Cognitive Bias Modification-Interpretation in the Context of Social Anxiety: Effects on Stress-Relevant Cognitive and Psychophysiological Markers

Cognitive Bias Modification for Interpretation (CBM-I) is designed to alter interpretation biases (IBs) and may have potential for reducing stress reactivity in individuals with social anxiety. However, evidence for such transfer effects remains inconsistent and largely restricted to specific cognitive or self-report outcomes. Physiological responses, such as heart rate, heart rate variability, and salivary cortisol, have received disproportionately limited attention in CBM-I research, despite their relevance to the social anxiety symptom spectrum. Moreover, previous studies have rarely employed comprehensive experimental designs that directly compare positive, negative, and control training conditions. To address these gaps, the present study compared the effects of three CBM-I training conditions (positive, negative, neutral) on changes in IBs and on self-reported and physiological responses to a standardized laboratory stressor (anagram task). The sample included N = 87 individuals with moderate levels of social anxiety. Results showed that CBM-I successfully modified IB in a condition-congruent direction. However, stress-related outcomes changed similarly over time across all conditions. Self-reported stress and heart rate increased, whereas heart rate variability decreased. Cortisol levels remained unchanged. These findings suggest that although CBM-I can modify IB, such changes may not readily translate into reduced acute stress reactivity. Factors such as training intensity, alignment between training and stressor, and the sensitivity of stress markers may moderate this transfer. Future research should refine CBM-I protocols and measurement approaches to better elucidate the mechanisms linking cognitive change with stress physiology.