Framing social information and generalized social phobia

Patients with generalized social phobia (GSP, N=33) and matched community controls (N=31) engaged in a social interaction that was constructed to go well, and then received feedback that framed social cues reflecting either the absence of negative outcomes or the presence of positive outcomes. Following feedback that framed positive social cues, the GSP group predicted they would experience more anxiety in a subsequent interaction than did non-phobic controls. In contrast, following feedback framing the absence of negative outcomes, the GSP group did not differ from controls in their anxiety predictions. The results demonstrated that framing paradigms and methods can be usefully applied to the study of cognitive processes in social phobia and indicated that research to examine how GSP patients process specific types of social information is needed.     

Interpretation and judgmental biases in social phobia

Previous research demonstrated that social phobia is characterized by content-specific interpretation and judgmental biases. The present study investigated whether this interpretation bias occurs not only in ambiguous, but also in positive and negative social events, and whether social phobic patients (SPs) are more characterized by a judgmental bias in costs than in probability. Besides, we argued that the judgmental bias observed in former studies could also be attributed to accurate estimations of SPs (of, for example, stuttering). Therefore, we assessed judgmental bias by the ratings of probability and costs of a negative evaluation (e.g. ‘people dislike me’) and not, as in previous studies, of negative social events (e.g. ‘stuttering’). SPs (n=228) and normal controls (n=33) were presented social and non-social events ranging from positive to profoundly negative. They ranked four different interpretations on likelihood to assess interpretation bias, and rated the profoundly negative interpretation on probability and cost to assess judgmental bias. SPs demonstrated content-specific interpretation and judgmental biases that also occurred in positive and negative social events. In contrast with expectations, SPs were characterized by a judgmental bias in both costs and probability.     

The interpretation of negative social events in social phobia: changes during treatment and relationship to outcome

Catastrophic interpretations of negative social events are considered to be an important factor underlying social phobia. This study investigated the extent to which these interpretative biases change during cognitive-behavioural treatment for social phobia, and examined whether within-treatment changes in different types of interpretations predict longer-term treatment outcome. Results showed that treatment was associated with decreases in various types of maladaptive interpretations of negative social events, but that social phobia symptoms 3 months after treatment were independently predicted only by within-treatment reductions in the degree to which individuals personally believed that negative social events were indicative of unfavourable self-characteristics. These findings are discussed in relation to cognitive models of the maintenance of social anxiety, and implications for treatment are considered.     

Experimental modification of interpretation bias in socially anxious children: Changes in interpretation, anticipated interpersonal anxiety, and social anxiety symptoms

We report on an experimental manipulation of interpretation bias in socially anxious youths. A non-clinical sample of 10–11-year-olds selected for high social anxiety was trained over three sessions to endorse benign rather than negative interpretations of potentially threatening social scenarios. This group was subsequently less likely to endorse negative interpretations of new ambiguous social situations than children in a test–retest condition. Children who received interpretation training also showed reduced trait social anxiety and reported significantly less anxiety about an anticipated interpersonal encounter, compared with the control group.     

Forced choice reaction time paradigm in children with separation anxiety disorder, social phobia, and nonanxious controls

Cognitive distortions refer to cognitive processes that are biased and therefore yield dysfunctional and maladaptive products (e.g., interpretation bias). Automatic aspects of information processing need to be considered and investigating these aspects requires forms of assessment other than self-report. Studies focussing on the specificity of cognitive biases across different types of anxiety disorders in childhood are rare. Thus, a forced choice reaction time paradigm with picture stimuli was used to assess the interpretation bias in anxious children online. The study investigated disorder-specific interpretation bias in 71 children with separation anxiety disorder (SAD), 31 children with social phobia, and 42 children without mental disorders, aged 5–13 years. Results indicated that children with SAD rated ambiguous separation pictures as significantly more unpleasant and more arousing than nonanxious children. However, no support was found that children with SAD and social phobia interpret ambiguous separation or social pictures in a more negative way than nonanxious children. Furthermore, no group differences were found in reaction times to all picture categories.     

Recognition bias for critical faces in social phobia: a replication and extension

Studies using linguistic stimuli have provided little support for explicit memory biases among individuals with social phobia (SP). However, using facial stimuli rated on their criticalness, Lundh and Ost (1996) found that individuals with SP recognized more critical than accepting faces, whereas non-anxious controls tended to show the opposite pattern. Since the publication of Lundh and Ost's findings, additional studies using a variety of facial stimuli have produced inconsistent findings (J. Anxiety Disord. 14 (2000) 501; Behav. Res. Ther. 39 (2001) 967). Unfortunately, these inconsistencies are difficult to reconcile given great variation in methods and stimuli. Therefore, we designed a study to replicate and extend the work of Lundh and Ost (Behav. Res. Ther. 34 (1996) 787). Similar to Lundh and Ost, individuals with SP identified a significantly higher proportion of old critical faces as old than did non-anxious controls. Further, extending the work of Lundh and Ost, signal detection analyses revealed group differences on response bias according to face type. Specifically, controls showed a response bias towards indicating that accepting faces were previously seen, whereas individuals with SP did not. Finally, signal detection analyses failed to reveal group differences in the accuracy of memory.     

