Trial Outcomes & Findings for Web-based Interpretation Training For Anxiety (NCT NCT02382003)

NCT ID: NCT02382003

Last Updated: 2025-02-20

Results Overview

To measure interpretation bias, participants will read ambiguous scenarios with titles, after which they will see the titles of each scenario, followed by 2 disambiguated interpretations of the scenario: 1 positive and 1 negative. Participants will rate each disambiguated interpretation based on how similar in meaning it is to the original scenario on a 4-point scale ranging from 1 to 4. The mean of the positive, threat-related ratings index positive interpretation bias. Higher scores represent a more positive interpretation bias.

Recruitment status

COMPLETED

Study phase

PHASE2

Target enrollment

807 participants

Primary outcome timeframe

Baseline, and after sessions 3 (~2 weeks following baseline), 6 (~10 days after session 3), and 8 (~7 days after session 6) & at 2-month follow-up. Measure will be completed immediately following that day's training session.

Results posted on

2025-02-20

Participant Flow

Participant milestones

Participant milestones
Measure	Positive Training+Anxious Imagery Prime Positive Cognitive Bias Modification - Interpretation training paired with a preceding Anxious Imagery Prime Positive Cognitive Bias Modification - Interpretation: Training involves presenting participants with brief scenarios that introduce an ambiguous potential threat. Critically, the ambiguity regarding how the situation is resolved remains until the last word of the scenario, which is presented as a word fragment that the participant must solve, which will then assign a benign (rather than threatening) meaning to the scenario. Anxious Imagery Prime: We will test whether priming anxious concerns and feared negative outcomes on the web via the addition of a guided anxious imagery prime at the start of each session will enhance effects.	Positive Training+Neutral Imagery Prime Positive Cognitive Bias Modification - Interpretation training paired with a preceding Neutral Imagery Prime Positive Cognitive Bias Modification - Interpretation: Training involves presenting participants with brief scenarios that introduce an ambiguous potential threat. Critically, the ambiguity regarding how the situation is resolved remains until the last word of the scenario, which is presented as a word fragment that the participant must solve, which will then assign a benign (rather than threatening) meaning to the scenario. Neutral Imagery Prime: At the start of each session, participants will complete a neutral control imagery exercise where they do a guided imagery exercise imagining upcoming mundane tasks, like brushing one's teeth.	50/50 Training+Anxious Imagery Prime 50/50 Cognitive Bias Modification - Interpretation (half positive \& half negative scenarios) paired with a preceding Anxious Imagery Prime 50/50 Cognitive Bias Modification - Interpretation: This condition follows the same design and content as the Positive Training conditions, except the word fragments differ; rather than consistently resolving the scenario in a positive direction, half of the scenarios will end with a negative (anxiety-congruent) word fragment, and half will end with a positive word fragment. Anxious Imagery Prime: We will test whether priming anxious concerns and feared negative outcomes on the web via the addition of a guided anxious imagery prime at the start of each session will enhance effects.	50/50 Training+Neutral Imagery Prime 50/50 Cognitive Bias Modification - Interpretation (half positive \& half negative scenarios) paired with a preceding Neutral Imagery Prime 50/50 Cognitive Bias Modification - Interpretation: This condition follows the same design and content as the Positive Training conditions, except the word fragments differ; rather than consistently resolving the scenario in a positive direction, half of the scenarios will end with a negative (anxiety-congruent) word fragment, and half will end with a positive word fragment. Neutral Imagery Prime: At the start of each session, participants will complete a neutral control imagery exercise where they do a guided imagery exercise imagining upcoming mundane tasks, like brushing one's teeth.	No Scenario+Anxious Imagery Prime No scenarios paired with a preceding Anxious Imagery Prime Anxious Imagery Prime: We will test whether priming anxious concerns and feared negative outcomes on the web via the addition of a guided anxious imagery prime at the start of each session will enhance effects.	No Scenario+Neutral Imagery Prime No scenarios paired with a preceding Neutral Imagery Prime Neutral Imagery Prime: At the start of each session, participants will complete a neutral control imagery exercise where they do a guided imagery exercise imagining upcoming mundane tasks, like brushing one's teeth.
Overall Study COMPLETED	10	25	13	22	13	22
Overall Study NOT COMPLETED	101	116	108	122	123	132
Overall Study STARTED	111	141	121	144	136	154

