PONE-D-20-31856

Efficacy of the Chinese version interpretation bias modification training in an unselected sample

PLOS ONE

Dear Dr. Deng,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

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The key concerns noted by the reviewers relate to the reporting of the methods. Specifically, the reviewers requested clarity regarding the randomization and allocation concealment procedures, the calculated sample size, and the methods used for multiple imputation. Reviewer 1 noted that the reporting could be improved to more closely align with the CONSORT guidelines. 

Reviewer 2 has recommended that you cite specific previously published works. As always, we recommend that you please review and evaluate the requested works to determine whether they are relevant and should be cited. It is not a requirement to cite these works. 

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Staff Editor

PLOS ONE

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Partly

Reviewer #2: Yes

Reviewer #3: Yes

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: No

Reviewer #2: Yes

Reviewer #3: Yes

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3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: No

Reviewer #2: Yes

Reviewer #3: No

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: The objective of this prospective, randomized controlled trial (RCT) is to assess the effectiveness of the IMP training (compared to the ICC training) on evaluation of interpretation bias, social anxiety, and attentional bias, and subsequently determine possible mediation effects. The study was registered as a RCT within the Chinese Clinical Trial Registry (with a legit ChiCTR number), and was approved by the respective IRB/Ethics Committee. While the study objectives sound interesting, is important, and on target, some shortcomings were observed, in regards to abiding by the CONSORT guidelines for conducting and reporting results of high-quality randomized controlled trials (RCTs). Some other (statistical) comments were also provided.

1. Methods:

Methods reporting appeared very messy. An orderly manner is suggested, following CONSORT guidelines, without repeating information, such as Trial Design, Participant Eligibility Crtieria and settings, Interventions, Outcomes, sample size/power considerations, Interim analysis and stopping rules, Randomization (details on random number generation, allocation concealment, implementation), Blinding issues, etc, should be mentioned. The authors are advised to create separate subsections for each of the possible topics (whichever necessary), and that way produce a very clear writeup. I see the Authors indeed made an attempt; however, they are advised to write it carefully, following nice examples in the manuscript below:

https://www.sciencedirect.com/science/article/pii/S0889540619300010

Specific comments:

(a) For instance, the randomization and allocation concealment should be made very clear (they are NOT the same thing); the trial staff recruiting patients should NOT have the randomization list. Randomization should be prepared by the trial statistician, and he/she would not participate in the recruiting.

(b) The paper states: "....assigned to IMP and ICC groups with 1:1 allocation ratio." (see page 4). Was it a block randomization (BR), given that BR is often recommended in clinical studies to ensure a balance in sample size across groups over time.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2267325/

If Yes, then what's the block size?

(c) Sample size/power: The sample size/power computations should be conducted using the primary response; it is not clear what was done. Furthermore, the sample size/power statement should include "the name of the statistical test (one- or two-sided) employed", and also the sample size number thus obtained. Those are missing.

(d) Statistical Analysis: Overall, looks straightforward. Repeated measures ANOVA was used; however, ANOVA methods are based on strict normality of the responses. Was that ascertained in the analysis?

Multiple imputation was conducted, but what method was used? Was it MICE?

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3074241/

2. Results & Conclusions:

(a) The authors should check that any statement of significance should be followed by a p-value in the entire Results section. The Results section look OK.

(b) The current study utilizes 51 patients, almost giving the feeling of a pilot study. The Conclusions section should clearly state that the results/conclusions are "only" from this Chinese population, and allude to future studies with higher sample sizes, and/or combining other populations to determine the differences.

Reviewer #2: This article reports an RCT of an interpretation training program vs. sham training on social anxiety in an unselected Chinese student sample.

Overall, my evaluation of the manuscript was positive. It represents a first step in testing out this particular interpretation training paradigm for social anxiety in a Chinese sample, as is reported appropriately as such. The reporting standards are generally good, and other strengths include the pre-registration, availability of data and protocol, and use of intention to treat analyses. I have only some relatively minor suggestions to make:

Abstract:

Say 'may be an effective way' instead of 'is an effective way' in the first sentence -efficacy is still an open question

2nd sentence needs reworking or some punctuation added to be easily understandable

Introduction:

The first paragraph needs to be a bit more cautious about the evidence for CBM, as it is a bit mixed.

Methods:

Randomization - I appreciated the detail provided by the authors, but it was still is a bit unclear. Was the allocation actually random (and if so how was it done - e.g. any blocks / stratification etc) or was it simply pseudo-random based on alternating participant numbers?

What were the predictor variables for the multiple imputation, and how many imputed datasets were created?

Results:

When describing the results for the DASS it would be useful to have the statistics and the effect sizes for the non-significant main effect of time and the timex group interaction. Given that the group x time interaction is n.s. it is not really justified to present the two t-tests comparing pre and post-training scores across the groups.

