Skip to main content

Advertisement

SpringerLink
Log in

Is interpretation bias for threat content specific to youth anxiety symptoms/diagnoses? A systematic review and meta-analysis

  • Review
  • Published:
European Child & Adolescent Psychiatry Aims and scope Submit manuscript

Abstract

Anxiety is the most common mental health problem in youth. Numerous studies have identified that youth anxiety is associated with interpretation bias or the attribution of threatening meaning to ambiguity. Interpretation bias has been proposed as a mechanism underlying the development and maintenance of pediatric anxiety. Theoretically, interpretation bias should be content-specific to individual youth anxiety symptom domains. However, extant studies have reported conflicting findings of whether interpretation bias is indeed content specific to youth anxiety symptoms or diagnoses. The present meta-analysis aimed to synthesize the literature and answer the question: is the relationship between interpretation bias and anxiety content specific? Search of PubMed and PsycINFO databases from January 1, 1960 through May 28, 2019 yielded 9967 citations, of which 19 studies with 20 comparisons and 2976 participants met eligibility criteria. Meta-analysis with random effects models was conducted to examine an overall effect (Pearson r) between anxiety domain and content-specific interpretation bias in single sample studies, and an overall effect size difference (Cohen’s d) in studies comparing anxious to non-anxious youth. Results support a content specific correlation between interpretation bias and anxiety symptom domain in single sample studies (r = 0.18, p = 0.03). However, it is currently undetermined whether this relationship holds in studies that compare the relationship between content-specific interpretation bias and anxiety in anxious versus non-anxious youth. A variety of methodologic considerations across studies are discussed, with implications for further investigation of interpretation bias and youth anxiety.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

Notes

  1. Seven studies met inclusion criteria 1 through 4 described above, but did not provide sufficient data to calculate effect sizes and were therefore excluded: [25,26,27,28,29,30,31]

    Two studies met inclusion criteria 1 through 4 described above but examined bias in other disorder group samples and were therefore excluded: [32, 33]

  2. Comprehensive Meta-Analysis software converts the correlation coefficient to the Fisher’s z scale, with analyses performed using transformed values, with the results converted back to correlations to presentations [37]

References

  1. Beesdo K, Knappe S, Pine DS (2009) Anxiety and anxiety disorders in children and adolescents: developmental issues and implications for DSM-V. Psychiatr Clin North Am 32(3):483–524. https://doi.org/10.1016/j.psc.2009.06.002

    Article  PubMed  PubMed Central  Google Scholar 

  2. Merikangas KR, He J, Burstein M, Swanson SA, Avenevoli S, Cui L, Benjet C, Georgiades K, Swendsen J (2010) Lifetime prevalence of mental disorders in U. S. Adolescents: results from the national comorbidity survey replication–adolescent supplement (Ncs-a). J Am Acad Child Adolesc Psychiatry 49(10):980–989. https://doi.org/10.1016/j.jaac.2010.05.017

    Article  PubMed  PubMed Central  Google Scholar 

  3. Bittner A, Egger HL, Erkanli A, Jane Costello E, Foley DL, Angold A (2007) What do childhood anxiety disorders predict? J Child Psychol Psychiatry 48(12):1174–1183. https://doi.org/10.1111/j.1469-7610.2007.01812.x

    Article  PubMed  Google Scholar 

  4. Pine DS, Cohen P, Gurley D, Brook J, Ma Y (1998) The risk for early-adulthood anxiety and depressive disorders in adolescents with anxiety and depressive disorders. Arch Gen Psychiatry 55(1):56. https://doi.org/10.1001/archpsyc.55.1.56

    Article  CAS  PubMed  Google Scholar 

  5. Benjamin CL, Harrison JP, Settipani CA, Brodman DM, Kendall PC (2013) Anxiety and related outcomes in young adults 7 to 19 years after receiving treatment for child anxiety. J Consult Clin Psychol 81(5):865–876. https://doi.org/10.1037/a0033048

