Experienced disgust causes a negative interpretation bias: a causal role for disgust in anxious psychopathology

This paper reports the results of an experiment investigating the effect of induced disgust on interpretational bias using the homophone spelling task. Four groups of participants experienced a disgust, anxiety, happy or neutral mood induction and then completed the homophone spelling task which requires the participant to interpret ambiguous words presented through headphones. Both the disgust and anxiety groups interpreted significantly more threat/neutral homophones as threat than both the happy and neutral groups; the disgust group also interpreted significantly fewer positive/neutral homophones as positive than the happy group. These findings are consistent with the view that induced disgust causes a negative interpretational bias which is similar to that reported for anxiety. The results could not be interpreted in terms of the disgust induction concurrently raising levels of self-reported anxiety, but could be interpreted in terms of disgust maintaining existing levels of anxiety. The effect of disgust was to facilitate negative interpretations rather than emotional interpretations regardless of valence. These findings provide the basis for a causal role for disgust in anxious psychopathology. Because the effect is a non-specific emotion-congruent one, elevated disgust levels will result in a predisposition to interpret information in a threatening way across a broad range of anxious- and threat-relevant domains.     

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

Two studies aimed to examine whether high socially anxious individuals are more likely to negatively interpret ambiguous social scenarios and facial expressions compared to low socially anxious individuals. We also examined whether interpretation bias serves as a mediator of the relationship between trait social anxiety and state anxiety responses, in particular current state anxiety, bodily sensations, and perceived probability and cost of negative evaluation pertaining to a speech task. Study 1 used ambiguous social scenarios and Study 2 used ambiguous facial expressions as stimuli to objectively assess interpretation bias. Undergraduate students with high and low social anxiety completed measures of state anxiety responses at three time points: baseline, after the interpretation bias task, and after the preparation for an impromptu speech. Results showed that high socially anxious individuals were more likely to endorse threat interpretations for ambiguous social scenarios and to interpret ambiguous faces as negative than low socially anxious individuals. Furthermore, negative interpretations mediated the relationship between trait social anxiety and perceived probability of negative evaluation pertaining to the speech task in Study 1 but not Study 2. The present studies provide new insight into the role of interpretation bias in social anxiety.     

Interpretive biases for ambiguous information in body dysmorphic disorder

Anxiety-disordered patients and individuals with high trait anxiety tend to interpret ambiguous information as threatening. The purpose of this study was to investigate whether interpretive biases would also occur in body dysmorphic disorder (BDD), which is characterized by a preoccupation with imagined defects in one's appearance. We tested whether BDD participants, compared with obsessive-compulsive disorder participants and healthy controls, would choose threatening interpretations for ambiguous body-related, ambiguous social, and general scenarios. As we hypothesized, BDD participants exhibited a negative interpretive bias for body-related scenarios and for social scenarios, whereas the other groups did not. Moreover, both clinical groups exhibited a negative interpretive bias for general scenarios.     

Look before you leap: the role of negative urgency in appraisals of ambiguous and unambiguous scenarios in individuals high in generalized anxiety disorder symptoms

Negative interpretation bias, the propensity to make threatening interpretations of ambiguous information, is associated with symptoms of generalized anxiety disorder (GAD). Apart from its relationship with intolerance of uncertainty (IU), little is known about what explains the presence of this cognitive bias in GAD. One factor may be negative urgency (NU), the tendency to take rash action when distressed, which is related to GAD symptoms and to cognitive biases in nonclinical populations. The aim of the present study was to examine the relationship between NU and interpretation bias in individuals high in GAD symptoms (N = 111). IU, trait anxiety, and other forms of impulsivity were examined concurrently as competing correlates of interpretation bias. Greater NU and IU were found to be unique correlates of greater threatening interpretations of ambiguous scenarios. Greater NU was also a unique correlate of greater threatening interpretations of negative and positive scenarios. No other forms of impulsivity were uniquely related to interpretation bias. The findings suggest that greater NU may have a role in the tendency for individuals high in GAD symptoms to make threatening interpretations in response to ambiguous scenarios, overtly threatening situations, and situations without indication of threat or danger. Theoretical implications of these findings are discussed.     