Reasons for withdrawal

Withdrawal data not reported

Baseline Characteristics

Web-based Interpretation Training For Anxiety

Baseline characteristics by cohort

Baseline characteristics by cohort
Measure	Positive Training+Anxious Imagery Prime n=111 Participants Positive Cognitive Bias Modification - Interpretation training paired with a preceding Anxious Imagery Prime Positive Cognitive Bias Modification - Interpretation: Training involves presenting participants with brief scenarios that introduce an ambiguous potential threat. Critically, the ambiguity regarding how the situation is resolved remains until the last word of the scenario, which is presented as a word fragment that the participant must solve, which will then assign a benign (rather than threatening) meaning to the scenario. Anxious Imagery Prime: We will test whether priming anxious concerns and feared negative outcomes on the web via the addition of a guided anxious imagery prime at the start of each session will enhance effects.	Positive Training+Neutral Imagery Prime n=141 Participants Positive Cognitive Bias Modification - Interpretation training paired with a preceding Neutral Imagery Prime Positive Cognitive Bias Modification - Interpretation: Training involves presenting participants with brief scenarios that introduce an ambiguous potential threat. Critically, the ambiguity regarding how the situation is resolved remains until the last word of the scenario, which is presented as a word fragment that the participant must solve, which will then assign a benign (rather than threatening) meaning to the scenario. Neutral Imagery Prime: At the start of each session, participants will complete a neutral control imagery exercise where they do a guided imagery exercise imagining upcoming mundane tasks, like brushing one's teeth.	50/50 Training+Anxious Imagery Prime n=121 Participants 50/50 Cognitive Bias Modification - Interpretation (half positive \& half negative scenarios) paired with a preceding Anxious Imagery Prime 50/50 Cognitive Bias Modification - Interpretation: This condition follows the same design and content as the Positive Training conditions, except the word fragments differ; rather than consistently resolving the scenario in a positive direction, half of the scenarios will end with a negative (anxiety-congruent) word fragment, and half will end with a positive word fragment. Anxious Imagery Prime: We will test whether priming anxious concerns and feared negative outcomes on the web via the addition of a guided anxious imagery prime at the start of each session will enhance effects.	50/50 Training+Neutral Imagery Prime n=144 Participants 50/50 Cognitive Bias Modification - Interpretation (half positive \& half negative scenarios) paired with a preceding Neutral Imagery Prime 50/50 Cognitive Bias Modification - Interpretation: This condition follows the same design and content as the Positive Training conditions, except the word fragments differ; rather than consistently resolving the scenario in a positive direction, half of the scenarios will end with a negative (anxiety-congruent) word fragment, and half will end with a positive word fragment. Neutral Imagery Prime: At the start of each session, participants will complete a neutral control imagery exercise where they do a guided imagery exercise imagining upcoming mundane tasks, like brushing one's teeth.	No Scenario+Anxious Imagery Prime n=136 Participants No scenarios paired with a preceding Anxious Imagery Prime Anxious Imagery Prime: We will test whether priming anxious concerns and feared negative outcomes on the web via the addition of a guided anxious imagery prime at the start of each session will enhance effects.	No Scenario+Neutral Imagery Prime n=154 Participants No scenarios paired with a preceding Neutral Imagery Prime Neutral Imagery Prime: At the start of each session, participants will complete a neutral control imagery exercise where they do a guided imagery exercise imagining upcoming mundane tasks, like brushing one's teeth.	Total n=807 Participants Total of all reporting groups
Age, Continuous	34.42 years STANDARD_DEVIATION 13.04 • n=5 Participants	32.22 years STANDARD_DEVIATION 12.22 • n=7 Participants	32.06 years STANDARD_DEVIATION 12.39 • n=5 Participants	34.22 years STANDARD_DEVIATION 14.51 • n=4 Participants	33.45 years STANDARD_DEVIATION 13.37 • n=21 Participants	35.16 years STANDARD_DEVIATION 14.39 • n=8 Participants	33.59 years STANDARD_DEVIATION 13.32 • n=8 Participants
Sex/Gender, Customized Gender (Female)	79 Participants n=5 Participants	106 Participants n=7 Participants	87 Participants n=5 Participants	104 Participants n=4 Participants	94 Participants n=21 Participants	113 Participants n=8 Participants	583 Participants n=8 Participants
Sex/Gender, Customized Male	31 Participants n=5 Participants	31 Participants n=7 Participants	29 Participants n=5 Participants	38 Participants n=4 Participants	37 Participants n=21 Participants	37 Participants n=8 Participants	203 Participants n=8 Participants
Sex/Gender, Customized Other	1 Participants n=5 Participants	2 Participants n=7 Participants	1 Participants n=5 Participants	1 Participants n=4 Participants	1 Participants n=21 Participants	2 Participants n=8 Participants	8 Participants n=8 Participants
Sex/Gender, Customized Prefer not to answer	0 Participants n=5 Participants	1 Participants n=7 Participants	2 Participants n=5 Participants	0 Participants n=4 Participants	2 Participants n=21 Participants	1 Participants n=8 Participants	6 Participants n=8 Participants
Sex/Gender, Customized Transgender	0 Participants n=5 Participants	1 Participants n=7 Participants	1 Participants n=5 Participants	1 Participants n=4 Participants	2 Participants n=21 Participants	1 Participants n=8 Participants	6 Participants n=8 Participants
Sex/Gender, Customized Not reported	0 Participants n=5 Participants	0 Participants n=7 Participants	1 Participants n=5 Participants	0 Participants n=4 Participants	0 Participants n=21 Participants	0 Participants n=8 Participants	1 Participants n=8 Participants
Race/Ethnicity, Customized White/European Origin	85 Participants n=5 Participants	116 Participants n=7 Participants	92 Participants n=5 Participants	109 Participants n=4 Participants	103 Participants n=21 Participants	121 Participants n=8 Participants	626 Participants n=8 Participants
Race/Ethnicity, Customized Black/African Origin	5 Participants n=5 Participants	2 Participants n=7 Participants	3 Participants n=5 Participants	5 Participants n=4 Participants	5 Participants n=21 Participants	4 Participants n=8 Participants	24 Participants n=8 Participants
Race/Ethnicity, Customized East/South Asian	8 Participants n=5 Participants	11 Participants n=7 Participants	7 Participants n=5 Participants	15 Participants n=4 Participants	12 Participants n=21 Participants	10 Participants n=8 Participants	63 Participants n=8 Participants
Race/Ethnicity, Customized American Indian/Alaska Native	2 Participants n=5 Participants	0 Participants n=7 Participants	2 Participants n=5 Participants	0 Participants n=4 Participants	2 Participants n=21 Participants	0 Participants n=8 Participants	6 Participants n=8 Participants
Race/Ethnicity, Customized Other or Unknown	8 Participants n=5 Participants	5 Participants n=7 Participants	8 Participants n=5 Participants	10 Participants n=4 Participants	10 Participants n=21 Participants	13 Participants n=8 Participants	54 Participants n=8 Participants
Race/Ethnicity, Customized Prefer not to answer	4 Participants n=5 Participants	9 Participants n=7 Participants	5 Participants n=5 Participants	11 Participants n=4 Participants	6 Participants n=21 Participants	6 Participants n=8 Participants	41 Participants n=8 Participants
Race/Ethnicity, Customized Not reported	0 Participants n=5 Participants	1 Participants n=7 Participants	1 Participants n=5 Participants	0 Participants n=4 Participants	0 Participants n=21 Participants	1 Participants n=8 Participants	3 Participants n=8 Participants
Race/Ethnicity, Customized Native Hawaiian/Pacific Islander	0 Participants n=5 Participants	0 Participants n=7 Participants	1 Participants n=5 Participants	0 Participants n=4 Participants	0 Participants n=21 Participants	1 Participants n=8 Participants	2 Participants n=8 Participants
Race/Ethnicity, Customized Not Hispanic/Latino	89 Participants n=5 Participants	115 Participants n=7 Participants	108 Participants n=5 Participants	108 Participants n=4 Participants	115 Participants n=21 Participants	132 Participants n=8 Participants	667 Participants n=8 Participants
Race/Ethnicity, Customized Hispanic/Latino	11 Participants n=5 Participants	11 Participants n=7 Participants	5 Participants n=5 Participants	17 Participants n=4 Participants	13 Participants n=21 Participants	10 Participants n=8 Participants	67 Participants n=8 Participants
Race/Ethnicity, Customized Unknown	7 Participants n=5 Participants	5 Participants n=7 Participants	2 Participants n=5 Participants	8 Participants n=4 Participants	2 Participants n=21 Participants	5 Participants n=8 Participants	29 Participants n=8 Participants
Marital Status Married	40 Participants n=5 Participants	40 Participants n=7 Participants	28 Participants n=5 Participants	42 Participants n=4 Participants	45 Participants n=21 Participants	52 Participants n=8 Participants	247 Participants n=8 Participants
Marital Status Single	28 Participants n=5 Participants	47 Participants n=7 Participants	47 Participants n=5 Participants	51 Participants n=4 Participants	42 Participants n=21 Participants	50 Participants n=8 Participants	265 Participants n=8 Participants
Marital Status Prefer not to answer	1 Participants n=5 Participants	3 Participants n=7 Participants	3 Participants n=5 Participants	2 Participants n=4 Participants	0 Participants n=21 Participants	4 Participants n=8 Participants	13 Participants n=8 Participants
Marital Status Other options	42 Participants n=5 Participants	51 Participants n=7 Participants	43 Participants n=5 Participants	49 Participants n=4 Participants	49 Participants n=21 Participants	48 Participants n=8 Participants	282 Participants n=8 Participants
Education High school or below	8 Participants n=5 Participants	10 Participants n=7 Participants	15 Participants n=5 Participants	11 Participants n=4 Participants	11 Participants n=21 Participants	12 Participants n=8 Participants	67 Participants n=8 Participants
Education Graduate school	34 Participants n=5 Participants	33 Participants n=7 Participants	32 Participants n=5 Participants	46 Participants n=4 Participants	44 Participants n=21 Participants	47 Participants n=8 Participants	236 Participants n=8 Participants
Education Bachelor's degree	33 Participants n=5 Participants	38 Participants n=7 Participants	27 Participants n=5 Participants	34 Participants n=4 Participants	29 Participants n=21 Participants	39 Participants n=8 Participants	200 Participants n=8 Participants
Education Other	36 Participants n=5 Participants	59 Participants n=7 Participants	46 Participants n=5 Participants	53 Participants n=4 Participants	52 Participants n=21 Participants	56 Participants n=8 Participants	302 Participants n=8 Participants
Education Not reported	0 Participants n=5 Participants	1 Participants n=7 Participants	1 Participants n=5 Participants	0 Participants n=4 Participants	0 Participants n=21 Participants	0 Participants n=8 Participants	2 Participants n=8 Participants
Income < $75,000	49 Participants n=5 Participants	66 Participants n=7 Participants	53 Participants n=5 Participants	54 Participants n=4 Participants	56 Participants n=21 Participants	72 Participants n=8 Participants	350 Participants n=8 Participants
Income > $200,000	5 Participants n=5 Participants	5 Participants n=7 Participants	5 Participants n=5 Participants	7 Participants n=4 Participants	9 Participants n=21 Participants	4 Participants n=8 Participants	35 Participants n=8 Participants
Income Between $75,000 and $200,000	38 Participants n=5 Participants	37 Participants n=7 Participants	36 Participants n=5 Participants	47 Participants n=4 Participants	38 Participants n=21 Participants	47 Participants n=8 Participants	243 Participants n=8 Participants
Income Prefer not to answer	9 Participants n=5 Participants	20 Participants n=7 Participants	15 Participants n=5 Participants	19 Participants n=4 Participants	19 Participants n=21 Participants	15 Participants n=8 Participants	97 Participants n=8 Participants
Income Not reported	0 Participants n=5 Participants	1 Participants n=7 Participants	0 Participants n=5 Participants	0 Participants n=4 Participants	0 Participants n=21 Participants	0 Participants n=8 Participants	1 Participants n=8 Participants
Income Don't know	10 Participants n=5 Participants	12 Participants n=7 Participants	12 Participants n=5 Participants	17 Participants n=4 Participants	14 Participants n=21 Participants	16 Participants n=8 Participants	81 Participants n=8 Participants
Employment Status Working full-time	56 Participants n=5 Participants	52 Participants n=7 Participants	41 Participants n=5 Participants	62 Participants n=4 Participants	54 Participants n=21 Participants	72 Participants n=8 Participants	337 Participants n=8 Participants
Employment Status Student	31 Participants n=5 Participants	46 Participants n=7 Participants	36 Participants n=5 Participants	41 Participants n=4 Participants	37 Participants n=21 Participants	38 Participants n=8 Participants	229 Participants n=8 Participants
Employment Status Working part-time	12 Participants n=5 Participants	15 Participants n=7 Participants	25 Participants n=5 Participants	15 Participants n=4 Participants	11 Participants n=21 Participants	13 Participants n=8 Participants	91 Participants n=8 Participants
Employment Status Unemployed or looking for work	6 Participants n=5 Participants	9 Participants n=7 Participants	7 Participants n=5 Participants	9 Participants n=4 Participants	15 Participants n=21 Participants	11 Participants n=8 Participants	57 Participants n=8 Participants
Employment Status Retired	2 Participants n=5 Participants	4 Participants n=7 Participants	2 Participants n=5 Participants	5 Participants n=4 Participants	4 Participants n=21 Participants	9 Participants n=8 Participants	26 Participants n=8 Participants
Employment Status Other	4 Participants n=5 Participants	14 Participants n=7 Participants	9 Participants n=5 Participants	12 Participants n=4 Participants	13 Participants n=21 Participants	11 Participants n=8 Participants	63 Participants n=8 Participants
Employment Status Not reported	0 Participants n=5 Participants	1 Participants n=7 Participants	1 Participants n=5 Participants	0 Participants n=4 Participants	2 Participants n=21 Participants	0 Participants n=8 Participants	4 Participants n=8 Participants