    Article  PubMed  Google Scholar 

  6. Walkup JT, Albano AM, Piacentini J, Birmaher B, Compton SN, Sherrill JT, Ginsburg GS, Rynn MA, McCracken J, Waslick B, Iyengar S, March JS, Kendall PC (2008) Cognitive behavioral therapy, sertraline, or a combination in childhood anxiety. N Engl J Med 359(26):2753–2766. https://doi.org/10.1056/NEJMoa0804633

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Ginsburg GS, Becker EM, Keeton CP, Sakolsky D, Piacentini J, Albano AM, Compton SN, Iyengar S, Sullivan K, Caporino N, Peris T, Birmaher B, Rynn M, March J, Kendall PC (2014) Naturalistic follow-up of youths treated for pediatric anxiety disorders. JAMA Psychiatry 71(3):310–318. https://doi.org/10.1001/jamapsychiatry.2013.4186

    Article  PubMed  PubMed Central  Google Scholar 

  8. March JS (2011) Looking to the future of research in pediatric anxiety disorders. Depress Anxiety 3:322–333. https://doi.org/10.1002/da.20754

    Article  Google Scholar 

  9. Sherrill JT (2008) Commentary: expanding the research agenda on interventions for child and adolescent anxiety disorders. Cogn Behav Pract 15(2):166–171. https://doi.org/10.1016/j.cbpra.2007.11.002

    Article  Google Scholar 

  10. Daleiden EL, Vasey MW (1997) An information-processing perspective on childhood anxiety. Clin Psychol Rev 17(4):407–429. https://doi.org/10.1016/S0272-7358(97)00010-X

    Article  CAS  PubMed  Google Scholar 

  11. Field AP, Lester KJ (2010) Is there room for development in developmental models of information processing biases to threat in children and adolescents? Clin Child Fam Psychol Rev 13(4):315–332. https://doi.org/10.1007/s10567-010-0078-8

    Article  PubMed  Google Scholar 

  12. Muris P, Field AP (2008) Distorted cognition and pathological anxiety in children and adolescents. Cogn Emot 22(3):395–421. https://doi.org/10.1080/02699930701843450

    Article  Google Scholar 

  13. Creswell C, Schniering CA, Rapee RM (2005) Threat interpretation in anxious children and their mothers: comparison with nonclinical children and the effects of treatment. Behav Res Ther 43(10):1375–1381. https://doi.org/10.1016/j.brat.2004.10.009

    Article  PubMed  Google Scholar 

  14. Miers AC, Blöte AW, Bögels SM, Westenberg PM (2008) Interpretation bias and social anxiety in adolescents. J Anxiety Disord 22(8):1462–1471. https://doi.org/10.1016/j.janxdis.2008.02.010

    Article  PubMed  Google Scholar 

  15. Amir N, Beard C, Bower E (2005) Interpretation bias and social anxiety. Cognitive Therapy Res 29(4):433–443. https://doi.org/10.1007/s10608-005-2834-5

    Article  Google Scholar 

  16. Rozenman M, Amir N, Weersing VR (2014) Performance-based interpretation bias in clinically anxious youths: relationships with attention, anxiety, and negative cognition. Behav Ther 45(5):594–605. https://doi.org/10.1016/j.beth.2014.03.009

    Article  PubMed  Google Scholar 

  17. Rozenman M, Vreeland A, Piacentini J (2017) Thinking anxious, feeling anxious, or both? Cognitive bias moderates the relationship between anxiety disorder status and sympathetic arousal in youth. J Anxiety Disord 45:34–42. https://doi.org/10.1016/j.janxdis.2016.11.004

    Article  PubMed  Google Scholar 

  18. Waters AM, Wharton TA, Zimmer-Gembeck MJ, Craske MG (2008) Threat-based cognitive biases in anxious children: comparison with non-anxious children before and after cognitive behavioural treatment. Behav Res Ther 46(3):358–374. https://doi.org/10.1016/j.brat.2008.01.002