Social skills and social phobia: An investigation of DSM-IV subtypes

Social phobia is characterized as pervasive social timidity in social settings. Although much is known about this disorder, aspects of its clinical presentation remain unexplored, in particular characteristics that distinguish the generalized and non-generalized subtypes. For example, it remains unclear whether patients with the non-generalized subtype display social skills deficits in social interactions, and if so, are these deficits clinically, as well as statistically, significant? In this study, adults with either the non-generalized (NGSP; n = 60) or generalized (GSP; n = 119) subtype of social phobia and adults with no psychological disorder (n = 200) completed an extensive behavioral assessment of social skill and social anxiety. As expected, adults with NGSP and GSP reported equal distress and displayed similar rates of avoidance during an Impromptu Speech Task when compared to adults with no disorder. In contrast, the three groups were distinctly different when interacting with another person in various social situations. Adults with NGSP displayed social skill deficits when compared to individuals with no disorder, but they had fewer deficits than the GSP subtype. However, the identified skill deficits were clinically as well as statistically significant only for the GSP subtype. The results are discussed in terms of the contribution of skill deficits to the conceptualization and treatment of social phobia.     

The effects of modifying interpretation bias on worry in generalized anxiety disorder

This study investigated whether facilitating a benign interpretive bias decreases negative thought intrusions in generalized anxiety disorder (GAD). Clients were randomly allocated to an interpretation modification condition in which they repeatedly accessed benign meanings of emotionally ambiguous homographs and scenarios, or to a control condition in which they accessed threat and benign meanings with equal frequency. Worry frequency was assessed using a breathing focus task that involved categorising the valence of thought intrusions before and after an instructed worry period. Interpretation bias was assessed during the modification tasks, and on a different measure of interpretation bias (sentence completion) following a period of worry. The experimental procedure modified interpretations made during training, and in the later sentence completion task. Furthermore, compared to the control group, the benign group showed fewer negative thought intrusions during breathing focus (as rated by both participants and an assessor). These findings show that it is possible to induce a more benign interpretive bias in GAD clients and that this reduces negative thought intrusions.     

Recognition and evaluation of emotional prosody in individuals with generalized social phobia: a pilot study

Studies using facial emotional expressions as stimuli partially support the assumption of biased processing of social signals in social phobia. This pilot study explored for the first time whether individuals with social phobia display a processing bias towards emotional prosody. Fifteen individuals with generalized social phobia and fifteen healthy controls (HC) matched for gender, age, and education completed a recognition test consisting of meaningless utterances spoken in a neutral, angry, sad, fearful, disgusted or happy tone of voice. Participants also evaluated the stimuli with regard to valence and arousal. While these ratings did not differ significantly between groups, analysis of the recognition test revealed enhanced identification of sad and fearful voices and decreased identification of happy voices in individuals with social phobia compared with HC. The two groups did not differ in their processing of neutral, disgust, and anger prosody.     

A multi-session interpretation modification program: changes in interpretation and social anxiety symptoms

Previous research suggests that socially anxious individuals interpret ambiguous social information in a more threatening manner compared to non-anxious individuals. Recently, studies have experimentally modified interpretation and shown that this subsequently affected anxiety in non-anxious individuals. If similar procedures can modify interpretation biases in socially anxious individuals, they may lead to a reduction in social anxiety symptoms. In the current study, we examined the effect of a computerized Interpretation Modification Program (IMP) on interpretation bias and social anxiety symptoms. Twenty-seven socially anxious individuals were randomly assigned to the IMP or a control condition. Participants completed eight computer sessions over four weeks. The IMP modified interpretation by providing positive feedback when participants made benign interpretations and negative feedback in response to threat interpretations. The IMP successfully decreased threat interpretations, increased benign interpretations, and decreased social anxiety symptoms compared to the control condition. Moreover, changes in benign interpretation mediated IMP's effect on social anxiety. This initial trial suggests that interpretation modification may have clinical utility when applied as a multi-session intervention.     

