Cognitive bias modification in alcohol use disorder and problematic drinking: A revised and updated IPD Bayesian meta-analysis

Ting Pan; Xiaochang Zhao; František Bartoš; Helle Larsen; Victoria Manning; Marilisa Boffo; Reinout W. Wiers

doi:10.1016/j.cpr.2026.102709

Cognitive bias modification in alcohol use disorder and problematic drinking: A revised and updated IPD Bayesian meta-analysis

Ting Pan^*
, Xiaochang Zhao
, František Bartoš
, Helle Larsen
, Victoria Manning
, Marilisa Boffo
, Reinout W. Wiers

^*Corresponding author for this work

BRAVE

University of Amsterdam
Addiction Development and Psychopathology (ADAPT) Laboratory
University of Twente
Center for Urban Mental Health
Monash University

Research output: Contribution to journal › Review article › Academic › peer-review

2 Citations (Scopus)

46 Downloads (Pure)

Abstract

Background:

Recent advances in Cognitive Bias Modification (CBM) for problematic drinking, including Alcohol Use Disorder, alongside methodological refinements, warrant an update of the Individual Participant Data (IPD) Bayesian meta-analysis. This study integrates new datasets, focuses on alcohol CBM, and applies a two-stage IPD framework to examine CBM's effects on cognitive bias, alcohol consumption, and relapse.

Methods:

A two-stage IPD Bayesian meta-analysis was performed, supplemented by frequentist sensitivity analyses. The first stage estimated study-specific CBM effects, the second stage pooled these to examine within-study moderators (adherence, addiction severity) and between-study moderators (CBM type, control condition, additional therapy, training congruency, and context).

Results:

23 studies with 8297 participants were included. CBM showed a small unadjusted effect on bias (d = −0.18, 95% CrI [−0.32, 0.00], BF₁₀ = 10.88) and relapse (log OR = −0.26, 95% CrI [−0.38, −0.14], BF₁₀ = 155.07; number needed to treat = 18.7), but not on alcohol consumption (d = 0.003, 95% CrI [0.00, 0.06], BF₁₀ = 0.08). Effects were attenuated after adjusting for moderators. Moderator analyses revealed that face-to-face CBM context (unadjusted and within-study adjusted) and additional psychological therapy (within-study adjusted) were associated with greater bias reduction, and higher training intensity (unadjusted) was related to better relapse prevention. Frequentist sensitivity analyses largely supported these findings.

Conclusions:

CBM reduced alcohol-related biases and relapse risk. Although overall evidence was no longer supported after adjusting for moderators, moderator analyses suggest CBM can be effective under specific conditions (e.g., face-to-face delivery, alongside therapy, higher training intensity). These findings underscore the need for refined, context-sensitive CBM protocols in alcohol interventions.

Original language	English
Article number	102709
Journal	Clinical Psychology Review
Volume	124
DOIs	https://doi.org/10.1016/j.cpr.2026.102709
Publication status	Published - Mar 2026

Bibliographical note

Publisher Copyright:
© 2026 The Authors

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This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

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Cognitive bias modification in alcohol use disorder and problematic drinkingFinal published version, 4.65 MBLicence: CC BY

Cite this

@article{1d3719e4993c48d088b44c05048f250f,

title = "Cognitive bias modification in alcohol use disorder and problematic drinking: A revised and updated IPD Bayesian meta-analysis",

abstract = "Background: Recent advances in Cognitive Bias Modification (CBM) for problematic drinking, including Alcohol Use Disorder, alongside methodological refinements, warrant an update of the Individual Participant Data (IPD) Bayesian meta-analysis. This study integrates new datasets, focuses on alcohol CBM, and applies a two-stage IPD framework to examine CBM's effects on cognitive bias, alcohol consumption, and relapse. Methods: A two-stage IPD Bayesian meta-analysis was performed, supplemented by frequentist sensitivity analyses. The first stage estimated study-specific CBM effects, the second stage pooled these to examine within-study moderators (adherence, addiction severity) and between-study moderators (CBM type, control condition, additional therapy, training congruency, and context). Results: 23 studies with 8297 participants were included. CBM showed a small unadjusted effect on bias (d = −0.18, 95\% CrI [−0.32, 0.00], BF₁₀ = 10.88) and relapse (log OR = −0.26, 95\% CrI [−0.38, −0.14], BF₁₀ = 155.07; number needed to treat = 18.7), but not on alcohol consumption (d = 0.003, 95\% CrI [0.00, 0.06], BF₁₀ = 0.08). Effects were attenuated after adjusting for moderators. Moderator analyses revealed that face-to-face CBM context (unadjusted and within-study adjusted) and additional psychological therapy (within-study adjusted) were associated with greater bias reduction, and higher training intensity (unadjusted) was related to better relapse prevention. Frequentist sensitivity analyses largely supported these findings. Conclusions: CBM reduced alcohol-related biases and relapse risk. Although overall evidence was no longer supported after adjusting for moderators, moderator analyses suggest CBM can be effective under specific conditions (e.g., face-to-face delivery, alongside therapy, higher training intensity). These findings underscore the need for refined, context-sensitive CBM protocols in alcohol interventions.",

author = "Ting Pan and Xiaochang Zhao and Franti{\v s}ek Barto{\v s} and Helle Larsen and Victoria Manning and Marilisa Boffo and Wiers, \{Reinout W.\}",

note = "Publisher Copyright: {\textcopyright} 2026 The Authors",

year = "2026",

month = mar,

doi = "10.1016/j.cpr.2026.102709",

language = "English",

volume = "124",

journal = "Clinical Psychology Review",

issn = "0272-7358",

publisher = "Elsevier Inc.",

}

TY - JOUR

T1 - Cognitive bias modification in alcohol use disorder and problematic drinking

