Trial Outcomes & Findings for Interpretation Training to Reduce Anxiety: Evaluating Technology-based Delivery Models and Methods to Reduce Attrition (NCT NCT03498651)

NCT ID: NCT03498651

Last Updated: 2025-02-19

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 4 interpretations of the scenario: 1 positive and threat related, 1 negative and threat related, 1 positive and threat unrelated, and 1 negative and threat unrelated. Participants will rate each 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: 1748 participants
• Primary outcome timeframe: Baseline, and after session 3 (2-3 weeks following baseline), session 5 (~2 weeks after session 3), & at 2-month follow-up (~ 2 months after session 5). Measure will be completed immediately following that day's training session.
• Results posted on: 2025-02-19

Participant Flow

Participant milestones

Measure	Received CBM-I and Not Classified as High/Low Risk for Attrition This group started treatment (and had been Stage 1 randomized to CBM-I) but did not complete Session 1 of CBM-I training plus assessments, so was not classified as high/low risk for attrition and thus not randomized for Stage 2 of SMART design	Received CBM-I and Classified Low Attrition Computer- or phone-based Cognitive Bias Modification - Interpretation training Cognitive Bias Modification - Interpretation training: 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 typically then assign a benign (rather than threatening) meaning to the scenario.	Received CBM-I and Classified High Attrition and no Coach Given Computer- or phone-based Cognitive Bias Modification - Interpretation training Cognitive Bias Modification - Interpretation training: 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 typically then assign a benign (rather than threatening) meaning to the scenario.	Received CBM-I and Classified High Attrition and Given a Coach Computer- or phone-based Cognitive Bias Modification - Interpretation training + Coaching Cognitive Bias Modification - Interpretation training: 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 typically then assign a benign (rather than threatening) meaning to the scenario. Coaching: Participants identified as high risk for attrition will receive low-intensity coaching, which includes a mix of brief phone calls, texts, and/or emails with a trained member of the study team to help address challenges with adherence to and application of the training.	Psychoeducation Online psychoeducation about anxiety Online psychoeducation about anxiety: Participants will review webpages that describe information about symptoms and causes of anxiety, including the nature of biased thinking in anxiety.	Psychoeducation, Lacking Classification Measures This group started treatment (and had been Stage 1 randomized to psychoeducation) but did not complete Session 1 of psychoeducation plus assessments, so is not part of the classification measure completer sample	Not Randomized to Treatment Completed consent but didn't complete baseline assessments or reach point of Stage 1 randomization to a treatment arm
Overall Study STARTED	149	288	265	282	242	13	509
Overall Study COMPLETED	0	140	134	131	154	0	0
Overall Study NOT COMPLETED	149	148	131	151	88	13	509

Reasons for withdrawal

Withdrawal data not reported

Baseline Characteristics

Interpretation Training to Reduce Anxiety: Evaluating Technology-based Delivery Models and Methods to Reduce Attrition

Baseline characteristics by cohort

Measure	Received CBM-I and Not Classified as High/Low Risk for Attrition n=148 Participants This group started treatment (and had been randomized to CBM-I) but did not complete Session 1 of CBM-I training plus assessments, so was not classified as high/low risk for attrition and thus not randomized for Stage 2 of SMART design	Received CBM-I and Classified Low Attrition n=288 Participants Computer- or phone-based Cognitive Bias Modification - Interpretation training Cognitive Bias Modification - Interpretation training: 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 typically then assign a benign (rather than threatening) meaning to the scenario.	Received CBM-I and Classified High Attrition and no Coach Given n=263 Participants Computer- or phone-based Cognitive Bias Modification - Interpretation training Cognitive Bias Modification - Interpretation training: 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 typically then assign a benign (rather than threatening) meaning to the scenario.	Received CBM-I and Classified High Attrition and Given a Coach n=281 Participants Computer- or phone-based Cognitive Bias Modification - Interpretation training + Coaching Cognitive Bias Modification - Interpretation training: 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 typically then assign a benign (rather than threatening) meaning to the scenario. Coaching: Participants identified as high risk for attrition will receive low-intensity coaching, which includes a mix of brief phone calls, texts, and/or emails with a trained member of the study team to help address challenges with adherence to and application of the training.	Psychoeducation n=241 Participants Online psychoeducation about anxiety Online psychoeducation about anxiety: Participants will review webpages that describe information about symptoms and causes of anxiety, including the nature of biased thinking in anxiety.	Psychoeducation, Lacking Classification Measures n=13 Participants This group started treatment (and had been Stage 1 randomized to psychoeducation) but did not complete Session 1 of psychoeducation plus assessments, so is not part of the classification measure completer sample	Not Randomized to Treatment Completed consent but didn't complete baseline assessments or reach point of Stage 1 randomization to a treatment arm	Removed From Analyses n=5 Participants 5 participants were removed from analyses as there were concerns with the integrity of their data	Total n=1239 Participants Total of all reporting groups
Age, Continuous	34.16 years STANDARD_DEVIATION 12.09 • n=5 Participants	37.2 years STANDARD_DEVIATION 12.33 • n=7 Participants	34.24 years STANDARD_DEVIATION 11.13 • n=5 Participants	34.37 years STANDARD_DEVIATION 11.9 • n=4 Participants	35.09 years STANDARD_DEVIATION 12.3 • n=21 Participants	31.54 years STANDARD_DEVIATION 10.44 • n=8 Participants	—	28.50 years STANDARD_DEVIATION 3.32 • n=24 Participants	35.09 years STANDARD_DEVIATION 11.97 • n=42 Participants
Sex/Gender, Customized Female	112 Participants n=5 Participants	237 Participants n=7 Participants	217 Participants n=5 Participants	231 Participants n=4 Participants	194 Participants n=21 Participants	11 Participants n=8 Participants	—	1 Participants n=24 Participants	1003 Participants n=42 Participants
Sex/Gender, Customized Male	33 Participants n=5 Participants	45 Participants n=7 Participants	38 Participants n=5 Participants	43 Participants n=4 Participants	41 Participants n=21 Participants	2 Participants n=8 Participants	—	3 Participants n=24 Participants	205 Participants n=42 Participants
Sex/Gender, Customized Transgender	0 Participants n=5 Participants	0 Participants n=7 Participants	2 Participants n=5 Participants	2 Participants n=4 Participants	1 Participants n=21 Participants	0 Participants n=8 Participants	—	0 Participants n=24 Participants	5 Participants n=42 Participants
Sex/Gender, Customized Transgender Female	0 Participants n=5 Participants	0 Participants n=7 Participants	0 Participants n=5 Participants	0 Participants n=4 Participants	0 Participants n=21 Participants	0 Participants n=8 Participants	—	0 Participants n=24 Participants	0 Participants n=42 Participants
Sex/Gender, Customized Transgender Male	0 Participants n=5 Participants	1 Participants n=7 Participants	2 Participants n=5 Participants	0 Participants n=4 Participants	1 Participants n=21 Participants	0 Participants n=8 Participants	—	0 Participants n=24 Participants	4 Participants n=42 Participants
Sex/Gender, Customized Other	2 Participants n=5 Participants	4 Participants n=7 Participants	4 Participants n=5 Participants	4 Participants n=4 Participants	2 Participants n=21 Participants	0 Participants n=8 Participants	—	0 Participants n=24 Participants	16 Participants n=42 Participants
Sex/Gender, Customized Prefer not to answer	1 Participants n=5 Participants	1 Participants n=7 Participants	0 Participants n=5 Participants	1 Participants n=4 Participants	2 Participants n=21 Participants	0 Participants n=8 Participants	—	1 Participants n=24 Participants	6 Participants n=42 Participants
Race/Ethnicity, Customized Ethnicity · Hispanic or Latino	22 Participants n=5 Participants	40 Participants n=7 Participants	31 Participants n=5 Participants	38 Participants n=4 Participants	30 Participants n=21 Participants	3 Participants n=8 Participants	—	0 Participants n=24 Participants	164 Participants n=42 Participants
Race/Ethnicity, Customized Ethnicity · Not Hispanic or Latino	118 Participants n=5 Participants	230 Participants n=7 Participants	224 Participants n=5 Participants	236 Participants n=4 Participants	201 Participants n=21 Participants	10 Participants n=8 Participants	—	2 Participants n=24 Participants	1021 Participants n=42 Participants
Race/Ethnicity, Customized Ethnicity · Unknown	3 Participants n=5 Participants	7 Participants n=7 Participants	4 Participants n=5 Participants	5 Participants n=4 Participants	2 Participants n=21 Participants	0 Participants n=8 Participants	—	1 Participants n=24 Participants	22 Participants n=42 Participants
Race/Ethnicity, Customized Ethnicity · Prefer not to answer	5 Participants n=5 Participants	11 Participants n=7 Participants	4 Participants n=5 Participants	2 Participants n=4 Participants	8 Participants n=21 Participants	0 Participants n=8 Participants	—	2 Participants n=24 Participants	32 Participants n=42 Participants
Race/Ethnicity, Customized Race · American Indian/Alaska Native	1 Participants n=5 Participants	3 Participants n=7 Participants	3 Participants n=5 Participants	1 Participants n=4 Participants	1 Participants n=21 Participants	0 Participants n=8 Participants	—	0 Participants n=24 Participants	9 Participants n=42 Participants
Race/Ethnicity, Customized Race · Black/African origin	12 Participants n=5 Participants	31 Participants n=7 Participants	27 Participants n=5 Participants	19 Participants n=4 Participants	31 Participants n=21 Participants	2 Participants n=8 Participants	—	0 Participants n=24 Participants	122 Participants n=42 Participants
Race/Ethnicity, Customized Race · East Asian	4 Participants n=5 Participants	5 Participants n=7 Participants	7 Participants n=5 Participants	11 Participants n=4 Participants	9 Participants n=21 Participants	0 Participants n=8 Participants	—	1 Participants n=24 Participants	37 Participants n=42 Participants
Race/Ethnicity, Customized Race · Native Hawaiian/Pacific Islander	1 Participants n=5 Participants	2 Participants n=7 Participants	1 Participants n=5 Participants	0 Participants n=4 Participants	0 Participants n=21 Participants	0 Participants n=8 Participants	—	0 Participants n=24 Participants	4 Participants n=42 Participants
Race/Ethnicity, Customized Race · South Asian	3 Participants n=5 Participants	4 Participants n=7 Participants	6 Participants n=5 Participants	5 Participants n=4 Participants	7 Participants n=21 Participants	2 Participants n=8 Participants	—	2 Participants n=24 Participants	29 Participants n=42 Participants
Race/Ethnicity, Customized Race · White/European origin	95 Participants n=5 Participants	211 Participants n=7 Participants	185 Participants n=5 Participants	212 Participants n=4 Participants	179 Participants n=21 Participants	8 Participants n=8 Participants	—	1 Participants n=24 Participants	891 Participants n=42 Participants
Race/Ethnicity, Customized Race · More than one race	18 Participants n=5 Participants	18 Participants n=7 Participants	22 Participants n=5 Participants	24 Participants n=4 Participants	5 Participants n=21 Participants	0 Participants n=8 Participants	—	0 Participants n=24 Participants	87 Participants n=42 Participants
Race/Ethnicity, Customized Race · Other or Unknown	12 Participants n=5 Participants	10 Participants n=7 Participants	10 Participants n=5 Participants	6 Participants n=4 Participants	4 Participants n=21 Participants	1 Participants n=8 Participants	—	0 Participants n=24 Participants	43 Participants n=42 Participants
Race/Ethnicity, Customized Race · Prefer not to answer	2 Participants n=5 Participants	4 Participants n=7 Participants	2 Participants n=5 Participants	3 Participants n=4 Participants	5 Participants n=21 Participants	0 Participants n=8 Participants	—	1 Participants n=24 Participants	17 Participants n=42 Participants
Country United States	133 Participants n=5 Participants	256 Participants n=7 Participants	251 Participants n=5 Participants	259 Participants n=4 Participants	214 Participants n=21 Participants	12 Participants n=8 Participants	—	2 Participants n=24 Participants	1127 Participants n=42 Participants
Country Australia	4 Participants n=5 Participants	17 Participants n=7 Participants	8 Participants n=5 Participants	10 Participants n=4 Participants	12 Participants n=21 Participants	1 Participants n=8 Participants	—	0 Participants n=24 Participants	52 Participants n=42 Participants
Country United Kingdom	3 Participants n=5 Participants	4 Participants n=7 Participants	1 Participants n=5 Participants	0 Participants n=4 Participants	4 Participants n=21 Participants	0 Participants n=8 Participants	—	1 Participants n=24 Participants	13 Participants n=42 Participants
Country Canada	3 Participants n=5 Participants	4 Participants n=7 Participants	1 Participants n=5 Participants	1 Participants n=4 Participants	3 Participants n=21 Participants	0 Participants n=8 Participants	—	0 Participants n=24 Participants	12 Participants n=42 Participants
Country Other	4 Participants n=5 Participants	7 Participants n=7 Participants	2 Participants n=5 Participants	11 Participants n=4 Participants	7 Participants n=21 Participants	0 Participants n=8 Participants	—	1 Participants n=24 Participants	32 Participants n=42 Participants
Country Prefer not to answer	1 Participants n=5 Participants	0 Participants n=7 Participants	0 Participants n=5 Participants	0 Participants n=4 Participants	1 Participants n=21 Participants	0 Participants n=8 Participants	—	1 Participants n=24 Participants	3 Participants n=42 Participants

