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Internet-based cognitive behavioural therapy combined with attentional bias modification training in generalized anxiety disorder: a randomized, controlled multi-session experiment

Published online by Cambridge University Press:  24 October 2022

Zijiang Lin
Department of Psychiatry, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
Jiaying Zhang
School of Mental Health, Wenzhou Medical University, Wenzhou, China
Fenzan Wu
Laboratory of Translational Medicine, Affiliated Cixi Hospital, Wenzhou Medical University, Ningbo, China
Kewei Xu
School of Mental Health, Wenzhou Medical University, Wenzhou, China
Meiliu Peng
School of Mental Health, Wenzhou Medical University, Wenzhou, China
Changlv Wang
Department of Psychiatry, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
Chuang Yang
Department of Psychiatry, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
Xinhua Yang
The Affiliated Kangning Hospital, Wenzhou Medical University, Wenzhou, 325035, China
Xinhua Shen
Department of Psychosomatic Diseases, Huzhou Third People’s Hospital, Zhejiang Province, China
Wei Wang
School of Mental Health, Wenzhou Medical University, Wenzhou, China
Yanlong Liu*
School of Mental Health, Wenzhou Medical University, Wenzhou, China The Affiliated Kangning Hospital, Wenzhou Medical University, Wenzhou, 325035, China
Li Chen*
School of Mental Health, Wenzhou Medical University, Wenzhou, China The Affiliated Kangning Hospital, Wenzhou Medical University, Wenzhou, 325035, China
*Corresponding authors. Emails:;
*Corresponding authors. Emails:;



Although attentional bias modification training (ABM) and cognitive behavioural therapy (CBT) are two effective methods to decrease the symptoms of generalized anxiety disorders (GAD), to date, no randomized controlled trials have yet evaluated the effectiveness of an intervention combining internet-based cognitive behavioural therapy (ICBT) and ABM for adults with GAD.


This study aimed to investigate the effectiveness of an intervention combining ICBT and ABM for adults with GAD.


Sixty-three participants diagnosed with GAD were randomly assigned to the treatment group (ICBT with ABM; 31 participants) or the control group (ICBT with ABM placebo; 32 participants), and received 8 weeks of treatment and three evaluations. The CBT, ABM and ABM-placebo training were conducted via the internet. The evaluations were conducted at baseline, 8 weeks later, and 1 month later, respectively.


Both the treatment and control groups reported significantly reduced anxiety symptoms and attentional bias, with no clear superiority of either intervention. However, the treatment group showed a greater reduction in negative automatic thoughts than the control group after treatment and at 1-month follow-up (η2 = 0.123).


The results suggest that although not differing in therapeutic efficacy, the intervention combining ICBT and ABM is superior to the intervention combining ICBT and ABM-placebo in the reduction of negative automatic thoughts. ABM may be a useful augmentation of ICBT on reducing anxiety symptoms.

© The Author(s), 2022. Published by Cambridge University Press on behalf of the British Association for Behavioural and Cognitive Psychotherapies

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These authors contributed equally to this work.


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