Introduction

Childhood abuse and neglect are robust causal risk factors for a wide range of mental health outcomes, including internalizing disorders (e.g., depression and anxiety), externalizing disorders (e.g., conduct problems and attention deficit/hyperactivity disorder), and psychosis [1]. Individuals with a history of childhood maltreatment are approximately 2.8 times more likely to develop a mental disorder than those without such experiences [2] and tend to show earlier onset, greater symptom severity, and more chronic clinical courses [3]. These patterns underscore the need for preventive interventions that directly target latent vulnerability processes to alter risk trajectories before the emergence or consolidation of psychopathology [4].

Altered threat processing has been proposed as a key latent vulnerability linking childhood maltreatment to psychopathology [5]. Within this framework, threat-related interpretation bias, defined as the tendency to interpret ambiguous social cues as threatening, has been identified as a central cognitive marker of altered threat processing [4,6]. Recent evidence suggests that individuals with a history of childhood abuse, but not neglect, are more likely to interpret ambiguous anger-happiness expressions as angry. Furthermore, childhood abuse is associated with somatization, phobic anxiety, and hostility, specifically through a bias toward interpreting ambiguous facial expressions as anger [7]. These findings suggest that anger-related interpretation bias may represent a critical pathway through which childhood abuse confers the risk for psychopathology [4,6], highlighting interpretation bias as a promising preventive intervention target.

One approach designed to directly modify interpretation bias is cognitive bias modification for interpretation (CBM-I), which trains individuals to adopt benign or positive interpretations of ambiguous information [8]. Interpretation Bias Modification Training (IBMT), a facial expression– based CBM-I paradigm, specifically targets negative interpretations of ambiguous faces [9]. IBMT has been shown to reduce hostile interpretation bias and anger in youth with disruptive mood dysregulation disorder [10] and to decrease interpretation bias and depressive symptoms in young adults with bipolar disorder [11].

However, cognitive training paradigms such as IBMT often show stronger effects on the targeted cognitive process (near transfer) than on broader clinical outcomes (far transfer), raising questions about their clinical utility [12,13]. Meta-analyses have indicated that CBM-I has small effects on anxiety, depression [14], and aggressive behaviors [15]. One explanation for this pattern is that automatically trained cognitive shifts may not be readily generalized to everyday contexts. Accordingly, augmenting CBM-I with interventions that explicitly teach cognitive strategies and support their application in daily life may enhance far transfer [13]. Cognitive restructuring, a prototypical top-down intervention targeting maladaptive interpretations [8], has been proposed as a relevant augmentation strategy for individuals with a history of childhood maltreatment [16].

Furthermore, identifying the potential mechanisms by which IBMT exerts its effects is essential for strengthening its theoretical and clinical relevance. Prior CBM-I research has suggested that participants who show meaningful reductions in cognitive bias tend to exhibit corresponding improvements in depression and anxiety [17]. Negative interpretations of ambiguous facial expressions have been linked to everyday affective experiences [18], and CBM-I has been shown to reduce negative affect, along with depressive and anxiety symptoms [19]. Together, these findings suggest that changes in interpretation bias and affect may represent potential mechanisms underlying the effects of IBMT.

The present study evaluated an IBMT protocol for adults with a history of childhood abuse in a randomized controlled trial (RCT). Specifically, we examined whether IBMT reduced interpretation bias and psychopathology, whether changes in interpretation bias and affect were associated with symptom improvement, and whether cognitive restructuring–based psychoeducation (PE) enhanced the effects of IBMT on psychopathological outcomes.

Based on these considerations, the following hypotheses were proposed.

H1. Participants in the IBMT conditions (IBMT or IBMT+PE) will show greater reductions in interpretation bias and psychopathological symptoms than those in the active placebo control group and compared to baseline.

H2. Changes in interpretation bias and affect will be positively associated with changes in psychopathological symptoms.

H3. The IBMT+PE group will show greater reductions in interpretation bias and psychopathological symptoms than the IBMT group.

