A tablet-based attentional cognitive bias modification intervention for positive emotion processing in major depressive disorder: a single-blind randomised controlled two-centre trial
- Journal
- EBioMedicine (Q1)
- Published
- 1 September 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Zoe Katharina Kratochwil, Jessica Kesik, Duygu Keskin-Gökcelli, Katrin Sakreida, Norbert Scherbaum, Bernhard Wolfram Müller, et al.
- PMID
- 42679601
- DOI
- 10.1016/j.ebiom.2026.106453
Why clinicians should know about it
- Picked for Radiology, Radiation Oncology, Nuclear Medicine, Medical Physics and Imaging (top studies of the week, 6 September 2026): Randomised trial of cognitive bias modification, EEG outcomes
- Picked for Psychiatry and Mental Health (paper of the day, 3 September 2026): CBM positivity training RCT for major depressive disorder
Abstract
BACKGROUND: Patients with Major Depressive Disorder (MDD) exhibit biased information processing. This study investigates the clinical and neural efficacy of a cognitive bias modification (CBM) training in patients and healthy control (HCS), fostering processing of positive emotion stimuli. METHODS: In a single-blind randomised controlled trial (DRKS00029756), MDD outpatients and HCS, aged 18-60 years, were randomised to positivity training (PT) or control training (CT). Randomisation was carried out by study assistants, blinding researchers. Participants underwent 10 tablet-based dot-probe sessions over 14 days. PT implicitly redirected attention toward positive stimuli to improve depressive symptoms. Primary outcome was pre and post-training EEG-derived Early Posterior Negativity (EPN), investigating neural sensitivity towards positive stimuli. Secondary clinical outcomes included changes in depression symptoms. FINDINGS: From February 2023 to October 2024, 240 participants were included (119 MDD; 121 HCS). 62 MDD and 61 HCS underwent PT; 57 MDD and 60 HCS received CT. In MDD, EPN to positive high arousal stimuli revealed an interaction between time (pre/post) and training (PT/CT), F(1,97) = 5.017, p < 0.028, η2 = 0.049. The between-treatment difference was 1.65 μV, 95% CI [0.19, 3.11]. EPN amplitudes shifted towards negativity in PT and positivity in CT. Depression symptom decreased from pre to post and from pre to follow-up. With respect to adverse events, one patient in the control training was regularly admitted to hospital. INTERPRETATION: CBM positivity training was associated with neural changes in MDD, supporting its potential to target pre-attentive positive emotion processing. Further EEG follow-up and higher stimulus contrasts in the training conditions may clarify clinical relevance. FUNDING: Funded by DFG (ID: 507720021).
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.