PRIMARY outcome

Timeframe: Baseline, and after sessions 3 (~2 weeks following baseline), 6 (~10 days after session 3), and 8 (~7 days after session 6) & at 2-month follow-up. Measure will be completed immediately following that day's training session.

Population: Due to attrition, the number of participants differs at each session.

Outcome measures

Outcome measures
Measure	Positive Training+Anxious Imagery Prime n=111 Participants Positive Cognitive Bias Modification - Interpretation training paired with a preceding Anxious Imagery Prime Positive Cognitive Bias Modification - Interpretation: Training involves presenting participants with brief scenarios that introduce an ambiguous potential threat. Critically, the ambiguity regarding how the situation is resolved remains until the last word of the scenario, which is presented as a word fragment that the participant must solve, which will then assign a benign (rather than threatening) meaning to the scenario. Anxious Imagery Prime: We will test whether priming anxious concerns and feared negative outcomes on the web via the addition of a guided anxious imagery prime at the start of each session will enhance effects.	Positive Training+Neutral Imagery Prime n=141 Participants Positive Cognitive Bias Modification - Interpretation training paired with a preceding Neutral Imagery Prime Positive Cognitive Bias Modification - Interpretation: Training involves presenting participants with brief scenarios that introduce an ambiguous potential threat. Critically, the ambiguity regarding how the situation is resolved remains until the last word of the scenario, which is presented as a word fragment that the participant must solve, which will then assign a benign (rather than threatening) meaning to the scenario. Neutral Imagery Prime: At the start of each session, participants will complete a neutral control imagery exercise where they do a guided imagery exercise imagining upcoming mundane tasks, like brushing one's teeth.	50/50 Training+Anxious Imagery Prime n=121 Participants 50/50 Cognitive Bias Modification - Interpretation (half positive \& half negative scenarios) paired with a preceding Anxious Imagery Prime 50/50 Cognitive Bias Modification - Interpretation: This condition follows the same design and content as the Positive Training conditions, except the word fragments differ; rather than consistently resolving the scenario in a positive direction, half of the scenarios will end with a negative (anxiety-congruent) word fragment, and half will end with a positive word fragment. Anxious Imagery Prime: We will test whether priming anxious concerns and feared negative outcomes on the web via the addition of a guided anxious imagery prime at the start of each session will enhance effects.	50/50 Training+Neutral Imagery Prime n=144 Participants 50/50 Cognitive Bias Modification - Interpretation (half positive \& half negative scenarios) paired with a preceding Neutral Imagery Prime 50/50 Cognitive Bias Modification - Interpretation: This condition follows the same design and content as the Positive Training conditions, except the word fragments differ; rather than consistently resolving the scenario in a positive direction, half of the scenarios will end with a negative (anxiety-congruent) word fragment, and half will end with a positive word fragment. Neutral Imagery Prime: At the start of each session, participants will complete a neutral control imagery exercise where they do a guided imagery exercise imagining upcoming mundane tasks, like brushing one's teeth.	No Scenario+Anxious Imagery Prime n=136 Participants No scenarios paired with a preceding Anxious Imagery Prime Anxious Imagery Prime: We will test whether priming anxious concerns and feared negative outcomes on the web via the addition of a guided anxious imagery prime at the start of each session will enhance effects.	No Scenario+Neutral Imagery Prime n=154 Participants No scenarios paired with a preceding Neutral Imagery Prime Neutral Imagery Prime: At the start of each session, participants will complete a neutral control imagery exercise where they do a guided imagery exercise imagining upcoming mundane tasks, like brushing one's teeth.
Change in Recognition Ratings (Positive Interpretation Bias) Baseline	1.23 score on a scale Standard Deviation 0.87	1.19 score on a scale Standard Deviation 0.82	1.22 score on a scale Standard Deviation 0.83	1.16 score on a scale Standard Deviation 0.88	1.17 score on a scale Standard Deviation 0.83	1.22 score on a scale Standard Deviation 0.83
Change in Recognition Ratings (Positive Interpretation Bias) Session 3	1.63 score on a scale Standard Deviation 0.90	1.57 score on a scale Standard Deviation 0.83	1.47 score on a scale Standard Deviation 0.70	1.38 score on a scale Standard Deviation 0.94	1.20 score on a scale Standard Deviation 0.77	1.43 score on a scale Standard Deviation 0.71
Change in Recognition Ratings (Positive Interpretation Bias) Session 6	1.67 score on a scale Standard Deviation 0.78	1.47 score on a scale Standard Deviation 0.79	1.50 score on a scale Standard Deviation 0.85	1.30 score on a scale Standard Deviation 0.98	1.33 score on a scale Standard Deviation 0.82	1.51 score on a scale Standard Deviation 0.71
Change in Recognition Ratings (Positive Interpretation Bias) Session 8	1.58 score on a scale Standard Deviation 0.78	1.38 score on a scale Standard Deviation 0.74	1.72 score on a scale Standard Deviation 0.76	1.43 score on a scale Standard Deviation 0.97	1.42 score on a scale Standard Deviation 0.63	1.38 score on a scale Standard Deviation 0.66
Change in Recognition Ratings (Positive Interpretation Bias) 2-month Follow-up	1.50 score on a scale Standard Deviation 1.16	1.64 score on a scale Standard Deviation 0.51	1.47 score on a scale Standard Deviation 0.81	1.24 score on a scale Standard Deviation 0.73	1.62 score on a scale Standard Deviation 0.68	2.05 score on a scale Standard Deviation 0.79

PRIMARY outcome

Timeframe: Baseline, and after sessions 1,2,3,4,5,6,7,8 (sessions will be spaced ~3-4 days apart) & at 2-month follow-up. Measure will be completed immediately following that day's training session. Session 2 is expected to occur within 3-8 days of the baseline.