    Article  PubMed  Google Scholar 

  19. Cristea I, Kok RN, Cuijpers P (2015) The efficacy of cognitive bias modification interventions for mental health problems: a meta-analysis. Eur Psychiatry 30:850. https://doi.org/10.1016/S0924-9338(15)30663-5

    Article  Google Scholar 

  20. Hallion LS, Ruscio AM (2011) A meta-analysis of the effect of cognitive bias modification on anxiety and depression. Psychol Bull 137(6):940–958. https://doi.org/10.1037/a0024355

    Article  PubMed  Google Scholar 

  21. Gonzalez A, Rozenman M, Langley AK, Kendall PC, Ginsburg GS, Compton S, Walkup JT, Birmaher B, Albano AM, Piacentini J (2017) Social interpretation bias in children and adolescents with anxiety disorders: psychometric examination of the self-report of ambiguous social situations for youth (SASSY) scale. Child Youth Care Forum 46(3):395–412. https://doi.org/10.1007/s10566-016-9381-y

    Article  PubMed  Google Scholar 

  22. Stuijfzand S, Creswell C, Field AP, Pearcey S, Dodd H (2018) Research review: Is anxiety associated with negative interpretations of ambiguity in children and adolescents? A systematic review and meta-analysis. J Child Psychol Psychiatry 59(11):1127–1142. https://doi.org/10.1111/jcpp.12822

    Article  PubMed  Google Scholar 

  23. Hankin BL, Gibb BE, Abela JRZ, Flory K (2010) Selective attention to affective stimuli and clinical depression among youth: role of anxiety and specificity of emotion. J Abnorm Psychol 119(3):491–501. https://doi.org/10.1037/a0019609

    Article  PubMed  PubMed Central  Google Scholar 

  24. Crick NR, Dodge KA (1994) A review and reformulation of social information-processing mechanisms in children’s social adjustment. Psychol Bull 115(1):74–101. https://doi.org/10.1037/0033-2909.115.1.74

    Article  Google Scholar 

  25. Orchard F, Apetroaia A, Clarke K, Creswell C (2017) Cognitive bias modification of interpretation in children with social anxiety disorder. J Anxiety Disord 45:1–8. https://doi.org/10.1016/j.janxdis.2016.10.012

    Article  PubMed  PubMed Central  Google Scholar 

  26. Perez-Olivas G, Stevenson J, Hadwin JA (2011) The association between elevated maternal panic-like and depression symptoms and separation-related interpretive biases in offspring. J Child Fam Stud 20(2):232–239. https://doi.org/10.1007/s10826-010-9408-1

    Article  Google Scholar 

  27. Sportel BE, de Hullu E, de Jong PJ, Nauta MH (2013) Cognitive bias modification versus CBT in reducing adolescent social anxiety: a randomized controlled trial. PLoS ONE 8(5):e64355. https://doi.org/10.1371/journal.pone.0064355

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. van Niekerk RE, Klein AM, Allart-van Dam E, Rinck M, Souren PM, Hutschemaekers GJ, Becker ES (2018) Biases in interpretation as a vulnerability factor for children of parents with an anxiety disorder. J Am Acad Child Adolesc Psychiatry 57(7):462–470. https://doi.org/10.1016/j.jaac.2018.04.009

    Article  PubMed  Google Scholar 

  29. Vassilopoulos SP, Blackwell SE, Moberly NJ, Karahaliou E (2012) Comparing imagery and verbal instructions for the experimental modification of interpretation and judgmental bias in children. J Behav Ther Exp Psychiatry 43(1):594–601. https://doi.org/10.1016/j.jbtep.2011.08.004

    Article  PubMed  Google Scholar 

  30. Vassilopoulos SP, Brouzos A (2016) Cognitive bias modification of interpretations in children: processing information about ambiguous social events in a duo. J Child Fam Stud 25(1):299–307. https://doi.org/10.1007/s10826-015-0194-7

