{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T11:52:48Z","timestamp":1791373968964,"version":"4.3.1"},"update-to":[{"DOI":"10.12688\/wellcomeopenres.25609.1","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T00:00:00Z","timestamp":1779667200000}}],"reference-count":56,"publisher":"F1000 Research Ltd","license":[{"start":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T00:00:00Z","timestamp":1779667200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Wellcome","id":[{"id":"https:\/\/ror.org\/029chgv08","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":["wellcomeopenresearch.org"],"crossmark-restriction":false},"short-container-title":["Wellcome Open Res"],"abstract":"<ns3:p>\n                    Background Cognitive Bias Modification (CBM) is a potentially effective intervention for social anxiety disorder (SAD). However, the relative efficacy of CBM subtypes remains uncertain. Methods We co-produced a living systematic review of controlled studies evaluating stand alone CBM in participants with SAD and in non-clinical participants undergoing a social stressor, seeking to triangulate these. Databases were searched until October 2025 and two independent reviewers screened, extracted and critically appraised studies. The primary outcome was reduction in SAD symptoms, but we collected data on other mental health outcomes. Random-effect network meta-analysis was conducted. Credibility was assessed using the Confidence In Network Meta-Analysis framework. Results CBM for attention (CBM-A) demonstrated the largest reduction in SAD symptoms relative to control CBM-A although this estimate was imprecise (Standardised Mean Difference (SMD)\u00a0=\u00a0\u22120.18, 95% CI: \u22120.41 to 0.05, 95% PI: \u22121.02 to 1.04). Opposite CBM-A, training attention towards negative stimuli, performed similarly (SMD -0.17, 95% CI: \u22120.65 to 0.31, 95% PI: \u22120.97 to 1.21). CBM for interpretation (CBM-I) reduced SAD symptoms (SMD\u00a0=\u00a0\u22120.47, 95% CI: \u22120.84 to \u22120.09, 95% PI: \u22120.53 to 1.46) and cognitive bias versus its task-matched control condition without active bias training. The SAD network showed high inconsistency and 95% of studies were at moderate or high risk of bias. Three comparisons involving CBM-A were rated as moderate confidence, all others were low or very low. Sparse data precluded NMA of outcomes in non-SAD participants. Conclusion Inconsistency and imprecision in the network preclude firm conclusions regarding CBM efficacy for SAD. CBM-A showed a small effect but its similarity to opposite CBM-A suggests benefits may not depend on training direction. Future studies should explore the mechanism of CBM and reporting on potential side-effects. We will update this living systematic review as part of the GALENOS project.\n                    <ns3:bold>Registration:<\/ns3:bold>\n                    PROSPERO-ID:CRD42024601380.\n                  <\/ns3:p>","DOI":"10.12688\/wellcomeopenres.25609.2","type":"journal-article","created":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T14:29:09Z","timestamp":1779719349000},"page":"154","update-policy":"https:\/\/doi.org\/10.12688\/wellcomeopenres.crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Cognitive bias modification for social anxiety: a living systematic review and network meta-analysis"],"prefix":"10.12688","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7312-8676","authenticated-orcid":false,"given":"Jaycee","family":"Kennett","sequence":"first","affiliation":[{"name":"Department of Psychiatry Oxford University of Oxford"},{"name":"Oxford Precision Psychiatry Lab Oxford England NIHR Oxford Biomedical Research 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studies.","volume":"3","author":"J Higgins","year":"2012","journal-title":"Res Synth Methods.eak?>"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"193-209","DOI":"10.1080\/16506070701421313","article-title":"Cognitive factors that maintain Social Anxiety Disorder: a comprehensive model and its treatment implications.","volume":"36","author":"S Hofmann","year":"2007","journal-title":"Cogn Behav Ther."},{"key":"ref23","doi-asserted-by":"publisher","first-page":"237-286","DOI":"10.1016\/S2215-0366(17)30513-8","article-title":"The Lancet psychiatry commission on psychological treatments research in tomorrow\u2019s science.","volume":"5","author":"E Holmes","year":"2018","journal-title":"Lancet Psychiatry."},{"key":"ref24","doi-asserted-by":"publisher","first-page":"332941241268625","DOI":"10.1177\/00332941241268625","article-title":"Decoding cognitive control and cognitive flexibility as concomitants for experiential avoidance in social anxiety.","author":"T Jain","year":"2024","journal-title":"Psychol Rep."},{"key":"ref25","doi-asserted-by":"publisher","first-page":"175-183","DOI":"10.1016\/j.jad.2017.07.034","article-title":"Cognitive bias modification: a review of meta-analyses.","volume":"223","author":"E Jones","year":"2017","journal-title":"J Affect Disord."