# Threat Interpretation Bias as Cognitive Marker and Treatment Target in Pediatric Anxiety

> **NIH NIH R61** · UNIVERSITY OF DENVER (COLORADO SEMINARY) · 2020 · $223,617

## Abstract

PROJECT SUMMARY
 The proposed phased innovation grant will test personalized cognitive bias modification as a novel
intervention to reduce interpretation bias and, subsequently, anxiety in clinically anxious youth.
Anxiety is the most common mental health problem across development, affecting one in four children and
adolescents. In response to data that evidence-based interventions are ineffective for a substantial proportion
(~50%) of youth, experts have called for development of novel treatments that directly target underlying
mechanisms. One such promising mechanism is interpretation bias, the inaccurate attribution of threat when
faced with ambiguity. We have previously demonstrated that interpretation bias is a ubiquitous marker of
anxiety in children and adolescents, and therefore may be an ideal treatment target. Cognitive bias
modification for interpretation bias (CBM-I) is a computerized intervention that attempts to reduce anxiety
symptoms by directly reducing interpretation bias. In CBM-I, participants are provided with real-time corrective
feedback when they select threat-relevant interpretations of ambiguity, with the expectation that they will learn
to automatically make more neutral (rather than threat) interpretations over time. CBM-I has demonstrated
preliminary efficacy in adults for reducing anxiety symptoms. Yet extant data on CBM-I in clinically anxious
youth are sparse, with little examination of interpretation bias as a malleable target and mechanism of
action. To date, several critical questions remain to be answered: 1) is the targeted mechanism (interpretation
bias) modified by CBM-I in youth?; 2) what dose reflects meaningful interpretation bias change?; and 3) does
anxiety reduce because of reductions in interpretation bias? In response to RFA-MH-18-704, we use an
experimental therapeutics approach to test interpretation bias as a putative intervention target with
CBM-I. This proposal includes a two-phased study of personalized CBM-I in youth ages 10 to 17 who meet
diagnostic criteria for anxiety disorder (generalized, social, separation). In the R61 Phase (N=36), a
randomized controlled trial (RCT) examines whether and at what dose CBM-I personalized to youths’ individual
anxiety symptoms reduces interpretation bias compared to a matched computerized interpretation control
condition (ICC). In the R33 phase, an RCT (N=66) validates target engagement and conducts a mechanism
test (i.e., whether anxiety reduction is due to interpretation bias reduction) by comparing personalized CBM-I to
cognitive restructuring, a clinically relevant psychosocial intervention that also targets anxious cognition.
Strategic design decisions based on the extant literature in both adults and youth will maximize the
likelihood of target engagement. If successful, this experimental intervention could represent a significant
step forward in developing personalized treatments that directly modify processes underlying youth
anxiety, with potenti...

## Key facts

- **NIH application ID:** 9873661
- **Project number:** 1R61MH121552-01
- **Recipient organization:** UNIVERSITY OF DENVER (COLORADO SEMINARY)
- **Principal Investigator:** Michelle Sherry Rozenman
- **Activity code:** R61 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $223,617
- **Award type:** 1
- **Project period:** 2020-01-01 → 2021-12-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9873661

## Citation

> US National Institutes of Health, RePORTER application 9873661, Threat Interpretation Bias as Cognitive Marker and Treatment Target in Pediatric Anxiety (1R61MH121552-01). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/9873661. Licensed CC0.

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