    Article  Google Scholar 

  31. Vassilopoulos SP, Moberly NJ, Lau JY (2015) Cognitive bias modification training in children affects anxiety during anticipatory processing of social evaluation. Int J Cogn Ther 8(4):318–334. https://doi.org/10.1521/ijct.2015.8.4.318

    Article  Google Scholar 

  32. Klein AM, Salemink E, de Hullu E, Houtkamp E, Papa M, van der Molen M (2018) Cognitive bias modification reduces social anxiety symptoms in socially anxious adolescents with mild intellectual disabilities: a randomized controlled trial. J Autism Dev Disord 48(9):3116–3126. https://doi.org/10.1007/s10803-018-3579-9

    Article  PubMed  PubMed Central  Google Scholar 

  33. Houtkamp EO, van der Molen MJ, de Voogd EL, Salemink E, Klein AM (2017) The relation between social anxiety and biased interpretations in adolescents with mild intellectual disabilities. Res Dev Disabil 67:94–98. https://doi.org/10.1016/j.ridd.2017.06.003

    Article  PubMed  Google Scholar 

  34. Loscalzo Y, Giannini M, Miers AC (2018) Social anxiety and interpretation bias: examining clinical and subclinical components in adolescents. Child Adolesc Ment Health 23(3):169–176. https://doi.org/10.1111/camh.12221

    Article  PubMed  Google Scholar 

  35. In-Albon T, Dubi K, Rapee RM, Schneider S (2009) Forced choice reaction time paradigm in children with separation anxiety disorder, social phobia, and nonanxious controls. Behav Res Ther 47(12):1058–1065. https://doi.org/10.1016/j.brat.2009.08.003

    Article  PubMed  Google Scholar 

  36. Borenstein M, Hedges L, Higgins J, Rothstein H (2013) Comprehensive meta-analysis version 3. Biostat, Engelwood

    Google Scholar 

  37. Borenstein M, Hedges LV, Higgins JPT, Rothstein HR (2009) Introduction to meta-analysis. John Wiley & Sons, Hoboken

    Book  Google Scholar 

  38. Cohen J (1988) Statistical power analysis for the behavioral sciences. Academic press, New York

    Google Scholar 

  39. Cohen J (1992) Statistical power analysis. Curr Dir Psychol Sci 1(3):81–101. https://doi.org/10.1111/1467-8721.ep10768783

    Article  Google Scholar 

  40. Duval S, Tweedie R (2000) Trim and fill: a simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics 56(2):455–463. https://doi.org/10.1111/j.0006-341X.2000.00455.x

    Article  CAS  PubMed  Google Scholar 

  41. Mullen B (1989) Advanced BASIC meta-analysis. Lawrence Erlbaum Associates, Hillsdale

    Google Scholar 

  42. Giannini M, Loscalzo Y (2016) Social anxiety and adolescence: interpretation bias in an Italian Sample. Scand J Psychol 57:65–72. https://doi.org/10.1111/sjop.12263

    Article  Google Scholar 

  43. Haller SPW, Raeder SM, Scerif G, Cohen Kadosh K, Lau JYF (2016) Measuring online interpretations and attributions of social situations: links with adolescent social anxiety. J Behav Ther Exp Psychiatry 50:250–256. https://doi.org/10.1016/j.jbtep.2015.09.009

    Article  PubMed  Google Scholar 

  44. In-Albon T, Klein A, Rinck M, Becker E, Schneider S (2008) Development and evaluation of a new paradigm for the assessment of anxiety-disorder-specific interpretation bias using picture stimuli. Cogn Emot 22(3):422–436. https://doi.org/10.1080/02699930701872293

    Article  Google Scholar 

  45. Klein AM, Titulaer G, Simons C, Allart E, de Gier E, Bögels SM, Becker ES, Rinck M (2014) Biased interpretation and memory in children with varying levels of spider fear. Cogn Emot 28(1):182–192. https://doi.org/10.1080/02699931.2013.810144