},{"key":"ref26","doi-asserted-by":"publisher","first-page":"350-358","DOI":"10.1016\/j.brat.2012.02.015","article-title":"Attention training to reduce attention bias and social stressor reactivity: an attempt to replicate and extend previous findings.","volume":"50","author":"K Julian","year":"2012","journal-title":"Behav Res Ther."},{"key":"ref27","article-title":"Cognitive bias modification for social anxiety: a living systematic review and network meta-analysis.","author":"J Kennett","year":"2025"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"657","DOI":"10.12688\/wellcomeopenres.23278.2","article-title":"Cognitive bias modification for social anxiety: protocol 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MacLeod","year":"2012","journal-title":"Annu Rev Clin Psychol."},{"key":"ref35","doi-asserted-by":"publisher","first-page":"104180","DOI":"10.1016\/j.brat.2022.104180","article-title":"Attention and interpretation cognitive bias change: a systematic review and meta-analysis of bias modification paradigms.","volume":"157","author":"A Martinelli","year":"2022","journal-title":"Behav Res Ther."},{"key":"ref36","doi-asserted-by":"publisher","first-page":"40-46","DOI":"10.1136\/eb-2015-102088","article-title":"A primer on network meta-analysis with emphasis on mental health.","volume":"18","author":"D Mavridis","year":"2015","journal-title":"Evid Based Ment Health."},{"key":"ref37","article-title":"robvis: an R package and web application for visualising risk-of-bias assessments.","author":"L McGuinness","year":"2019"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"249-274","DOI":"10.1146\/annurev-clinpsy-050212-185631","article-title":"Social anxiety and Social Anxiety 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names, many benefits, many concerns for the next generation evidence synthesis tool.","volume":"3","author":"G Salanti","year":"2012","journal-title":"Res Synth Methods."},{"key":"ref46","doi-asserted-by":"publisher","first-page":"163-171","DOI":"10.1016\/j.jclinepi.2010.03.016","article-title":"Graphical methods and numerical summaries for presenting results from multiple-treatment meta-analysis: an overview and tutorial.","volume":"64","author":"G Salanti","year":"2011","journal-title":"J Clin Epidemiol."},{"key":"ref47","doi-asserted-by":"publisher","first-page":"5-14","DOI":"10.1037\/a0013643","article-title":"Attention training for generalized social anxiety disorder.","volume":"118","author":"N Schmidt","year":"2009","journal-title":"J Abnorm Psychol."},{"key":"ref48","doi-asserted-by":"publisher","first-page":"63-70","DOI":"10.1016\/j.adolescence.2019.04.007","article-title":"Age-related changes in cognitive biases during adolescence.","volume":"74","author":"R Slavny","year":"2019","journal-title":"J Adolesc."},{"key":"ref49","doi-asserted-by":"publisher","first-page":"1-6","DOI":"10.1192\/bjp.2025.10457","article-title":"GALENOS approach to Triangulating Evidence (GATE): transforming the landscape of psychiatric research.","volume":"1\u20136","author":"K Smith","year":"2025","journal-title":"Br J Psychiatry."},{"key":"ref50","doi-asserted-by":"publisher","first-page":"l4898","DOI":"10.1136\/bmj.l4898","article-title":"RoB 2: a revised tool for assessing risk of bias in randomised trials.","volume":"366","author":"J Sterne","year":"2019","journal-title":"BMJ."},{"key":"ref51","doi-asserted-by":"publisher","first-page":"48-54","DOI":"10.1080\/16506070902980737","article-title":"Why is the self important in understanding and treating social phobia?","volume":"38","author":"L Stopa","year":"2009","journal-title":"Cogn Behav Ther."},{"key":"ref53","doi-asserted-by":"publisher","first-page":"395-401","DOI":"10.1016\/j.jad.2020.01.032","article-title":"Sensitivity to change and minimal clinically important difference of the 7-item Generalized Anxiety Disorder Questionnaire (GAD-7).","volume":"265","author":"A Toussaint","year":"2020","journal-title":"J Affect Disord."},{"key":"ref54","doi-asserted-by":"publisher","first-page":"535-554","DOI":"10.1017\/S1352465813000301","article-title":"The differential effects of written and spoken presentation for the modification of interpretation and judgmental bias in children.","volume":"42","author":"S Vassilopoulos","year":"2014","journal-title":"Behav Cogn Psychother."},{"key":"ref55","doi-asserted-by":"publisher","first-page":"e0194274","DOI":"10.1371\/journal.pone.0194274","article-title":"A randomized controlled trial of multi-session online interpretation bias modification training: short- and long-term effects on anxiety and depression in unselected adolescents.","volume":"13","author":"L Voogd","year":"2018","journal-title":"PLoS One."},{"key":"ref56","doi-asserted-by":"publisher","first-page":"104557","DOI":"10.1016\/j.brat.2024.104557","article-title":"Towards implementation of cognitive bias modification in mental health care: state of the science, best practices, and ways forward.","volume":"179","author":"J Vrijsen","year":"2024","journal-title":"Behav Res Ther."},{"key":"ref57","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-319-24277-4","author":"H Wickham","year":"2016","journal-title":"ggplot2: elegant graphics for data analysis."