Shifting Episodic Prediction With Online Cognitive Bias Modification: A Randomized Controlled Trial.

Negative future thinking pervades emotional disorders. This hybrid efficacy-effectiveness trial tested a four-session, scalable online cognitive bias modification program for training more positive episodic prediction. 958 adults (73.3% female, 86.5% White, 83.4% from United States) were randomized to positive conditions with ambiguous future scenarios that ended positively, 50/50 conditions that ended positively or negatively, or a control condition with neutral scenarios. As hypothesized (preregistration: https://osf.io/jrst6), positive training participants improved more than control participants in negative expectancy bias ( d = -0.58), positive expectancy bias ( d = 0.80), and self-efficacy ( d = 0.29). Positive training was also superior to 50/50 training for expectancy bias and optimism ( d = 0.31). Training gains attenuated yet remained by 1-month follow-up. Unexpectedly, participants across conditions improved comparably in anxiety and depression symptoms and growth mindset. Targeting a transdiagnostic process with a scalable program may improve bias and outlook; however, further validation of outcome measures is required.