PRIMARY outcome

Timeframe: Baseline, and after session 3 (2-3 weeks following baseline), session 5 (~2 weeks after session 3), & at 2-month follow-up (~ 2 months after session 5). Measure will be completed immediately following that day's training session.

Population: A few participants were excluded from analyses during data cleaning due to concerns about integrity of their data, hence the # of analyzed participants is slightly below the enrollment #.

To measure interpretation bias, participants will read ambiguous scenarios with titles, after which they will see the titles of each scenario, followed by 4 interpretations of the scenario: 1 positive and threat related, 1 negative and threat related, 1 positive and threat unrelated, and 1 negative and threat unrelated. Participants will rate each 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.

Outcome measures

Measure	Psychoeducation, Lacking Classification Measures n=13 Participants This group started treatment (and had been Stage 1 randomized to psychoeducation) but did not complete Session 1 of psychoeducation plus assessments, so is not part of the classification measure completer sample	Received CBM-I and Not Classified as High/Low Risk for Attrition n=148 Participants This group started treatment (and had been randomized to CBM-I) but did not complete Session 1 of CBM-I training plus assessments, so was not classified as high/low risk for attrition and thus not randomized for Stage 2 of SMART design	Received CBM-I and Classified Low Attrition n=288 Participants Computer- or phone-based Cognitive Bias Modification - Interpretation training Cognitive Bias Modification - Interpretation training: 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 typically then assign a benign (rather than threatening) meaning to the scenario.	Received CBM-I and Classified High Attrition and no Coach Given n=263 Participants Computer- or phone-based Cognitive Bias Modification - Interpretation training Cognitive Bias Modification - Interpretation training: 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 typically then assign a benign (rather than threatening) meaning to the scenario.	Received CBM-I and Classified High Attrition and Given a Coach n=281 Participants Computer- or phone-based Cognitive Bias Modification - Interpretation training + Coaching Cognitive Bias Modification - Interpretation training: 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 typically then assign a benign (rather than threatening) meaning to the scenario. Coaching: Participants identified as high risk for attrition will receive low-intensity coaching, which includes a mix of brief phone calls, texts, and/or emails with a trained member of the study team to help address challenges with adherence to and application of the training.	Psychoeducation n=241 Participants Online psychoeducation about anxiety Online psychoeducation about anxiety: Participants will review webpages that describe information about symptoms and causes of anxiety, including the nature of biased thinking in anxiety.
Change in Recognition Ratings (Positive Interpretation Bias) Baseline assessment	2.40 units on a scale Standard Deviation 0.60	2.40 units on a scale Standard Deviation 0.47	2.29 units on a scale Standard Deviation 0.53	2.29 units on a scale Standard Deviation 0.54	2.30 units on a scale Standard Deviation 0.53	2.33 units on a scale Standard Deviation 0.54
Change in Recognition Ratings (Positive Interpretation Bias) Session 3 assessment	—	—	2.89 units on a scale Standard Deviation 0.44	2.84 units on a scale Standard Deviation 0.48	2.92 units on a scale Standard Deviation 0.49	2.39 units on a scale Standard Deviation 0.57
Change in Recognition Ratings (Positive Interpretation Bias) Session 5 assessment	—	—	2.83 units on a scale Standard Deviation 0.52	2.92 units on a scale Standard Deviation 0.44	2.86 units on a scale Standard Deviation 0.50	2.42 units on a scale Standard Deviation 0.55
Change in Recognition Ratings (Positive Interpretation Bias) Follow-up assessment	—	—	2.71 units on a scale Standard Deviation 0.47	2.80 units on a scale Standard Deviation 0.46	2.75 units on a scale Standard Deviation 0.54	2.48 units on a scale Standard Deviation 0.53

PRIMARY outcome

Timeframe: Baseline, and after session 3 (2-3 weeks following baseline), session 5 (~2 weeks after session 3), & at 2-month follow-up (~ 2 months after session 5). Measure will be completed immediately following that day's training session.

Population: A few participants were excluded from analyses during data cleaning due to concerns about integrity of their data, hence the # of analyzed participants is slightly below the enrollment #.

To measure interpretation bias, participants will read ambiguous scenarios with titles, after which they will see the titles of each scenario, followed by 4 interpretations of the scenario: 1 positive and threat related, 1 negative and threat related, 1 positive and threat unrelated, and 1 negative and threat unrelated. Participants will rate each 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

Measure	Psychoeducation, Lacking Classification Measures n=13 Participants This group started treatment (and had been Stage 1 randomized to psychoeducation) but did not complete Session 1 of psychoeducation plus assessments, so is not part of the classification measure completer sample	Received CBM-I and Not Classified as High/Low Risk for Attrition n=148 Participants This group started treatment (and had been randomized to CBM-I) but did not complete Session 1 of CBM-I training plus assessments, so was not classified as high/low risk for attrition and thus not randomized for Stage 2 of SMART design	Received CBM-I and Classified Low Attrition n=288 Participants Computer- or phone-based Cognitive Bias Modification - Interpretation training Cognitive Bias Modification - Interpretation training: 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 typically then assign a benign (rather than threatening) meaning to the scenario.	Received CBM-I and Classified High Attrition and no Coach Given n=263 Participants Computer- or phone-based Cognitive Bias Modification - Interpretation training Cognitive Bias Modification - Interpretation training: 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 typically then assign a benign (rather than threatening) meaning to the scenario.	Received CBM-I and Classified High Attrition and Given a Coach n=281 Participants Computer- or phone-based Cognitive Bias Modification - Interpretation training + Coaching Cognitive Bias Modification - Interpretation training: 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 typically then assign a benign (rather than threatening) meaning to the scenario. Coaching: Participants identified as high risk for attrition will receive low-intensity coaching, which includes a mix of brief phone calls, texts, and/or emails with a trained member of the study team to help address challenges with adherence to and application of the training.	Psychoeducation n=241 Participants Online psychoeducation about anxiety Online psychoeducation about anxiety: Participants will review webpages that describe information about symptoms and causes of anxiety, including the nature of biased thinking in anxiety.
Change in Recognition Ratings (Negative Interpretation Bias) Baseline assessment	2.70 units on a scale Standard Deviation 0.60	2.78 units on a scale Standard Deviation 0.53	2.90 units on a scale Standard Deviation 0.54	2.96 units on a scale Standard Deviation 0.51	2.94 units on a scale Standard Deviation 0.55	2.89 units on a scale Standard Deviation 0.50
Change in Recognition Ratings (Negative Interpretation Bias) Session 3 assessment	—	—	2.56 units on a scale Standard Deviation 0.56	2.49 units on a scale Standard Deviation 0.55	2.46 units on a scale Standard Deviation 0.58	2.87 units on a scale Standard Deviation 0.55
Change in Recognition Ratings (Negative Interpretation Bias) Session 5 assessment	—	—	2.58 units on a scale Standard Deviation 0.55	2.53 units on a scale Standard Deviation 0.56	2.56 units on a scale Standard Deviation 0.52	2.74 units on a scale Standard Deviation 0.59
Change in Recognition Ratings (Negative Interpretation Bias) Follow-up assessment	—	—	2.55 units on a scale Standard Deviation 0.55	2.48 units on a scale Standard Deviation 0.56	2.43 units on a scale Standard Deviation 0.58	2.68 units on a scale Standard Deviation 0.58

PRIMARY outcome

Timeframe: Baseline, and after session 3 (2-3 weeks following baseline), session 5 (~2 weeks after session 3), & at 2-month follow-up (~ 2 months after session 5). Measure will be completed immediately following that day's training session.