Materials and Methods

1. Participants and procedures

Participants were university students aged 19~25 years with a history of childhood abuse, assessed using the Adverse Childhood Experiences International Questionnaire (ACE-IQ) [20]. Individuals currently receiving psychiatric medication or psychotherapy, or those who failed to meet the response-validity criterion at baseline (≤70% accuracy on validity-check trials), were excluded.

An a priori power analysis conducted using G*Power [21] for a two-way mixed ANOVA with three groups and three assessment points (power=.80, effect size f=0.29; [22]) indicated a required sample size of 27. To account for a 30% dropout rate, the target sample size was set at 36. Of the 88 individuals who provided written consent and underwent screening, 45 were excluded for not meeting the inclusion criteria, and eight were excluded for incomplete baseline assessment. The final sample of 35 participants was then randomly assigned in a 1:1:1 ratio to IBMT, IBMT plus psychoeducation (IBMT+PE), or an active placebo control using an online randomizer (https://www.randomizer.org) with permuted blocks of six. Participants were blinded to group assignment.

Data were collected between September 2023 and April 2025 via large urban universities in South Korea and public online notice boards. All participants provided written informed consent prior to the start of the screening. All procedures were conducted online using the Pavlovia and SurveyMonkey platforms. Participants completed a 2-week training consisting of six sessions (15 min each). Each session included an interpretation bias assessment task followed by condition-specific training. Participants in the IBMT+PE condition received psychoeducation after Sessions 1 and 6 (15 and 5 min, respectively). Assessments were conducted at pre-, mid-, post-training, and 2-week follow-up. Interpretation bias and affect were assessed at pre-, mid-, and post-training, whereas psychopathology was assessed at pre-, post-training, and at follow-up. This study was approved by the Institutional Review Board of Pusan National University (PNU IRB/2023_167_HR).

2. IBMT protocol

The IBMT protocol is based on established CBM-I paradigms targeting facial emotion interpretation [9,23,24]. A pilot RCT (N=24) was conducted to evaluate feasibility and acceptability and to optimize key parameters (e.g., number of sessions, trials, and stimulus characteristics).

Facial stimuli were generated using FaceGen Modeller v3.5.3 by morphing happy and angry expressions across 13 levels (20:80 to 80:20 in 5% increments; Fig. 1). A validation study by the authors with a non-clinical undergraduate sample (N=66; aged 19~25 years) was performed to select the stimuli. Based on the validation ratings, a final set of 234 facial stimuli from 18 gender-neutral identities was selected (4 for assessment and 14 for training).

1) Interpretation bias assessment task

At the start of each session, an interpretation bias assessment task was administered to estimate balance point (BP) and determine session-specific feedback contingencies. BP served as the index of interpretation bias and was calculated as the proportion of happy responses across the 52 assessment trials multiplied by 13, yielding scores from 0 to 13. For example, if a participant responded “happy” in 20 of 52 trials, the BP was 5.00 (i.e., [20÷52]×13=5.00). Each trial of assessment task consisted of a fixation cross (1,000 ms), a facial stimulus (300 ms), and a forced-choice response (“angry” or “happy”). Face-morphs were presented in random order. At baseline, eight validity-check trials with unambiguous expressions (100% happy or 100% angry) were included to assess response validity.

2) Training

During IBMT, participants received trial-by-trial feedback (“correct” or “incorrect”) designed to shift interpretations toward happiness. Feedback contingencies were set to reinforce “happy” responses up to two morph levels beyond each participant’s BP, as measured using the assessment task right before training. Thus, the target level for feedback was individualized for each participant and updated at every session based on the most recent BP estimate. Each trial of training included a fixation point (1,000 ms), stimulus presentation (300 ms), a response, and feedback (2,000 ms). Each training session comprised 182 trials.

3) Active placebo training

The active placebo control condition was procedurally identical to the IBMT one, except that feedback contingencies were configured to reinforce participants’ existing BP rather than induce changes. Feedback was recalibrated for each session based on the current assessment.

4) Psychoeducation

Participants in the IBMT+PE condition received two brief psychoeducation sessions based on cognitive restructuring principles. Content was derived from cognitive behavioral therapy self-help manuals for depression and anxiety [25-28]. The first session introduced a cognitive model linking thoughts, emotions, and behaviors and provided strategies for identifying and modifying negative interpretations in daily social interactions. The second session focused on reviewing and consolidating the strategies learned during IBMT and psychoeducation. Both sessions were delivered via prerecorded online videos.

