122 COGNITIVE THEORY AND RESEARCH ON ANXIETY
tional training using a dot probe task, individuals with GAD trained to selectively attend
to neutral words had a significant decrease in attentional threat bias and anxiety symp-
toms (Amir, Beard, Burns, & Bomyea, 2009), and in a second similar study socially
anxious participants trained to disengage from negative social cues also reported signifi-
cantly greater reductions in social anxiety and trait anxiety than the no- training control
group (Schmidt, Richey, Buckner, & Timpano, 2009). Together these studies indicate
that cognitive bias training may be effective in reducing anxiety, which provides further
support for a causal basis to threat bias in anxiety.
Summary
There is relatively little research on cognitive vulnerability to anxiety that has employed
self- report questionnaires of dysfunctional beliefs about threat, except for some stud-
ies reporting inconsistent findings on enduring beliefs in OCD. However, more recent
experimental studies employing different training protocols have demonstrated that a
threat interpretation bias can be created in nonanxious individual that may be similar
to the selective processing bias for threat that characterizes anxiety. Evidence of some
durability over time and transfer of induced processing style to novel stimuli and changes
in environmental context suggests that these training effects may be quite robust. How-
ever, the causal effects of induced threat interpretation bias on anxiety are not simple.
It is apparent that training effects on anxiety are most likely when the induced bias is
activated when individuals are required to generate personally threatening meanings
(Mathews & Mackintosh, 2000) or, possibly when interpretation bias activates per-
sonally threatening imagery (Hirsch, Clark, & Mathews, 2006). Moreover, the mood-
congruency effects of induced interpretation bias are most notable with exposure to a
stressor. Thus the evidence to date indicates that threat interpretation bias plays a causal
role in modifying vulnerability to emotional reactivity. However, this research is still in
its infancy and many fundamental questions remain unanswered.
Training in positive interpretation bias may prove to be an effective treatment for
clinical anxiety states. Studies on cognitive bias modification have demonstrated sig-
nificant reductions in anxious symptoms. Mathews et al. (2007) found that training in
positive interpretation bias reduced trait anxiety scores. Furthermore, use of imagery
during interpretation training might improve training effects as indicated by reductions
in state anxiety and increases in positive affect (Holmes, Mathews, Dalgleish, & Mack-
intosh, 2006; see also Holmes, Arntz, & Smucker, 2007). The current findings, then,
are most promising and are our strongest experimental evidence to date that schematic
threat activation in the form of interpretative threat bias plays a significant contribu-
tory role in anxious reactivity to stress. Moreover, there may be significant therapeutic
benefits in reversing the preexisting cognitive bias by training vulnerable individuals to
make positive interpretations of ambiguous threat stimuli.
Clinician Guideline 4.5
Deliberate and sustained training in generating positive, nonthreatening interpretations of
personally meaningful situations relevant to the client’s primary anxious concerns can coun-
ter the hypervalent schematic threat activation that characterizes vulnerability to anxiety.