Population: Due to attrition, the number of participants differs at each session.

The Overall Anxiety Severity and Impairment Scale (OASIS; Norman, Hami Cissell, Means-Christensen, \& Stein, 2006) assesses anxiety frequency, severity, and associated avoidance, work and social interference. This 5-item measure of anxiety symptom severity and impairment has good psychometric properties, shows treatment sensitivity, and is valid in community and clinical samples. All items are rated on a scale of 0 (lowest impairment/severity) to 4 (highest impairment/severity). Total scores on the OASIS are calculated by summing the scores of each of the 5 questions. The total score on the OASIS ranges from 0 to 20, with higher scores indicating greater anxiety. A cut-score of 8 or higher on the OASIS is considered to indicate probable anxiety disorder.

Outcome measures

Outcome measures
Measure	Positive Training+Anxious Imagery Prime n=111 Participants Positive Cognitive Bias Modification - Interpretation training paired with a preceding Anxious Imagery Prime Positive Cognitive Bias Modification - Interpretation: Training involves presenting participants with brief scenarios that introduce an ambiguous potential threat. Critically, the ambiguity regarding how the situation is resolved remains until the last word of the scenario, which is presented as a word fragment that the participant must solve, which will then assign a benign (rather than threatening) meaning to the scenario. Anxious Imagery Prime: We will test whether priming anxious concerns and feared negative outcomes on the web via the addition of a guided anxious imagery prime at the start of each session will enhance effects.	Positive Training+Neutral Imagery Prime n=141 Participants Positive Cognitive Bias Modification - Interpretation training paired with a preceding Neutral Imagery Prime Positive Cognitive Bias Modification - Interpretation: Training involves presenting participants with brief scenarios that introduce an ambiguous potential threat. Critically, the ambiguity regarding how the situation is resolved remains until the last word of the scenario, which is presented as a word fragment that the participant must solve, which will then assign a benign (rather than threatening) meaning to the scenario. Neutral Imagery Prime: At the start of each session, participants will complete a neutral control imagery exercise where they do a guided imagery exercise imagining upcoming mundane tasks, like brushing one's teeth.	50/50 Training+Anxious Imagery Prime n=121 Participants 50/50 Cognitive Bias Modification - Interpretation (half positive \& half negative scenarios) paired with a preceding Anxious Imagery Prime 50/50 Cognitive Bias Modification - Interpretation: This condition follows the same design and content as the Positive Training conditions, except the word fragments differ; rather than consistently resolving the scenario in a positive direction, half of the scenarios will end with a negative (anxiety-congruent) word fragment, and half will end with a positive word fragment. Anxious Imagery Prime: We will test whether priming anxious concerns and feared negative outcomes on the web via the addition of a guided anxious imagery prime at the start of each session will enhance effects.	50/50 Training+Neutral Imagery Prime n=144 Participants 50/50 Cognitive Bias Modification - Interpretation (half positive \& half negative scenarios) paired with a preceding Neutral Imagery Prime 50/50 Cognitive Bias Modification - Interpretation: This condition follows the same design and content as the Positive Training conditions, except the word fragments differ; rather than consistently resolving the scenario in a positive direction, half of the scenarios will end with a negative (anxiety-congruent) word fragment, and half will end with a positive word fragment. Neutral Imagery Prime: At the start of each session, participants will complete a neutral control imagery exercise where they do a guided imagery exercise imagining upcoming mundane tasks, like brushing one's teeth.	No Scenario+Anxious Imagery Prime n=136 Participants No scenarios paired with a preceding Anxious Imagery Prime Anxious Imagery Prime: We will test whether priming anxious concerns and feared negative outcomes on the web via the addition of a guided anxious imagery prime at the start of each session will enhance effects.	No Scenario+Neutral Imagery Prime n=154 Participants No scenarios paired with a preceding Neutral Imagery Prime Neutral Imagery Prime: At the start of each session, participants will complete a neutral control imagery exercise where they do a guided imagery exercise imagining upcoming mundane tasks, like brushing one's teeth.
Change in Overall Anxiety Severity and Impairment Scale Session 1	10.152778 score on a scale Standard Deviation 0.55	10.458333 score on a scale Standard Deviation 0.60	11.168675 score on a scale Standard Deviation 0.58	10.011111 score on a scale Standard Deviation 0.58	10.836957 score on a scale Standard Deviation 0.55	10.271845 score on a scale Standard Deviation 0.63
Change in Overall Anxiety Severity and Impairment Scale Session 3	7.782609 score on a scale Standard Deviation 0.47	9.292683 score on a scale Standard Deviation 0.60	10.285714 score on a scale Standard Deviation 0.57	8.526316 score on a scale Standard Deviation 0.53	10.171429 score on a scale Standard Deviation 0.58	8.745098 score on a scale Standard Deviation 0.65
Change in Overall Anxiety Severity and Impairment Scale Session 4	8.750000 score on a scale Standard Deviation 0.48	8.514286 score on a scale Standard Deviation 0.57	10.600000 score on a scale Standard Deviation 0.47	7.771429 score on a scale Standard Deviation 0.62	10.142857 score on a scale Standard Deviation 0.49	8.406250 score on a scale Standard Deviation 0.50
Change in Overall Anxiety Severity and Impairment Scale Session 5	9.066667 score on a scale Standard Deviation 0.45	8.535714 score on a scale Standard Deviation 0.59	10.058824 score on a scale Standard Deviation 0.64	7.666667 score on a scale Standard Deviation 0.53	8.071429 score on a scale Standard Deviation 0.57	8.115385 score on a scale Standard Deviation 0.52
Change in Overall Anxiety Severity and Impairment Scale Session 8	9.200000 score on a scale Standard Deviation 0.30	9.521739 score on a scale Standard Deviation 0.57	11.454545 score on a scale Standard Deviation 0.68	8.041667 score on a scale Standard Deviation 0.42	7.400000 score on a scale Standard Deviation 0.47	7.357143 score on a scale Standard Deviation 0.50
Change in Overall Anxiety Severity and Impairment Scale 2-month Follow-up	3.000000 score on a scale Standard Deviation 0.55	7.400000 score on a scale Standard Deviation 0.53	11.333333 score on a scale Standard Deviation 0.45	8.333333 score on a scale Standard Deviation 0.58	8.000000 score on a scale Standard Deviation 0.50	6.000000 score on a scale Standard Deviation 0.63
Change in Overall Anxiety Severity and Impairment Scale Baseline	10.367925 score on a scale Standard Deviation 0.65	11.066667 score on a scale Standard Deviation 0.63	11.470085 score on a scale Standard Deviation 0.62	10.544118 score on a scale Standard Deviation 0.69	11.131783 score on a scale Standard Deviation 0.60	10.486111 score on a scale Standard Deviation 0.67
Change in Overall Anxiety Severity and Impairment Scale Session 2	8.725490 score on a scale Standard Deviation 0.57	9.587302 score on a scale Standard Deviation 0.62	10.433962 score on a scale Standard Deviation 0.68	9.571429 score on a scale Standard Deviation 0.57	10.592593 score on a scale Standard Deviation 0.61	9.760417 score on a scale Standard Deviation 0.63
Change in Overall Anxiety Severity and Impairment Scale Session 6	7.928571 score on a scale Standard Deviation 0.43	8.407407 score on a scale Standard Deviation 0.53	9.200000 score on a scale Standard Deviation 0.58	8.391304 score on a scale Standard Deviation 0.45	8.714286 score on a scale Standard Deviation 0.50	8.500000 score on a scale Standard Deviation 0.58
Change in Overall Anxiety Severity and Impairment Scale Session 7	7.222222 score on a scale Standard Deviation 0.54	8.285714 score on a scale Standard Deviation 0.54	8.818182 score on a scale Standard Deviation 0.49	7.681818 score on a scale Standard Deviation 0.73	8.384615 score on a scale Standard Deviation 0.46	7.631579 score on a scale Standard Deviation 0.52

PRIMARY outcome

Population: Due to attrition, the number of participants differs at each session.