}],"container-title":["Wellcome Open Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/wellcomeopenresearch.org\/articles\/11-154\/v2\/xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/wellcomeopenresearch.org\/articles\/11-154\/v2\/pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/wellcomeopenresearch.org\/articles\/11-154\/v2\/iparadigms","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T11:14:10Z","timestamp":1791371650000},"score":1,"resource":{"primary":{"URL":"https:\/\/wellcomeopenresearch.org\/articles\/11-154\/v2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,25]]},"references-count":56,"URL":"https:\/\/doi.org\/10.12688\/wellcomeopenres.25609.2","relation":{"has-version":[{"id-type":"doi","id":"10.12688\/wellcomeopenres.25609.1","asserted-by":"subject"}],"has-review":[{"id-type":"doi","id":"10.21956\/wellcomeopenres.29444.r163244","asserted-by":"subject"},{"id-type":"doi","id":"10.21956\/wellcomeopenres.29444.r163244","asserted-by":"object"}]},"ISSN":["2398-502X"],"issn-type":[{"value":"2398-502X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,25]]},"assertion":[{"value":"Indexed","URL":"https:\/\/wellcomeopenresearch.org\/articles\/11-154\/v2#article-reports","order":0,"name":"referee-status","label":"Referee status","group":{"name":"current-referee-status","label":"Current Referee Status"}},{"value":"10.21956\/wellcomeopenres.28205.r149673, Ian S Penton-Voak, University of Bristol, Bristol, England, 24 Mar 2026, version 1, 1 approved, 1 approved with reservations","URL":"https:\/\/wellcomeopenresearch.org\/articles\/11-154\/v1#referee-response-149673","order":0,"name":"referee-response-149673","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.21956\/wellcomeopenres.28205.r149669, Eni S. Becker, Radboud Universiteit, Nijmegen, 15 Apr 2026, version 1, 1 approved, 1 approved with reservations","URL":"https:\/\/wellcomeopenresearch.org\/articles\/11-154\/v1#referee-response-149669","order":1,"name":"referee-response-149669","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"<b>Jaycee Kennett<\/b>; \n<i>Posted: 08 May 2026<\/i>; We thank Professor Becker for her feedback and her valuable comments. We have revised the manuscript and provided details below on the changes we have made to each point.  Reviewer: \n<b>1. Theory \/ content<\/b> My main conceptual comment concerns the scope of the review. The review is broad in important ways: it includes a wide range of CBM variants, a broad set of control conditions, and both clinical and non-clinical populations. At the same time, it is narrower than it may first appear, because it focuses on stand-alone CBM and excludes CBM delivered concurrently with psychotherapy or pharmacological treatment. This choice makes methodological sense, but it should be made much clearer from the outset. Clinically, CBM is often discussed and considered as an augmentation approach, and readers may otherwise overgeneralise the conclusions. 1.1 I would therefore recommend stating more explicitly, already in the introduction and ideally also in the abstract, that this review addresses stand-alone CBM only, and that this is important for interpretation of the findings. \n<b>Our response:<\/b> Additional text highlighting this has been added to the abstract and introduction: Abstract: \n<i>\u201cWe co-produced a living systematic review of controlled studies evaluating stand-alone CBM in participants with SAD and in non-clinical participants undergoing a social stressor, seeking to triangulate these.\u201d<\/i> Introduction: \n<i>\u201cWhile CBM is often used to augment other interventions, we have chosen to include stand-alone CBM only in order to isolate the relative efficacy of these interventions for social anxiety. This review took an intentionally narrow approach and as the review progresses into living mode and is updated, we may decide to include trials in which CBM augments other psychological interventions.\u201d<\/i> &nbsp;  Reviewer: Related to this, I would encourage the authors to highlight more clearly from the beginning that the review is intentionally broad, but that this breadth comes at a cost in terms of heterogeneity. This is particularly relevant for the included populations. Participants of any age were eligible, and the review combines diagnosed SAD, above-threshold symptom samples, and non-clinical participants exposed to analogue social stressors. Age seems especially important here. In the literature on cognitive biases, developmental differences matter considerably, and findings in children and adolescents are often mixed. I therefore think age should be discussed more explicitly as a potential source of variability and as a limitation on generalisability. \n<b>Our response:<\/b> Text discussing this has been added to the limitations section: \n<i>\u201cIn addition, the sparse and inconsistent data in both the clinical and the non-clinical samples limits the generalisability of our findings.<\/i>\n<i> Further to this, while we kept our eligibility criteria deliberately broad and included participants of all ages, it has been argued that cognitive biases differ by developmental stage (Abend et al., 2019; Slavny, Sebastian &amp; Pote, 2019); as such, this may have contributed to heterogeneity in our findings.