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Cognitive Bias Modification – Interpretation (CBM-I) aims to alter maladaptive interpretations in social anxiety, yet effects are often small and outcome measures are diverse. Although CBM-I has shown promise, its underlying mechanisms remain unclear and integration with psychophysiological and neural measures has been limited. In this double-blind, randomized controlled trial, eighty-eight participants with high levels of social anxiety completed two lab sessions, an online training in between, and online follow-up. Participants filled out questionnaires, completed interpretation bias tasks, and underwent neuro-psychophysiological assessments. Active CBM-I trained positive resolutions of ambiguous social scenarios, while the sham version used neutral scenarios. The primary outcome, i.e., scores on the Liebowitz Social Anxiety Scale (LSAS), decreased across time in both groups, without group differences. The Brief Fear of Negative Evaluation decreased only in the active group. Interpretation bias shifted more strongly toward positive outcomes in the active group. Autonomic measures confirmed sensitivity to stress induction but did not differentiate between conditions. Electrophysiological results paralleled subjective ratings, as participants exhibited ambivalent responses to socially relevant stimuli but clearly differentiated responses toward neutral stimuli. Baseline correlations indicated strong convergence across self-report and interpretation tasks. Mediation analyses showed that reductions in negative interpretations mediated the effect of the training group on LSAS scores at follow-up. These findings identify interpretation bias as a modifiable mechanism underlying social anxiety and underscore its role as a transdiagnostic marker. Targeting interpretation bias through easily accessible and applicable online interventions may strengthen preventive and therapeutic approaches for social anxiety and related disorders.

Cognitive Bias Modification for Interpretation (CBM-I) is designed to alter interpretation biases (IBs) and may have potential for reducing stress reactivity in individuals with social anxiety. However, evidence for such transfer effects remains inconsistent and largely restricted to specific cognitive or self-report outcomes. Physiological responses, such as heart rate, heart rate variability, and salivary cortisol, have received disproportionately limited attention in CBM-I research, despite their relevance to the social anxiety symptom spectrum. Moreover, previous studies have rarely employed comprehensive experimental designs that directly compare positive, negative, and control training conditions. To address these gaps, the present study compared the effects of three CBM-I training conditions (positive, negative, neutral) on changes in IBs and on self-reported and physiological responses to a standardized laboratory stressor (anagram task). The sample included N = 87 individuals with moderate levels of social anxiety. Results showed that CBM-I successfully modified IB in a condition-congruent direction. However, stress-related outcomes changed similarly over time across all conditions. Self-reported stress and heart rate increased, whereas heart rate variability decreased. Cortisol levels remained unchanged. These findings suggest that although CBM-I can modify IB, such changes may not readily translate into reduced acute stress reactivity. Factors such as training intensity, alignment between training and stressor, and the sensitivity of stress markers may moderate this transfer. Future research should refine CBM-I protocols and measurement approaches to better elucidate the mechanisms linking cognitive change with stress physiology.

The Clinician-Administered PTSD Scale (CAPS-5) is a structured diagnostic interview developed for diagnosing post-traumatic stress disorder (PTSD). To ensure compliance with PTSD inclusion criteria, an initial study investigated the psychometric properties and factorial structure of the German version of CAPS-5 using data collected previously. The present study’s objective was to validate the robustness of the psychometric properties of the German CAPS-5 by assessing its validity within a routine clinical context.

Cognitive biases play a critical role in the maintenance of specific phobias, yet reliable assessment tools remain scarce. This study examined the psychometric properties of three novel measures designed to evaluate interpretational processing biases in acrophobia: the Scrambled Sentences Task (SST), the Encoding Recognition Test (ERT), and the German version of the Heights Interpretation Questionnaire (HIQ). Using an online cross-sectional design, the convergent and divergent validity as well as the reliability of these tasks were assessed. The sample included N = 286 participants with mild to severe acrophobia. Overall, all measures demonstrated good convergent validity, and their weak associations with non-acrophobia-related questionnaires support divergent validity. The measures also showed high internal consistency and moderate to high parallel forms of reliability, indicating strong reliability overall. Consistent intercorrelations among the tasks further support their coherence in assessing interpretation bias. Finally, regression analyses revealed that the SST and HIQ were the strongest predictors of acrophobic symptoms, suggesting that each task may tap into distinct facets of interpretation bias despite their overlap. These findings offer empirically grounded insights that can inform future research, especially within intervention contexts. For example, embedding these bias measures in randomized controlled trials could illuminate their role in identifying and precisely tracking cognitive markers during therapy, enabling more targeted interventions in acrophobia treatment.

Intermittent theta burst stimulation (iTBS), a variant of repetitive transcranial magnetic stimulation (rTMS), is an established treatment for adults with major depressive disorder (MDD). Due to its favorable safety profile, iTBS is also a promising early intervention in the transition phase from adolescence to early adulthood, but this has not been systematically investigated to date. Thus, the EARLY-BURST trial investigates the efficacy and safety of iTBS over the left dorsolateral prefrontal cortex (lDLPFC) in treatment-seeking young patients (age 16–26 years) with depressive disorders (i.e. major depressive disorder, persistent depressive disorder, bipolar depression), allowing for relevant co-morbidities. Participants have not received antidepressant or antipsychotic medication during the last 12 months except for short-term (\textless 2 weeks) on-demand medication. The trial will employ a novel sequential Bayesian, randomized, double-blind, parallel-group, sham-controlled design. Up to 90 patients at two clinical sites (Munich, Augsburg) will be randomized 1:1 to the treatment groups, with sequential analyses starting after 26 patients in each group completed the treatment. The primary outcome will be the difference in depression severity at week 6 (post-treatment visit) between active iTBS and sham iTBS, assessed with the Montgomery-Åsberg Depression Rating Scale (MADRS). The trial is planned to be expanded towards a three-arm leapfrog design, contingent on securing additional funding. Thus, in addition to potentially providing evidence of iTBS’s efficacy in adolescents and young adults with depressive disorders, the EARLY-BURST trial aims at setting the stage for subsequent platform trials in this dynamic research field, where novel adaptive study designs are required to meet the need for rapidly testing promising new vs established rTMS protocols.