3. Measures

A history of childhood abuse and neglect was assessed using the Korean version of the ACE-IQ [20,29]. Of the 29 ACE-IQ items, 9 items assessing abuse and neglect were used. Items are rated on a 4-point Likert scale (1=“never” to 4=“many times”). Consistent with WHO guidelines [20], endorsement of “many times” on at least one abuse item was coded as indicating a history of childhood abuse.

Interpretation bias, the primary outcome, was assessed using the interpretation bias assessment task. Interpretation bias was indexed by BP, which ranged from 0 to 13, with lower scores indicating a greater tendency to interpret ambiguous faces as angry and higher scores indicating a greater tendency to interpret them as happy. Based on the validation study in a non-clinical undergraduate sample (M=6.91, SD=0.41), BP scores below 6.91 were interpreted as indicating an anger-biased interpretation, and scores above 6.91 as reflecting a happiness-biased interpretation.

Psychopathology symptoms, the secondary outcome, were measured using the Korean version of the Symptom Checklist-90-Revised (SCL-90-R) [30,31]. Items are rated on a 5-point Likert scale (0=“not at all” to 4=“extremely”). The SCL-90-R assesses nine symptom dimensions and yields a Global Severity Index (GSI) reflecting overall psychological distress. T-scores were interpreted according to established guidelines (subclinical: ≥55; clinical: ≥63; [32]). Cronbach’s α of the Korean version ranged from .88 to .93 [32].

Positive and negative affect, examined as candidate mechanisms of change, were assessed using the Korean version of the International Positive and Negative Affect Schedule Short Form (I-PANAS-SF) [33]. Each subscale consists of five items rated on a 5-point Likert scale (1=“not at all” to 5=“extremely”), with higher scores reflecting greater affect intensity. Cronbach’s α of the Korean version was .86 for positive affect and .83 for negative affect [33].

Training acceptability was assessed at follow-up using seven open-ended questions informed by the Theoretical Framework of Acceptability [34].

4. Statistical analyses

Four participants who discontinued the training before session 2 were excluded from the analyses. For interpretation bias, trials with reaction times below 100 ms or above 3,000 ms were excluded as outliers, and BP values were treated as missing when more than 15% of the trials were excluded. Psychopathology scores exceeding ±3.0 SD from the mean were coded as missing. Missing data were handled using multiple imputation in SPSS 27.0. Five imputed datasets were generated by including all variables assessed in the study in the imputation model. The final results were pooled based on Rubin’s rule [35].

Between-condition effects over time were examined using general linear models (GLMs), with group (0=active placebo, 1=IBMT or IBMT+PE) and time as predictors. For interpretation bias, planned contrasts were used to compare pre-training with mid- and post-training assessments. For psychopathological outcomes, contrasts were conducted between pre- and post-training and follow-up assessments, estimating group×time interactions and main effects.

Within-condition changes were examined using paired-sample t-tests for the IBMT conditions (IBMT and IBMT+PE combined) and for the active placebo condition across adjacent time points. To control for multiple comparisons, Bonferroni correction (p＜.005; i.e., 0.05÷10=0.005) was applied to psychopathology outcomes (nine symptom scales and the GSI), while the single interpretation bias measure (BP) was tested at ɑ=.05.

To explore candidate mechanisms of change, Pearson correlations were estimated among change scores for interpretation bias, affect, and psychopathology within the IBMT conditions. BP change scores were reverse-coded so that higher values reflected a greater reduction in interpretation bias.

To test whether psychoeducation enhanced IBMT effects, change scores were compared between the IBMT and IBMT+PE groups using independent-samples t-tests. Bonferroni-corrected significance thresholds (p＜.005) were applied to psychopathology outcomes. GLM models were fitted using the R package mitml, correlation analyses were conducted using mice, and paired-sample t-tests were performed using SPSS 27.0.