T2 - A revised and updated IPD Bayesian meta-analysis

AU - Pan, Ting

AU - Zhao, Xiaochang

AU - Bartoš, František

AU - Larsen, Helle

AU - Manning, Victoria

AU - Boffo, Marilisa

AU - Wiers, Reinout W.

PY - 2026/3

Y1 - 2026/3

N2 - Background: Recent advances in Cognitive Bias Modification (CBM) for problematic drinking, including Alcohol Use Disorder, alongside methodological refinements, warrant an update of the Individual Participant Data (IPD) Bayesian meta-analysis. This study integrates new datasets, focuses on alcohol CBM, and applies a two-stage IPD framework to examine CBM's effects on cognitive bias, alcohol consumption, and relapse. Methods: A two-stage IPD Bayesian meta-analysis was performed, supplemented by frequentist sensitivity analyses. The first stage estimated study-specific CBM effects, the second stage pooled these to examine within-study moderators (adherence, addiction severity) and between-study moderators (CBM type, control condition, additional therapy, training congruency, and context). Results: 23 studies with 8297 participants were included. CBM showed a small unadjusted effect on bias (d = −0.18, 95% CrI [−0.32, 0.00], BF₁₀ = 10.88) and relapse (log OR = −0.26, 95% CrI [−0.38, −0.14], BF₁₀ = 155.07; number needed to treat = 18.7), but not on alcohol consumption (d = 0.003, 95% CrI [0.00, 0.06], BF₁₀ = 0.08). Effects were attenuated after adjusting for moderators. Moderator analyses revealed that face-to-face CBM context (unadjusted and within-study adjusted) and additional psychological therapy (within-study adjusted) were associated with greater bias reduction, and higher training intensity (unadjusted) was related to better relapse prevention. Frequentist sensitivity analyses largely supported these findings. Conclusions: CBM reduced alcohol-related biases and relapse risk. Although overall evidence was no longer supported after adjusting for moderators, moderator analyses suggest CBM can be effective under specific conditions (e.g., face-to-face delivery, alongside therapy, higher training intensity). These findings underscore the need for refined, context-sensitive CBM protocols in alcohol interventions.

AB - Background: Recent advances in Cognitive Bias Modification (CBM) for problematic drinking, including Alcohol Use Disorder, alongside methodological refinements, warrant an update of the Individual Participant Data (IPD) Bayesian meta-analysis. This study integrates new datasets, focuses on alcohol CBM, and applies a two-stage IPD framework to examine CBM's effects on cognitive bias, alcohol consumption, and relapse. Methods: A two-stage IPD Bayesian meta-analysis was performed, supplemented by frequentist sensitivity analyses. The first stage estimated study-specific CBM effects, the second stage pooled these to examine within-study moderators (adherence, addiction severity) and between-study moderators (CBM type, control condition, additional therapy, training congruency, and context). Results: 23 studies with 8297 participants were included. CBM showed a small unadjusted effect on bias (d = −0.18, 95% CrI [−0.32, 0.00], BF₁₀ = 10.88) and relapse (log OR = −0.26, 95% CrI [−0.38, −0.14], BF₁₀ = 155.07; number needed to treat = 18.7), but not on alcohol consumption (d = 0.003, 95% CrI [0.00, 0.06], BF₁₀ = 0.08). Effects were attenuated after adjusting for moderators. Moderator analyses revealed that face-to-face CBM context (unadjusted and within-study adjusted) and additional psychological therapy (within-study adjusted) were associated with greater bias reduction, and higher training intensity (unadjusted) was related to better relapse prevention. Frequentist sensitivity analyses largely supported these findings. Conclusions: CBM reduced alcohol-related biases and relapse risk. Although overall evidence was no longer supported after adjusting for moderators, moderator analyses suggest CBM can be effective under specific conditions (e.g., face-to-face delivery, alongside therapy, higher training intensity). These findings underscore the need for refined, context-sensitive CBM protocols in alcohol interventions.

UR - https://www.scopus.com/pages/publications/105029239145

U2 - 10.1016/j.cpr.2026.102709

DO - 10.1016/j.cpr.2026.102709

M3 - Review article

C2 - 41653812

AN - SCOPUS:105029239145

SN - 0272-7358

VL - 124

JO - Clinical Psychology Review

JF - Clinical Psychology Review

M1 - 102709

ER -

Cognitive bias modification in alcohol use disorder and problematic drinking: A revised and updated IPD Bayesian meta-analysis

Abstract

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