The indirect effect of attention bias on memory via interpretation bias: Evidence for the combined cognitive bias hypothesis in subclinical depression

Little research has investigated functional relations among attention, interpretation, and memory biases in depressed samples. The present study tested the indirect effect of attention bias on memory through interpretation bias as an intervening variable in a mixed sample of non-depressed and subclinically depressed individuals. Subclinically depressed and non-depressed individuals completed a spatial cueing task (to measure attention bias), followed by a scrambled sentences test (to measure interpretation bias), and an incidental free recall task (to measure memory bias). Bias-corrected bootstrapping yielded evidence for the hypothesised indirect effect model, in that an emotional bias in attention is related to a congruent bias in interpretative choices which are in turn reflected in memory. These findings extend previous research and provide further support for the combined cognitive bias hypothesis in depression. Theoretical and clinical implications of our findings are discussed.     

Psychometric properties of the social phobia inventory: further evaluation

This study investigated the psychometric properties of the Social Phobia Inventory [SPIN; Connor, K. M., Davidson, J. R. T., Churchill, L. E., Sherwood, A., Foa, E., Wesler, R.H., 2000. Psychometric properties of the Social Phobia Inventory (SPIN). British Journal of Psychiatry, 176, 379-386], a measure of severity in social phobia (social anxiety disorder). Participants included 132 participants with social phobia, 57 participants with panic disorder and agoraphobia (PDA), and 62 participants with obsessive-compulsive disorder (OCD). Confirming findings from an initial validation study, the SPIN was found to have excellent internal consistency and good test-retest reliability. It also distinguished well between those with social phobia and those with either PDA or OCD. Good convergent and discriminant validity were established by examining correlations with other conceptually related and unrelated scales. Finally, the SPIN was sensitive to changes in social phobia severity following cognitive behavioral group treatment. In conclusion, the SPIN is both reliable and valid for the measurement of social phobia severity and outcome following psychological treatment.     

Selective attention in social phobia and the moderating effect of a concurrent depressive disorder

Studies using the modified Stroop colour naming task have provided results consistent with the hypothesis that social phobia is associated with an attentional bias towards negative social-evaluative words. However, these results could also have arisen as a consequence of non-attentional processes. For this reason, the present study uses a modified version of MacLeod et al.'s (J. Abnorm. Psychol. 95 (1986) 15) dot-probe task, which provides a more direct measure of attention. Patients with social phobia (n=28), patients with social phobia and a concurrent depressive disorder (n=33), and non-patients (n=40) were presented with word pairs each consisting of a neutral word and a threat word. The results indicated that patients with social phobia show an attentional bias towards social-threat words while non-patients tend to avoid social-threat words. Patients with social phobia and a concurrent depressive disorder behaved like non-patients, indicating that concurrent depression abolishes the attentional bias. Physical threat words were also included in the study. The main analysis indicated that social phobia is also associated with an attentional bias to physical threat. However, a post hoc analysis (which requires replication) suggested that the physical threat bias might have arisen because some social phobia patients also had another anxiety disorder in which physical concerns are likely to have been prominent. Overall, the results emphasise the importance of assessing comorbidity when investigating attentional biases.     

When ambiguity hurts: social standards moderate self-appraisals in generalized social phobia

Thirty-nine individuals with generalized social phobia (social anxiety disorder) and 39 nonclinical controls performed a public speech after receiving cues about social standards. Using a novel video manipulation paradigm, one third of participants received cues indicating that standards for performance were high, one third received cues that standards were low, and the remaining third were given no explicit information about expected standards (i.e., standards were ambiguous). Individuals with social phobia performed objectively worse than controls in all conditions, but rated their performance as being worse only in the high and ambiguous standards conditions. These results suggest that in social phobia, negative self-perception is context-dependent. Implications for the cognitive model and treatment are discussed.     

In the absence of rose-colored glasses: Ratings of self-attributes and their differential certainty and importance across multiple dimensions in social phobia

Sixty-seven individuals with social phobia (social anxiety disorder) and 60 healthy controls rated their perceived standing relative to others on 13 self-attribute dimensions, their level of certainty concerning those standings, and the importance of each dimension. As expected, individuals with social phobia provided self-ratings that were significantly more negative than controls across all dimensions. In addition, positive self-views were equated with higher levels of certainty and importance for controls, but not for individuals with social phobia. Thus, whereas reports of control participants reflected a healthy, positive framing of self-views, the ratings of clinical participants demonstrated an orientation toward self-framing that was neither positive nor negative. Together, these novel findings shed light on the nature of self-appraisals in social anxiety. Implications of these results are discussed in terms of contemporary cognitive-behavioral models of social phobia.     