\u201d<\/i> &nbsp;  Reviewer: I also found the discussion of the attention findings interesting, especially the observation that CBM-A did not clearly outperform opposite CBM-A. This is an important and thought-provoking result. It may be useful to place this more explicitly in the context of related work in other disorders, such as PTSD (Bar Haim), where attention training findings have also not always conformed to the original theoretical predictions. This would help readers to see that these findings may reflect a broader question about mechanism rather than an isolated anomaly in the social-anxiety literature. \n<b>Our response:<\/b> This has been added to the discussion to support reader interpretation. \n<i>\u201c<\/i>\n<i>This echoes the findings of Lazarov et al (2018) who found that attention control training (that does not seek to change a bias) outperformed attentional training that sought to actively reduce bias in individuals with PTSD. This potential for mismatch between original theoretical predictions of the mechanism of CBM-A <\/i>\n<i>supports more research on the importance of cognitive flexibility and its role in SAD and is important to consider in future research on CBM training for the disorder ( <\/i>\n<i>Arlt et al., 2016<\/i>\n<i>; <\/i>\n<i>Jain et al., 2024<\/i>\n<i>).<\/i> &nbsp;  Reviewer: \n<b>2. Methods<\/b> Overall, the methodological work is careful and in many respects strong. The review is registered, the search is broad and repeatedly updated, study selection and extraction were conducted independently by two reviewers, and appropriate tools were used for risk of bias and confidence in the evidence. The use of both pairwise meta-analysis and NMA is also understandable given the diversity of interventions and comparators in the field. My main concern here is not with the conduct of the analyses, but with the evidence base available to support them. The review necessarily draws on a highly heterogeneous literature. Interventions differ in content, delivery, dosage, and likely mechanism; populations are broad; and control conditions vary considerably. Under those circumstances, the network meta-analysis becomes difficult to interpret. The manuscript does acknowledge inconsistency, imprecision, and low confidence for many comparisons, which is appropriate. Still, I think the paper should state even more clearly that the underlying literature may not yet support strong conclusions about fine-grained relative efficacy between nodes. \n<b>Our response:<\/b> Text acknowledging this limitation has been added to the limitations section: \n<i>\u201cThis heterogeneity makes the results of the NMA difficult to interpret and highlights that evidence in CBM literature to date does not support definitive conclusions as to the relative efficacy of specific CBM subtypes.\u201d<\/i>  Reviewer: Related to this, the classification of interventions and controls deserves fuller explanation in the main manuscript. I understand and appreciate that classification was adjudicated by experts blind to extracted data, but given how much hinges on these nodes in the NMA, readers would benefit from a clearer sense of the rationale for grouping somewhat diverse procedures together. &nbsp; \n<b>Our response: <\/b>Further information on this process has been added to the methods section: \n<i>\u201cThe adjudication panel used the intervention descriptions extracted from the included studies (including the authors\u2019 own description of the respective interventions) and considered their intended targets and procedures in order to classify CBM subtypes. The panel then discussed uncertainties in the classifications of subtypes, and any disagreements were resolved via discussion.<\/i> &nbsp;  Reviewer: I was also uncertain about the reporting of the search strategy. The manuscript describes the databases searched and the general approach, but I could not easily locate the actual search terms. If these are available only in the extended materials, I would recommend signposting this much more clearly. In a systematic review, and particularly in a living review, readers generally expect the search strategy to be readily accessible, at least in an appendix or supplement. &nbsp; \n<b>Our response:<\/b> In addition to the link to the search strategy in the methods section, a description of all files in the extended data (including the search strategy) and a link can be found at the bottom of the manuscript. &nbsp;  Reviewer: A further point concerns the living-review format itself. Since this is presented as a living review, I would have expected a clearer update scheme. The manuscript notes the search updates and indicates that this is version 1, but I missed a clear explanation of how often updates are planned, what will trigger a new version, and how readers should orient themselves across versions. This will become increasingly important as the evidence base develops. Relatedly, clearer version numbering and guidance for readers would be helpful. &nbsp; \n<b>Our response:<\/b> Additional information has been added to the methods section and the discussion section with additional signposting to our protocol: Methods: \n<i>\u201cUpdate searches will be performed every three months, as specified in our protocol (see Kennett et al., 2025).