Results

1. Baseline characteristics

Participants (N=35) had a mean age of 22.29 years (SD=1.96), and 82.9% were female. Most participants reported a history of emotional abuse (97.1%), and 80.0% reported both abuse and neglect. The mean interpretation bias score (BP) was 5.82 (SD=2.49), indicating a stronger tendency to interpret ambiguous stimuli as anger compared with the non-clinical undergraduate sample (mean BP=6.91). Negative affect (M=13.17, SD=5.02) was higher than positive affect (M=10.03, SD=4.28), and all psychopathology symptom scores were elevated (all mean T-scores ≥55). No significant baseline differences were observed across conditions in any of the 18 comparisons (Table 1).

2. Effects of IBMT

1) Between-condition differences over time

Regarding between-condition effects, no significant group×time interactions were observed for any of the outcome measures (Table 2, 3). However, GLM analyses revealed significant main effects of time on the GSI, somatization, obsessive –compulsive symptoms, interpersonal sensitivity, anxiety, and hostility. These symptoms decreased significantly from pre- to post-training across all conditions, and the reductions were maintained at follow-up. For interpretation bias (BP), depression, phobic anxiety, paranoid ideation, and psychoticism, neither the main effects nor the interaction effects were significant.

2) Within-condition changes across time

Within the IBMT conditions, interpretation bias showed significant reductions across all pairwise comparisons (pre–mid, pre–post, and mid–post), indicating a progressive shift away from anger-biased interpretations beginning at mid-training (Table 4). All psychopathological symptom dimensions, except phobic anxiety, decreased significantly following IBMT, with effects maintained at follow-up. Effect sizes were large for anxiety (Cohen’s d=0.97~0.99), interpersonal sensitivity (d=0.84~0.97), hostility (d=0.80~0.84), depression (d=0.65~0.83), and psychoticism (d=0.63~0.85). Phobic anxiety showed a significant reduction only from pre-training to follow-up.

By contrast, the active placebo control condition showed no significant changes in interpretation bias over time. However, reductions were observed for obsessive–compulsive symptoms, interpersonal sensitivity, and anxiety from pre- to post-assessment, with decreases in obsessive–compulsive symptoms and anxiety maintained at follow-up (Table 4).

3. Mechanisms of change in IBMT

Exploratory correlation analyses revealed significant associations between changes in interpretation bias and psychopathological symptoms (Table 5). Reductions in interpretation bias from pre- to mid-training were associated with decreases in depression (r=.27) and interpersonal sensitivity (r=.19), and with increases in psychoticism scores (r=−.20). Pre- to post-training changes in interpretation bias were associated with decreases in interpersonal sensitivity (r=.36), depression (r=.29), psychoticism (r=.26), and anxiety (r=.16), and with increases in phobic anxiety (r=−.28).

IBMT was associated with significant reductions in negative affect at both the pre–mid and pre– post intervals (pre–mid t=2.21, p=.027; pre–post t=3.13, p=.002), but not with significant changes in positive affect (pre–mid t=−1.90, p=.057; pre– post t=−1.24, p=.216). Reductions in negative affect were positively correlated with decreases across all psychopathological symptom dimensions, with the strongest associations observed for interpersonal sensitivity (r=.51~.65), hostility (r=.48~.61), anxiety (r=.41~.44), and phobic anxiety (r=.44~.46).

4. Incremental effects of psychoeducation on IBMT

A comparison of change scores between the IBMT and IBMT+PE groups revealed no significant differences across any outcome or time interval (all p＞.05). The addition of psychoeducation did not yield incremental effects beyond IBMT alone in terms of interpretation bias or psychopathological symptoms.

Discussion

This study evaluated an IBMT tailored to individuals with a history of childhood abuse and examined its effects on interpretation bias and psychopathology. Overall, the findings provide preliminary support for the IBMT as a mechanism-focused intervention targeting anger-related interpretation bias in this high-risk population.