Population: A few participants were excluded from analyses during data cleaning due to concerns about integrity of their data, hence the # of analyzed participants is slightly below the enrollment #.

To assess interpretation change, participants are presented with ambiguous events and then asked to rate three alternative explanations for why the event might have occurred on a 5-point scale ranging from 0 to 4. One option is always negative and threat related, whereas the other options are mixed in valence but threat unrelated. We computed the mean of the threat-unrelated ratings as an index of benign interpretation bias. Higher scores represent a more benign interpretation bias.

Outcome measures

Measure	Psychoeducation, Lacking Classification Measures n=13 Participants This group started treatment (and had been Stage 1 randomized to psychoeducation) but did not complete Session 1 of psychoeducation plus assessments, so is not part of the classification measure completer sample	Received CBM-I and Not Classified as High/Low Risk for Attrition n=148 Participants This group started treatment (and had been randomized to CBM-I) but did not complete Session 1 of CBM-I training plus assessments, so was not classified as high/low risk for attrition and thus not randomized for Stage 2 of SMART design	Received CBM-I and Classified Low Attrition n=288 Participants Computer- or phone-based Cognitive Bias Modification - Interpretation training Cognitive Bias Modification - Interpretation training: 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 typically then assign a benign (rather than threatening) meaning to the scenario.	Received CBM-I and Classified High Attrition and no Coach Given n=263 Participants Computer- or phone-based Cognitive Bias Modification - Interpretation training Cognitive Bias Modification - Interpretation training: 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 typically then assign a benign (rather than threatening) meaning to the scenario.	Received CBM-I and Classified High Attrition and Given a Coach n=281 Participants Computer- or phone-based Cognitive Bias Modification - Interpretation training + Coaching Cognitive Bias Modification - Interpretation training: 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 typically then assign a benign (rather than threatening) meaning to the scenario. Coaching: Participants identified as high risk for attrition will receive low-intensity coaching, which includes a mix of brief phone calls, texts, and/or emails with a trained member of the study team to help address challenges with adherence to and application of the training.	Psychoeducation n=241 Participants Online psychoeducation about anxiety Online psychoeducation about anxiety: Participants will review webpages that describe information about symptoms and causes of anxiety, including the nature of biased thinking in anxiety.
Change in Brief Bodily Sensations Interpretations Questionnaire (Benign Interpretation Bias) Baseline assessment	2.23 units on a scale Standard Deviation 0.38	2.04 units on a scale Standard Deviation 0.55	2.00 units on a scale Standard Deviation 0.53	2.13 units on a scale Standard Deviation 0.49	2.05 units on a scale Standard Deviation 0.52	2.07 units on a scale Standard Deviation 0.55
Change in Brief Bodily Sensations Interpretations Questionnaire (Benign Interpretation Bias) Session 3 assessment	—	—	2.25 units on a scale Standard Deviation 0.55	2.38 units on a scale Standard Deviation 0.53	2.36 units on a scale Standard Deviation 0.52	2.20 units on a scale Standard Deviation 0.51
Change in Brief Bodily Sensations Interpretations Questionnaire (Benign Interpretation Bias) Session 5 assessment	—	—	2.34 units on a scale Standard Deviation 0.62	2.51 units on a scale Standard Deviation 0.52	2.45 units on a scale Standard Deviation 0.53	2.19 units on a scale Standard Deviation 0.58
Change in Brief Bodily Sensations Interpretations Questionnaire (Benign Interpretation Bias) Follow-up assessment	—	—	2.31 units on a scale Standard Deviation 0.56	2.35 units on a scale Standard Deviation 0.58	2.36 units on a scale Standard Deviation 0.55	2.23 units on a scale Standard Deviation 0.61

PRIMARY outcome

Timeframe: Baseline, and after session 3 (2-3 weeks following baseline), session 5 (~2 weeks after session 3), & at 2-month follow-up (~ 2 months after session 5). Measure will be completed immediately following that day's training session.

Population: A few participants were excluded from analyses during data cleaning due to concerns about integrity of their data, hence the # of analyzed participants is slightly below the enrollment #.

To assess interpretation change, participants are presented with ambiguous events and then asked to rate three alternative explanations for why the event might have occurred on a 5-point scale ranging from 0 to 4. One option is always negative and threat related, whereas the other options are mixed in valence but threat unrelated. We computed the mean of the negative, threat-related ratings as an index of negative interpretation bias. Higher scores represent a more negative interpretation bias.

Outcome measures

Measure	Psychoeducation, Lacking Classification Measures n=13 Participants This group started treatment (and had been Stage 1 randomized to psychoeducation) but did not complete Session 1 of psychoeducation plus assessments, so is not part of the classification measure completer sample	Received CBM-I and Not Classified as High/Low Risk for Attrition n=148 Participants This group started treatment (and had been randomized to CBM-I) but did not complete Session 1 of CBM-I training plus assessments, so was not classified as high/low risk for attrition and thus not randomized for Stage 2 of SMART design	Received CBM-I and Classified Low Attrition n=288 Participants Computer- or phone-based Cognitive Bias Modification - Interpretation training Cognitive Bias Modification - Interpretation training: 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 typically then assign a benign (rather than threatening) meaning to the scenario.	Received CBM-I and Classified High Attrition and no Coach Given n=263 Participants Computer- or phone-based Cognitive Bias Modification - Interpretation training Cognitive Bias Modification - Interpretation training: 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 typically then assign a benign (rather than threatening) meaning to the scenario.	Received CBM-I and Classified High Attrition and Given a Coach n=281 Participants Computer- or phone-based Cognitive Bias Modification - Interpretation training + Coaching Cognitive Bias Modification - Interpretation training: 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 typically then assign a benign (rather than threatening) meaning to the scenario. Coaching: Participants identified as high risk for attrition will receive low-intensity coaching, which includes a mix of brief phone calls, texts, and/or emails with a trained member of the study team to help address challenges with adherence to and application of the training.	Psychoeducation n=241 Participants Online psychoeducation about anxiety Online psychoeducation about anxiety: Participants will review webpages that describe information about symptoms and causes of anxiety, including the nature of biased thinking in anxiety.
Change in Brief Bodily Sensations Interpretations Questionnaire (Negative Interpretation Bias) Baseline assessment	1.35 units on a scale Standard Deviation 0.94	1.42 units on a scale Standard Deviation 0.83	1.61 units on a scale Standard Deviation 0.86	1.52 units on a scale Standard Deviation 0.81	1.58 units on a scale Standard Deviation 0.82	1.61 units on a scale Standard Deviation 0.81
Change in Brief Bodily Sensations Interpretations Questionnaire (Negative Interpretation Bias) Session 3 assessment	—	—	0.93 units on a scale Standard Deviation 0.80	0.85 units on a scale Standard Deviation 0.66	0.85 units on a scale Standard Deviation 0.71	1.36 units on a scale Standard Deviation 0.81
Change in Brief Bodily Sensations Interpretations Questionnaire (Negative Interpretation Bias) Session 5 assessment	—	—	0.81 units on a scale Standard Deviation 0.68	0.77 units on a scale Standard Deviation 0.68	0.83 units on a scale Standard Deviation 0.70	1.24 units on a scale Standard Deviation 0.78
Change in Brief Bodily Sensations Interpretations Questionnaire (Negative Interpretation Bias) Follow-up assessment	—	—	0.78 units on a scale Standard Deviation 0.62	0.79 units on a scale Standard Deviation 0.62	0.69 units on a scale Standard Deviation 0.57	1.16 units on a scale Standard Deviation 0.77

PRIMARY outcome

Timeframe: Baseline, and after sessions 1,2, 3, 4, 5 (sessions will be spaced ~1 week apart) & at 2-month follow-up (~2 months after session 5). Session 1 occurs ~0-7 days after baseline. Measure will be completed immediately following that day's training session.

Population: A few participants were excluded from analyses during data cleaning due to concerns about integrity of their data, hence the # of analyzed participants is slightly below the enrollment #.

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. Item range = 0 to 4 (5-point scale). Total scale range = 0-20, with a higher score indicating more severe anxiety. Average item scores are reported below.