Discussion:

There are a couple of recent studies investigating different kinds of CBM for interpretation in Chinese samples, and it would be good to refer to these in the context of the relatively recent testing of CBM-I in China:

https://link.springer.com/article/10.1007/s12144-020-01094-4

https://link.springer.com/article/10.1007/s12144-020-00867-1

Reviewer #3: The authors test the efficacy of a Chinese version of interpretation bias modification training on interpretation bias, attention bias, and self-report measures of anxiety and social anxiety. Effects of interpretation bias modification training were found on interpretation bias and social anxiety, but not on attention bias and anxiety measured by the DASS. I have several comments to improve the manuscript.

1) The general aim of this manuscript was to test the efficacy of interpretation bias modification using Chinese word stimuli. However, the importance of this contribution is not well discussed in the discussion.

2) What do the authors mean by “benign interpretations”? I think positive would be more appropriate, unless I’m mistaken.

3) The authors use the word “prove” quite liberally when discussing research findings. This should be changed.

4) In addition to these wording issues, there are several other locations where the readability in English could be improved.

5) The authors state in the methods that “Then, participants coded each of their sentence completion as positive, negative or neutral…” could this effect the results? In the context of the training, it may prime certain responses or increase the likelihood of demand characteristic.

6) On page 8, the authors state “Independent t-tests revealed that there were no differences between ICC and IMP in production of positive and negative interpretations before training (ps>0.05)…” Can the authors provide the full statistics for positive and negative interpretations?

7) Similarly, on page nine when reporting the attention bias effects, the authors state “However, the interaction effect and the main effect of group were not significant (ps>0.05).” Can the full statistics for these effects (and others that may be missing) be reported?

8) The authors should briefly discuss why they think there was main effect of time on AB?

9) What was the power for the mediation tests?

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Reviewer #1: No

Reviewer #2: No

Reviewer #3: No

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PONE-D-20-31856R1

Efficacy of the Chinese version interpretation bias modification training in an unselected sample: a randomized trial

PLOS ONE

Dear Dr. Deng,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

Please submit your revised manuscript by Jun 28 2021 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

• A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: http://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols.

We look forward to receiving your revised manuscript.

Kind regards,

Sandra Carvalho

Academic Editor

PLOS ONE

Journal Requirements:

Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: (No Response)

Reviewer #2: (No Response)

Reviewer #3: All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: (No Response)

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3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: (No Response)

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4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: (No Response)

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5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: (No Response)

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6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: The authors addressed all my previous queries. Maybe, it will be a bit more prudent to provide a reference, or some references, to the use of reciprocals for normalization, as that is not so commonly used!

Reviewer #2: Thank you to the authors for revising their manuscript following my comments. Although the revisions were largely helpful, there were some points where something was still unclear or potentially problematic:

2.5 Sample size calculation:

This still needs a bit more information, e.g. what kind of interaction (incl. how many groups and time-points), and what kind of effect size (partial eta squared?) is the 0.4? And why was a large effect assumed?

2.6 Interim analyses and stopping guidelines

I think the authors have misunderstood this item on the CONSORT checklist- this is about the whole trial (e.g. stopping if many adverse events noticed) not individual participants.

2.7 Randomization and blinding

There is still not enough information about the randomization - how were these numbers generated by the computer? Or were the numbers just sequential, alternating odd and even, in which case the allocation is not really random (which would be quite a major limitation that would need addressing in the discussion).

"Allocation concealment was kept until the end of the study" - I think the researchers have misunderstood the term allocation concealment and should read the CONSORT elaboration document carefully.

2.8 Data analysis

It is good to have some extra information about the multiple imputation, but I am not sure I fully understand - the authors say all dependent variables were included - does this mean only post-training variables, or also baseline variables? It would be good to be more explicit about this in the paper.

Some minor points:

The sentence in the abstract "But few Chinese training procedure was available and the effect of interpretation training on attentional bias remained unclear." would read better as "However, little research had been carried out in Chinese samples, and the effect of interpretation training on other processes such as attentional bias also remained unclear.

And in the second to last sentence it would be better to say 'efficacy' rather than 'effectiveness' of the training.

In the section 2.3 Intervention

"Participants would saw a total..." should be "Participants saw a total"

In 2.8 Data analysis

" skewers distribution" should be "skewed distribution"

Reviewer #3: (No Response)

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

Reviewer #2: No

Reviewer #3: No

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

Efficacy of the Chinese version interpretation bias modification training in an unselected sample: a randomized trial

PONE-D-20-31856R2

Dear Dr. Deng,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

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Kind regards,

Sandra Carvalho

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments: