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).

Cognitive control training for impulsivity

What do self-injury, bulimia, anxiety, binge drinking, and aggression all have in common? Although these types of harmful behaviors and disorders are distinct, they all involve a tendency to lose control over behavior during strong emotions. This tendency towards emotion-based impulsivity may be related to basic deficits in cognition. People who struggle with this type of impulsivity have difficulties with tasks that involve prepotent response inhibition, or the ability to stop quickly when necessary. Based on this research, it is possible that improving this basic cognitive skill might help people to gain control over behavior during strong emotions. That is the main hypotheses we are testing in this NIMH-funded project (F32 MH115530) led by Dr. Andrew Peckham.

We are testing if emotion-based impulsivity decreases when people practice short daily exercises on a computer to strengthen mental resources that support inhibition. We are also curious about the underlying brain mechanisms that might change during this training. In order to show that our training program works the way we think it does, it is important to test if the parts of the brain that help with inhibition are changing too. To test this, we are using EEG to measure brain activity before and after the training.

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