To measure interpretation bias, participants will read ambiguous scenarios with titles, after which they will see the titles of each scenario, followed by 2 disambiguated interpretations of the scenario: 1 positive and 1 negative. Participants will rate each disambiguated interpretation based on how similar in meaning it is to the original scenario on a 4-point scale ranging from 1 to 4. The mean of the negative, threat-related ratings index negative interpretation bias. Higher scores represent a more negative interpretation bias.

Outcome measures

Outcome measures
Measure	Positive Training+Anxious Imagery Prime n=111 Participants Positive Cognitive Bias Modification - Interpretation training paired with a preceding Anxious Imagery Prime Positive Cognitive Bias Modification - Interpretation: Training involves presenting participants with brief scenarios that introduce an ambiguous potential threat. Critically, the ambiguity regarding how the situation is resolved remains until the last word of the scenario, which is presented as a word fragment that the participant must solve, which will then assign a benign (rather than threatening) meaning to the scenario. Anxious Imagery Prime: We will test whether priming anxious concerns and feared negative outcomes on the web via the addition of a guided anxious imagery prime at the start of each session will enhance effects.	Positive Training+Neutral Imagery Prime n=141 Participants Positive Cognitive Bias Modification - Interpretation training paired with a preceding Neutral Imagery Prime Positive Cognitive Bias Modification - Interpretation: Training involves presenting participants with brief scenarios that introduce an ambiguous potential threat. Critically, the ambiguity regarding how the situation is resolved remains until the last word of the scenario, which is presented as a word fragment that the participant must solve, which will then assign a benign (rather than threatening) meaning to the scenario. Neutral Imagery Prime: At the start of each session, participants will complete a neutral control imagery exercise where they do a guided imagery exercise imagining upcoming mundane tasks, like brushing one's teeth.	50/50 Training+Anxious Imagery Prime n=121 Participants 50/50 Cognitive Bias Modification - Interpretation (half positive \& half negative scenarios) paired with a preceding Anxious Imagery Prime 50/50 Cognitive Bias Modification - Interpretation: This condition follows the same design and content as the Positive Training conditions, except the word fragments differ; rather than consistently resolving the scenario in a positive direction, half of the scenarios will end with a negative (anxiety-congruent) word fragment, and half will end with a positive word fragment. Anxious Imagery Prime: We will test whether priming anxious concerns and feared negative outcomes on the web via the addition of a guided anxious imagery prime at the start of each session will enhance effects.	50/50 Training+Neutral Imagery Prime n=144 Participants 50/50 Cognitive Bias Modification - Interpretation (half positive \& half negative scenarios) paired with a preceding Neutral Imagery Prime 50/50 Cognitive Bias Modification - Interpretation: This condition follows the same design and content as the Positive Training conditions, except the word fragments differ; rather than consistently resolving the scenario in a positive direction, half of the scenarios will end with a negative (anxiety-congruent) word fragment, and half will end with a positive word fragment. Neutral Imagery Prime: At the start of each session, participants will complete a neutral control imagery exercise where they do a guided imagery exercise imagining upcoming mundane tasks, like brushing one's teeth.	No Scenario+Anxious Imagery Prime n=136 Participants No scenarios paired with a preceding Anxious Imagery Prime Anxious Imagery Prime: We will test whether priming anxious concerns and feared negative outcomes on the web via the addition of a guided anxious imagery prime at the start of each session will enhance effects.	No Scenario+Neutral Imagery Prime n=154 Participants No scenarios paired with a preceding Neutral Imagery Prime Neutral Imagery Prime: At the start of each session, participants will complete a neutral control imagery exercise where they do a guided imagery exercise imagining upcoming mundane tasks, like brushing one's teeth.
Change in Recognition Ratings (Negative Interpretation Bias) Baseline	1.66 score on a scale Standard Deviation 0.94	1.70 score on a scale Standard Deviation 0.89	1.75 score on a scale Standard Deviation 0.87	1.74 score on a scale Standard Deviation 0.92	1.77 score on a scale Standard Deviation 0.84	1.77 score on a scale Standard Deviation 0.88
Change in Recognition Ratings (Negative Interpretation Bias) Session 3	1.21 score on a scale Standard Deviation 0.83	1.38 score on a scale Standard Deviation 0.79	1.74 score on a scale Standard Deviation 0.85	1.68 score on a scale Standard Deviation 0.92	1.85 score on a scale Standard Deviation 0.86	1.54 score on a scale Standard Deviation 0.84
Change in Recognition Ratings (Negative Interpretation Bias) Session 6	1.04 score on a scale Standard Deviation 0.73	1.18 score on a scale Standard Deviation 0.76	1.88 score on a scale Standard Deviation 0.86	1.67 score on a scale Standard Deviation 0.90	1.78 score on a scale Standard Deviation 0.76	1.52 score on a scale Standard Deviation 0.83
Change in Recognition Ratings (Negative Interpretation Bias) Session 8	1.20 score on a scale Standard Deviation 0.73	1.30 score on a scale Standard Deviation 0.72	1.51 score on a scale Standard Deviation 0.99	1.58 score on a scale Standard Deviation 0.90	1.83 score on a scale Standard Deviation 0.68	1.50 score on a scale Standard Deviation 0.77
Change in Recognition Ratings (Negative Interpretation Bias) 2-month Follow-up	1.17 score on a scale Standard Deviation 0.97	1.25 score on a scale Standard Deviation 0.70	1.67 score on a scale Standard Deviation 0.59	1.78 score on a scale Standard Deviation 0.71	1.73 score on a scale Standard Deviation 0.67	0.78 score on a scale Standard Deviation 0.26

PRIMARY outcome

Population: Due to attrition, the number of participants differs at each session.

The Brief Bodily Sensation Interpretation Questionnaire (BBSIQ; Clark et al., 1997) was administered as a more independent, additional measure of interpretation bias. In the BBSIQ, participants are presented with fourteen ambiguous events related to physical (e.g., feeling lightheaded) or external (e.g., smelling smoke, social situations) concerns, along with three possible explanations for each ambiguous event (one negative, and two neutral or positive explanations). Participants rated the extent to which they believed each explanation for why the ambiguous event occurred on a Likert scale from 0 ("not at all likely") to 4 ("extremely likely"). Typically, the BBSIQ is administered on an eight-point Likert scale, but a 0-4 scale was used to align with other rating scales in the study. Negative interpretation bias score was computed by averaging the likelihood ratings for all negative explanations (following Steinman \& Teachman, 2010, 2015).

