Interpretation bias and social anxiety: does interpretation bias mediate the relationship between trait social anxiety and state anxiety responses?

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.

Social Evaluation in Emerging Adults: Associations with Interpretation Bias and Perceived Social Support

Social anxiety symptoms are one of the most common mental health concerns across the lifespan (Bandelow and Michaelis in Dialogues Clin Neurosci 17(3):327-335, 2015. https://doi.org/10.31887/DCNS.2015.17.3/bbandelow ) and are especially relevant during emerging adulthood, when social feedback occurs daily (Auxier and Anderson in Social media use in 2021, 2021. https://www.pewresearch.org/internet/2021/04/07/social-media-use-in-2021/ ) as emerging adults navigate new social environments. Two cognitive processes have been identified as relevant to social anxiety: high threat interpretation bias (i.e., the tendency to appraise threat from ambiguity; Rozenman et al. in Behav Ther 45(5):594-605, 2014. https://doi.org/10.1016/j.beth.2014.03.009 ; J Anxiety Disord 45:34-42, 2017. https://doi.org/10.1016/j.janxdis.2016.11.004 ) is associated with high social anxiety, whereas high perceived social support is associated with low social anxiety. In this study, emerging adults (N = 303) completed an online adaptation of the Chatroom task (Guyer et al. in Arch Gener Psychiatry 65(11):1303-1312, 2008. https://doi.org/10.1001/archpsyc.65.11.1303 ), an experimental paradigm designed to simulate social acceptance and rejection, as well as a performance-based measure of interpretation bias (Word Sentence Association Paradigm; Beard and Amir in Behav Res Ther 46(10):1135-1141, 2008. https://doi.org/10.1016/j.brat.2008.05.012 ), and a self-report measure of perceived social support (Multidimensional Scale of Perceived Social Support; Zimet et al. in J Pers Assess 52(1), 30-41, 1988. https://doi.org/10.1207/s15327752jpa5201_2 ). Social anxiety symptoms did not increase as a function of acceptance or rejection during the Chatroom task. However, there were significant interactions between each cognitive predictor and social anxiety change: emerging adults with low interpretation bias towards threat and emerging adults with high perceived social support both experienced decreases in social anxiety from pre- to post-Chatroom task, regardless of whether they were accepted or rejected during the Chatroom task. If replicated, low interpretation bias and high perceived social support may serve as promotive factors in social interactions for emerging adults.

The role of interpretation biases and safety behaviours in social anxiety: an intensive longitudinal study

BACKGROUND

Interpretation bias and safety behaviours (Safe-B) have been proposed as factors perpetuating social anxiety (SA). However, longitudinal research on how they contribute to SA in everyday life is scarce.

AIM

The aim was to examine whether interpretation bias predicts daily Safe-B and SA. A mediated moderation was hypothesized, where the relationship between daily social stressors and Safe-B would be moderated by interpretation bias, and Safe-B, in turn, would mediate the association between stressors and SA levels. In addition, it was hypothesized that prior levels of SA would predict higher Safe-B use, especially in co-occurrence with stressors.

METHOD

An intensive longitudinal design was employed, with 138 vocational training students (51% men, mean age 20.15 years). They completed initial measures of SA and interpretation bias and 7-day diaries with measures of social stressors, Safe-B, and SA. They reported SA levels two months later.

RESULTS

Both stressors and interpretation bias in ambiguous situations predicted Safe-B, which in turn predicted daily SA levels. However, neither interpretation bias nor Safe-B predicted SA levels at the follow-up, and interpretation bias did not moderate the association between stressors and daily SA. In addition, the relationship between stressors and Safe-B was stronger in people with higher initial SA levels.

CONCLUSIONS

The results suggest that Safe-B are a mechanism through which earlier SA levels and interpretation bias contribute to higher SA levels in daily life.

The effect of virtual reality exposure therapy on focus of attention, self-criticism, and interpretation bias in university students with social anxiety

BACKGROUND

The present research aims to investigate the effectiveness of virtual reality exposure therapy on the focus of attention, self-criticism, and interpretation bias among university students with social anxiety.

MATERIALS AND METHODS

The present research was conducted using quasi-experimental research with pre-test and post-test control group design. The participants were university students aged between 10 and 30 years old who had visited Isfahan counseling centers in 1399 HS. Among 53 patients referred to the counseling centers, 30 were randomly selected by convenience sampling and then assigned to an experimental group (15 individuals) and a control group (15 individuals). The experimental group received eight sessions of 30-minute and face-to-face virtual reality-based interventions. In contrast, the control group remained on the waiting list. A structured clinical interview and Social Phobia Inventory (SPIN) were used to select and screen students, and the Focus of Attention Questionnaire (FAQ), Levels of Self-Criticism Scale (LOSC), and revised interpretation bias inventory were applied for the pre-test and the post-test. Then, all the data were analyzed by a statistical analysis of covariance.

