not find significant effects on cognitive and clinical outcomes. However, studies of CBMT-I alone showed some improvement in interpretation bias. The combination of CBMT-A and CBMT-I appeared promising in reducing both attentionl and interpretation biases. Limitations: The paucity of studies and the heterogeneity across studies (e.g., format of CBMT, assessment measures) limit the calculation of overall effect sizes and the examination of predictors, moderators, and mediators of outcome. Conclusions: Technology-driven interventions such as CBMT have the potential to extend treatments outside the clinic setting and to augment current therapies for social anxiety. Further research is needed to develop CBMT procedures that optimize learning in group and real-world settings and to identify predictors of treatment response. Understanding the neural correlates of response to CBMT may help identify future targets for intervention.