A systematic review of the word sentence association paradigm (WSAP)

Adaptation and validation of a suicide-focused Word Sentence Association Paradigm to assess suicide-specific interpretation biases

The cognitive model of suicide proposes that biased cognitive processes contribute to suicidal thoughts and behaviors, and initial evidence suggests that attentional bias to suicide-congruent cues may predict suicidal behavior beyond established clinical risk factors. To date, much less work has explored the potential role of interpretation biases in the development and prediction of suicide risk. The present study assessed the psychometric properties, including reliability, concurrent validity, and predictive validity, of a novel adaptation of the Word Sentence Association Paradigm (WSAP) to assess suicide-suicide interpretation biases. In a sample of 239 psychiatric inpatients, including patients with no recent suicidal ideation or lifetime attempts (n = 35), those with recent suicide attempts (n = 29), and those with recent suicidal ideation (n = 174), participants completed the modified WSAP as well as self-reported suicidal ideation and attempts for the subsequent 6 months. Although the WSAP demonstrated good reliability, evidence of concurrent and prospective validity (in terms of self-reported suicidal ideation and attempts) was limited. Specifically, the clinical groups did not differ from one another on any measure of interpretation bias, nor did suicide-specific interpretation endorsements predict concurrent or future suicidal ideation when controlling for dysphoric interpretation bias. However, suicide-specific interpretation biases were uniquely associated with a history of a lifetime suicide attempt. Future work should further clarify the extent and specificity of the relationship between suicide-specific interpretation biases and clinical outcomes.

Cognitive bias modification for perfectionism and intolerance of uncertainty: A randomized controlled trial

This study investigated the efficacy of combined cognitive bias modification (CBM) on perfectionism and intolerance of uncertainty. Fifty-four university students scoring over 70.5 on the Brief Symptom Measure were randomly assigned to experimental and placebo control groups. The CBM intervention was administered online for 4 weeks. Assessments were given at baseline, after the 4-week intervention, and 1 month post-intervention. Results showed a statistically significant decrease in two dimensions of perfectionism, concern over mistakes and parental criticism, and intolerance of uncertainty of those in the experimental group, compared to those in the control group. The findings related to the interpretation of perfectionism revealed a significant interaction effect of time and direction of sentences for the experimental group. Lastly, the experimental group's interpretation bias scores for intolerance of uncertainty showed a statistically significant increase after the intervention compared to those in the control group. The study's findings provide preliminary support for the effectiveness of CBM on perfectionism and intolerance of uncertainty.

Acceptability and Engagement of a Smartphone-Delivered Interpretation Bias Intervention in a Sample of Black and Latinx Adults: Open Trial

BACKGROUND

Access to evidence-based interventions is urgently required, especially for individuals of minoritized identities who experience unique barriers to mental health care. Digital mental health interventions have the potential to increase accessibility. Previous pilot studies testing HabitWorks, a smartphone app providing an interpretation bias intervention, have found strong engagement and adherence for HabitWorks; however, previous trials' samples consisted of predominantly non-Hispanic, White individuals.

OBJECTIVE

This study conducted an open trial of HabitWorks in a community sample of adults who identified as Black, Hispanic or Latinx, or both. This study aims to test safety, acceptability, and engagement with the HabitWorks app for Black and Latinx adults.

METHODS

Black, Hispanic or Latinx adults (mean age 32.83, SD 11.06 y; 22/31, 71% women) who endorsed symptoms of anxiety or depression were asked to complete interpretation modification exercises via HabitWorks 3 times per week for 1 month. Interpretation bias and anxiety and depression symptoms were assessed at baseline and posttreatment assessments. Participants completed qualitative interviews to assess overall perceptions of HabitWorks.

RESULTS

Of the 31 participants that downloaded the app, 27 (87%) used HabitWorks all 4 weeks. On average, participants completed 15.74 (SD 7.43) exercises out of the 12 prescribed, demonstrating high engagement. Acceptability ratings met all a priori benchmarks except for relevancy. Qualitative interviews also demonstrated high acceptability and few negative experiences. Significant improvements were found in interpretation style (t30=2.29; P<.001), with a large effect size (Cohen d=1.53); anxiety symptoms (t30=2.29; P=.03), with a small effect size (Cohen d=0.41); and depression symptoms (t30=3.065; P=.005), with a medium effect size (Cohen d=0.55).