Validation of an interpretation bias assessment for body dissatisfaction

Currently, research on interpretation bias and body dissatisfaction is limited. The few experimental paradigms that have been used to explore this phenomenon utilized a method that may not accurately capture the nature of interpretation bias as explained by cognitive theory. The present study investigated the reliability and validity of a novel computerized assessment of interpretation bias (WSAP) for body dissatisfaction, which may more accurately reflect the cognitive processing involved in such bias by implementing the Word Sentence Association Paradigm (WSAP), a previously established method of measuring interpretation bias in other clinical populations. Undergraduate females (n = 214) completed the WSAP and other measures. Results indicate initial support for the WSAP as a valid, reliable measure of interpretation bias for body dissatisfaction. Although preliminary, this study contributes to the minimal research in this area and serves as the first psychometric investigation of the WSAP to measure such interpretation bias for body dissatisfaction.     

Social anxiety and interpretation biases for facial displays of emotion: emotion detection and ratings of social cost

The current study assessed the processing of facial displays of emotion (Happy, Disgust, and Neutral) of varying emotional intensities in participants with high vs. low social anxiety. Use of facial expressions of varying intensities allowed for strong external validity and a fine-grained analysis of interpretation biases. Sensitivity to perceiving negative evaluation in faces (i.e., emotion detection) was assessed at both long (unlimited) and brief (60 ms) stimulus durations. In addition, ratings of perceived social cost were made indicating what participants judged it would be like to have a social interaction with a person exhibiting the stimulus emotion. Results suggest that high social anxiety participants did not demonstrate biases in their sensitivity to perceiving negative evaluation (i.e. disgust) in facial expressions. However, high social anxiety participants did estimate the perceived cost of interacting with someone showing disgust to be significantly greater than low social anxiety participants, regardless of the intensity of the disgust expression. These results are consistent with a specific type of interpretation bias in which participants with social anxiety have elevated ratings of the social cost of interacting with individuals displaying negative evaluation.     

Developing a measure of interpretation bias for depressed mood: An ambiguous scenarios test

The tendency to interpret ambiguous everyday situations in a relatively negative manner (negative interpretation bias) is central to cognitive models of depression. Limited tools are available to measure this bias, either experimentally or in the clinic. This study aimed to develop a pragmatic interpretation bias measure using an ambiguous scenarios test relevant to depressed mood (the AST-D).¹ In Study 1, after a pilot phase (N = 53), the AST-D was presented via a web-based survey (N = 208). Participants imagined and rated each AST-D ambiguous scenario. As predicted, higher dysphoric mood was associated with lower pleasantness ratings (more negative bias), independent of mental imagery measures. In Study 2, self-report ratings were compared with objective ratings of participants’ imagined outcomes of the ambiguous scenarios (N = 41). Data were collected in the experimental context of a functional Magnetic Resonance Imaging scanner. Consistent with subjective bias scores, independent judges rated more sentences as negatively valenced for the high versus low dysphoric group. Overall, results suggest the potential utility of the AST-D in assessing interpretation bias associated with depressed mood.     

Cascading effects: the influence of attention bias to threat on the interpretation of ambiguous information

Both attention bias to threat and negative interpretive bias have been implicated in the emergence and maintenance of anxiety disorders. However, relations between attention and interpretive biases remain poorly understood. The current study experimentally manipulated attention bias to threat and examined the effects of attention training on the way ambiguous information was interpreted. Results suggest that the preferential allocation of attention towards threat affects the manner in which ambiguous information is interpreted. Individuals trained to attend to threat were more likely than individuals in a placebo training group to interpret ambiguous information in a threat-related manner. These data suggest that perturbations in the initial stages of information processing associated with anxiety may lead to a cascade of subsequent processing biases.     

Inducing an interpretation bias changes self-imagery: a preliminary investigation

Prior work suggests that variations in self-imagery can influence the emotional interpretations people make about social situations. The current experiment investigated the converse possibility: that inducing an inferential bias can change the content of self-related images. The effects of repeated practice in accessing either negative or positive social outcomes was tested by having participants report on self-images generated during subsequent experience with ambiguous social situations. Participants and independent judges rated the content of participants’ self-images as being more negative after prior practice in accessing negative rather than positive social outcomes. Furthermore, participants who practiced accessing negative outcomes rated their anticipated anxiety in an imagined stressful social situation as being greater, and their expected social performance as poorer than participants in the positive outcome group. Groups did not differ in state anxiety levels when making their ratings, so it is unlikely that any observed differences between groups can be attributed to mood effects. We suggest that this finding is consistent with the hypothesis that inferential biases and content of self-images can interact with each other and may together serve to maintain social anxiety.