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Exposure is highly effective for treating acrophobia and there is growing consensus that cognitive mechanisms play an important role in exposure-based therapies. The present randomized controlled trial investigated whether adding a Cognitive Bias Modification - Interpretation (CBM-I) training to a single-session exposure therapy further facilitates cognitive change. The sample included diagnosed acrophobia patients (N = 81), all of whom received exposure therapy. One day after the exposure therapy, patients were randomized to receive either CBM-I or a sham training. The CBM-I trained patients to interpret and appraise ambiguous, height-related scenarios in a less threatening and adaptive manner, whereas the sham training comprised ambiguous, neutral scenarios. Outcomes included changes in interpretational biases (Encoding Recognition Task, Heights Interpretation Questionnaire, Scrambled Sentences Task), acrophobia-related symptoms (Acrophobia Questionnaire), and behavioral avoidance (Behavioral Approach Test). In intention-to-treat analyses patients receiving CBM-I showed a greater reduction in interpretational biases post-training compared to the sham condition (primary outcome). However, group differences were not sustained at follow-up and both groups demonstrated improvements across all outcomes, except for the Scrambled Sentences Task. Exploratory analyses revealed strong associations between the assessed cognitive, behavioral, and subjective outcomes, but neither of these outcomes correlated with hormonal measures (progesterone, estradiol). To conclude, our findings suggest that while CBM-I can temporarily facilitate cognitive change in the context of exposure, its long-term benefits and downstream effects may require further optimization. Future research should refine CBM-I protocols to maximize its efficacy as a potential adjunct to exposure therapy.

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A large number of EEG studies have identified a distinct event related potential (ERP) component during error processing known as the Error-Related Negativity (ERN). In an influential study, Hajcak and Foti (2008) explored the idea that errors could trigger defensive motivational reactions and that the ERN might forecast the intensity of defensive reactions following errors. Using a flanker task, thirty-one college-aged participants responded to the direction of a central arrow with acoustic startle probes administered pseudo-randomly throughout. Hajcak and Foti’s (2008) findings indicated the ERN is indicative of individual variations in aversive reactions to errors. This has influenced understanding of the ERN being more than a simple error detection mechanism and sheds light on how people differ in their emotional responses to mistakes. As part of the #EEGManyLabs project, an international network of laboratories, we will test the replicability of the results from this influential study. The data will later be combined to compute global effect sizes of the ERN, startle potentiation, and their interaction. Collectively, these replications will help solidify the results from this highly-cited study. Given that the ERN is an integral part of a broader neural system responding to potentially threatening stimuli, this replication will provide a more solid foundation for our understanding of error processing and its relationship to defensive reactivity.