CONCLUSIONS

This study adds to the literature evaluating digital mental health interventions in Black and Latinx adults. Preliminary results further support a future controlled trial testing the effectiveness of HabitWorks as an intervention.

Anxious youth and adults share threat-biased interpretations of linguistic and visual ambiguity: A proof of concept study

Interpretation bias, or the threatening appraisal of ambiguous information, has been linked to anxiety disorder. Interpretation bias has been demonstrated for linguistic (e.g., evaluation of ambiguous sentences) and visual judgments (e.g., categorizing emotionally ambiguous facial expressions). It is unclear how these separate components of bias might be associated. We examined linguistic and visual interpretation biases in youth and emerging adults with (n = 44) and without (n = 40) anxiety disorder, and in youth-parent dyads (n = 40). Linguistic and visual biases were correlated with each other, and with anxiety. Compared to non-anxious participants, those with anxiety demonstrated stronger biases, and linguistic bias was especially predictive of anxiety symptoms and diagnosis. Age did not moderate these relationships. Parent linguistic bias was correlated with youth anxiety but not linguistic bias; parent and youth visual biases were correlated. Linguistic and visual interpretation biases are linked in clinically-anxious youth and emerging adults.

Autonomic reactivity during acute social stress: exploratory investigation of an interaction by threat interpretation bias and emotion regulation difficulties

Objective: This preliminary study examined the interactive influences of interpretation bias and emotion dysregulation in predicting autonomic stress response.Methods: Participants (N = 72 college students; ages 18-25, 70% female, 47% Hispanic/Latinx), completed a performance-based assessment of threat interpretation bias and self-report measures of emotion regulation difficulties. Electrodermal activity (EDA; skin conductance level) was collected while participants completed a standardized psychosocial stressor task.Results: Interpretation bias and emotion regulation difficulties interacted to predict EDA trajectories (β = 0.054, SE = .001, CI:.007, .002, p < .001) during acute stress: presence of either interpretation bias toward threat (β = 6.950, SE = 2.826, CI: 1.407, 12.488, p = .013) or emotion regulation difficulties (β = 9.387, SE = 3.685, CI: 2.141, 16.636, p = .011) was associated with greater reactivity and poorer recovery; presence of both was associated with the lowest resting state EDA and blunted reactivity (β = 1.340, SE = 3.085, CI: -4.721, 7.407, p = .66).Conclusions: Preliminary findings support interpretation bias and emotion regulation difficulties, and their distinct interactive patterns, as predictors of autonomic reactivity trajectories during stress. Interpretation bias modification and emotion regulation skills may be important intervention targets for common psychological conditions that are influenced by aberrant psychophysiological processes.

Negative interpretation bias connects to real-world daily affect: A multistudy approach

Negative interpretation bias, the tendency to appraise ambiguous stimuli as threatening, shapes our emotional lives. Various laboratory tasks, which differ in stimuli features and task procedures, can quantify negative interpretation bias. However, it is unknown whether these tasks globally predict individual differences in real-world negative (NA) and positive (PA) affect. Across two studies, we tested whether different lab-based negative interpretation bias tasks predict daily NA and PA, measured via mobile phone across months. To quantify negative interpretation bias, Study 1 (N = 69) used a verbal, self-referential task whereas Study 2 (N = 110) used a perceptual, emotional image task with faces and scenes. Across tasks, negative interpretation bias was linked to heightened daily NA. However, only negative interpretation bias in response to ambiguous faces was related to decreased daily PA. These results illustrate the ecological validity of negative interpretation bias tasks and highlight converging and unique relationships between distinct tasks and naturalistic emotion. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Effects of interpretation bias modification on hostile attribution bias and reactive cyber-aggression in Chinese adolescents: a randomized controlled trial

