The combined cognitive bias hypothesis in anxiety: A systematic review and meta-analysis

• Published in: Journal of anxiety disorders 2022-06, Vol.89, p.102575-102575, Article 102575
• Main Authors: Leung, Chantel J., Yiend, Jenny, Trotta, Antonella, Lee, Tatia M.C.
• Format: Article
• Language: English
• Subjects: Anxiety; Attention bias; Combined cognitive bias hypothesis; Interpretation bias; Memory bias
• ISSN: 0887-6185; 1873-7897
• DOI: 10.1016/j.janxdis.2022.102575

Cognitive theories have postulated the relational nature of different cognitive biases in the development and maintenance of anxiety disorders. To test this combined cognitive bias hypothesis, this review addressed the following questions: (i) whether different cognitive biases are associated with each other and (ii) whether one bias influences another bias. We identified 36 articles that studied the relationship between cognitive biases (attention, interpretation and memory bias). Of these, 31 studies were entered into two meta-analyses. Sixteen studies were included in the first meta-analysis of the correlation between cognitive bias indices. A further 15 studies were included in another meta-analysis to examine the transfer effects of cognitive bias modification (CBM) to another bias. Both meta-analyses yielded small but significant overall pooled effect sizes after the removal of outliers (r = 0.11 and g = 0.19 respectively). Moderator analyses revealed that the relationship between interpretation and memory bias was significantly stronger than other types of cognitive bias correlations and CBM is more potent in modifying biases when it was delivered in the laboratory compared with online. Our review quantifies the strength of the relationships between biases and transfer effects following CBM, which serves as a basis to further understand the mechanisms underlying biased information processing. •We meta-analysed the relationship between cognitive biases (CB) in anxiety.•CB were correlated and could modify each other by training but effects were small.•Correlation between interpretation and memory bias was stronger than the others.•CB training in laboratory was stronger in modifying another CB than online delivery.•The results supported the Combined Cognitive Bias Hypothesis in anxiety.