Outcome measures

Measure	Psychoeducation, Lacking Classification Measures n=13 Participants This group started treatment (and had been Stage 1 randomized to psychoeducation) but did not complete Session 1 of psychoeducation plus assessments, so is not part of the classification measure completer sample	Received CBM-I and Not Classified as High/Low Risk for Attrition n=148 Participants This group started treatment (and had been randomized to CBM-I) but did not complete Session 1 of CBM-I training plus assessments, so was not classified as high/low risk for attrition and thus not randomized for Stage 2 of SMART design	Received CBM-I and Classified Low Attrition n=288 Participants Computer- or phone-based Cognitive Bias Modification - Interpretation training Cognitive Bias Modification - Interpretation training: 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 typically then assign a benign (rather than threatening) meaning to the scenario.	Received CBM-I and Classified High Attrition and no Coach Given n=263 Participants Computer- or phone-based Cognitive Bias Modification - Interpretation training Cognitive Bias Modification - Interpretation training: 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 typically then assign a benign (rather than threatening) meaning to the scenario.	Received CBM-I and Classified High Attrition and Given a Coach n=281 Participants Computer- or phone-based Cognitive Bias Modification - Interpretation training + Coaching Cognitive Bias Modification - Interpretation training: 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 typically then assign a benign (rather than threatening) meaning to the scenario. Coaching: Participants identified as high risk for attrition will receive low-intensity coaching, which includes a mix of brief phone calls, texts, and/or emails with a trained member of the study team to help address challenges with adherence to and application of the training.	Psychoeducation n=241 Participants Online psychoeducation about anxiety Online psychoeducation about anxiety: Participants will review webpages that describe information about symptoms and causes of anxiety, including the nature of biased thinking in anxiety.
Change in Overall Anxiety Severity and Impairment Scale Baseline assessment	2.62 units on a scale Standard Deviation 0.79	2.28 units on a scale Standard Deviation 0.75	2.32 units on a scale Standard Deviation 0.71	2.31 units on a scale Standard Deviation 0.67	2.34 units on a scale Standard Deviation 0.67	2.31 units on a scale Standard Deviation 0.68
Change in Overall Anxiety Severity and Impairment Scale Session 1 assessment	—	2.00 units on a scale Standard Deviation NA 1 Participant	2.22 units on a scale Standard Deviation 0.73	2.15 units on a scale Standard Deviation 0.75	2.21 units on a scale Standard Deviation 0.72	2.24 units on a scale Standard Deviation 0.73
Change in Overall Anxiety Severity and Impairment Scale Session 2 assessment	—	—	1.75 units on a scale Standard Deviation 0.74	1.71 units on a scale Standard Deviation 0.74	1.79 units on a scale Standard Deviation 0.75	1.92 units on a scale Standard Deviation 0.75
Change in Overall Anxiety Severity and Impairment Scale Session 3 assessment	—	—	1.80 units on a scale Standard Deviation 0.80	1.72 units on a scale Standard Deviation 0.79	1.84 units on a scale Standard Deviation 0.74	2.00 units on a scale Standard Deviation 0.78
Change in Overall Anxiety Severity and Impairment Scale Session 4 assessment	—	—	1.63 units on a scale Standard Deviation 0.84	1.48 units on a scale Standard Deviation 0.80	1.53 units on a scale Standard Deviation 0.78	1.85 units on a scale Standard Deviation 0.90
Change in Overall Anxiety Severity and Impairment Scale Session 5 assessment	—	—	1.58 units on a scale Standard Deviation 0.78	1.50 units on a scale Standard Deviation 0.78	1.62 units on a scale Standard Deviation 0.80	1.77 units on a scale Standard Deviation 0.85
Change in Overall Anxiety Severity and Impairment Scale Follow-up assessment	—	—	1.59 units on a scale Standard Deviation 0.79	1.56 units on a scale Standard Deviation 0.87	1.60 units on a scale Standard Deviation 0.79	1.68 units on a scale Standard Deviation 0.81

PRIMARY outcome

Timeframe: Baseline, and after session 3 (2-3 weeks following baseline), session 5 (~2 weeks after session 3), & at 2-month follow-up (~ 2 months after session 5). Measure will be completed immediately following that day's training session.

Population: A few participants were excluded from analyses during data cleaning due to concerns about integrity of their data, hence the # of analyzed participants is slightly below the enrollment #.

This 7-item measure of anxiety symptoms has good psychometric properties, shows treatment sensitivity, and is valid in community and clinical samples. Item range = 0 to 3 (4-point scale). Total DASS-21 anxiety subscale range = 0-21 (multiplied by 2 for DASS-42 = 0-42), with a higher score indicating more severe anxiety symptoms. Average item scores are reported below.

Outcome measures

Measure	Psychoeducation, Lacking Classification Measures n=13 Participants This group started treatment (and had been Stage 1 randomized to psychoeducation) but did not complete Session 1 of psychoeducation plus assessments, so is not part of the classification measure completer sample	Received CBM-I and Not Classified as High/Low Risk for Attrition n=148 Participants This group started treatment (and had been randomized to CBM-I) but did not complete Session 1 of CBM-I training plus assessments, so was not classified as high/low risk for attrition and thus not randomized for Stage 2 of SMART design	Received CBM-I and Classified Low Attrition n=288 Participants Computer- or phone-based Cognitive Bias Modification - Interpretation training Cognitive Bias Modification - Interpretation training: 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 typically then assign a benign (rather than threatening) meaning to the scenario.	Received CBM-I and Classified High Attrition and no Coach Given n=263 Participants Computer- or phone-based Cognitive Bias Modification - Interpretation training Cognitive Bias Modification - Interpretation training: 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 typically then assign a benign (rather than threatening) meaning to the scenario.	Received CBM-I and Classified High Attrition and Given a Coach n=281 Participants Computer- or phone-based Cognitive Bias Modification - Interpretation training + Coaching Cognitive Bias Modification - Interpretation training: 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 typically then assign a benign (rather than threatening) meaning to the scenario. Coaching: Participants identified as high risk for attrition will receive low-intensity coaching, which includes a mix of brief phone calls, texts, and/or emails with a trained member of the study team to help address challenges with adherence to and application of the training.	Psychoeducation n=241 Participants Online psychoeducation about anxiety Online psychoeducation about anxiety: Participants will review webpages that describe information about symptoms and causes of anxiety, including the nature of biased thinking in anxiety.
Change in Depression, Anxiety, Stress Scales-Short Form: Anxiety Subscale Baseline assessment	1.71 units on a scale Standard Deviation 0.64	1.61 units on a scale Standard Deviation 0.55	1.58 units on a scale Standard Deviation 0.53	1.65 units on a scale Standard Deviation 0.54	1.65 units on a scale Standard Deviation 0.53	1.65 units on a scale Standard Deviation 0.52
Change in Depression, Anxiety, Stress Scales-Short Form: Anxiety Subscale Session 3 assessment	—	—	1.01 units on a scale Standard Deviation 0.61	0.98 units on a scale Standard Deviation 0.62	1.07 units on a scale Standard Deviation 0.62	1.19 units on a scale Standard Deviation 0.64
Change in Depression, Anxiety, Stress Scales-Short Form: Anxiety Subscale Session 5 assessment	—	—	0.89 units on a scale Standard Deviation 0.58	0.83 units on a scale Standard Deviation 0.57	0.89 units on a scale Standard Deviation 0.62	1.03 units on a scale Standard Deviation 0.67
Change in Depression, Anxiety, Stress Scales-Short Form: Anxiety Subscale Follow-up assessment	—	—	0.82 units on a scale Standard Deviation 0.57	0.80 units on a scale Standard Deviation 0.63	0.80 units on a scale Standard Deviation 0.64	0.97 units on a scale Standard Deviation 0.62

SECONDARY outcome

Timeframe: Baseline, and after session 3 (2-3 weeks following baseline), session 5 (~2 weeks after session 3), & at 2-month follow-up (~ 2 months after session 5). Measure will be completed immediately following that day's training session.

Population: Some weeks have less participants reported than overall number analyzed because of attrition - participants did not fill out the survey and thus we do not have data to report on all participants across all weeks.

The Patient Health Questionnaire 2 (PHQ-2) inquires about the frequency of depressed mood and anhedonia. A score of 3 or higher on the Patient Health Questionnaire-2 (PHQ-2) is considered an indication of major depressive disorder. The PHQ-2 is a two-question screening tool that asks how often a person has experienced depressed mood or anhedonia over the past two weeks. The score range is 0-6, with higher scores indicating more frequent symptoms, and response options 0-3 for each question where 0: Not at all, 1: Several days, 2: More than half the days, 3: Nearly every day.

Outcome measures

Measure	Psychoeducation, Lacking Classification Measures n=13 Participants This group started treatment (and had been Stage 1 randomized to psychoeducation) but did not complete Session 1 of psychoeducation plus assessments, so is not part of the classification measure completer sample	Received CBM-I and Not Classified as High/Low Risk for Attrition n=148 Participants This group started treatment (and had been randomized to CBM-I) but did not complete Session 1 of CBM-I training plus assessments, so was not classified as high/low risk for attrition and thus not randomized for Stage 2 of SMART design	Received CBM-I and Classified Low Attrition n=288 Participants Computer- or phone-based Cognitive Bias Modification - Interpretation training Cognitive Bias Modification - Interpretation training: 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 typically then assign a benign (rather than threatening) meaning to the scenario.	Received CBM-I and Classified High Attrition and no Coach Given n=263 Participants Computer- or phone-based Cognitive Bias Modification - Interpretation training Cognitive Bias Modification - Interpretation training: 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 typically then assign a benign (rather than threatening) meaning to the scenario.	Received CBM-I and Classified High Attrition and Given a Coach n=281 Participants Computer- or phone-based Cognitive Bias Modification - Interpretation training + Coaching Cognitive Bias Modification - Interpretation training: 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 typically then assign a benign (rather than threatening) meaning to the scenario. Coaching: Participants identified as high risk for attrition will receive low-intensity coaching, which includes a mix of brief phone calls, texts, and/or emails with a trained member of the study team to help address challenges with adherence to and application of the training.	Psychoeducation n=241 Participants Online psychoeducation about anxiety Online psychoeducation about anxiety: Participants will review webpages that describe information about symptoms and causes of anxiety, including the nature of biased thinking in anxiety.
Change in Depression Comorbid Symptoms Baseline	2.92 score on a scale Standard Deviation 0.95	2.77 score on a scale Standard Deviation 0.86	2.76 score on a scale Standard Deviation 0.90	2.68 score on a scale Standard Deviation 0.93	2.77 score on a scale Standard Deviation 0.91	2.78 score on a scale Standard Deviation 0.89
Change in Depression Comorbid Symptoms Session 3	—	—	2.35 score on a scale Standard Deviation 0.92	2.22 score on a scale Standard Deviation 0.86	2.32 score on a scale Standard Deviation 0.90	2.49 score on a scale Standard Deviation 0.96
Change in Depression Comorbid Symptoms Session 5	—	—	2.15 score on a scale Standard Deviation 0.92	2.12 score on a scale Standard Deviation 0.90	2.13 score on a scale Standard Deviation 0.90	2.36 score on a scale Standard Deviation 0.97
Change in Depression Comorbid Symptoms 2-month Follow-up	—	—	2.15 score on a scale Standard Deviation 0.91	2.00 score on a scale Standard Deviation 0.93	2.00 score on a scale Standard Deviation 0.89	2.09 score on a scale Standard Deviation 0.88

SECONDARY outcome

Timeframe: Baseline, and after session 3 (2-3 weeks following baseline), session 5 (~2 weeks after session 3), & at 2-month follow-up (~ 2 months after session 5). Measure will be completed immediately following that day's training session.