Cancer fear and the interpretation of ambiguous information related to cancer

We tested the hypothesis that people with a high fear of cancer would be more likely to interpret ambiguous information about cancer in a negative manner compared with people low on cancer fear. Adults (n=47) aged 50–70, who scored either high (n=16) or low (n=31) on cancer fear, took part in a laboratory-based ambiguous sentences task. Participants were presented with ambiguous cancer and social threat scenarios mixed with unambiguous neutral scenarios. Interpretations were assessed in a recognition task, by asking participants to rate disambiguated sentences in terms of how similar in meaning they were to the originals. People high on cancer fear were more likely to endorse negative interpretations of the original ambiguous cancer scenarios than were people low on cancer fear. This negative interpretation bias was specific to cancer scenarios and was not observed for the social threat scenarios.     

Sex differences in interpretation bias in adolescents

Interpretation biases, in which ambiguous information is interpreted negatively, have been hypothesized to place adolescent females at greater risk of developing anxiety and mood disorders than same‐aged males. We tested the hypothesis that adolescent girls interpret ambiguous scenarios more negatively, and/or less positively, than same‐aged males using the Adolescent Interpretation and Belief Questionnaire (N = 67, 11–15 years old). We also tested whether adolescent girls and boys differed in judging positive or negative interpretations to be more believable and whether the scenario content (social vs. non‐social) affected any sex difference in interpretation bias. The results showed that girls had higher average negative interpretation scores than boys, with no sex differences in positive interpretation scores. Girls and boys did not differ on which interpretation they found to be most believable. Both sexes reported that positive interpretations were less likely to come to mind, and were less believable, for social than for non‐social scenarios. These results provide preliminary evidence for sex differences in interpretation biases in adolescence and support the hypothesis that social scenarios are a specific source of anxiety to this age group. A greater understanding of the aetiology of interpretation biases will potentially enhance sex‐ and age‐specific interventions for anxiety and mood disorders.     

Interpretation of ambiguous emotional information in clinically anxious children and adolescents

Cognitive theories of anxiety based on adult data predict that individuals vulnerable to anxiety should show threat - related interpretations of ambiguous material and it is proposed that this is an important maintaining factor in anxiety disorders. In the present study, interpretation of ambiguous emotional/neutral information was examined in child and adolescent anxious patients. Two groups of participants, anxious patients (n = 17) and healthy controls (n = 40), were presented with a series of homographs, each with a threatening and a neutral interpretation. For each homograph, the participants were asked to construct a sentence using the homograph. Anxious children and adolescents produced significantly more sentences consistent with threatening homograph interpretations and less consistent with neutral interpretations than did normal controls. Regression analyses revealed no relationship between age and this interpretive bias. Preliminary developmental and theoretical implications are discussed.     

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.     

Facilitating a benign interpretation bias in a high socially anxious population

Previous research has shown that high socially anxious individuals lack the benign interpretation bias present in people without social anxiety. The tendency of high socially anxious people to generate more negative interpretations may lead to anticipated anxiety about future social situations. If so, developing a more benign interpretation bias could lead to a reduction in this anxiety. The current study showed that a benign interpretation bias could be facilitated (or 'trained') in a high socially anxious population. Participants in the benign training groups had repeated practice in accessing benign (positive or non-negative) interpretations of potentially threatening social scenarios. Participants in the control condition were presented with the same social scenarios but without their outcomes being specified. In a later recognition task, participants who received benign interpretation training generated more benign, and less negative, interpretations of new ambiguous social situations compared to the control group. Participants who received benign training also predicted that they would be significantly less anxious in a future social situation than those in the control group. Possible implications of the findings for therapeutic interventions in social phobia are discussed.     

Threat interpretation bias as a vulnerability factor in childhood anxiety disorders

The present study examined threat interpretation biases in children 7-12 years of age with separation, social and generalised anxiety disorders (N=15), non-anxious offspring at risk due to parental anxiety (N=16) and non-anxious controls of non-anxious parents (N=14). Children provided interpretations of ambiguous situations to assess cognitive, emotional and behavioural responses. In comparison with non-anxious control children and at-risk children who did not differ from each other, anxious children reported stronger negative emotion and less ability to influence ambiguous situations. These results suggest that threat interpretation bias may be a cognitive factor associated with ongoing childhood anxiety but not a vulnerability factor associated with parental anxiety.     