First, although no significant between-group differences were observed for interpretation bias and psychopathological symptoms, significant within-group reductions in interpretation bias were found in the IBMT conditions (IBMT and IBMT+PE). Participant reactions showed a progressive shift from anger-biased interpretations beginning at mid-training and continuing through post-training. While participants initially exhibited a heightened tendency to interpret ambiguous facial expressions as angry relative to non-clinical college students, this bias shifted toward a more positive interpretative style following training. Psychopathological symptoms also decreased significantly from pre- to post-training, and this pattern was maintained at the 2-week follow-up. Notably, hostility, interpersonal sensitivity, and depressive symptoms decreased from near-clinical levels to borderline or non-clinical ranges, showing a trend toward clinical improvement within the groups. However, given that obsessive–compulsive symptoms, anxiety, and interpersonal sensitivity also decreased in the active placebo condition, the possibility that non-specific treatment effects contributed to the observed symptom reductions should be considered.

Second, changes in interpretation bias and negative affect were associated with decreased symptom severity, supporting their roles as candidate mechanisms of change. Reductions in interpretation bias were most strongly associated with improvements in depression and anxiety, whereas reductions in negative affect were most strongly associated with interpersonal sensitivity, anxiety, and phobic anxiety. These results suggest two possible complementary pathways through which IBMT might be linked to symptom reduction. First, a reduction in negative interpretations of ambiguous cues was associated with decreased depression and anxiety, which is consistent with evidence that maladaptive interpretation bias plays a causal role in emotional disorders [36]. Second, reductions in negative affect may correlate with broader symptom improvement, given that interpreting social cues as threatening is closely linked to affective states such as hostility and fear, which are central to interpersonal sensitivity and phobic anxiety [18,32].

Hostility and interpersonal sensitivity emerged as particularly salient symptom domains, showing both the largest reductions following IBMT and the strongest associations with changes in interpretation bias and negative affect. As these constructs reflect heightened perceptions of interpersonal threats and negative expectations of others’ reactions, the present findings suggest that IBMT may contribute to improvements in interpersonal difficulties commonly observed in individuals with histories of childhood abuse by modifying anger-related interpretation bias [37]. Consistent with this interpretation, previous studies applying a similar IBMT protocol to individuals with bipolar disorder demonstrated improvements in family support following training [11]. Future studies incorporating additional interpersonal constructs, such as aggression [38] and irritability [24], may further clarify the broader interpersonal impact of IBMT.

Third, the addition of psychoeducation did not yield incremental benefits beyond IBMT alone for either interpretation bias or psychopathological symptoms. This finding may indicate that the psychoeducation component used in the present study was not optimally matched to the training or that IBMT alone was associated with moderate to large symptom reductions, which may have limited the ability to detect additional effects. Given previous reports that CBM-based interventions often show modest effects on symptom outcomes [14,15], the medium-to-large within-group effect sizes observed here provide preliminary evidence for the potential utility of IBMT.

This study had some limitations that warrant cautious interpretation. First, IBMT efficacy was supported primarily by within-group changes, and between-group differences relative to the active placebo condition were not consistently significant. Accordingly, conclusions regarding the superiority of IBMT over the active placebo should be drawn with caution. Additionally, the limited sample size may have reduced statistical power to detect smaller effects; therefore, non-significant results should be interpreted cautiously. Second, negative affect items (e.g., nervous, hostile, afraid) overlapped conceptually with the core emotional components of interpersonal sensitivity and phobic anxiety, and all constructs were assessed using self-report measures. Therefore, shared content and method variance may have strengthened the association between negative affect and these symptom domains.

Finally, although the present study supports the potential efficacy of IBMT, some aspects of the protocol may benefit from further refinement. Some participants reported that the training was lengthy or monotonous and that facial stimuli were perceived as unpleasant or threatening, which may reduce engagement and increase dropout risk. Future studies should focus on improving acceptability and engagement through gamified CBM-I formats [39], optimizing session length and trial numbers [15], and incorporating more ecologically valid stimuli that better reflect everyday interpersonal cues.

Despite these limitations, the potential clinical utility of IBMT may be considered from several perspectives. First, in contrast to prior CBM-I protocols [8], IBMT was designed to reduce a generalized tendency toward negative interpretations while preserving accurate recognition of clearly negative stimuli. Specifically, feedback was structured such that “happy” responses were reinforced for stimuli up to two morph levels beyond each participant’s balance point, whereas stimuli exceeding this range continued to be reinforced as “angry.” In this regard, IBMT may function as a more ecologically valid intervention that modifies interpretation bias in a realistic and balanced direction, rather than simply promoting a positive bias [8].

