HabitWorks: Cognitive bias modification for interpretation
Daily life constantly requires the resolution of ambiguity. For example, not getting a job or a friend not returning a call can be interpreted in multiple ways. The way in which individuals automatically resolve the countless such ambiguous situations encountered each day has a large impact on how they feel and what they do. A tendency to jump to negative conclusions (interpretation bias) can lead to anxiety, depression, and maladaptive coping. Cognitive therapy has targeted interpretation bias for decades, but it is time-intensive, difficult, and requires a trained clinician.
Led by Dr. Courtney Beard, this NIMH-funded (R34MH113600) project seeks to develop a smartphone app called “HabitWorks” to deliver a Cognitive Bias Modification (CBM) treatment personalized to the individual and with engaging features (e.g., instructional videos, progressing through levels). We are testing the usefulness of the app for patients attending the Behavioral Health Partial Hospital Program at McLean Hospital. We will examine whether using the app during the month following acute psychiatric care leads to better mental health outcomes. Dr. Beard recently received two NIMH funded supplements to test neural changes associated with CBM using EEG and to explore CBM's effects on suicidal ideation and behaviors.
We are also testing the usefulness of the HabitWorks app for parents of anxious children. Research suggests that cognitive biases are passed down from parent to child, leading to child anxiety. However, current treatments for child anxiety do not target parental interpretation bias. Our hope is that HabitWorks may lead to healthier interpretations and ultimately improving anxiety symptoms in both parents and children.
Cognitive bias modification for OCD
Led by Dr. Martha Falkenstein we are currently testing the usefulness of two types of CBM interventions for patients at the Obsessive Compulsive Disorder (OCD) Institute at McLean Hospital, funded by the International OCD Foundation and the Department of Psychiatry at Harvard Medical School. Exposure and response prevention (ERP) is the first line of treatment for OCD, however many patients do not recover. There is a critical need to more efficiently and effectively augment ERP for treatment-resistant OCD, and CBM interventions are a promising strategy. One of our studies is examining the relationship between interpretation bias and mental health outcomes in OCD, and whether targeting interpretation bias in addition to routine care at the OCD Institute helps to improve these outcomes.
The second CBM for OCD study is also an augmentation to treatment as usual at the OCD Institute, in which we are specifically targeting avoidance, a common treatment-interfering behavior that prevents patients from fully benefiting from ERP. We are testing an innovative method for facilitating approach towards feared stimuli, expanding upon evidence that automatic approach tendencies can be modified through a type of CBM training, Approach-Avoidance Training (AAT).
On-line vs Smartphone CBT
Led by Dr. Courtney Beard, we are currently testing the real world effectiveness of two virtual CBT platforms during the COVID-19 pandemic. Funded by the Combined Jewish Philanthropies of Greater Boston,
this project aims to address the increased demand for mental health treatment during COVID by providing low-intensity forms of CBT to at least 300 people in the community. We will pilot procedures for a sustainable virtual CBT program at McLean. Finally, we will examine predictors of outcome and drop-out, as well as patterns of engagement.