    Article  PubMed  Google Scholar 

  46. Klein AM, Bakens R, van Niekerk RE, Ouwens MA, Rapee RM, Bögels SM, Becker ES, Rinck M (2018) The relation between generalized anxiety disorder symptoms and content-specific interpretation biases for auditory stimuli in children. J Behav Ther Exp Psychiatry 61:121–127. https://doi.org/10.1016/j.jbtep.2018.06.011

    Article  PubMed  Google Scholar 

  47. Klein AM, Flokstra E, van Niekerk R, Klein S, Rapee RM, Hudson JL, Bögels SM, Becker ES, Rinck M (2018) The role of self-reports and behavioral measures of interpretation biases in children with varying levels of anxiety. Child Psychiatry Hum Dev 49(6):897–905. https://doi.org/10.1007/s10578-018-0804-x

    Article  PubMed  PubMed Central  Google Scholar 

  48. Klein AM, Rapee RM, Hudson JL, Morris TM, Schneider SC, Schniering CA, Becker ES, Rinck M (2019) Content-specific interpretation biases in clinically anxious children. Behav Res Ther 121:103452. https://doi.org/10.1016/j.brat.2019.103452

    Article  PubMed  Google Scholar 

  49. Lau JYF, Pettit E, Creswell C (2013) Reducing children’s social anxiety symptoms: exploring a novel parent-administered cognitive bias modification training intervention. Behav Res Ther 51(7):333–337. https://doi.org/10.1016/j.brat.2013.03.008

    Article  PubMed  Google Scholar 

  50. Lisk SC, Pile V, Haller SPW, Kumari V, Lau JYF (2018) Multisession cognitive bias modification targeting multiple biases in adolescents with elevated social anxiety. Cognit Ther Res 42(5):581–597. https://doi.org/10.1007/s10608-018-9912-y

    Article  PubMed  PubMed Central  Google Scholar 

  51. Mobach L, Rinck M, Becker ES, Hudson JL, Klein AM (2019) Content-specific interpretation bias in children with varying levels of anxiety: the role of gender and age. Child Psychiatry Hum Dev 50(5):803–814. https://doi.org/10.1007/s10578-019-00883-8

    Article  PubMed  PubMed Central  Google Scholar 

  52. Muris P, Kindt M, Bögels S, Merckelbach H, Björn G, Moulaert V (2000) Anxiety and threat perception abnormalities in normal children. J Psychopathol Behav Assess 22:183–199. https://doi.org/10.1023/A:1007588524525

    Article  Google Scholar 

  53. Muris P, Luermans J, Merckelbach H, Mayer B (2000) “Danger is lurking everywhere”. The relation between anxiety and threat perception abnormalities in normal children. J Behav Ther Exp Psychiatry 31(2):123–136. https://doi.org/10.1016/S0005-7916(00)00016-1

    Article  CAS  PubMed  Google Scholar 

  54. Muris P, Merckelbach H, Damsma E (2000) Threat perception bias in nonreferred, socially anxious children. J Clin Child Psychol 29(3):348–359. https://doi.org/10.1207/S15374424JCCP2903_6

    Article  CAS  PubMed  Google Scholar 

  55. Smith-Janik SB, Green JS, Teachman BA (2013) Age differences in information processing biases in spider fear. Int J Cogn Ther 6(4):401–420. https://doi.org/10.1521/ijct.2013.6.4.401

    Article  Google Scholar 

  56. Vassilopoulos SP, Banerjee R (2012) Social anxiety and content specificity of interpretation and judgemental bias in children: specificity of cognitive biases in children. Infant Child Dev 21(3):298–309. https://doi.org/10.1002/icd.746

    Article  Google Scholar 

  57. Yu M, Westenberg PM, Li W, Wang J, Miers AC (2019) Cultural evidence for interpretation bias as a feature of social anxiety in Chinese adolescents. Anxiety, Stress, Coping 32(4):376–386. https://doi.org/10.1080/10615806.2019.1598556