Outcome measures

Outcome measures
Measure	Positive Training+Anxious Imagery Prime n=111 Participants Positive Cognitive Bias Modification - Interpretation training paired with a preceding Anxious Imagery Prime Positive Cognitive Bias Modification - Interpretation: Training involves presenting participants with brief scenarios that introduce an ambiguous potential threat. Critically, the ambiguity regarding how the situation is resolved remains until the last word of the scenario, which is presented as a word fragment that the participant must solve, which will then assign a benign (rather than threatening) meaning to the scenario. Anxious Imagery Prime: We will test whether priming anxious concerns and feared negative outcomes on the web via the addition of a guided anxious imagery prime at the start of each session will enhance effects.	Positive Training+Neutral Imagery Prime n=141 Participants Positive Cognitive Bias Modification - Interpretation training paired with a preceding Neutral Imagery Prime Positive Cognitive Bias Modification - Interpretation: Training involves presenting participants with brief scenarios that introduce an ambiguous potential threat. Critically, the ambiguity regarding how the situation is resolved remains until the last word of the scenario, which is presented as a word fragment that the participant must solve, which will then assign a benign (rather than threatening) meaning to the scenario. Neutral Imagery Prime: At the start of each session, participants will complete a neutral control imagery exercise where they do a guided imagery exercise imagining upcoming mundane tasks, like brushing one's teeth.	50/50 Training+Anxious Imagery Prime n=121 Participants 50/50 Cognitive Bias Modification - Interpretation (half positive \& half negative scenarios) paired with a preceding Anxious Imagery Prime 50/50 Cognitive Bias Modification - Interpretation: This condition follows the same design and content as the Positive Training conditions, except the word fragments differ; rather than consistently resolving the scenario in a positive direction, half of the scenarios will end with a negative (anxiety-congruent) word fragment, and half will end with a positive word fragment. Anxious Imagery Prime: We will test whether priming anxious concerns and feared negative outcomes on the web via the addition of a guided anxious imagery prime at the start of each session will enhance effects.	50/50 Training+Neutral Imagery Prime n=144 Participants 50/50 Cognitive Bias Modification - Interpretation (half positive \& half negative scenarios) paired with a preceding Neutral Imagery Prime 50/50 Cognitive Bias Modification - Interpretation: This condition follows the same design and content as the Positive Training conditions, except the word fragments differ; rather than consistently resolving the scenario in a positive direction, half of the scenarios will end with a negative (anxiety-congruent) word fragment, and half will end with a positive word fragment. Neutral Imagery Prime: At the start of each session, participants will complete a neutral control imagery exercise where they do a guided imagery exercise imagining upcoming mundane tasks, like brushing one's teeth.	No Scenario+Anxious Imagery Prime n=136 Participants No scenarios paired with a preceding Anxious Imagery Prime Anxious Imagery Prime: We will test whether priming anxious concerns and feared negative outcomes on the web via the addition of a guided anxious imagery prime at the start of each session will enhance effects.	No Scenario+Neutral Imagery Prime n=154 Participants No scenarios paired with a preceding Neutral Imagery Prime Neutral Imagery Prime: At the start of each session, participants will complete a neutral control imagery exercise where they do a guided imagery exercise imagining upcoming mundane tasks, like brushing one's teeth.
Change in Brief Bodily Sensations Interpretations Questionnaire Baseline	1.81 units on a scale Standard Deviation 1.15	1.83 units on a scale Standard Deviation 1.16	1.93 units on a scale Standard Deviation 1.17	1.91 units on a scale Standard Deviation 1.16	1.90 units on a scale Standard Deviation 1.13	1.85 units on a scale Standard Deviation 1.12
Change in Brief Bodily Sensations Interpretations Questionnaire Session 6	1.66 units on a scale Standard Deviation 1.09	1.85 units on a scale Standard Deviation 1.16	1.94 units on a scale Standard Deviation 1.13	1.94 units on a scale Standard Deviation 1.27	1.92 units on a scale Standard Deviation 1.22	1.90 units on a scale Standard Deviation 1.08
Change in Brief Bodily Sensations Interpretations Questionnaire Session 3	1.82 units on a scale Standard Deviation 1.16	1.82 units on a scale Standard Deviation 1.17	1.80 units on a scale Standard Deviation 1.04	1.94 units on a scale Standard Deviation 1.14	1.86 units on a scale Standard Deviation 1.11	1.77 units on a scale Standard Deviation 1.03
Change in Brief Bodily Sensations Interpretations Questionnaire Session 8	1.58 units on a scale Standard Deviation 1.14	1.78 units on a scale Standard Deviation 1.16	1.90 units on a scale Standard Deviation 1.15	1.85 units on a scale Standard Deviation 1.24	1.87 units on a scale Standard Deviation 1.07	1.82 units on a scale Standard Deviation 1.17
Change in Brief Bodily Sensations Interpretations Questionnaire 2-month Follow-up	1.68 units on a scale Standard Deviation 1.33	1.59 units on a scale Standard Deviation 0.80	2.04 units on a scale Standard Deviation 1.06	1.98 units on a scale Standard Deviation 1.30	2.13 units on a scale Standard Deviation 1.22	1.25 units on a scale Standard Deviation 1.04

SECONDARY outcome

Timeframe: At 2-month follow-up

Population: Due to attrition, the number of participants differs at from the overall number in the participant flow, as user experience was only assessed at follow-up, during which we did not receive responses from a majority of participants.

This questionnaire assesses users' opinions about the intervention. Participants could select from options "Not at all=0, Slightly=1, Somewhat=2, Mostly=3, Very=4, Decline to answer=5" for questions 1-13 as well as 15 and 16 (examples listed below); question 14 asked "This training program was 8 sessions. How many sessions do you think would have been ideal?" with an open ended response box, which we will not include in the means and SDs. We will recode "Decline to answer=5" as NA. Higher scores on this scale indicate more positive experiences with the program in general across questions, from 0-4. 1. How helpful did you find the web program for reducing your anxiety? 2. How much did the web program improve your overall quality of life? 3. How much did the web program help improve your overall mood (e.g., feeling happier)? 4. How likely would you be to recommend this web program to others with similar anxiety difficulties? 5. How easy was the web program to use?

Outcome measures

Outcome measures
Measure	Positive Training+Anxious Imagery Prime n=1 Participants Positive Cognitive Bias Modification - Interpretation training paired with a preceding Anxious Imagery Prime Positive Cognitive Bias Modification - Interpretation: Training involves presenting participants with brief scenarios that introduce an ambiguous potential threat. Critically, the ambiguity regarding how the situation is resolved remains until the last word of the scenario, which is presented as a word fragment that the participant must solve, which will then assign a benign (rather than threatening) meaning to the scenario. Anxious Imagery Prime: We will test whether priming anxious concerns and feared negative outcomes on the web via the addition of a guided anxious imagery prime at the start of each session will enhance effects.	Positive Training+Neutral Imagery Prime n=3 Participants Positive Cognitive Bias Modification - Interpretation training paired with a preceding Neutral Imagery Prime Positive Cognitive Bias Modification - Interpretation: Training involves presenting participants with brief scenarios that introduce an ambiguous potential threat. Critically, the ambiguity regarding how the situation is resolved remains until the last word of the scenario, which is presented as a word fragment that the participant must solve, which will then assign a benign (rather than threatening) meaning to the scenario. Neutral Imagery Prime: At the start of each session, participants will complete a neutral control imagery exercise where they do a guided imagery exercise imagining upcoming mundane tasks, like brushing one's teeth.	50/50 Training+Anxious Imagery Prime n=3 Participants 50/50 Cognitive Bias Modification - Interpretation (half positive \& half negative scenarios) paired with a preceding Anxious Imagery Prime 50/50 Cognitive Bias Modification - Interpretation: This condition follows the same design and content as the Positive Training conditions, except the word fragments differ; rather than consistently resolving the scenario in a positive direction, half of the scenarios will end with a negative (anxiety-congruent) word fragment, and half will end with a positive word fragment. Anxious Imagery Prime: We will test whether priming anxious concerns and feared negative outcomes on the web via the addition of a guided anxious imagery prime at the start of each session will enhance effects.	50/50 Training+Neutral Imagery Prime n=3 Participants 50/50 Cognitive Bias Modification - Interpretation (half positive \& half negative scenarios) paired with a preceding Neutral Imagery Prime 50/50 Cognitive Bias Modification - Interpretation: This condition follows the same design and content as the Positive Training conditions, except the word fragments differ; rather than consistently resolving the scenario in a positive direction, half of the scenarios will end with a negative (anxiety-congruent) word fragment, and half will end with a positive word fragment. Neutral Imagery Prime: At the start of each session, participants will complete a neutral control imagery exercise where they do a guided imagery exercise imagining upcoming mundane tasks, like brushing one's teeth.	No Scenario+Anxious Imagery Prime n=6 Participants No scenarios paired with a preceding Anxious Imagery Prime Anxious Imagery Prime: We will test whether priming anxious concerns and feared negative outcomes on the web via the addition of a guided anxious imagery prime at the start of each session will enhance effects.	No Scenario+Neutral Imagery Prime n=2 Participants No scenarios paired with a preceding Neutral Imagery Prime Neutral Imagery Prime: At the start of each session, participants will complete a neutral control imagery exercise where they do a guided imagery exercise imagining upcoming mundane tasks, like brushing one's teeth.
Multi-Session User Experience Questionnaire	2.54 score on a scale Standard Deviation 1.05	2.31 score on a scale Standard Deviation 1.36	2.66 score on a scale Standard Deviation 1.05	2.74 score on a scale Standard Deviation 1.03	2.81 score on a scale Standard Deviation 1.33	2.21 score on a scale Standard Deviation 1.09

SECONDARY outcome

Timeframe: After sessions 1,2,3,4,5,6,7,8 (sessions will be spaced ~3-4 days apart). Measure will be completed following that day's imagery prime (which immediately precedes the training session).