Population: Some weeks have less participants reported than overall number analyzed because of attrition - participants did not fill out the survey and thus we do not have data to report on all participants across all weeks.

The Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) is a 3-item alcohol screen that can help identify persons who are hazardous drinkers or have active alcohol use disorders. The AUDIT has 10 questions and the possible responses to each question are scored 0, 1, 2, 3 or 4, with the exception of questions 9 and 10 which have possible responses of 0, 2 and 4. The range of possible scores is from 0 to 40 where 0 indicates an abstainer who has never had any problems from alcohol. A score of 1 to 7 suggests low-risk consumption according to World Health Organization (WHO) guidelines. Scores from 8 to 14 suggest hazardous or harmful alcohol consumption and a score of 15 or more indicates the likelihood of alcohol dependence (moderate-severe alcohol use disorder).

Outcome measures

Measure	Psychoeducation, Lacking Classification Measures n=13 Participants This group started treatment (and had been Stage 1 randomized to psychoeducation) but did not complete Session 1 of psychoeducation plus assessments, so is not part of the classification measure completer sample	Received CBM-I and Not Classified as High/Low Risk for Attrition n=148 Participants This group started treatment (and had been randomized to CBM-I) but did not complete Session 1 of CBM-I training plus assessments, so was not classified as high/low risk for attrition and thus not randomized for Stage 2 of SMART design	Received CBM-I and Classified Low Attrition n=288 Participants Computer- or phone-based Cognitive Bias Modification - Interpretation training Cognitive Bias Modification - Interpretation training: 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 typically then assign a benign (rather than threatening) meaning to the scenario.	Received CBM-I and Classified High Attrition and no Coach Given n=263 Participants Computer- or phone-based Cognitive Bias Modification - Interpretation training Cognitive Bias Modification - Interpretation training: 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 typically then assign a benign (rather than threatening) meaning to the scenario.	Received CBM-I and Classified High Attrition and Given a Coach n=281 Participants Computer- or phone-based Cognitive Bias Modification - Interpretation training + Coaching Cognitive Bias Modification - Interpretation training: 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 typically then assign a benign (rather than threatening) meaning to the scenario. Coaching: Participants identified as high risk for attrition will receive low-intensity coaching, which includes a mix of brief phone calls, texts, and/or emails with a trained member of the study team to help address challenges with adherence to and application of the training.	Psychoeducation n=241 Participants Online psychoeducation about anxiety Online psychoeducation about anxiety: Participants will review webpages that describe information about symptoms and causes of anxiety, including the nature of biased thinking in anxiety.
Change in Alcohol Use Comorbid Symptoms Session 3	—	—	0.88 score on a scale Standard Deviation 0.89	0.92 score on a scale Standard Deviation 0.83	0.80 score on a scale Standard Deviation 0.73	0.84 score on a scale Standard Deviation 0.85
Change in Alcohol Use Comorbid Symptoms 2-month Follow-up	—	—	0.78 score on a scale Standard Deviation 0.80	0.80 score on a scale Standard Deviation 0.70	0.59 score on a scale Standard Deviation 0.62	0.71 score on a scale Standard Deviation 0.80
Change in Alcohol Use Comorbid Symptoms Session 5	—	—	0.75 score on a scale Standard Deviation 0.75	0.85 score on a scale Standard Deviation 0.77	0.71 score on a scale Standard Deviation 0.73	0.78 score on a scale Standard Deviation 0.80
Change in Alcohol Use Comorbid Symptoms Baseline	0.64 score on a scale Standard Deviation 0.73	0.92 score on a scale Standard Deviation 0.82	0.90 score on a scale Standard Deviation 0.84	0.94 score on a scale Standard Deviation 0.86	0.95 score on a scale Standard Deviation 0.79	0.90 score on a scale Standard Deviation 0.89

SECONDARY outcome

Timeframe: Baseline, and after session 3 (2-3 weeks following baseline), session 5 (~2 weeks after session 3), & at 2-month follow-up (~ 2 months after session 5). Measure will be completed immediately following that day's training session.

Population: Some weeks have less participants reported than overall number analyzed because of attrition - participants did not fill out the survey and thus we do not have data to report on all participants across all weeks.

Items 3 and 7 from the Life Orientation Test-Revised (LOT-R) assess generalized optimism versus pessimism.

Responses include: 0 = Strongly disagree, 1 = Disagree, 2 = Neutral, 3 = Agree, and 4 = Strongly agree, plus Prefer not to answer. Total aggregate scores range from 0 to 4 by taking the mean of the 2 items.

Higher scores indicate lower optimism/higher pessimism. We calculate participants' optimism scores by taking the mean of the two items, and we are reporting these mean optimism scores below.

Questions are:

If something can go wrong with me, it will. I hardly ever expect things to go my way.

Outcome measures

Measure	Psychoeducation, Lacking Classification Measures n=13 Participants This group started treatment (and had been Stage 1 randomized to psychoeducation) but did not complete Session 1 of psychoeducation plus assessments, so is not part of the classification measure completer sample	Received CBM-I and Not Classified as High/Low Risk for Attrition n=148 Participants This group started treatment (and had been randomized to CBM-I) but did not complete Session 1 of CBM-I training plus assessments, so was not classified as high/low risk for attrition and thus not randomized for Stage 2 of SMART design	Received CBM-I and Classified Low Attrition n=288 Participants Computer- or phone-based Cognitive Bias Modification - Interpretation training Cognitive Bias Modification - Interpretation training: 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 typically then assign a benign (rather than threatening) meaning to the scenario.	Received CBM-I and Classified High Attrition and no Coach Given n=263 Participants Computer- or phone-based Cognitive Bias Modification - Interpretation training Cognitive Bias Modification - Interpretation training: 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 typically then assign a benign (rather than threatening) meaning to the scenario.	Received CBM-I and Classified High Attrition and Given a Coach n=281 Participants Computer- or phone-based Cognitive Bias Modification - Interpretation training + Coaching Cognitive Bias Modification - Interpretation training: 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 typically then assign a benign (rather than threatening) meaning to the scenario. Coaching: Participants identified as high risk for attrition will receive low-intensity coaching, which includes a mix of brief phone calls, texts, and/or emails with a trained member of the study team to help address challenges with adherence to and application of the training.	Psychoeducation n=241 Participants Online psychoeducation about anxiety Online psychoeducation about anxiety: Participants will review webpages that describe information about symptoms and causes of anxiety, including the nature of biased thinking in anxiety.
Change in Wellness Measures - Optimism Baseline	1.85 score on a scale Standard Deviation 1.43	1.33 score on a scale Standard Deviation 1.00	1.40 score on a scale Standard Deviation 0.97	1.39 score on a scale Standard Deviation 0.96	1.45 score on a scale Standard Deviation 1.02	1.29 score on a scale Standard Deviation 0.97
Change in Wellness Measures - Optimism Session 3	—	—	1.82 score on a scale Standard Deviation 0.94	1.82 score on a scale Standard Deviation 1.05	1.79 score on a scale Standard Deviation 1.07	1.52 score on a scale Standard Deviation 0.98
Change in Wellness Measures - Optimism Session 5	—	—	1.85 score on a scale Standard Deviation 1.03	1.97 score on a scale Standard Deviation 1.06	1.82 score on a scale Standard Deviation 1.01	1.57 score on a scale Standard Deviation 0.97
Change in Wellness Measures - Optimism 2-month Follow-up	—	—	1.93 score on a scale Standard Deviation 1.03	1.84 score on a scale Standard Deviation 1.08	1.95 score on a scale Standard Deviation 1.07	1.65 score on a scale Standard Deviation 0.93

SECONDARY outcome

Timeframe: Baseline, and after session 3 (2-3 weeks following baseline), session 5 (~2 weeks after session 3), & at 2-month follow-up (~ 2 months after session 5). Measure will be completed immediately following that day's training session.

Population: Some weeks have less participants reported than overall number analyzed because of attrition - participants did not fill out the survey and thus we do not have data to report on all participants across all weeks.

Items 1, 5, and 7 from the Growth Mindset Measure were administered to measure changes in thinking styles (altered from the original items that reference intelligence).

Responses include: 0 = Strongly disagree, 1 = Disagree, 2 = Neutral, 3 = Agree, and 4 = Strongly agree, plus Prefer not to answer. Total aggregate scores can range from 0 to 4 by taking the mean of the 3 items.

Higher scores indicate a lack of a growth mindset (AKA more negative outcome). We calculate participants' growth mindset scores by taking the mean of the two items, and we are reporting these mean growth mindset scores below.

Questions are:

You can learn new things, but you can't really change how you think. No matter how much you have been thinking a particular way, you can always change it quite a bit.

You can always substantially change how you think.