    Article  PubMed  Google Scholar 

  58. Van de Mortel TF (2008) Fake it: social desirability response bias in self-report research. Aust J Adv Nurs 25(4):40

    Google Scholar 

  59. Ellis PD (2010) The essential guide to effect sizes: statistical power, meta-analysis, and the interpretation of research results. Cambridge University Press, Cambridge

    Book  Google Scholar 

  60. Rosenthal JA (1996) Qualitative descriptors of strength of association and effect size. J Soc Serv Res 21(4):37–59. https://doi.org/10.1016/0005-7967(95)00082-8

    Article  Google Scholar 

  61. Rothstein HR, Sutton AJ, Borenstein M (2005) Publication bias in meta-analysis: prevention, assessment and adjustments, 1–7

  62. Heeren, Mogoase, Philippot, & McNally (2015) Attention bias modification for social anxiety: a systematic review and meta-analysis. Clin Psychol Rev 40: 76–90. https://doi.org/10.1016/j.cpr.2015.06.001

  63. Goh JX, Hall JA, Rosenthal R (2016) Mini meta-analysis of your own studies: some arguments on why and a primer on how: mini meta-analysis. Soc Personal Psychol Compass 10(10):535–549. https://doi.org/10.1111/spc3.12267

    Article  Google Scholar 

  64. Valentine JC, Pigott TD, Rothstein HR (2010) How many studies do you need? A primer on statistical power for meta-analysis. J Educ Behav Stat 35(2):215–247. https://doi.org/10.3102/1076998609346961

    Article  Google Scholar 

  65. Greco T, Zangrillo A, Biondi-Zoccai G, Landoni G (2013) Meta-analysis: pitfalls and hints. Heart Lung Vessel 5(4):219–225

    CAS  PubMed  PubMed Central  Google Scholar 

  66. Grissom RJ, Kim JJ (2012) Effect sizes for research: Univariate and multivariate applications. Routledge, London

    Book  Google Scholar 

  67. Hedges L, Olkin I (2014) Statistical methods for meta-analysis. Academic press, Cambridge

    Google Scholar 

  68. Kraemer H, Gavins A (1982) A nonparametric technique for meta-analysis effect size calculation. Psychol Bull 91(2):404. https://doi.org/10.1037/0033-2909.91.2.404

    Article  Google Scholar 

  69. Rosenthal R (1986) Meta-analytic procedures for social science research. Educ Res J 15(8):18–20

    Google Scholar 

  70. Zakzanis KK (2001) Statistics to tell the truth, the whole truth, and nothing but the truth Formulae, illustrative numerical examples, and heuristic interpretation of effect size analyses for neuropsychological researchers. Arch Clin Neuropsychol 16(7):653–667. https://doi.org/10.1093/arclin/16.7.653

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Behavioral Research for Anxiety InterVention Efficiency (BRAVE) Lab, Department of Psychology, University of Denver, 2155 S. Race St., Denver, CO, 80210, USA

    Anni R. Subar, Kaeli Humphrey & Michelle Rozenman

Authors
  1. Anni R. Subar
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kaeli Humphrey
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Michelle Rozenman
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the study conception and design. Material preparation, data extraction, and analysis were performed by Anni Subar, Kaeli Humphrey, and Michelle Rozenman. The first draft of the manuscript was written by Anni Subar and Michelle Rozenman and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Anni R. Subar.

Ethics declarations

Conflict of interest

None of the authors have any conflicts of interest for the current work. The last author has received funding in the last 3 years from the National Institute of Mental Health (R61MH121552), NIH/NCATS (UL1TR000124), University of Denver Professional Research Opportunities for Faculty, and UCLA Friends of Semel Research Scholar Program to conduct research unrelated to the current work.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Subar, A.R., Humphrey, K. & Rozenman, M. Is interpretation bias for threat content specific to youth anxiety symptoms/diagnoses? A systematic review and meta-analysis. Eur Child Adolesc Psychiatry 31, 1341–1352 (2022). https://doi.org/10.1007/s00787-021-01740-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00787-021-01740-7

Keywords

Search

Navigation