Population: Due to attrition, the number of participants differs at each session.

Following the anxious or neutral imagery prime, participants reported on the questions provided. Minimum score = 3; maximum score =115. Higher scores indicate more vividness and anxiety following the anxious imagery prime. How vividly did you imagine the situation? 1=Not at all vivid 2=Somewhat vivid 3=Moderately vivid 4=Very vivid 5=Totally vivid How anxious did you feel (at the highest level of anxiety) as you completed the imagery task? (using a 0-100 slider with the following anchors marked) 0=Not at all anxious, 50= Moderately anxious, 100=Totally anxious How likely is it that this situation will turn out well vs. turn out badly? 1=Very likely to turn out well, 2=Somewhat likely to turn out well, 3=Neutral, 4= Somewhat likely to turn out badly, 5= Very likely to turn out badly If this situation did turn out badly, how well or badly would you be able to handle it? 1=Very well, 2=Somewhat well, 3=Neutral, 4=Somewhat badly, 5=Very badly

Outcome measures

Outcome measures
Measure	Positive Training+Anxious Imagery Prime n=111 Participants Positive Cognitive Bias Modification - Interpretation training paired with a preceding Anxious Imagery Prime Positive Cognitive Bias Modification - Interpretation: Training involves presenting participants with brief scenarios that introduce an ambiguous potential threat. Critically, the ambiguity regarding how the situation is resolved remains until the last word of the scenario, which is presented as a word fragment that the participant must solve, which will then assign a benign (rather than threatening) meaning to the scenario. Anxious Imagery Prime: We will test whether priming anxious concerns and feared negative outcomes on the web via the addition of a guided anxious imagery prime at the start of each session will enhance effects.	Positive Training+Neutral Imagery Prime n=141 Participants Positive Cognitive Bias Modification - Interpretation training paired with a preceding Neutral Imagery Prime Positive Cognitive Bias Modification - Interpretation: Training involves presenting participants with brief scenarios that introduce an ambiguous potential threat. Critically, the ambiguity regarding how the situation is resolved remains until the last word of the scenario, which is presented as a word fragment that the participant must solve, which will then assign a benign (rather than threatening) meaning to the scenario. Neutral Imagery Prime: At the start of each session, participants will complete a neutral control imagery exercise where they do a guided imagery exercise imagining upcoming mundane tasks, like brushing one's teeth.	50/50 Training+Anxious Imagery Prime n=121 Participants 50/50 Cognitive Bias Modification - Interpretation (half positive \& half negative scenarios) paired with a preceding Anxious Imagery Prime 50/50 Cognitive Bias Modification - Interpretation: This condition follows the same design and content as the Positive Training conditions, except the word fragments differ; rather than consistently resolving the scenario in a positive direction, half of the scenarios will end with a negative (anxiety-congruent) word fragment, and half will end with a positive word fragment. Anxious Imagery Prime: We will test whether priming anxious concerns and feared negative outcomes on the web via the addition of a guided anxious imagery prime at the start of each session will enhance effects.	50/50 Training+Neutral Imagery Prime n=144 Participants 50/50 Cognitive Bias Modification - Interpretation (half positive \& half negative scenarios) paired with a preceding Neutral Imagery Prime 50/50 Cognitive Bias Modification - Interpretation: This condition follows the same design and content as the Positive Training conditions, except the word fragments differ; rather than consistently resolving the scenario in a positive direction, half of the scenarios will end with a negative (anxiety-congruent) word fragment, and half will end with a positive word fragment. Neutral Imagery Prime: At the start of each session, participants will complete a neutral control imagery exercise where they do a guided imagery exercise imagining upcoming mundane tasks, like brushing one's teeth.	No Scenario+Anxious Imagery Prime n=136 Participants No scenarios paired with a preceding Anxious Imagery Prime Anxious Imagery Prime: We will test whether priming anxious concerns and feared negative outcomes on the web via the addition of a guided anxious imagery prime at the start of each session will enhance effects.	No Scenario+Neutral Imagery Prime n=154 Participants No scenarios paired with a preceding Neutral Imagery Prime Neutral Imagery Prime: At the start of each session, participants will complete a neutral control imagery exercise where they do a guided imagery exercise imagining upcoming mundane tasks, like brushing one's teeth.
Impact of Anxious Imagery Prime (Change Over Time is Exploratory But Should Show Anxious/Neutral Prime Differences; e.g., in Subjective Distress) Session 1	18.73311 score on a scale Standard Deviation 30.59704	7.899425 score on a scale Standard Deviation 11.26371	18.77632 score on a scale Standard Deviation 30.67108	7.927326 score on a scale Standard Deviation 11.675453	18.57796 score on a scale Standard Deviation 30.46432	8.783981 score on a scale Standard Deviation 13.011083
Impact of Anxious Imagery Prime (Change Over Time is Exploratory But Should Show Anxious/Neutral Prime Differences; e.g., in Subjective Distress) Session 2	18.17045 score on a scale Standard Deviation 29.38720	7.154762 score on a scale Standard Deviation 10.01027	18.62903 score on a scale Standard Deviation 30.21894	6.808140 score on a scale Standard Deviation 9.383420	19.16111 score on a scale Standard Deviation 31.42217	6.867925 score on a scale Standard Deviation 9.533016
Impact of Anxious Imagery Prime (Change Over Time is Exploratory But Should Show Anxious/Neutral Prime Differences; e.g., in Subjective Distress) Session 3	17.76786 score on a scale Standard Deviation 28.40848	8.500000 score on a scale Standard Deviation 12.48014	18.68750 score on a scale Standard Deviation 30.42976	8.821429 score on a scale Standard Deviation 13.216355	19.04167 score on a scale Standard Deviation 31.10353	7.986842 score on a scale Standard Deviation 11.633403
Impact of Anxious Imagery Prime (Change Over Time is Exploratory But Should Show Anxious/Neutral Prime Differences; e.g., in Subjective Distress) Session 4	18.55556 score on a scale Standard Deviation 30.30694	7.879630 score on a scale Standard Deviation 11.37995	16.55000 score on a scale Standard Deviation 26.40416	8.375000 score on a scale Standard Deviation 12.900746	16.89062 score on a scale Standard Deviation 27.09552	8.556818 score on a scale Standard Deviation 12.628915
Impact of Anxious Imagery Prime (Change Over Time is Exploratory But Should Show Anxious/Neutral Prime Differences; e.g., in Subjective Distress) Session 5	19.16667 score on a scale Standard Deviation 30.67189	7.784091 score on a scale Standard Deviation 11.31204	17.87500 score on a scale Standard Deviation 28.95789	8.050000 score on a scale Standard Deviation 12.239715	14.39583 score on a scale Standard Deviation 22.71050	7.411765 score on a scale Standard Deviation 10.369064
Impact of Anxious Imagery Prime (Change Over Time is Exploratory But Should Show Anxious/Neutral Prime Differences; e.g., in Subjective Distress) Session 6	21.00000 score on a scale Standard Deviation 34.45232	7.637500 score on a scale Standard Deviation 11.05529	18.76923 score on a scale Standard Deviation 30.67833	8.307692 score on a scale Standard Deviation 12.367694	17.75000 score on a scale Standard Deviation 28.83588	8.050000 score on a scale Standard Deviation 11.665366
Impact of Anxious Imagery Prime (Change Over Time is Exploratory But Should Show Anxious/Neutral Prime Differences; e.g., in Subjective Distress) Session 7	16.75000 score on a scale Standard Deviation 27.00975	8.308824 score on a scale Standard Deviation 12.36007	17.79545 score on a scale Standard Deviation 28.39446	7.250000 score on a scale Standard Deviation 10.811497	17.27500 score on a scale Standard Deviation 27.77881	7.437500 score on a scale Standard Deviation 10.966967
Impact of Anxious Imagery Prime (Change Over Time is Exploratory But Should Show Anxious/Neutral Prime Differences; e.g., in Subjective Distress) Session 8	18.00000 score on a scale Standard Deviation 28.50996	10.017857 score on a scale Standard Deviation 15.63498	18.96875 score on a scale Standard Deviation 31.28617	5.725000 score on a scale Standard Deviation 8.042796	14.61111 score on a scale Standard Deviation 23.71496	7.083333 score on a scale Standard Deviation 10.676861