\u201d<\/i> Discussion: \n<i>\u201cAs per our protocol (Kennett et al., 2025), we will carry out searches for new evidence every 3 months. As we find new evidence, the authors of the last iteration of the review will assess the evidence and based on its potential to substantially change the overall findings, we will incorporate it into the review. We will report all updates using the versioning system of F1000 (Wellcome Open Research), highlight the new evidence added, and specify when each update has been performed.\u201d<\/i> &nbsp;  Reviewer: \n<b>3. Wording \/ minor points<\/b> The manuscript is generally well written, but in several places the language becomes overly technical and difficult to follow. I noticed this already in the abstract. Terms such as \u201cstructurally matched control\u201d are not immediately transparent without explanation, and formulations such as \u201cwith CBM subtypes targeting different cognitive biases...\u201d are rather dense. Since this paper is likely to be read by readers beyond a narrow methodological audience, I think the manuscript would benefit from simpler and more accessible phrasing in several key places, especially in the abstract, introduction, and discussion. &nbsp; \n<b>Our response:<\/b> To make the manuscript more accessible, the phrase \u2018structurally matched control\u2019 has been changed to: \u201c\n<i>task-matched control condition without active bias training\u201d<\/i> and the phrase \u2018CBM subtypes targeting different cognitive biases\u2019 has been changed to: \n<i>\u201cSubtypes of CBM aim to train different cognitive biases and using varying procedures\u201d.<\/i> Language has been simplified or explained throughout the abstract, introduction, discussion, and conclusion to provide more clarity to the reader. &nbsp;  Reviewer: I also found Figure 3 difficult to interpret. As I understand it, all treatments are presented relative to Control CBM-A, but the rationale for choosing this reference category is not sufficiently clear, nor is the figure itself easy to understand without returning to the methods section. This may be statistically defensible, but it needs better explanation in either the text or the figure legend. &nbsp; \n<b>Our response: <\/b>More explanation has been added to the figure legend and in the associated text we have clarified why this was chosen as our reference node. Legend: \n<i>\u201cFigure 3. Forest plot of relative efficacy of CBM interventions for SAD (clinical source of evidence) compared to control CBM-A. Treatments are all subtypes of CBM included in our review. Positive values represent a treatment being less effective than control CBM-A, and negative values represent a treatment being more effective than control CBM-A. SMD = standardised mean difference, CI = 95% confidence interval. Effect sizes and confidence intervals were calculated using the random effects model.\u201d<\/i> Results section: \n<i>\u201cControl CBM-A is structurally similar to other forms of CBM (in terms of intervention duration, use of training tasks, and delivery) but does not train an active bias; this treatment was also well-connected with other treatments through direct evidence. As such, control CBM-A was selected as the reference treatment in our forest plot (figure 3).\u201d<\/i> &nbsp;  Reviewer: Finally, because this is a living review, presentation and orientation are especially important. Clearer explanations of versioning, updates, and the interpretation of key figures would make the paper more accessible and more useful over time. &nbsp; \n<b>Our response:&nbsp;<\/b>As detailed above, more information on the living mode of the review has been added to the discussion and methods section, including signposting to our versioning system on Wellcome Open Research. &nbsp; We hope these revisions adequately address the reviewer's concerns and have substantially improved the manuscript.","URL":"https:\/\/wellcomeopenresearch.org\/articles\/11-154\/v2#referee-comment-6559","order":2,"name":"referee-comment-6559","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.21956\/wellcomeopenres.29444.r163244, Colette Hirsch, King's College London, London, 07 Oct 2026, version 2, indexed","URL":"https:\/\/wellcomeopenresearch.org\/articles\/11-154\/v2#referee-response-163244","order":3,"name":"referee-response-163244","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"We are funded by Wellcome, a global charitable foundation. The funders had no role in the study design, data collection and analysis, or the preparation of the manuscript. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.","order":4,"name":"grant-information","label":"Grant Information"},{"value":"This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.","order":0,"name":"copyright-info","label":"Copyright"}]}}