Furthermore, with over 25,000 reported cases of child maltreatment annually [40], only approximately 15% of those affected currently receive formal psychological treatment due to limited resources [41]. Additionally, maltreated children often face significant barriers to accessing professional care until their symptoms reach clinical thresholds [4]. Therefore, online-based, self-administered IBMT may be an effective preventive intervention for individuals with a history of childhood abuse by directly targeting maladaptive interpretation processes.

Notes

Acknowledgements

This article is based on the first author’s doctoral dissertation completed at Pusan National University.

Conflicts of interest

The authors declared no conflict of interest.

Funding

This work was supported by NRF (National Research Foundation of Korea) Grant funded by the Korean Government (NRF-2019-Global Ph.D. Fellowship Program; NRF-2019H1A2A1074286).

Fig. 1.

Morphed facial stimuli used in the IBMT, illustrating a continuum from happy to angry expressions across 13 levels.

References

• 1. Baldwin JR, Wang B, Karwatowska L, Schoeler T, Tsaligopoulou A, Munafò MR, et al. Childhood maltreatment and mental health problems: A systematic review and meta-analysis of quasi-experimental studies. The American Journal of Psychiatry. 2023;180:117-126. Epub 20230111. https://doi.org/10.1176/appi.ajp.20220174ArticlePubMedPMC
• 2. Scott JG, Malacova E, Mathews B, Haslam DM, Pacella R, Higgins DJ, et al. The association between child maltreatment and mental disorders in the Australian Child Maltreatment Study. Medical Journal of Australia. 2023;218:S26-S33. https://doi.org/10.5694/mja2.51870ArticlePubMedPMC
• 3. Teicher MH, Samson JA. Childhood maltreatment and psychopathology: A case for ecophenotypic variants as clinically and neurobiologically distinct subtypes. American Journal of Psychiatry. 2013;170:1114-1133. https://doi.org/10.1176/appi.ajp.2013.12070957ArticlePubMedPMC
• 4. McCrory EJ, Viding E. The theory of latent vulnerability: Reconceptualizing the link between childhood maltreatment and psychiatric disorder. Development and Psychopathology. 2015;27:493-505. https://doi.org/10.1017/S0954579415000115ArticlePubMed
• 5. McCrory EJ, Gerin MI, Viding E. Annual Research Review: Childhood maltreatment, latent vulnerability and the shift to preventative psychiatry - the contribution of functional brain imaging. Journal of Child Psychology and Psychiatry. 2017;58:338-357. https://doi.org/10.1111/jcpp.12713ArticlePubMedPMC
• 6. McLaughlin KA, DeCross SN, Jovanovic T, Tottenham N. Mechanisms linking childhood adversity with psychopathology: Learning as an intervention target. Behaviour Research and Therapy. 2019;118:101-109. https://doi.org/10.1016/j.brat.2019.04.008ArticlePubMedPMC
• 7. Ha H, Shim EJ. Interpretation bias as a mediator linking childhood maltreatment to psychopathology: A network analysis. Psychiatry. Published online February 2, 2026. https://doi.org/10.1080/00332747.2025.2609251ArticlePubMed
• 8. Woud ML, Hofmann SG. Changing biased interpretations in CBT: A brief history and overview. In ML Woud (Eds.), Interpretational processing biases in emotional psychopathology: From experimental investigation to clinical practice. Springer; 2023, p. 229-45.
• 9. Penton-Voak IS, Thomas J, Gage SH, McMurran M, McDonald S, Munafò MR. Increasing recognition of happiness in ambiguous facial expressions reduces anger and aggressive behavior. Psychological Science. 2013;24:688-697. https://doi.org/10.1177/0956797612459657ArticlePubMed
• 10. Stoddard J, Sharif-Askary B, Harkins EA, Frank HR, Brotman MA, Penton-Voak IS, et al. An open pilot study of training hostile interpretation bias to treat disruptive mood dysregulation disorder. Journal of Child and Adolescent Psychopharmacology. 2016;26:49-57. https://doi.org/10.1089/cap.2015.0100ArticlePubMedPMC
• 11. Van Meter A, Stoddard J, Penton-Voak I, Munafò MR. Interpretation bias training for bipolar disorder: A randomized controlled trial. Journal of Affective Disorders. 2021;282:876-884. https://doi.org/10.1016/j.jad.2020.12.162ArticlePubMedPMC
• 12. Cristea IA, Kok RN, Cuijpers P. Efficacy of cognitive bias modification interventions in anxiety and depression: meta-analysis. The British Journal of Psychiatry. 2015;206:7-16. https://doi.org/10.1192/bjp.bp.114.146761ArticlePubMed
• 13. Peckham AD. Why don’t cognitive training programs transfer to real life? Three possible explanations and recommendations for future research. The Behavior Therapist. 2021;44:357-360.PubMedPMC
• 14. Fodor LA, Georgescu R, Cuijpers P; Szamoskozi Ş, David D, Furukawa TA, et al. Efficacy of cognitive bias modification interventions in anxiety and depressive disorders: a systematic review and network meta-analysis. The Lancet Psychiatry. 2020;7:506-514. https://doi.org/10.1016/S2215-0366(20)30130-9ArticlePubMed
• 15. AlMoghrabi N, Verhoef RE, Smeijers D, Huijding J, van Dijk A. The effects of cognitive bias modification on hostile interpretation bias and aggressive behavior: A systematic review and meta-analysis. Cognitive Therapy and Research. 2024;48:628-647. https://doi.org/10.1007/s10608-023-10415-3Article
• 16. Samson JA, Newkirk TR, Teicher MH. Practitioner review: Neurobiological consequences of childhood maltreatment-clinical and therapeutic implications for practitioners. Journal of Child Psychology and Psychiatry. 2024;65:369-380. https://doi.org/10.1111/jcpp.13883ArticlePubMed
• 17. Grafton B, MacLeod C, Rudaizky D, Holmes EA, Salemink E, Fox E, et al. Confusing procedures with process when appraising the impact of cognitive bias modification on emotional vulnerability. British Journal of Psychiatry. 2017;211:266-271. https://doi.org/10.1192/bjp.bp.115.176123ArticlePubMed
• 18. Puccetti NA, Villano WJ, Stamatis CA, Hall KA, Torrez VF, Neta M, et al. Negative interpretation bias connects to real-world daily affect: A multistudy approach. Journal of Experimental Psychology: General. 2023;152:1690-1704. https://doi.org/10.1037/xge0001351ArticlePubMedPMC
• 19. Chan SW, Lau JY, Reynolds SA. Is cognitive bias modification training truly beneficial for adolescents? Journal of Child Psychology and Psychiatry. 2015;56:1239-1148. https://doi.org/10.1111/jcpp.12368ArticlePubMed
• 20. World Health Organization. Guidance for Analyzing ACE-IQ [Internet]. World Health Organization; 2020. Available from: https://cdn.who.int/media/docs/default-source/documents/child-maltreatment/ace-iq-guidance-for-analysing.pdf?sfvrsn=adfe12bb_2
• 21. Faul F, Erdfelder E, Buchner A, Lang A-G. Statistical power analyses using G* Power 3.1: Tests for correlation and regression analyses. Behavior Research Methods. 2009;41:1149-1160. https://doi.org/10.3758/BRM.41.4.1149ArticlePubMedPMC
• 22. Martinelli A, Gruell J, Baum C. Attention and interpretation cognitive bias change: A systematic review and meta-analysis of bias modification paradigms. Behaviour Research and Therapy. 2022;157:104180. https://doi.org/10.1016/j.brat.2022.104180ArticlePubMed
• 23. Gober CD, Lazarov A, Bar-Haim Y. From cognitive targets to symptom reduction: Overview of attention and interpretation bias modification research. Evidence-based Mental Health. 2021;24:42-46. https://doi.org/10.1136/ebmental-2020-300216ArticlePubMedPMC