SECONDARY outcome

Timeframe: Baseline, after session 8 (~4 weeks after baseline) & at 2-month follow-up.

Population: Due to attrition, the number of participants differs at each session.

While we use the OASIS as a primary measure of anxiety symptom severity, we are using the DASS-AS (Lovibond \& Lovibond, 1995) as another 7-item measure of anxiety symptoms. Higher scores indicate more severe anxiety symptoms. Minimum score = 0; maximum score = 21. 0 = Did not apply to me at all 1. = Applied to me to some degree, or some of the time 2. = Applied to me to a considerable degree, or a good part of time 3. = Applied to me very much, or most of the time Qs: 1. I was aware of dryness of my mouth. 2. I experienced breathing difficulty (e.g., excessively rapid breathing, breathlessness in the absence of physical exertion). 3. I experienced trembling (e.g., in the hands). 4. I was worried about situations in which I might panic and make a fool of myself. 5. I felt I was close to panic. 6. I was aware of the action of my heart in the absence of physical exertion (e.g., sense of heart rate increase, heart missing a beat). 7. I felt scared without any good reason.

Outcome measures

Outcome measures
Measure	Positive Training+Anxious Imagery Prime n=111 Participants Positive Cognitive Bias Modification - Interpretation training paired with a preceding Anxious Imagery Prime Positive Cognitive Bias Modification - Interpretation: Training involves presenting participants with brief scenarios that introduce an ambiguous potential threat. Critically, the ambiguity regarding how the situation is resolved remains until the last word of the scenario, which is presented as a word fragment that the participant must solve, which will then assign a benign (rather than threatening) meaning to the scenario. Anxious Imagery Prime: We will test whether priming anxious concerns and feared negative outcomes on the web via the addition of a guided anxious imagery prime at the start of each session will enhance effects.	Positive Training+Neutral Imagery Prime n=141 Participants Positive Cognitive Bias Modification - Interpretation training paired with a preceding Neutral Imagery Prime Positive Cognitive Bias Modification - Interpretation: Training involves presenting participants with brief scenarios that introduce an ambiguous potential threat. Critically, the ambiguity regarding how the situation is resolved remains until the last word of the scenario, which is presented as a word fragment that the participant must solve, which will then assign a benign (rather than threatening) meaning to the scenario. Neutral Imagery Prime: At the start of each session, participants will complete a neutral control imagery exercise where they do a guided imagery exercise imagining upcoming mundane tasks, like brushing one's teeth.	50/50 Training+Anxious Imagery Prime n=121 Participants 50/50 Cognitive Bias Modification - Interpretation (half positive \& half negative scenarios) paired with a preceding Anxious Imagery Prime 50/50 Cognitive Bias Modification - Interpretation: This condition follows the same design and content as the Positive Training conditions, except the word fragments differ; rather than consistently resolving the scenario in a positive direction, half of the scenarios will end with a negative (anxiety-congruent) word fragment, and half will end with a positive word fragment. Anxious Imagery Prime: We will test whether priming anxious concerns and feared negative outcomes on the web via the addition of a guided anxious imagery prime at the start of each session will enhance effects.	50/50 Training+Neutral Imagery Prime n=144 Participants 50/50 Cognitive Bias Modification - Interpretation (half positive \& half negative scenarios) paired with a preceding Neutral Imagery Prime 50/50 Cognitive Bias Modification - Interpretation: This condition follows the same design and content as the Positive Training conditions, except the word fragments differ; rather than consistently resolving the scenario in a positive direction, half of the scenarios will end with a negative (anxiety-congruent) word fragment, and half will end with a positive word fragment. Neutral Imagery Prime: At the start of each session, participants will complete a neutral control imagery exercise where they do a guided imagery exercise imagining upcoming mundane tasks, like brushing one's teeth.	No Scenario+Anxious Imagery Prime n=136 Participants No scenarios paired with a preceding Anxious Imagery Prime Anxious Imagery Prime: We will test whether priming anxious concerns and feared negative outcomes on the web via the addition of a guided anxious imagery prime at the start of each session will enhance effects.	No Scenario+Neutral Imagery Prime n=152 Participants No scenarios paired with a preceding Neutral Imagery Prime Neutral Imagery Prime: At the start of each session, participants will complete a neutral control imagery exercise where they do a guided imagery exercise imagining upcoming mundane tasks, like brushing one's teeth.
Change in Depression, Anxiety, Stress Scales-Short Form: Anxiety Subscale Baseline	22.4 score on a scale Standard Deviation 7.92	22.64 score on a scale Standard Deviation 7.91	24.7 score on a scale Standard Deviation 8.0	22.7 score on a scale Standard Deviation 7.93	23.84 score on a scale Standard Deviation 9.80	22.48 score on a scale Standard Deviation 7.94
Change in Depression, Anxiety, Stress Scales-Short Form: Anxiety Subscale Session 8	14.4 score on a scale Standard Deviation 9.11	14.3 score on a scale Standard Deviation 9.07	19.8 score on a scale Standard Deviation 9.20	11.37 score on a scale Standard Deviation 9.17	16.36 score on a scale Standard Deviation 9.10	14.17 score on a scale Standard Deviation 9.10
Change in Depression, Anxiety, Stress Scales-Short Form: Anxiety Subscale 2-month Follow-up	13 score on a scale Standard Deviation 9.72	15.6 score on a scale Standard Deviation 9.54	19.0 score on a scale Standard Deviation 9.60	10.67 score on a scale Standard Deviation 9.60	9.67 score on a scale Standard Deviation 9.29	14 score on a scale Standard Deviation 9.29

SECONDARY outcome

Population: Number of participants varies by session due to attrition.

The Quality of Life Scale (Flanagan, 1978) is a 16-item questionnaire chosen to evaluate change in quality of life in five domains: recreation, relationships, well-being, personal fulfillment and development, and social activities. Higher scores indicate more positive feelings about quality of life/more satisfaction. Minimum score = 16; maximum score = 80. The question asks "How satisfied are you with..." with each of the following options as separate questions: material, health, relationships, children, spouse, friend, helping, participating, learning, understanding, work, expression, socializing, reading, recreation, independence (just providing a key word for purposes of description, but questions include a full statement such as "Material comforts home, food, conveniences, financial security " for material). Response options range from Completely unsatisfied=1, Somewhat unsatisfied=2, Mixed=3, Somewhat satisfied=4, Completely satisfied=5.