Social anxiety and adolescence: Interpretation bias in an Italian Sample

Interpretation bias, namely the tendency to systematically assign a negative meaning to ambiguous social situations, has been extensively studied in adult populations, while in adolescents it has received little attention. We aimed to address this gap by analyzing the three components of interpretation bias (negative interpretations, positive interpretations, belief in negative interpretations) in Italian adolescents aged between 14 and 17, comparing two groups: high (n = 32) and average (n = 33) social anxiety. The participants filled Social Phobia Inventory (SPIN), Positive and Negative Affect Schedule (PANAS), and Adolescents’ Interpretation and Belief Questionnaire (AIBQ). We found that the bias is specific to social anxiety (not due to the presence of negative mood) and present only in social situations. Instead, contrary to the hypothesis, Italian adolescents with high social anxiety have both negative bias and absence of the positive bias. Hence, preventive interventions should focus not only on the reduction of negative interpretations. They should also reinforce positive interpretations and target belief in negative interpretations. Based on these considerations, we gave some suggestions to improve the tasks of the Cognitive Bias Modification addressed to adolescents. Finally, belief in negative interpretations and the relationship between negative and positive interpretations in social anxiety deserve further study, both in adolescents and in adults.     

Family influences on dysfunctional thinking in anxious children

Anxious children are found to interpret ambiguous stories in a negative way. The current study attempted to examine the possible influence of parental fear and parental interpretation bias on the maintenance of such an interpretation bias. Children varying in level of anxiety (n=25) and their parents, filled in a questionnaire to measure their own fears, and gave their interpretations concerning nine ambiguous stories, relevant for childhood ‘interactional’ anxieties: social anxiety, separation anxiety, and generalized anxiety. Then, parents were asked to talk with their children about three of the stories. After the family discussion the children had to give their final interpretations. Results indicated that parents' self‐reported fear level and interpretation bias were associated with children's interpretation bias before the family discussion. However, no evidence was found for the idea that parents maintain or enhance the interpretation bias of their children. That is, irrespective of parental fear and parental interpretation bias, children interpreted the ambiguous stories as less negative after discussing them with their parents. Copyright © 2003 John Wiley & Sons, Ltd.     

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.     

Covert and overt orienting of attention to emotional faces in anxiety

Attentional biases for emotional faces were investigated in high, medium, and low anxiety groups (N = 54) using a probe detection task. Four types of facial expression (threat, sad, happy, neutral) were used to examine the specificity of the bias. Attentional bias measures were derived from manual reaction times (RTs) to probes and the direction of initial eye movement (EM) to the faces. The RT data indicated enhanced vigilance for threat rather than neutral faces in high and medium, but not low, state anxiety. The bias for negative faces appeared to be a combined function of stimulus threat value and the individual's anxiety level. The RT bias did not seem to depend on overt orienting, as many participants made few EMs. However, those who made frequent EMs to the faces showed concordance between the RT and EM bias measures, and so the RT measure of attentional bias for negative versus positive faces at 500 ms appears to provide a valid index of the direction of initial orienting to emotional stimuli. There was no evidence of an anxiety - related bias for happy faces (predicted by the emotionality hypothesis), nor a dysphoria - related bias for sad faces. However, increased dysphoria scores were associated with reduced attentiveness to happy faces.     

In the Face of Uncertainty: A Twin Study of Ambiguous Information,Anxiety and Depression in Children

Anxiety and depression share genetic influences, and have been associated with similar cognitive biases. Psychological theories of anxiety and depression highlight threat interpretations of ambiguity. Little is known about whether genes influence cognitive style, or its links to symptoms. We assessed ambiguous word and scenario interpretations, anxiety and depression symptoms in 300 8-year-old twin pairs. There were significant correlations between both negative interpretations of ambiguous words and scenarios and depression symptoms after controlling for anxiety symptoms (r = .13 and .31, respectively), but no significant correlations with anxiety independent of depression. Genetic effects ranged from 16% for depression to 30% for ambiguous word interpretations. Non-shared environmental influences were large (68–70%). Both genetic and environmental influences contributed to the association between depression and ambiguous scenario interpretations. These findings support psychological theories, which emphasise the role of environmental stress both on the development of threat interpretations and on their links with symptoms. The data also support a role for genetic influence on threat interpretations, which may mediate responses to stress.     

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.     