Highly aggressive individuals tend to interpret others' motives and intentions as hostile in both offline and online social situations. The current study examined whether hostile interpretation bias can be modified to influence cyber-aggression in Chinese middle school students using an interpretation bias modification program. Gender differences and the heterogeneity of cyber-aggression were also investigated since previous studies suggest that they play important roles in determining the intervention effect. One hundred and twenty-one middle school students were randomized to receive either an eight-session interpretation bias modification task (CBM-I; n = 61) or an eight-session placebo control task (PCT; n = 60) over four weeks. Measures of hostile attribution bias and cyber-aggression were administered at baseline, post-training, and at one week follow-up. Results showed that compared to PCT, participants in CBM-I showed a significant reduction in reactive cyber-aggression. However, contrary to our expectation, there was no significant difference between the two groups in the reduction of hostile attribution bias after training. The moderated mediation analysis revealed that the effect of CBM-I on hostile attribution bias and the mediating role of hostile attribution bias in the relationship between CBM-I condition and reactive cyber-aggression was only observed among females, but not among males. These findings provide initial evidence for the potential of CBM-I in reducing hostile attribution bias and cyber-aggression. However, for male students, CBM-I might not be effective enough as expected.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12144-023-04433-3.

A Pilot Feasibility Open Trial of an Interpretation Bias Intervention for Parents of Anxious Children

Interpretation bias is a transdiagnostic mechanism underlying anxiety. Theoretical models highlight the role of parental interpretation bias in predicting and maintaining child anxiety. However, very few studies have examined parent interpretation bias as a treatment target. The current pilot study tested the feasibility and acceptability of an interpretation bias intervention delivered by a smartphone app, called HabitWorks, in parents of anxious children who self-reported at least mild symptoms of anxiety and negative interpretation bias. Parents of anxious youth (ages 8 to 16) were recruited from the waitlists of three child anxiety clinics. They were asked to complete interpretation modification exercises via the HabitWorks app 3 times per week for 1 month. Participants completed assessments at pre- and post-intervention and 1-month follow-up to assess changes in interpretation bias, anxiety symptoms, and overall perceptions of HabitWorks. Participants (N=14) (Mage=44.36; 14.29% men, 85.71% women) completed an average of 13.29 exercises out of the 12 prescribed. Acceptability ratings were high. Interpretation bias, as measured by an assessment version of the intervention exercise, significantly improved from pre- to posttreatment, and these improvements were maintained at the 1-month follow-up. Anxiety symptoms significantly improved from the "mild" severity range to the "none to minimal" range. In this pilot feasibility study in parents of anxious youth, HabitWorks was a feasible and acceptable low-intensity intervention. These preliminary results support a future controlled trial of HabitWorks for parents. Future studies are also needed to test whether targeting interpretation bias in parents has downstream effects on maladaptive parent behaviors and ultimately, child interpretation bias and anxiety.

The remediating effect of Attention Bias Modification on aggression in young offenders with antisocial tendency: A randomized controlled trial

BACKGROUND AND OBJECTIVES

An attention bias toward hostile stimuli is associated with an increased risk of aggressive behavior. Thus, reducing hostile attention bias may help to reduce aggression in young offenders. We evaluated the remediating effects of Attention Bias Modification (ABM) on hostile attention bias and aggressive behavior in Chinese male young offenders with antisocial tendencies.

METHODS

Institutionalized male young offenders (ages 16-18) were recruited and randomly assigned to ABM (n = 28), placebo (n = 28), or waiting list (n = 28). The ABM group received four weeks of training using visual search of emotional faces; the placebo group underwent similar training using visual search of neutral objects. Before and after treatment, aggressive behavior, attention bias toward positive stimuli and hostile stimuli were assessed.

RESULTS

Linear mixed models and hierarchical multiple regression analyses showed that the intervention effect of ABM was moderated by participants' initial attention bias. Young offenders with a high level of initial hostile attention bias, or with a low level of initial positive attention bias, benefitted most from ABM.

LIMITATIONS

The small sample size impedes investigation of the mechanism of the intervention's effects. Further research can determine whether the current results can be extrapolated to the population of female young offenders.

CONCLUSION

The results of the present study suggest that ABM is helpful for young offenders who show the greatest bias toward hostile stimuli and away from positive stimuli. These findings highlight the importance of matching the intervention and the participant.

TRIAL REGISTRATION

osf.io/vj5rk.

Scrambled but valid? The scrambled sentences task as a measure of interpretation biases in psychopathology: A systematic review and meta-analysis

The Scrambled Sentences Task (SST) is frequently used to assess interpretation biases (IBs). However, neither the range of its applications nor the quality of the empirical evidence it provides has been systematically examined. This systematic review investigates the types of samples and disorders in which the SST has been applied and evaluates its psychometric properties via a meta-analysis. The databases PubMed and EBSCOhost (including PsycINFO, PsycARTICLES, PSYNDEX, MEDLINE) were examined (last search: September 2021) and 93 studies from 91 manuscripts were included. Results showed that the SST has been applied predominantly in unselected samples or those with elevated levels of subsyndromal symptoms, with about a third of the studies employing the SST in a clinical population. While the SST was initially developed to assess depression-related IBs, it has now been extended to other disorders, in particular anxiety disorders. Results of the meta-analyses indicated good convergent validity and reliability across disorders, albeit in the context of substantial heterogeneity. Findings concerning divergent validity were mixed with high correlations across disorders between the SST and trait anxiety in particular, questioning its specificity. Future research should consider developing standardized SST versions and investigating its relationships with other measures of IB.

Development of a cognitive bias modification intervention for anxiety disorders in primary care

OBJECTIVES

There is a great need for low-intensity, scalable treatments in primary care, where most anxious patients first present for treatment. We describe Stage IA treatment development and a Stage IB feasibility trial of cognitive bias modification (CBM) for transdiagnostic anxiety in primary care.

METHODS

The online intervention, Mental Habits, comprised eight sessions of a personalized CBM targeting attention and interpretation biases. Coaches assisted patients in using the website, monitored progress via a dashboard, and shared information with primary care providers. We evaluated Mental Habits in an open trial (N = 14) and a randomized controlled trial (RCT) (N = 40) in primary care patients with anxiety disorders.

RESULTS

We compared results to a priori benchmarks of clinically meaningful outcomes. In the open trial, Mental Habits met feasibility, acceptability, and efficacy benchmarks. In the pilot RCT, there was greater dropout at one study site which ultimately closed. In the intent-to-treat analyses, Mental Habits met the benchmark for self-report, but not the interview measure of anxiety. Symptom Tracking did not meet the benchmark for self-report or interview measures of anxiety. In per-protocol analyses, Mental Habits exceeded the benchmark for both self-report and interview measures, whereas Symptom Tracking met the benchmark for self-report. Interpretation bias improved in the Mental Habits group, but not in Symptom Tracking. No effects were observed for attention bias.

CONCLUSION

The online CBM intervention demonstrated good acceptability and, when delivered at a stable primary care clinic, preliminary effectiveness in primary care. A larger RCT is warranted to test effectiveness.

PRACTITIONER POINTS

A personalized, transdiagnostic Cognitive Bias Modification (CBM) intervention for anxiety in primary care is acceptable to primary care patients with social anxiety disorder, generalized anxiety disorder, and/or panic disorder /agoraphobia. With training and supervision from licensed mental health clinicians, bachelor's-level coaches can assist primary care patients to self-administer CBM. Offering a low-intensity, self-directed anxiety intervention in primary care can greatly expand the reach of anxiety treatment, with minimal need for additional resources. Interpretation bias may be an important clinical target for primary care patients with anxiety.

How Social Experiences Affect Interpretation Bias Among Individuals With Non-clinical Depression: The Role of Ostracism

BACKGROUND

Extensive knowledge and research indicate that interpretation bias is very common among individuals with sub-clinical and clinical levels of depression. Nevertheless, little is known about the role of social experiences in enhancing interpretation bias. Given the major relevance of social experiences in the context of depression, the present study investigated the role of potential interactions between social experiences and levels of depression symptoms in the interpretation of ambiguous information.

METHOD

Seventy participants underwent a laboratory controlled manipulation either of social ostracism or of overinclusion. Participants completed a computerized task that measured both direct and indirect interpretation bias and reported their level of depression symptoms.

RESULTS

The findings show that ostracism enhanced interpretation bias when symptom levels were higher, while overinclusion did not. This interaction effect between social ostracism and symptom level was found both for direct and for indirect interpretation bias.

CONCLUSION

Whereas previous research showed the existence of interpretation bias among people with symptoms of depression, the present study expands previous knowledge by shedding light on the conditions under which interpretation bias emerges, suggesting that ostracism enhances negative interpretation of ambiguous information when levels of depression symptoms are higher.

Interpretation Bias in Breast Cancer Survivors Experiencing Fear of Cancer Recurrence

Introduction: Fear of cancer recurrence (FCR) is a prevalent and persistent challenge that many cancer survivors endure. While the role of interpretation bias, a tendency to perceive ambiguous situations as threatening, has been established in the onset and maintenance of FCR, few studies have examined cancer-related interpretation bias specifically. Grounded in the cognitive formulation of FCR, the current study aimed to fill this gap by investigating the relationship between cancer-related interpretation bias, FCR, and somatic symptoms, and examining whether bias mediates the relationship between somatic symptoms and FCR.

Materials and Methods: This study used baseline data from a randomized controlled trial of a cognitive bias modification intervention. Breast cancer survivors (n = 110) provided demographic and medical background information as well as self-report measures of FCR and severity of somatic symptoms. A computer-based assessment of interpretation bias was used to measure cancer-related interpretation bias on several bias indices: percentage of cancer-related threat endorsement, and percentage of benign endorsement; mean reaction time (RT) for threat, and mean RT for benign endorsement.

Results: Higher threat endorsement was linked to higher Overall Fear and emerged as a mediator of the relationship between overall somatic symptoms and Overall Fear. We also found that older age was related to longer benign endorsement RT.

Conclusion: This study contributes understanding of factors related to cancer-related interpretation bias and provides evidence that bias may influence the relationship between somatic symptoms and FCR in cancer survivors.

Effects of cognitive bias modification for interpretation on hostile interpretation bias and self-reported aggression in juvenile delinquents

BACKGROUND/OBJECTIVE

The social information processing model holds that aggressive behavior is closely related to the hostile interpretation of ambiguous social cues, suggesting the possibility that an intervention that reduces hostile interpretations could reduce aggression. This study in Mainland China evaluated the remediating effects of cognitive bias modification for interpretation (CBM-I) on the hostile interpretation bias and self-reported aggressive behaviors of male juvenile delinquents, taking into account initial hostile interpretation bias as a possible moderator of the intervention effect.

METHOD

Fifty-six male juvenile delinquents aged 16-18 were recruited and randomly assigned to the CBM-I group (n = 28) or the Waiting-List group (n = 28). Interpretation bias and self-reported aggressive behavior were assessed at pre-test and post-test.

RESULTS

The positive interpretations of participants in the CBM-I group were significantly increased compared with participants in the Waiting-List group. The intervention effect of CBM-I on self-reported physical aggression was significant only for juvenile delinquents with high pre-test hostile interpretation bias.

CONCLUSIONS

CBM-I can significantly improve the positive interpretation bias of juvenile delinquents, and reduce the self-reported physical aggression for some male juvenile delinquents. The results have implications for providing low-cost and high-efficiency intervention for juvenile delinquents' self-reported aggression behavior.