Outcome measures

Measure	Psychoeducation, Lacking Classification Measures n=13 Participants This group started treatment (and had been Stage 1 randomized to psychoeducation) but did not complete Session 1 of psychoeducation plus assessments, so is not part of the classification measure completer sample	Received CBM-I and Not Classified as High/Low Risk for Attrition n=148 Participants This group started treatment (and had been randomized to CBM-I) but did not complete Session 1 of CBM-I training plus assessments, so was not classified as high/low risk for attrition and thus not randomized for Stage 2 of SMART design	Received CBM-I and Classified Low Attrition n=288 Participants Computer- or phone-based Cognitive Bias Modification - Interpretation training Cognitive Bias Modification - Interpretation training: 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 typically then assign a benign (rather than threatening) meaning to the scenario.	Received CBM-I and Classified High Attrition and no Coach Given n=263 Participants Computer- or phone-based Cognitive Bias Modification - Interpretation training Cognitive Bias Modification - Interpretation training: 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 typically then assign a benign (rather than threatening) meaning to the scenario.	Received CBM-I and Classified High Attrition and Given a Coach n=281 Participants Computer- or phone-based Cognitive Bias Modification - Interpretation training + Coaching Cognitive Bias Modification - Interpretation training: 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 typically then assign a benign (rather than threatening) meaning to the scenario. Coaching: Participants identified as high risk for attrition will receive low-intensity coaching, which includes a mix of brief phone calls, texts, and/or emails with a trained member of the study team to help address challenges with adherence to and application of the training.	Psychoeducation n=241 Participants Online psychoeducation about anxiety Online psychoeducation about anxiety: Participants will review webpages that describe information about symptoms and causes of anxiety, including the nature of biased thinking in anxiety.
Change in Wellness Measures - Growth Mindset Baseline	2.13 score on a scale Standard Deviation 0.44	2.17 score on a scale Standard Deviation 0.57	2.14 score on a scale Standard Deviation 0.50	2.12 score on a scale Standard Deviation 0.55	2.10 score on a scale Standard Deviation 0.51	2.13 score on a scale Standard Deviation 0.53
Change in Wellness Measures - Growth Mindset 2-month Follow-up	—	—	2.22 score on a scale Standard Deviation 0.47	2.25 score on a scale Standard Deviation 0.52	2.26 score on a scale Standard Deviation 0.46	2.25 score on a scale Standard Deviation 0.50
Change in Wellness Measures - Growth Mindset Session 3	—	—	2.29 score on a scale Standard Deviation 0.53	2.33 score on a scale Standard Deviation 0.53	2.27 score on a scale Standard Deviation 0.47	2.20 score on a scale Standard Deviation 0.49
Change in Wellness Measures - Growth Mindset Session 5	—	—	2.29 score on a scale Standard Deviation 0.53	2.34 score on a scale Standard Deviation 0.51	2.25 score on a scale Standard Deviation 0.53	2.28 score on a scale Standard Deviation 0.52

SECONDARY outcome

Timeframe: Baseline, and after session 3 (2-3 weeks following baseline), session 5 (~2 weeks after session 3), & at 2-month follow-up (~ 2 months after session 5). Measure will be completed immediately following that day's training session.

Population: Some weeks have less participants reported than overall number analyzed because of attrition - participants did not fill out the survey and thus we do not have data to report on all participants across all weeks.

Items 2, 6, and 7 from the New General Self-Efficacy Scale (NGSES) will be administered to measure self-efficacy. Item range = 0 to 4. Total aggregate scores can range from 0 to 4 by taking the mean of the 3 items.

Higher scores indicate more self-efficacy. We calculate participants' self-efficacy scores by taking the mean of the 3 items.

Outcome measures

Measure	Psychoeducation, Lacking Classification Measures n=13 Participants This group started treatment (and had been Stage 1 randomized to psychoeducation) but did not complete Session 1 of psychoeducation plus assessments, so is not part of the classification measure completer sample	Received CBM-I and Not Classified as High/Low Risk for Attrition n=148 Participants This group started treatment (and had been randomized to CBM-I) but did not complete Session 1 of CBM-I training plus assessments, so was not classified as high/low risk for attrition and thus not randomized for Stage 2 of SMART design	Received CBM-I and Classified Low Attrition n=288 Participants Computer- or phone-based Cognitive Bias Modification - Interpretation training Cognitive Bias Modification - Interpretation training: 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 typically then assign a benign (rather than threatening) meaning to the scenario.	Received CBM-I and Classified High Attrition and no Coach Given n=263 Participants Computer- or phone-based Cognitive Bias Modification - Interpretation training Cognitive Bias Modification - Interpretation training: 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 typically then assign a benign (rather than threatening) meaning to the scenario.	Received CBM-I and Classified High Attrition and Given a Coach n=281 Participants Computer- or phone-based Cognitive Bias Modification - Interpretation training + Coaching Cognitive Bias Modification - Interpretation training: 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 typically then assign a benign (rather than threatening) meaning to the scenario. Coaching: Participants identified as high risk for attrition will receive low-intensity coaching, which includes a mix of brief phone calls, texts, and/or emails with a trained member of the study team to help address challenges with adherence to and application of the training.	Psychoeducation n=241 Participants Online psychoeducation about anxiety Online psychoeducation about anxiety: Participants will review webpages that describe information about symptoms and causes of anxiety, including the nature of biased thinking in anxiety.
Change in Wellness Measures - Self-efficacy Baseline	2.15 score on a scale Standard Deviation 1.04	2.27 score on a scale Standard Deviation 0.93	2.27 score on a scale Standard Deviation 0.92	2.37 score on a scale Standard Deviation 0.83	2.22 score on a scale Standard Deviation 0.93	2.20 score on a scale Standard Deviation 0.93
Change in Wellness Measures - Self-efficacy Session 3	—	—	2.71 score on a scale Standard Deviation 0.84	2.75 score on a scale Standard Deviation 0.85	2.59 score on a scale Standard Deviation 0.81	2.41 score on a scale Standard Deviation 0.83
Change in Wellness Measures - Self-efficacy Session 5	—	—	2.77 score on a scale Standard Deviation 0.81	2.75 score on a scale Standard Deviation 0.79	2.74 score on a scale Standard Deviation 0.84	2.57 score on a scale Standard Deviation 0.88
Change in Wellness Measures - Self-efficacy 2-month Follow-up	—	—	2.75 score on a scale Standard Deviation 0.75	2.82 score on a scale Standard Deviation 0.74	2.75 score on a scale Standard Deviation 0.78	2.58 score on a scale Standard Deviation 0.80

SECONDARY outcome

Timeframe: Baseline, and after session 3 (2-3 weeks following baseline), session 5 (~2 weeks after session 3), & at 2-month follow-up (~ 2 months after session 5). Measure will be completed immediately following that day's training session.

Population: Some weeks have less participants reported than overall number analyzed because of attrition - participants did not fill out the survey and thus we do not have data to report on all participants across all weeks.

Single-Item Life Satisfaction measure will be administered to measure overall satisfaction with one's life.

Participants are asked "All things considered, how satisfied are you with your life as a whole?" and can choose from the following options, with lower scores being more dissatisfied with life (AKA more negative):

0 (Completely dissatisfied)

1 2 3 4 5 6 7 8 9 10 (Completely satisfied) Prefer not to answer

Outcome measures

Measure	Psychoeducation, Lacking Classification Measures n=13 Participants This group started treatment (and had been Stage 1 randomized to psychoeducation) but did not complete Session 1 of psychoeducation plus assessments, so is not part of the classification measure completer sample	Received CBM-I and Not Classified as High/Low Risk for Attrition n=148 Participants This group started treatment (and had been randomized to CBM-I) but did not complete Session 1 of CBM-I training plus assessments, so was not classified as high/low risk for attrition and thus not randomized for Stage 2 of SMART design	Received CBM-I and Classified Low Attrition n=288 Participants Computer- or phone-based Cognitive Bias Modification - Interpretation training Cognitive Bias Modification - Interpretation training: 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 typically then assign a benign (rather than threatening) meaning to the scenario.	Received CBM-I and Classified High Attrition and no Coach Given n=263 Participants Computer- or phone-based Cognitive Bias Modification - Interpretation training Cognitive Bias Modification - Interpretation training: 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 typically then assign a benign (rather than threatening) meaning to the scenario.	Received CBM-I and Classified High Attrition and Given a Coach n=281 Participants Computer- or phone-based Cognitive Bias Modification - Interpretation training + Coaching Cognitive Bias Modification - Interpretation training: 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 typically then assign a benign (rather than threatening) meaning to the scenario. Coaching: Participants identified as high risk for attrition will receive low-intensity coaching, which includes a mix of brief phone calls, texts, and/or emails with a trained member of the study team to help address challenges with adherence to and application of the training.	Psychoeducation n=241 Participants Online psychoeducation about anxiety Online psychoeducation about anxiety: Participants will review webpages that describe information about symptoms and causes of anxiety, including the nature of biased thinking in anxiety.
Change in Wellness Measures - Life Satisfaction Baseline	4.31 score on a scale Standard Deviation 2.50	4.71 score on a scale Standard Deviation 2.28	4.77 score on a scale Standard Deviation 2.22	5.09 score on a scale Standard Deviation 2.16	4.95 score on a scale Standard Deviation 2.14	5.01 score on a scale Standard Deviation 2.18
Change in Wellness Measures - Life Satisfaction Session 3	—	—	5.69 score on a scale Standard Deviation 2.21	5.75 score on a scale Standard Deviation 2.05	5.94 score on a scale Standard Deviation 1.99	5.28 score on a scale Standard Deviation 2.13
Change in Wellness Measures - Life Satisfaction Session 5	—	—	5.81 score on a scale Standard Deviation 2.32	6.00 score on a scale Standard Deviation 2.08	6.01 score on a scale Standard Deviation 1.91	5.79 score on a scale Standard Deviation 2.05
Change in Wellness Measures - Life Satisfaction 2-month Follow-up	—	—	5.71 score on a scale Standard Deviation 2.16	6.12 score on a scale Standard Deviation 2.05	6.14 score on a scale Standard Deviation 2.03	5.76 score on a scale Standard Deviation 1.91

SECONDARY outcome

Timeframe: Baseline, and after session 3 (2-3 weeks following baseline), session 5 (~2 weeks after session 3), & at 2-month follow-up (~ 2 months after session 5). Measure will be completed immediately following that day's training session.

Population: Some weeks have less participants reported than overall number analyzed because of attrition - participants did not fill out the survey and thus we do not have data to report on all participants across all weeks.

Item 14 of the Cognitive Flexibility Inventory (CFI) will be administered to measure cognitive flexibility.

