Cultural evidence for interpretation bias as a feature of social anxiety in Chinese adolescents

Background and Objectives: Interpretation bias (IB), defined as the tendency to interpret ambiguous social situations in a threatening manner, has increasingly been studied in children and adolescents. Compared to Western samples, the relation between IB and social anxiety in Chinese youth has received little attention. The present study was to mainly examine the relationship between IB and social anxiety among Chinese adolescents.

Design: Cross-sectional design was utilized.

Methods: IB, measured by the Adolescents’ Interpretation Bias Questionnaire (AIBQ), and social anxiety were surveyed among a group of high socially anxious Chinese adolescents (n?=?25) and a control group (n?=?29). Participants were asked to rate the likelihood of interpretations coming to mind in social/non-social situations and to choose the most believable interpretation.

Results: The high social anxiety group had more negative interpretations and beliefs in social situations, and the interpretation bias was particular to social anxiety versus depression. Additionally, the cognitive content-specificity hypothesis was supported; the high anxious group showed interpretation bias in social situations, but didn’t have more negative interpretations of non-social situations, after controlling for depression.

Conclusions: The present study yielded comparable findings as found in Western samples regarding the relation between IB and social anxiety.     

Mental Imagery and Post-Event Processing in Anticipation of a Speech Performance Among Socially Anxious Individuals

The present study investigated whether post-event processing (PEP) involving mental imagery about a past speech is particularly detrimental for socially anxious individuals who are currently anticipating giving a speech. One hundred fourteen high and low socially anxious participants were told they would give a 5 min impromptu speech at the end of the experimental session. They were randomly assigned to one of three manipulation conditions: post-event processing about a past speech incorporating imagery (PEP-Imagery), semantic post-event processing about a past speech (PEP-Semantic), or a control condition, (n = 19 per experimental group, per condition [high vs low socially anxious]). After the condition inductions, individuals’ anxiety, their predictions of performance in the anticipated speech, and their interpretations of other ambiguous social events were measured. Consistent with predictions, high socially anxious individuals in the PEP-Imagery condition displayed greater anxiety than individuals in the other conditions immediately following the induction and before the anticipated speech task. They also interpreted ambiguous social scenarios in a more socially anxious manner than socially anxious individuals in the control condition. High socially anxious individuals made more negative predictions about their upcoming speech performance than low anxious participants in all conditions. The impact of imagery during post-event processing in social anxiety and its implications are discussed.     

社交焦虑个体对正性面孔刺激的解释偏差

本研究分别在短时（60ms）和长时（无时间限制）条件下呈现匹配的正性和中性面孔,要求高、低社交焦虑被试选择更具威胁性的面孔,以验证两者对正性刺激是否存在主观解释偏差,并考察该偏差产生于认知加工的哪一阶段。结果发现,长时条件下,高焦虑组选择正性面孔的比例显著高于低焦虑组;短时条件下无显著差异。提示高社交焦虑个体对正性刺激存在主观、外显的解释偏差,他们更倾向于对正性刺激做出消极解释,并且这种偏差产生于认知加工的后期。     

Attention Bias Modification Treatment for Adolescents With Social Anxiety Disorder

Social anxiety disorder (SAD) tends to emerge during the early teenage years and is particularly refractory to change even when standard evidence-based CBT treatments are delivered. Efforts have been made to develop novel, mechanistic-driven interventions for this disorder. In the present study, we examined Attention Bias Modification Treatment (ABMT) for youth with SAD. Participants were 58 adolescents (mean age = 14.29 years) who met diagnostic criteria for SAD and who were randomized to ABMT or a placebo control condition, Attention Control Training (ACT). We predicted that ABMT would result in greater changes in both threat biases and social anxiety symptoms. We also explored potential moderators of change including the severity of social anxiety symptoms, the level of threat bias at pretreatment, and the degree of temperament-defined attention control. Contrary to our hypotheses, changes in attention bias were not observed in either condition, changes in social anxiety symptoms and diagnosis were small, and significant differences were not observed between the ABMT and ACT conditions. Little support for the proposed moderators was obtained. Reasons for our failure to find support for ABMT and its potential moderators are explored and recommendations for changes in the ABMT paradigm are suggested.     

Positive Interpretation Bias Predicts Longitudinal Decreases in Social Anxiety

Theoretical models of social anxiety suggest that distorted interpretation processes contribute to its development and maintenance, although the pathways through which this occurs are not well understood. Therefore, the present longitudinal study sought to determine whether negative interpretation bias, positive interpretation bias, and interpretation inflexibility (the degree to which participants correctly revise initial interpretations) predict changes in social anxiety over time. In an important advance over prior studies, individual differences in working memory capacity (WMC) were accounted for, as WMC is thought to play a crucial role in the generation and maintenance of interpretation biases. Following a baseline assessment of social anxiety, interpretation biases, and WMC, participants completed follow-up assessments of social anxiety both 2 weeks (n = 106) and 4 weeks (n = 96) later. After controlling for baseline social anxiety and WMC, greater positive interpretation bias was found to predict lower social anxiety at both follow-ups. Neither negative interpretation bias nor interpretation inflexibility was significantly associated with follow-up social anxiety. These results provide support for greater positive interpretation bias as a facilitator of decreases in social anxiety and a potential target for clinical intervention.     

