BACKGROUND: Cognitive Bias Modification (CBM) refers to a family of interventions designed to systematically modify automatically activated cognitive biases (e.g., attentional, approach, and inhibitory biases). Recent advances in CBM for problematic drinking, including Alcohol Use Disorder, alongside methodological refinements, warrant an update of the Individual Participant Data (IPD) Bayesian meta-analysis. This study integrates new datasets, focuses on alcohol CBM, and applies a two-stage IPD framework to examine CBM's effects on cognitive bias, alcohol consumption, and relapse.

METHODS: A two-stage IPD Bayesian meta-analysis was performed, supplemented by frequentist sensitivity analyses. The first stage estimated study-specific CBM effects, the second stage pooled these to examine within-study moderators (adherence, addiction severity) and between-study moderators (CBM type, control condition, additional therapy, training congruency, and context).

RESULTS: 23 studies with 8297 participants were included. CBM showed a small unadjusted effect on bias (d = -0.18, 95% CrI [-0.32, 0.00], BF₁₀ = 10.88) and relapse (log OR = -0.26, 95% CrI [-0.38, -0.14], BF₁₀ = 155.07; number needed to treat = 18.7), but not on alcohol consumption (d = 0.003, 95% CrI [0.00, 0.06], BF₁₀ = 0.08). Effects were attenuated after adjusting for moderators. Moderator analyses revealed that face-to-face CBM context (unadjusted and within-study adjusted) and additional psychological therapy (within-study adjusted) were associated with greater bias reduction, and higher training intensity (unadjusted) was related to better relapse prevention. Frequentist sensitivity analyses largely supported these findings.

CONCLUSIONS: CBM reduced alcohol-related biases and relapse risk. Although overall evidence was no longer supported after adjusting for moderators, moderator analyses suggest CBM can be effective under specific conditions (e.g., face-to-face delivery, alongside therapy, higher training intensity). These findings underscore the need for refined, context-sensitive CBM protocols in alcohol interventions.