Training interpretation biases among individuals with body dysmorphic disorder symptoms

• The current study is the first to use CBM-I to shift BDD-relevant interpretations.
• Positive training reduced negative and increased positive BDD interpretations.
• Both positive and comparison training reduced socially threatening interpretations.
• Positive training did not reduce emotional vulnerability during two stressor tasks.
• Interpretation residual change predicted vulnerability despite training condition.

The current study provided an initial test of a Cognitive Bias Modification for Interpretations (CBM-I) training paradigm among a sample with elevated BDD symptoms (N = 86). As expected, BDD-relevant interpretations were reduced among participants who completed a positive (vs. comparison) training program. Results also pointed to the intriguing possibility that modifying biased appearance-relevant interpretations is causally related to changes in biased, socially relevant interpretations. Further, providing support for cognitive behavioral models, residual change in interpretations was associated with some aspects of in vivo stressor responding. However, contrary to expectations there were no significant effects of condition on emotional vulnerability to a BDD stressor, potentially because participants in both training conditions experienced reductions in biased socially-threatening interpretations following training (suggesting that the “comparison” condition was not inert). These findings have meaningful theoretical and clinical implications, and fit with transdiagnostic conceptualizations of psychopathology.