Participants are asked "I often look at a situation from different viewpoints." with response options as follows, with higher scores indicating more cognitive flexibility (AKA more positive outcome):

1. = Strongly disagree

2. = Disagree

3. = Somewhat disagree

4. = Neutral

5. = Somewhat agree

6. = Agree

7. = Strongly agree Prefer not to answer

Outcome measures

Measure	Psychoeducation, Lacking Classification Measures n=13 Participants This group started treatment (and had been Stage 1 randomized to psychoeducation) but did not complete Session 1 of psychoeducation plus assessments, so is not part of the classification measure completer sample	Received CBM-I and Not Classified as High/Low Risk for Attrition n=148 Participants This group started treatment (and had been randomized to CBM-I) but did not complete Session 1 of CBM-I training plus assessments, so was not classified as high/low risk for attrition and thus not randomized for Stage 2 of SMART design	Received CBM-I and Classified Low Attrition n=288 Participants Computer- or phone-based Cognitive Bias Modification - Interpretation training Cognitive Bias Modification - Interpretation training: 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 typically then assign a benign (rather than threatening) meaning to the scenario.	Received CBM-I and Classified High Attrition and no Coach Given n=263 Participants Computer- or phone-based Cognitive Bias Modification - Interpretation training Cognitive Bias Modification - Interpretation training: 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 typically then assign a benign (rather than threatening) meaning to the scenario.	Received CBM-I and Classified High Attrition and Given a Coach n=281 Participants Computer- or phone-based Cognitive Bias Modification - Interpretation training + Coaching Cognitive Bias Modification - Interpretation training: 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 typically then assign a benign (rather than threatening) meaning to the scenario. Coaching: Participants identified as high risk for attrition will receive low-intensity coaching, which includes a mix of brief phone calls, texts, and/or emails with a trained member of the study team to help address challenges with adherence to and application of the training.	Psychoeducation n=241 Participants Online psychoeducation about anxiety Online psychoeducation about anxiety: Participants will review webpages that describe information about symptoms and causes of anxiety, including the nature of biased thinking in anxiety.
Change in Mechanisms Underlying Bias Change - Cognitive Flexibility Baseline	5.54 score on a scale Standard Deviation 1.05	5.20 score on a scale Standard Deviation 1.41	5.20 score on a scale Standard Deviation 1.43	5.25 score on a scale Standard Deviation 1.38	5.17 score on a scale Standard Deviation 1.51	5.04 score on a scale Standard Deviation 1.44
Change in Mechanisms Underlying Bias Change - Cognitive Flexibility Session 3	—	—	5.41 score on a scale Standard Deviation 1.31	5.60 score on a scale Standard Deviation 1.33	5.41 score on a scale Standard Deviation 1.35	5.36 score on a scale Standard Deviation 1.24
Change in Mechanisms Underlying Bias Change - Cognitive Flexibility Session 5	—	—	5.40 score on a scale Standard Deviation 1.40	5.61 score on a scale Standard Deviation 1.35	5.52 score on a scale Standard Deviation 1.23	5.33 score on a scale Standard Deviation 1.26
Change in Mechanisms Underlying Bias Change - Cognitive Flexibility 2-month Follow-up	—	—	5.59 score on a scale Standard Deviation 1.15	5.57 score on a scale Standard Deviation 1.19	5.57 score on a scale Standard Deviation 1.20	5.47 score on a scale Standard Deviation 1.26

SECONDARY outcome

Timeframe: Baseline, and after session 3 (2-3 weeks following baseline), session 5 (~2 weeks after session 3), & at 2-month follow-up (~ 2 months after session 5). Measure will be completed immediately following that day's training session.

Population: Some weeks have less participants reported than overall number analyzed because of attrition - participants did not fill out the survey and thus we do not have data to report on all participants across all weeks.

Item 11 from the Comprehensive Assessment of ACT processes (CompACT) will be administered to measure experiential avoidance.

Participants are asked "I am willing to fully experience whatever thoughts, feelings, and sensations come up for me, without trying to change them." with response options as follows, with higher scores indicating less avoidance (AKA more positive outcome):

1. = Strongly disagree

2. = Disagree

3. = Somewhat disagree

4. = Neutral

5. = Somewhat agree

6. = Agree

7. = Strongly agree Prefer not to answer

Outcome measures

Measure	Psychoeducation, Lacking Classification Measures n=13 Participants This group started treatment (and had been Stage 1 randomized to psychoeducation) but did not complete Session 1 of psychoeducation plus assessments, so is not part of the classification measure completer sample	Received CBM-I and Not Classified as High/Low Risk for Attrition n=148 Participants This group started treatment (and had been randomized to CBM-I) but did not complete Session 1 of CBM-I training plus assessments, so was not classified as high/low risk for attrition and thus not randomized for Stage 2 of SMART design	Received CBM-I and Classified Low Attrition n=288 Participants Computer- or phone-based Cognitive Bias Modification - Interpretation training Cognitive Bias Modification - Interpretation training: 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 typically then assign a benign (rather than threatening) meaning to the scenario.	Received CBM-I and Classified High Attrition and no Coach Given n=263 Participants Computer- or phone-based Cognitive Bias Modification - Interpretation training Cognitive Bias Modification - Interpretation training: 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 typically then assign a benign (rather than threatening) meaning to the scenario.	Received CBM-I and Classified High Attrition and Given a Coach n=281 Participants Computer- or phone-based Cognitive Bias Modification - Interpretation training + Coaching Cognitive Bias Modification - Interpretation training: 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 typically then assign a benign (rather than threatening) meaning to the scenario. Coaching: Participants identified as high risk for attrition will receive low-intensity coaching, which includes a mix of brief phone calls, texts, and/or emails with a trained member of the study team to help address challenges with adherence to and application of the training.	Psychoeducation n=241 Participants Online psychoeducation about anxiety Online psychoeducation about anxiety: Participants will review webpages that describe information about symptoms and causes of anxiety, including the nature of biased thinking in anxiety.
Change in Mechanisms Underlying Bias Change - Experiential Avoidance Baseline	3.85 score on a scale Standard Deviation 1.41	4.05 score on a scale Standard Deviation 1.75	3.78 score on a scale Standard Deviation 1.66	3.89 score on a scale Standard Deviation 1.63	3.85 score on a scale Standard Deviation 1.64	3.80 score on a scale Standard Deviation 1.55
Change in Mechanisms Underlying Bias Change - Experiential Avoidance Session 3	—	—	4.33 score on a scale Standard Deviation 1.60	4.44 score on a scale Standard Deviation 1.60	3.94 score on a scale Standard Deviation 1.57	4.14 score on a scale Standard Deviation 1.53
Change in Mechanisms Underlying Bias Change - Experiential Avoidance Session 5	—	—	4.56 score on a scale Standard Deviation 1.55	4.72 score on a scale Standard Deviation 1.41	4.43 score on a scale Standard Deviation 1.56	4.25 score on a scale Standard Deviation 1.48
Change in Mechanisms Underlying Bias Change - Experiential Avoidance 2-month Follow-up	—	—	4.58 score on a scale Standard Deviation 1.51	4.73 score on a scale Standard Deviation 1.54	4.17 score on a scale Standard Deviation 1.61	4.35 score on a scale Standard Deviation 1.43

SECONDARY outcome

Timeframe: Baseline, and after session 3 (2-3 weeks following baseline), session 5 (~2 weeks after session 3), & at 2-month follow-up (~ 2 months after session 5). Measure will be completed immediately following that day's training session.

Population: Some weeks have less participants reported than overall number analyzed because of attrition - participants did not fill out the survey and thus we do not have data to report on all participants across all weeks.

Items 7 and 10 from the Emotion Regulation Questionnaire (ERQ) will be administered to measure cognitive reappraisal.

Participants are given two statements - "When I want to feel more positive emotion, I change the way I'm thinking about the situation" and "When I want to feel less negative emotion, I change the way I'm thinking about the situation" - with response options as follows, with higher scores indicating more reappraisal (AKA more positive outcome):

1. = Strongly disagree

2. = Disagree

3. = Somewhat disagree

4. = Neutral

5. = Somewhat agree

6. = Agree

7. = Strongly agree Prefer not to answer

Total aggregate scores can range from 0 to 7 by taking the mean of the two items. We calculate participants' Cognitive reappraisal scores by taking the mean of the two items, and we are reporting these mean Cognitive reappraisal scores below.

Outcome measures

Measure	Psychoeducation, Lacking Classification Measures n=13 Participants This group started treatment (and had been Stage 1 randomized to psychoeducation) but did not complete Session 1 of psychoeducation plus assessments, so is not part of the classification measure completer sample	Received CBM-I and Not Classified as High/Low Risk for Attrition n=148 Participants This group started treatment (and had been randomized to CBM-I) but did not complete Session 1 of CBM-I training plus assessments, so was not classified as high/low risk for attrition and thus not randomized for Stage 2 of SMART design	Received CBM-I and Classified Low Attrition n=288 Participants Computer- or phone-based Cognitive Bias Modification - Interpretation training Cognitive Bias Modification - Interpretation training: 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 typically then assign a benign (rather than threatening) meaning to the scenario.	Received CBM-I and Classified High Attrition and no Coach Given n=263 Participants Computer- or phone-based Cognitive Bias Modification - Interpretation training Cognitive Bias Modification - Interpretation training: 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 typically then assign a benign (rather than threatening) meaning to the scenario.	Received CBM-I and Classified High Attrition and Given a Coach n=281 Participants Computer- or phone-based Cognitive Bias Modification - Interpretation training + Coaching Cognitive Bias Modification - Interpretation training: 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 typically then assign a benign (rather than threatening) meaning to the scenario. Coaching: Participants identified as high risk for attrition will receive low-intensity coaching, which includes a mix of brief phone calls, texts, and/or emails with a trained member of the study team to help address challenges with adherence to and application of the training.	Psychoeducation n=241 Participants Online psychoeducation about anxiety Online psychoeducation about anxiety: Participants will review webpages that describe information about symptoms and causes of anxiety, including the nature of biased thinking in anxiety.
Change in Mechanisms Underlying Bias Change - Cognitive Reappraisal Baseline	4.65 score on a scale Standard Deviation 1.05	4.41 score on a scale Standard Deviation 1.57	4.28 score on a scale Standard Deviation 1.49	4.34 score on a scale Standard Deviation 1.42	4.29 score on a scale Standard Deviation 1.41	4.14 score on a scale Standard Deviation 1.36
Change in Mechanisms Underlying Bias Change - Cognitive Reappraisal Session 3	—	—	4.90 score on a scale Standard Deviation 1.25	4.81 score on a scale Standard Deviation 1.44	4.79 score on a scale Standard Deviation 1.28	4.59 score on a scale Standard Deviation 1.33
Change in Mechanisms Underlying Bias Change - Cognitive Reappraisal Session 5	—	—	5.11 score on a scale Standard Deviation 1.28	4.95 score on a scale Standard Deviation 1.20	4.89 score on a scale Standard Deviation 1.32	4.87 score on a scale Standard Deviation 1.29
Change in Mechanisms Underlying Bias Change - Cognitive Reappraisal 2-month Follow-up	—	—	5.00 score on a scale Standard Deviation 1.20	4.96 score on a scale Standard Deviation 1.18	5.01 score on a scale Standard Deviation 1.18	4.92 score on a scale Standard Deviation 1.11

SECONDARY outcome

Timeframe: Baseline, and after session 3 (2-3 weeks following baseline), session 5 (~2 weeks after session 3), & at 2-month follow-up (~ 2 months after session 5). Measure will be completed immediately following that day's training session.