Interpretation biases and depressive symptoms among anxiety-disordered children: The role of individual differences in respiratory sinus arrhythmia

Individual differences in interpretation biases-the tendency to interpret ambiguous stimuli as threatening-partially explain the presence of comorbid depressive symptoms among anxious youth. Increasing efforts have examined physiological processes that influence the association between interpretation biases and depressive symptoms in this population, and potential gender differences in this relationship. This study examined the moderating role of respiratory sinus arrhythmia (RSA) suppression (i.e., decrease from baseline)-an index of parasympathetic nervous system reactivity-in the association between interpretation biases and depressive symptoms in clinically anxious youth. One-hundred-and-five clinically anxious children (Mage  = 10.09 years, SD = 1.22; 56.7% female; 61.9% racial/ethnic minority) completed measures of self-reported and behaviorally indexed interpretation biases, reported anxiety/depression symptom severity, and participated in a speech task. RSA suppression during the task moderated the association between interpretation biases and depressive symptom severity in the total sample. Separate exploratory moderation analyses were conducted among girls and boys. Among girls, RSA suppression moderated the association between behaviorally indexed interpretation biases and depressive symptoms, and marginally moderated (p = .067) the association between self-reported interpretation biases and depressive symptoms. Among boys, RSA suppression was not a significant moderator. These findings may help identify clinically anxious youth most at-risk for comorbid depressive symptoms.

HabitWorks: Development of a CBM-I Smartphone App to Augment and Extend Acute Treatment

The month following discharge from acute psychiatric care is associated with increased risk of relapse, rehospitalization, and suicide. Effective and accessible interventions tailored to this critical transition are urgently needed. Cognitive bias modification for interpretation (CBM-I) is a low-intensity intervention that targets interpretation bias, a transdiagnostic process implicated in the development and maintenance of emotional disorders. We describe the development of a CBM-I smartphone app called HabitWorks as an augmentation to acute care that extends through the high-risk month postdischarge. We first obtained input from various stakeholders, including adults who had completed partial hospital treatment (patient advisory board), providers, CBM experts, and clinic program directors. We then iteratively tested versions of the app, incorporating feedback over three waves of users. Participants were recruited from a partial hospital program and completed CBM-I sessions via the HabitWorks app while attending the hospital program and during the month postdischarge. In this Stage 1A treatment development work, we obtained preliminary data regarding feasibility and acceptability, adherence during acute care, and target engagement. Pilot data met our a priori benchmarks. While adherence during acute treatment was good, it decreased during the postacute period. Qualitative feedback was generally positive and revealed themes of usability and helpfulness of app features. Participants varied in their perception of skill generalization to real-life situations. The feasibility and acceptability data suggest that a controlled trial of HabitWorks is warranted.

Interpretation Bias Across Body Dysmorphic, Social Anxiety and Generalized Anxiety Disorder—A Multilevel, Diffusion Model Account

Background

Interpretation biases are suggested to be transdiagnostic phenomena, but have rarely been compared across different disorders and current concerns.

Methods

We investigated explicit, decision-based, and more implicit, reaction time-based interpretation bias in individuals with body dysmorphic disorder (BDD; N = 29), social anxiety disorder (SAD; N = 36), generalized anxiety disorder (GAD; N = 22), and non-clinical controls (NC; N = 32), using an adapted Word Sentence Association Paradigm (WSAP).

Results

Results indicated that interpretation bias occurred transdiagnostically, while content-specific bias patterns varied meaningfully across groups. BDD and SAD shared explicit and, more inconsistently, implicit interpretation biases for appearance-related and social situations. The GAD group exhibited an explicit and implicit negative interpretation bias for general situations, and an additional implicit lack of positive bias. Mechanistic Wiener diffusion model analyses revealed that interpretation bias patterns were mainly driven by speeded information uptake, potentially mirroring disorder-specific associative memory organization.

Conclusions

These findings have important implications for understanding interpretation biases as both etiological and treatment factors.

Internet-based interpretation bias modification for body dissatisfaction: A three-armed randomized controlled trial

OBJECTIVE

Appearance-related interpretation bias is postulated to play a role in the maintenance of body dissatisfaction (BD), a risk factor for body dysmorphic disorder (BDD), and eating disorders (ED). Cognitive bias modification for interpretation (CBM-I) has been shown to reduce maladaptive interpretation bias and symptoms in various emotional disorders. This study investigated the acceptability and efficacy of an easily disseminable, web-based CBM-I program for BD.