焦虑障碍的认知偏向矫正：应用与争议

认知偏向是焦虑障碍患者的重要认知特征, 是指患者或高焦虑个体对负性或威胁性信息存在认知加工方面的偏向。目前该领域的研究聚焦于注意偏向和解释偏向。近年来, 研究者致力于将认知偏向的矫正应用于焦虑障碍患者的临床治疗, 得到了不一致的结果。本文总结了将认知偏向矫正应用于临床实践的不同方式, 并从主观报告的疗效证据、行为及生理指标的疗效证据, 以及未发现疗效证据的研究三方面回顾了近年来的研究成果。对于结果的高度不一致, 本文从期望效应、干预对象、因变量和其它参数等方面探讨了可能的原因, 并讨论了未来可能的研究方向。     

Attachment Relationships as Predictors of Cognitive Interpretation and Response Bias in Late Adolescence

We investigated behavioural and cognitive representations of attachment style. Specifically, we sought to test continuity in attachment style and whether participants' perceptions of their attachments to parents, peers, and romantic partners would predict cognitive interpretation and responses to 12 ambiguous situation scenarios. Participants were 161 undergraduate students (17–20 years) who completed the Parental Bonding Instrument, the Attachment Style Questionnaire and the Inventory of Parent and Peer Attachment (peer subscale). Participants then indicated whether they interpreted ambiguous situations as threatening versus non-threatening and how they would respond (proactively, aggressively, or avoidantly). Regression analyses revealed that insecure parental attachments were the main predictor of participants' interpretations and their planned responses, followed by romantic attachments. Peer attachments played little role in the predictions. These results suggest that interpretation of situations and subsequent plans of action may be influenced by attachment related experiences. We discuss our findings in terms of their relevance to attachment theory and their application to our understanding of the concepts of attachment in development of interpersonal relationships.     

Threat-Related Attentional Bias in Anxious Youth: A Review

The research literature suggests that children and adolescents suffering from anxiety disorders experience cognitive distortions that magnify their perceived level of threat in the environment. Of these distortions, an attentional bias toward threat-related information has received the most theoretical and empirical consideration. A large volume of research suggests that anxiety-disordered youth selectively allocate their attention toward threat-related information. The present review critically examines this research and highlights several issues relevant to the study of threat-related attentional bias in youth, including the influences of temperament, trait anxiety, and state anxiety on threat-related attentional bias. It furthermore identifies the need for developmental and methodological considerations and recommends directions for research.     

注意偏向训练对社交焦虑的干预：方法、效果与机制

社交焦虑障碍是最普遍且难于治疗的精神障碍之一。大量研究发现, 注意偏向训练可以有效缓解社交焦虑。研究者从自我报告、结构化评估、生理记录等方面考察发现, 接受了注意偏向训练的社交焦虑个体其注意偏向、生理唤醒和脑神经活动发生变化并且社交焦虑症状有所缓解。注意偏向训练对社交焦虑的干预机制可能是因为训练提升了个体对威胁性刺激的注意解除能力。今后的研究可以进一步明确注意偏向训练干预社交焦虑的效果与机制, 拓宽评估注意偏向训练效果的手段, 并探索其对社交焦虑干预的长期效果和对其它心理疾病的作用。     

A Randomized Trial of Attention Training for Generalized Social Phobia: Does Attention Training Change Social Behavior?

The use of attention training protocols for the treatment of generalized social anxiety disorder (SAD) is undergoing increased examination. Initial investigations were positive but more recent investigations have been less supportive of the treatment paradigm. One significant limitation of current investigations is overreliance on self-report. In this investigation, we expanded on initial investigations by using a multimodal assessment of patient functioning (i.e., including behavioral assessment). Patients with a primary diagnosis of SAD (n = 31) were randomly assigned to eight sessions of attention training (n = 15) or placebo/control (n = 16). Participants were assessed at pre- and posttreatment via self- and clinician-report of social anxiety as well as anxious and behavioral response to two in vivo social interactions. Results revealed no differences between groups at posttreatment for all study outcome variables, suggesting a lack of effect for the attention training condition. The results are concordant with recent investigations finding a lack of support for the use of attention training as an efficacious treatment for patients with SAD.     

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.     

Attention Training as a Low-Intensity Treatment for Concerning Anxiety in Clinic-Referred Youth

Although youth anxiety treatment research has focused largely on severe and impairing anxiety levels, even milder anxiety levels, including levels that do not meet full criteria for a diagnosis, can be impairing and cause for concern. There is a need to develop and test viable treatments for these concerning anxiety levels to improve functioning and reduce distress. We present findings from a randomized controlled efficacy trial of attention bias modification treatment (ABMT) and attention control training (ACT) for youths with concerning anxiety levels. Fifty-three clinic-referred youths (29 boys, M age = 9.3 years, SD age = 2.6) were randomized to either ABMT or ACT. ABMT and ACT consisted of attention-training trials in a dot-probe task presenting angry and neutral faces; probes appeared in the location of neutral faces in 100% of ABMT trials and 50% of ACT trials. Independent evaluators provided youth anxiety severity ratings; youths and parents provided youth anxiety severity and global impairment ratings; and youths completed measures of attention bias to threat and attention control at pretreatment, posttreatment, and 2-month follow-up. In both arms, anxiety severity and global impairment were significantly reduced at posttreatment and follow-up. At follow-up, anxiety severity and global impairment were significantly lower in ACT compared with ABMT. Attention control, but not attention bias to threat, was significantly improved at follow-up in both arms. Changes in attention control and attention focusing were significantly associated with changes in anxiety severity. Findings support the viability of attention training as a low-intensity treatment for youths with concerning anxiety levels, including levels that do not meet full criteria for a diagnosis. Superior anxiety reduction effects in ACT highlight the critical need for mechanistic research on attention training in this population.