Population: Some weeks have less participants reported than overall number analyzed because of attrition - participants did not fill out the survey and thus we do not have data to report on all participants across all weeks.

Items 1 and 7 from the Intolerance of Uncertainty Scale-Short Form (IUS-12) will be administered to measure intolerance of uncertainty. Item range = 1 to 7. Total range for aggregated 2 items = 2-14, with a higher score indicating more intolerance of uncertainty.

Outcome measures

Measure	Psychoeducation, Lacking Classification Measures n=13 Participants This group started treatment (and had been Stage 1 randomized to psychoeducation) but did not complete Session 1 of psychoeducation plus assessments, so is not part of the classification measure completer sample	Received CBM-I and Not Classified as High/Low Risk for Attrition n=148 Participants This group started treatment (and had been randomized to CBM-I) but did not complete Session 1 of CBM-I training plus assessments, so was not classified as high/low risk for attrition and thus not randomized for Stage 2 of SMART design	Received CBM-I and Classified Low Attrition n=288 Participants Computer- or phone-based Cognitive Bias Modification - Interpretation training Cognitive Bias Modification - Interpretation training: 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 typically then assign a benign (rather than threatening) meaning to the scenario.	Received CBM-I and Classified High Attrition and no Coach Given n=263 Participants Computer- or phone-based Cognitive Bias Modification - Interpretation training Cognitive Bias Modification - Interpretation training: 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 typically then assign a benign (rather than threatening) meaning to the scenario.	Received CBM-I and Classified High Attrition and Given a Coach n=281 Participants Computer- or phone-based Cognitive Bias Modification - Interpretation training + Coaching Cognitive Bias Modification - Interpretation training: 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 typically then assign a benign (rather than threatening) meaning to the scenario. Coaching: Participants identified as high risk for attrition will receive low-intensity coaching, which includes a mix of brief phone calls, texts, and/or emails with a trained member of the study team to help address challenges with adherence to and application of the training.	Psychoeducation n=241 Participants Online psychoeducation about anxiety Online psychoeducation about anxiety: Participants will review webpages that describe information about symptoms and causes of anxiety, including the nature of biased thinking in anxiety.
Change in Mechanisms Underlying Bias Change - Intolerance of Uncertainty 2-month Follow-up	—	—	5.10 score on a scale Standard Deviation 1.31	5.16 score on a scale Standard Deviation 1.20	5.02 score on a scale Standard Deviation 1.20	5.26 score on a scale Standard Deviation 1.19
Change in Mechanisms Underlying Bias Change - Intolerance of Uncertainty Baseline	5.62 score on a scale Standard Deviation 1.16	5.42 score on a scale Standard Deviation 1.27	5.57 score on a scale Standard Deviation 1.11	5.56 score on a scale Standard Deviation 1.14	5.65 score on a scale Standard Deviation 1.12	5.53 score on a scale Standard Deviation 1.23
Change in Mechanisms Underlying Bias Change - Intolerance of Uncertainty Session 3	—	—	5.22 score on a scale Standard Deviation 1.20	5.18 score on a scale Standard Deviation 1.19	5.29 score on a scale Standard Deviation 1.17	5.44 score on a scale Standard Deviation 1.20
Change in Mechanisms Underlying Bias Change - Intolerance of Uncertainty Session 5	—	—	5.00 score on a scale Standard Deviation 1.37	5.08 score on a scale Standard Deviation 1.14	5.03 score on a scale Standard Deviation 1.21	5.25 score on a scale Standard Deviation 1.22

SECONDARY outcome

Timeframe: Baseline, and after session 3 (2-3 weeks following baseline), session 5 (~2 weeks after session 3), & at 2-month follow-up (~ 2 months after session 5). Measure will be completed immediately following that day's training session.

Population: Some weeks have less participants reported than overall number analyzed because of attrition - participants did not fill out the survey and thus we do not have data to report on all participants across all weeks.

We will assess change in the extent anxiety is viewed as central to the person's self-concept.

Participants are asked "To what extent is your anxiety a central part of who you are currently?" and provided with 5 images of two circles, one labeled "My Anxiety" and one labeled "Me", where the circles start off not touching at all and get increasingly closer/overlapped, with the last image having the circles fully overlapped. We code these 5 images as 0 = No overlap, 1 = overlapped about 25%, 2 = overlapped about 50%, 3 = overlapped about 75%, 4 = Fully overlapped; higher scores indicate that anxiety is more central to the person's self-concept, and lower scores indicate that the person does not identify themself with their anxiety.

Outcome measures

Measure	Psychoeducation, Lacking Classification Measures n=13 Participants This group started treatment (and had been Stage 1 randomized to psychoeducation) but did not complete Session 1 of psychoeducation plus assessments, so is not part of the classification measure completer sample	Received CBM-I and Not Classified as High/Low Risk for Attrition n=148 Participants This group started treatment (and had been randomized to CBM-I) but did not complete Session 1 of CBM-I training plus assessments, so was not classified as high/low risk for attrition and thus not randomized for Stage 2 of SMART design	Received CBM-I and Classified Low Attrition n=288 Participants Computer- or phone-based Cognitive Bias Modification - Interpretation training Cognitive Bias Modification - Interpretation training: 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 typically then assign a benign (rather than threatening) meaning to the scenario.	Received CBM-I and Classified High Attrition and no Coach Given n=263 Participants Computer- or phone-based Cognitive Bias Modification - Interpretation training Cognitive Bias Modification - Interpretation training: 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 typically then assign a benign (rather than threatening) meaning to the scenario.	Received CBM-I and Classified High Attrition and Given a Coach n=281 Participants Computer- or phone-based Cognitive Bias Modification - Interpretation training + Coaching Cognitive Bias Modification - Interpretation training: 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 typically then assign a benign (rather than threatening) meaning to the scenario. Coaching: Participants identified as high risk for attrition will receive low-intensity coaching, which includes a mix of brief phone calls, texts, and/or emails with a trained member of the study team to help address challenges with adherence to and application of the training.	Psychoeducation n=241 Participants Online psychoeducation about anxiety Online psychoeducation about anxiety: Participants will review webpages that describe information about symptoms and causes of anxiety, including the nature of biased thinking in anxiety.
Change in Anxiety and Identity Circles Baseline	2.42 score on a scale Standard Deviation 0.79	2.48 score on a scale Standard Deviation 0.93	2.55 score on a scale Standard Deviation 0.90	2.51 score on a scale Standard Deviation 0.88	2.56 score on a scale Standard Deviation 0.85	2.49 score on a scale Standard Deviation 0.98
Change in Anxiety and Identity Circles Session 3	—	—	1.93 score on a scale Standard Deviation 0.93	1.86 score on a scale Standard Deviation 0.92	2.01 score on a scale Standard Deviation 0.90	2.12 score on a scale Standard Deviation 0.95
Change in Anxiety and Identity Circles Session 5	—	—	1.61 score on a scale Standard Deviation 1.00	1.69 score on a scale Standard Deviation 0.79	1.75 score on a scale Standard Deviation 0.99	1.83 score on a scale Standard Deviation 0.94
Change in Anxiety and Identity Circles 2-month Follow-up	—	—	1.57 score on a scale Standard Deviation 0.88	1.54 score on a scale Standard Deviation 0.85	1.57 score on a scale Standard Deviation 0.89	1.78 score on a scale Standard Deviation 1.01

Adverse Events

Received CBM-I and Not Classified as High/Low Risk for Attrition

Serious events: 0 serious events

Other events: 0 other events

Deaths: 0 deaths

Received CBM-I and Classified Low Attrition

Serious events: 0 serious events

Other events: 0 other events

Deaths: 0 deaths

Received CBM-I and Classified High Attrition and no Coach Given

Serious events: 0 serious events

Other events: 0 other events

Deaths: 0 deaths

Received CBM-I and Classified High Attrition and Given a Coach

Serious events: 0 serious events

Other events: 0 other events

Deaths: 0 deaths

Psychoeducation

Serious events: 0 serious events

Other events: 0 other events

Deaths: 0 deaths

Psychoeducation, Lacking Classification Measures

Serious events: 0 serious events

Other events: 0 other events

Deaths: 0 deaths

Not Randomized to Treatment

Serious events: 0 serious events

Other events: 0 other events

Deaths: 0 deaths

Serious adverse events

Adverse event data not reported

Other adverse events

Adverse event data not reported

Additional Information

Dr. Bethany Teachman

University of Virginia Department of Psychology

Phone: 434-924-0676

Email: bethanyteachman@gmail.com

Results disclosure agreements

• Principal investigator is a sponsor employee
• Publication restrictions are in place