• 24. Haller SP, Stoddard J, Botz-Zapp C, Clayton M, MacGillivray C, Perhamus G, et al. A randomized controlled trial of computerized interpretation bias training for disruptive mood dysregulation disorder: A fast-fail study. Journal of the American Academy of Child & Adolescent Psychiatry. 2022;61:37-45. https://doi.org/10.1016/j.jaac.2021.05.022ArticlePubMedPMC
• 25. Antony MM, Norton PJ. The anti-anxiety workbook: Proven strategies to overcome worry, phobias, panic, and obsessions. Guilford Publications; 2015.
• 26. Craske MG, Barlow DH. Mastery of your anxiety and worry. Oxford University Press; 2006.
• 27. Larson J, Lochman JE. Helping schoolchildren cope with anger: A cognitive-behavioral intervention. Guilford Press; 2010.
• 28. Tompkins MA. The anxiety and depression workbook: Simple, effective CBT techniques to manage moods and feel better now. New Harbinger Publications; 2021.
• 29. Ryu JH, Lee JY, Jung IJ, Song AY, Lee MJ. Understanding connections among abuse and violence in the life course (Report No. 2017-49) Korea Institute for Health and Social Affairs. 2017.
• 30. Derogatis LR, Rickels K, Rock AF. The SCL-90 and the MMPI: A step in the validation of a new self-report scale. The British Journal of Psychiatry. 1976;128:280-289. https://doi.org/10.1192/bjp.128.3.280ArticlePubMed
• 31. Kim KI, Kim JH, Won HT. Korean manual of Symptom Checklist-90-Revision. Seoul: Chungang Aptitude Publishing; 1984.
• 32. Won HT, Kim JH, Oh KJ, Kim CT, Kim YA, Kim MY. Manual for the Symptom Checklist-90-R. Seoul: HUNO; 2015.
• 33. Park H, Lee JM. A Validation Study of Korean Version of PANAS-Revised. Korean Journal of Psychology: General. 2016;35:617-641. https://doi.org/10.22257/kjp.2016.12.35.4.617Article
• 34. Sekhon M, Cartwright M, Francis JJ. Development of a theory-informed questionnaire to assess the acceptability of healthcare interventions. BMC Health Services Research. 2022;22:279. doi: 10.1186/s12913-022-07577-3ArticlePubMedPMCPDF
• 35. Rubin DB. Multiple imputation for nonresponse in surveys (Vol. 81). John Wiley & Sons; 2004.
• 36. Hirsch CR, Meeten F, Krahé C, Reeder C. Resolving ambiguity in emotional disorders: The nature and role of interpretation biases. Annual Review of Clinical Psychology. 2016;12:281-305. https://doi.org/10.1146/annurev-clinpsy-021815-093436ArticlePubMed
• 37. McCrory E, Foulkes L, Viding E. Social thinning and stress generation after childhood maltreatment: A neurocognitive social transactional model of psychiatric vulnerability. The Lancet Psychiatry. 2022;9:828-837. https://doi.org/10.1016/S2215-0366(22)00202-4ArticlePubMed
• 38. Dickerson KL, Skeem JL, Montoya L, Quas JA. Using positive emotion training with maltreated youths to reduce anger bias and physical aggression. Clinical Psychological Science. 2020;8:773-787. https://doi.org/10.1177/2167702620902118ArticlePubMedPMC
• 39. Salemink E, de Jong SR, Notebaert L, MacLeod C, Van Bockstaele B. Gamification of cognitive bias modification for interpretations in anxiety increases training engagement and enjoyment. Journal of Behavior Therapy and Experimental Psychiatry. 2022;76:101727. https://doi.org/10.1016/j.jbtep.2022.101727ArticlePubMed
• 40. Ministry of Health and Welfare. Child abuse & neglect Korea 2023 [Korean]. 2024 https://www.mohw.go.kr/board.es?mid=a10411010200&bid=0019&act=view&list_no=1487303
• 41. Save the Children. The reason why only 15% of abused children receive psychological treatment. 2021 Jul 30. https://m.sc.or.kr/mobile/news/magazineView.do?NO=71056

Figure & Data

References

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