RESULTS

The results showed that virtual reality exposure therapy significantly reduces the symptoms of the focus of attention, self-criticism, and interpretation bias in the experimental group compared to the control group. (P < 0/01).

CONCLUSION

The research showed that virtual reality exposure therapy reduced the symptoms of social anxiety. Therefore, this method can be applied to reduce some symptoms of social anxiety in university students.

Comparison of Social-Evaluative Anxiety and Theory of Mind Functions in Social Anxiety Disorder, Schizophrenia, and Healthy Controls

INTRODUCTION

Despite the similarities in poor social competence and clinical manifestations of poor social behavior, no study has compared the theory of mind performance between social anxiety disorder (SAD) and schizophrenia, considering the effect of social-evaluative anxiety and neurocognitive functions. In our study, we aimed to compare the theory of mind functions and social-evaluative anxiety between patients with SAD and schizophrenia and healthy controls and to examine the relationship between the theory of mind, neurocognitive skills, and social-evaluative anxiety.

METHODS

Thirty-four consecutive patients with schizophrenia, 29 patients with SAD, and 30 controls matched by age, education level, and sex were enrolled in the study. Structured Clinical Interview for DSM, Beck Depression Inventory, Liebowitz Social Anxiety Scale, Theory of Mind measures (Reading the Mind in the Eyes Test, Hinting Task, Faux Pas Test), Social Appearance Anxiety Scale, Fear of Positive Evaluation Scale, Fear of Negative Evaluation Scale-Short Form, and neuropsychological tests were administered to all participants.

RESULTS

A greater significant deterioration in theory of mind and neurocognitive functions was found in patients with schizophrenia compared to those with SAD and healthy controls. Social evaluation anxiety was highest in patients with SAD. Although social-evaluative anxiety was associated with the theory of mind function in schizophrenia, only fear of positive evaluation was associated with SAD. In all groups, neither theory of mind nor neurocognitive ability measures were correlated with social anxiety levels and related symptoms.

CONCLUSIONS

The impaired theory of mind functioning detected in our study is more prominent in the schizophrenia group and largely independent of anxiety in schizophrenia and SAD. Although social evaluation anxiety, as a transdiagnostic concept, seems to be independent of theory of mind function in general, fear of positive evaluation seems to be associated with hinting in both disorders.

Out of Sight, Still in Mind: The Consequences of Nonfoveal Viewing of Emotional Faces in Social Anxiety

Background: Anxiety sensitivity social concerns (ASSC) is a risk factor for social anxiety disorder that may motivate avoidance of eye contact (i.e., gaze avoidance), thereby maintaining anxiety. Gaze avoidance displaces socially relevant stimuli (e.g., faces) from foveal (i.e., center) vision, possibly reducing visual sensation of faces and giving an opportunity to misperceive others as rejecting. Methods: We tested the effects of non-foveal viewing on perceiving faces as rejecting, whether there is an indirect effect of ASSC on state anxiety explained by perceived rejection, and whether the indirect effect depended on non-foveal viewing of faces. Participants (N = 118) viewed faces presented within foveal and non-foveal positions and rated how rejecting each face appeared to be, followed by ratings of their own state anxiety. Results: ASSC was associated with perceiving faces as rejecting regardless of face position. There was an indirect effect of ASSC on state anxiety ratings that was explained by perceived rejection, but only in the non-foveal positions. The indirect effect was due to an association between perceived rejection and state anxiety that was only present when faces were viewed in non-foveal vision. Discussion: The findings suggest ASSC may maintain state anxiety partially through the perceived rejection someone experiences while avoiding the gaze of others. This study supports cognitive theories of social anxiety and encourages cognitive-behavioral interventions for gaze avoidance in people with social anxiety disorder.

Comparing evaluations of social situations for adults who do and do not stutter

PURPOSE

Numerous research studies indicate that stuttering is associated with increased risk for social anxiety disorder (SAD). Interpretation bias is one of four cognitive biases thought to maintain symptoms associated with SAD. Interpretation bias occurs when one evaluates social situations as more negative than they actually are. The purpose of this study was to investigate if adults who do and do not stutter interpret positive, ambiguous, mildly negative, and profoundly negative social situations similarly, or-if like individuals with SAD-adults who stutter exhibit negative interpretation biases.

METHOD

Forty-eight adults who stutter and 42 age-and gender-matched adults who do not stutter participated. Participants completed the Fear of Negative Evaluation (FNE) and were assigned to one of four groups: adults who stutter with high FNE (AWS-High), adults who stutter with low FNE (AWS-Low), adults who do not stutter with high FNE (AWNS-High), and adults who do not stutter with low FNE (AWNS-Low). All participants completed the trait scale of the State Trait Anxiety Inventory (STAI) and the Interpretation and Judgmental Questionnaire (IJQ). The IJQ contains descriptions of four types of social situations: positive, mildly negative, profoundly negative, and ambiguous. Within each situation type there are five different scenarios, for a total of 20 scenarios across the four situation types. Participants provided written responses to these 20 social scenarios. Qualitative analyses were used to understand how members of each group interpreted the different social scenarios.