Anxiety Sensitivity and Negative Interpretation Biases: Their Shared and Unique Associations with Anxiety Symptoms

Anxiety sensitivity (AS) is a psychological risk factor for anxiety disorders. Negative interpretation biases are a maladaptive form of information-processing also associated with anxiety disorders. The present study explored whether AS and negative interpretation biases make independent contributions to variance in panic and generalized anxiety symptoms and whether particular interpretation bias domains (e.g., of ambiguous arousal sensations) have specific associations with panic and/or generalized anxiety symptoms. Eighty-nine female undergraduates (44 low AS; 45 high AS) completed measures of AS, interpretation biases, and panic and generalized anxiety symptoms. Findings showed that AS and negative interpretation biases both significantly added to the prediction of anxiety symptoms. Negative interpretations of ambiguous arousal sensations were uniquely associated with panic symptoms, while negative interpretations of ambiguous general and social events were uniquely associated with generalized anxiety symptoms. Findings support the conceptual validity of AS and negative interpretation biases and their unique and shared contributions to anxiety symptoms.     

Interpretive biases for ambiguous stimuli in social anxiety.

A growing body of literature suggests that individuals with high levels of general anxiety form threatening interpretations of ambiguous events. Although theoretical formulations of pathological social anxiety emphasize the importance of a negative interpretive-style in the etiology and maintenance of the disorder, we are unaware of any study that documents this presumed phenomenon. To address this issue, we assessed for possible interpretive biases in a group of high and low socially-anxious students. The results indicated that socially-anxious subjects showed more threatening interpretations of ambiguous, interpersonal events when compared to the low-anxious participants. However, this bias was marked not so much by an outright negative interpretation style, but rather by a failure of the socially-anxious subjects to show a positive interpretation as was evinced by the low-anxious individuals. These group differences in interpretive style appeared to be influenced by trait aspects of social anxiety rather than differences in current mood state. No group differences emerged in interpretations of events that involved non-personal stimuli suggesting there is content specificity in the interpretive biases associated with social-anxiety.     

Lack of a benign interpretation bias in social anxiety disorder

Cognitive models of social anxiety posit that recurrent interpretation of ambiguous information as threatening maintains symptoms (e.g. Clark & Wells, 1995, pp. 69-93, Social phobia: Diagnosis, assessment, and treatment. New York: Guilford Press; Rapee & Heimberg, 1997, pp. 741-756, Behavior Research and Therapy, 35). However, biased interpretation may also be represented as a failure to make a benign interpretation of the ambiguous event. Furthermore, interpretation bias can be characterized by both an online (automatic) component and an offline (effortful) component (Hirsch & Clark, 2004, pp. 799-825, Clinical Psychology Review, 24). To measure both benign and threat biases, as well as examine the effect of social anxiety on offline versus online interpretations, Beard and Amir (2009, pp. 1135-1141, Behaviour Research and Therapy, 46) developed the Word Sentence Association Paradigm (WSAP). In the current study, we administered the WSAP to a group of participants diagnosed with social anxiety disorder (SAD) as well as to a group of non-anxious control (NAC) participants. We found that participants with SAD demonstrated a lack of benign online bias, but not an online threat bias when compared to NACs. However, when examining offline biases, SAD patients endorsed social threat interpretations and rejected benign social interpretations to a greater degree than non-anxious individuals. Our results, when taken together, clearly implicate the role of reduced bias toward benign information in SAD.     

Trained interpretive bias and anxiety

The relationship between anxiety and interpretive bias has been studied extensively, but the causal direction of this relationship remains largely unexplored. Do negative interpretations cause anxiety or is anxiety the cause of negative interpretations? Or are the two mutually reinforcing? The present study addressed this issue by experimentally inducing either a negative or a positive interpretive bias using Mathews and Mackintosh' [(2002). Induced emotional interpretation bias and anxiety. Journal of Abnormal Psychology, 109, 604-615] training paradigm and then examining its impact on state anxiety and anxiety vulnerability. In addition, it was investigated as to whether the interpretive bias was trained implicitly. Results indicated that style of interpreting could be manipulated. That is, when confronted with ambiguous information after the training, participants (n=118) interpreted this information congruent with their (positive or negative) training condition. Data on the issue of implicitness showed that participants tended to be explicitly aware of the valence of their training stimuli. Effects of trained interpretive bias on anxiety were only marginal and absent on anxiety vulnerability. It appears that interpretive bias can be trained reliably, but its effects on mood and vulnerability require further explanation.