Concreteness Training Reduces Dysphoria: Proof-of-Principle for Repeated Cognitive Bias Modification in Depression Ed R. Watkins, Celine B. Baeyens, and Rebecca Read University of Exeter A tendency toward abstract and overgeneral processing is a cognitive bias hypothesized to causally contribute to symptoms of depression. This hypothesis predicts that training dysphoric individuals to become more concrete and specific in their thinking would reduce depressive symptoms. To test this prediction, 60 participants with dysphoria were randomly allocated either to (a) concreteness training; (b) bogus concreteness training, matched with concreteness training for treatment rationale, experimenter contact, and treatment duration but without active engagement in concrete thinking; (c) a waiting-list, no training control. Concreteness training resulted in significantly greater decreases in depressive symptoms and significantly greater increases in concrete thinking than the waiting-list and the bogus training control, and significantly greater decreases in rumination than the waiting-list control. These findings suggest that concreteness training has potential as a guided self-help intervention for mild-to-moderate depressive symptoms. Keywords: cognitive bias modification, rumination, overgeneralization, depression, guided self-help Cognitive models of psychopathology propose that biases in cognitive processing, such as in attention, memory, and interpre- tations, may underpin the onset and maintenance of emotional disorders. Consistent with such models, cognitive biases, such as selective attention to negative information and negative interpre- tation of ambiguity, have been repeatedly found in anxious and depressed patients, relative to controls (see reviews in Harvey, Watkins, Mansell, & Shafran, 2004; J. M. G. Williams, Watts, MacLeod, & Matthews, 1997). However, the association of these cognitive biases with anxiety and depression is not sufficient to demonstrate that the cognitive biases play a causal role in the development of negative affect: Cognitive biases must be manip- ulated in experimental studies in order to demonstrate causality and find that such manipulations directly influence negative affect. To this end, the cognitive bias modification (CBM) approach has emerged in which participants repeatedly practice on cognitive- experimental tasks that engender a way of processing emotionally relevant information that is either consistent or inconsistent with an identified cognitive bias (e.g., MacLeod, Rutherford, Campbell, Ebsworthy, & Holker, 2002; Mathews & Mackintosh, 2000; Mathews & MacLeod, 2002). However, to date, CBM research has focused narrowly on the attention and interpretation biases, which are considered most relevant to anxiety disorders (see Mathews & MacLeod, 2005) and on the effect of these biases in influencing anxiety vulnerability, rather than explicitly addressing cognitive biases in depression. One cognitive bias strongly implicated in the onset and mainte- nance of depression is the tendency to process self-relevant infor- mation in an overgeneralized and abstract manner (Beck, 1976; Clark, Beck, & Alford, 1999). First, depression is characterized by an increased tendency toward overgeneralizations, in which a general rule or conclusion is drawn on the basis of isolated inci- dents and applied across the board to related and unrelated situa- tions. For example, a single negative event, such as a failure, is interpreted as indicating a global, characterological inadequacy (Beck, 1976; Carver & Ganellen, 1983). Overgeneralization has been found to be specific to depression and not anxiety (Carver & Ganellen, 1983; Carver, Lavoie, Kuhl, & Ganellen, 1988; Ganellen, 1988), and to prospectively predict subsequent levels of depression (Carver, 1998; Dykman, 1996; Edelman, Ahrens, & Haaga, 1994). Second, depression is characterized by increased recall of overgeneral memories, characterized by categoric sum- maries of repeated events (e.g., “making mistakes” or “playing golf every week”) even when asked to recall specific personal memories, relative to healthy controls and other psychiatric pa- tients (except posttraumatic stress disorder; J. M. G. Williams et al., 2007). Furthermore, overgeneral memory retrieval predicts poorer long-term outcome for depression in prospective studies (see J. M. G. Williams et al., 2007, for a review). Another cognitive process implicated in the onset and mainte- nance of depression (and other disorders, see Watkins, 2008) is depressive rumination, with longitudinal studies demonstrating that rumination prospectively predicts the likelihood, severity, and duration of syndromal depression (Nolen-Hoeksema, 2000; Spa- sojevic & Alloy, 2001). Depressive rumination is characterized by an abstract, evaluative style of processing that involves recurrent thinking about the causes, meanings, and implications of depres- sive symptoms (Nolen-Hoeksema, 1991). Experimental studies have indicated that such rumination plays a causal role in main- Ed R. Watkins, C. B. Baeyens, and R. Read, Mood Disorders Centre, School of Psychology, University of Exetfer, Exeter, United Kingdom. This research was supported by a UK Medical Research Council Ex- perimental Medicine Grant ID 77156 awarded to Ed R. Watkins. Correspondence concerning this article should be addressed to Ed R. Watkins, Mood Disorders Centre, School of Psychology, University of Exeter, Washington Singer Laboratories, Perry Road, Exeter EX4 4QG, United Kingdom. E-mail: e.r.watkins@exeter.ac.uk Journal of Abnormal Psychology © 2009 American Psychological Association 2009, Vol. 118, No. 1, 55– 64 0021-843X/09/$12.00 DOI: 10.1037/a0013642 55