RESULTS

Thematic analysis revealed that each group responded in similar ways to each of the social scenarios, regardless of the type of situation. Adults who do and do not stutter with low and high FNE agreed on many themes related to the 20 social scenarios, and they agreed across all four types of social situations. Somewhat surprisingly, the theme "stuttering" was mentioned infrequently by the adults who stutter.

CONCLUSIONS

Results suggested that adults who do and do not stutter with low and high FNE interpret social situations similarly, and that no group demonstrated a negative interpretation bias consistent with what is observed in adults with SAD. The interpretations provided by each group were appropriate to the specific scenarios being evaluated.

Perceptions towards an interaction partner predict social anxiety: an ecological momentary assessment study

Social anxiety occurs in everyday social interactions, yet the real-world factors that shape the moment-to-moment experience of social anxiety have not been fully explored. Using ecological momentary assessments (smartphone-based, five signals a day for 21 days), the present study examined the associations between state social anxiety (SSA) and characteristics of interaction partners in varied contexts, and how these momentary associations differed with trait social anxiety (TSA). Ninety-two participants (54% female, age from 18 to 34) completed 4185 momentary reports. Results from multilevel models showed that perceived judgmentalness and unfamiliarity of interaction partners were positively associated with SSA, and the associations were stronger for the high TSA group (n = 30) compared to a control group (n = 62). Exploratory analyses with various types of interaction partners and social settings revealed noticeable group differences in how the types were associated with SSA (e.g. acquaintance, close friend/romantic partner) and how they influenced the effect of judgmentalness and unfamiliarity on SSA (e.g. authority, work/school). Overall, the findings highlight the role of contextual associations in social anxiety, and the benefits and the need for more comprehensive approaches with EMA in studying social anxiety, particularly its contextual aspects.

Interpretation bias in social anxiety: A systematic review and meta-analysis

BACKGROUND

Interpretation bias, which involves interpreting ambiguous social events negatively and catastrophising even mildly negative social events, has been suggested as a key maintenance factor of Social Anxiety Disorder. Although some individual studies and narrative reviews have demonstrated a role for negative interpretation bias in social anxiety (disorder), findings have been mixed. Given the lack of a quantitative synthesis of the evidence, the current systematic review and meta-analysis examined the strength of the relationship between interpretation bias and social anxiety. It also investigated potential moderators of this relationship (i.e., types of measures and stimuli, samples, and study designs).

METHODS

Five databases (PsycINFO, PubMed, Medline, Scopus, and CINAHL) were searched. Of 46 studies identified, 44 were suitable for meta-analysis (N = 3859).

RESULTS

There was a large effect for the relationship between social anxiety and interpretation bias (g = 0.83). Types of measures (subjective versus objective) and stimuli (verbal versus visual) were identified as significant moderators, with subjective measures and verbal stimuli particularly adept at capturing interpretation bias in socially anxious individuals.

LIMITATIONS

The effect sizes displayed significant heterogeneity between studies, which likely reflects some publication bias, and thus, the overall effect size may be inflated.

CONCLUSION

Findings may help to refine clinical models and interventions for Social Anxiety Disorder, which in turn may maximise evidence-based interventions that target negative interpretation bias in this disorder.

Hypermentalizing in Social Anxiety: Evidence for a Context-Dependent Relationship

Social anxiety (SA) means fear of scrutiny and of others’ negative evaluation, thus indicating that hypermentalizing (HMZ) (i.e., the over-attribution of intentions and thoughts to others) might be the most common error of social cognition in SA. However, evidence for this is weak. One explanation is that HMZ is not stable in SA, but rather context-dependent. The first aim of the current study was testing this hypothesis. The second aim was analyzing whether the association between SA and HMZ is moderated by a negative self-image. One-hundred and thirteen young adults (85.8% females; M = 21.1 years old; SD = 2.7) were assessed on measures of SA, HMZ, and self-image. Given the over-representation of females, conclusions may not be safely extrapolated to males. Results revealed that HMZ is associated with SA only in the self-referential social situation [B = 2.68 (95% CI: 0.72–4.65), p = 0.007]. This supports that HMZ is not global in SA (i.e., a stable cognitive style), but rather is active only in some contexts. Implications for the conceptualization and treatment of SA are discussed. Contrary to predictions, neither self-esteem, nor positive or negative self-schema moderated the association between SA and self-referential HMZ. This contradicts findings in the field of paranoid delusion and requires replication, including measures of implicit self-esteem.