METHODS

Individuals with high BD (N = 318) were randomized to a multi-session CBM-I (Sentence Word Association Paradigm [SWAP] with feedback) vs. control (SWAP without feedback) versus waitlist condition. Interpretation bias, BD and associated symptoms were assessed at baseline and post-intervention. Symptoms were monitored up to 1-week and 4-week follow-up. We further investigated transference effects to stress reactivity, as predicted by cognitive-behavioral models, at post-intervention.

RESULTS

Appearance-related CBM-I led to a differential pre-post increase in adaptive interpretation patterns, particularly for appearance-related and social situations (d = 0.65-1.18). Both CBM-I and control training reduced BD, BDD symptom severity, and depression. However, CBM-I (vs. control and waitlist) improved appearance-related quality of life (d = 0.51), self-esteem (d = 0.52), and maladaptive appearance-related beliefs (d = 0.47). State stress reactivity was overall reduced in the CBM-I condition (vs. waitlist). Intervention effects largely held stable up to follow-ups. Treatment satisfaction was comparable to other CBM-I studies, with low rates of adverse reactions.

DISCUSSION

These findings support assumptions of cognitive-behavioral models for BD, BDD, and ED, and suggest that web-based CBM-I is an efficacious and acceptable intervention option.

Associations among interpretation bias, craving, and abstinence self-efficacy in adults with substance use disorders

OBJECTIVE

Interpretation bias is a crucial therapeutic target in emotional disorders. However, few studies have examined the role of interpretation bias in substance use disorders (SUDs). Our specific aims were: (1) to examine whether interpretation bias was associated with craving and abstinence self-efficacy, and (2) explore potential moderators of these associations, including anxiety severity, sex, and substance type.

METHODS

Adults attending an inpatient SUD treatment program (N = 224; mean age = 38.95; 67% male/33% female; 68% primary alcohol use disorder/29% primary opioid use disorder) completed the Word-Sentence Association Paradigm (WSAP) with ambiguous situations related to general anxiety domains (e.g., daily stress, health, relationships), as well as measures of craving (Craving Scale), abstinence self-efficacy (Brief Situational Confidence Scale), and anxiety symptoms (Overall Anxiety Severity and Impairment Scale [OASIS] and Anxiety Sensitivity Index-3).

RESULTS

Negative interpretation bias was modestly associated with more craving (r = .23, p =  .001) and less confidence to resist using substances (r = -0.23, p =  .001). In multiple linear regression models that included the anxiety measures, interpretation bias was the most robust predictor of craving and abstinence self-efficacy. Sex (N = 224) and substance type (opioid vs. alcohol; n = 219) did not moderate these relationships.

CONCLUSIONS

These findings suggest that interpretation bias might be an important individual difference within SUD populations.

Effortful control, interpretation biases, and child anxiety symptom severity in a sample of children with anxiety disorders

INTRODUCTION

Effortful control-the ability to inhibit impulsive reactions in favor of more adaptive responses-is negatively related to child anxiety severity. One potential explanation is that greater effortful control may "slow down" automatic, threat-laden interpretations, thereby lowering children's anxiety. The present investigation tested this hypothesis by examining associations between effortful control (and its subcomponents) and anxiety symptom severity, mediated by interpretation biases, in a diverse sample of clinically anxious youth.

METHOD

Participants (N = 105; M_age = 10.09 years, SD = 1.22; 56.7% female; 49% ethnic minority) completed a diagnostic interview; self-report measures of temperament, anxiety, and interpretation biases; a performance-based measure of interpretation biases; and a parent-child interaction task for which an index of behavioral anxiety was computed.

RESULTS

Significant indirect effects were found for effortful control, attentional control, and inhibitory control on child self-reported anxiety severity by way of self-reported (but not behaviorally-indexed) interpretation biases. Models predicting behaviorally-indexed child anxiety severity were not significant.

DISCUSSION

Greater effortful control may result in enhanced attentional capacities that allow children to assess automatic cognitions more objectively, potentially lowering their anxiety. Future work should evaluate whether targeting malleable temperamental constructs, such as effortful control, leads to clinically meaningful reductions in interpretation biases and child anxiety symptoms.