Elsevier

Behavior Therapy

Volume 45, Issue 5, September 2014, Pages 594-605
Behavior Therapy

Performance-Based Interpretation Bias in Clinically Anxious Youths: Relationships With Attention, Anxiety, and Negative Cognition

https://doi.org/10.1016/j.beth.2014.03.009Get rights and content

Highlights

  • Explored relationships between performance-based interpretation biases with attention and anxiety symptoms in clinically anxious youths

  • Components of interpretation (speed of responding and threat-valence judgments) examined

  • Performance-based interpretation accounted for 46% of variance in anxiety symptoms

  • Attention and interpretation correlated

  • Preliminary support for models of information processing in anxious youths

Abstract

This preliminary investigation sought to examine basic interpretive biases, as assessed via performance-based means, in the context of anxious symptomatology, attention, and negative cognition in children and adolescents. At a single assessment, 26 youths diagnosed with primary separation anxiety, social phobia, or generalized anxiety disorder completed performance-based assessments of interpretation and attention. Youths and parents also completed diagnostic interviews and youths completed a measure of negative self-statements. Components of interpretation (threat-valence judgments and speed of responding) were examined, and interpretation was explored as a correlate of youth anxiety, attention bias, and negative self-statements. Results found percentage of negative interpretations endorsed as the strongest predictor of anxiety symptoms; this index was also correlated with attention bias. Slower rejection of benign interpretations was also associated with youth-reported negative self-statements.This initial investigation provides support for a relationship between interpretation bias and anxiety and preliminary evidence for a relationship between attention and interpretation biases. Continued research dismantling the stages of basic cognition within the chain of information processing may provide a better understanding of the mechanisms underlying anxiety disorders in youths and lead to continued development and refinement of cognitive interventions.

Section snippets

Participants

The sample consisted of 26 clinically anxious youths ages 9 to 17 (M = 12.65, SD = 2.81) and 39% male. The majority of youths were Caucasian (58%), although a substantial proportion (42%) consisted of ethnic minorities, with 15% Hispanic, 8% Asian/Pacific Islander, and 19% of youths identifying with more than one racial/ethnic category. All youths met criteria for a primary DSM-IV-TR anxiety disorder, including generalized anxiety disorder (n = 14), social phobia (n = 11), and separation anxiety

Components of interpretation

The primary aim of this study was to probe the components of interpretation to examine whether percentage of interpretations endorsed and/or reaction time indices were useful indicators of interpretation bias. Pearson correlations across interpretation components and other variables under study were compared (see Table 1). Of all interpretation components, percentage of negative interpretations endorsed was most consistently associated with other variables, with significant positive

Discussion

Theoretical models of anxiety implicate the role of biases in basic cognitive processing as underlying mechanisms in the development and maintenance of anxiety disorders. While IP models have been widely tested and empirically supported in internalizing adults, the youth literature is at a far earlier stage of development. Only three investigations to date have assessed interpretation bias via performance-based means, and these studies have not examined specific components of interpretation

Conflict of Interest Statement

The authors declare that there are no conflicts of interest.

References (52)

  • J.S. Legerstee et al.

    Threat-related selective attention predicts treatment success in childhood anxiety disorders

    Journal of the American Academy of Child and Adolescent Psychiatry

    (2009)
  • J.A. Micco et al.

    Children’s interpretation and avoidant response biases in response to non-salient and salient situations: Relationships with mothers’ threat perception and coping expectations

    Journal of Anxiety Disorders

    (2008)
  • A.C. Miers et al.

    Interpretation bias and social anxiety in adolescents

    Journal of Anxiety Disorders

    (2008)
  • A.K. Roy et al.

    Attention bias toward threat in pediatric anxiety disorders

    Journal of the American Academy of Child & Adolescent Psychiatry

    (2008)
  • M. Rozenman et al.

    A case series of attention modification in clinically anxious youths

    Behaviour Research and Therapy

    (2011)
  • C.A. Schniering et al.

    Development and validation of a measure of children's automatic thoughts: The Children's Automatic Thoughts Scale

    Behaviour Research and Therapy

    (2002)
  • L. Stopa et al.

    Social phobia and interpretation of social events

    Behavior Research and Therapy

    (2000)
  • The Research Units on Pediatric Psychopharmacology Anxiety Study Group

    The Pediatric Anxiety Rating Scale (PARS): Development and psychometric properties

    Journal of the AmericanAcademy of Child and Adolescent Psychiatry

    (2002)
  • A.M. Waters et al.

    Attentional bias towards angry faces in childhood anxiety disorders

    Journal of Behavior Therapy and Experimental Psychiatry

    (2010)
  • A.M. Waters et al.

    Attentional bias toward fear-related stimuli: An investigation with nonselected children and adults and children with anxiety disorders

    Journal of Experimental Child Psychology

    (2004)
  • A.M. Waters et al.

    Direction of threat attention bias predicts treatment outcome in anxious children receiving cognitive-behavioural therapy

    Behaviour Research and Therapy

    (2012)
  • A.M. Waters et al.

    Threat-based cognitive biases in anxious children: Comparisons with non-anxious children before and after cognitive behavioural treatment

    Behaviour Research and Therapy

    (2008)
  • N. Amir et al.

    Resolving ambiguity: The effect of experience on interpretation of ambiguous events in generalized social phobia

    Journal of Abnormal Psychology

    (2005)
  • A. Angold et al.

    Comorbidity

    Journal of Child Psychology, Psychiatry, and Allied Disciplines

    (1999)
  • Y. Bar-Haim et al.

    Threat-related attentional bias in anxious and nonanxious individuals: A meta-analytic study

    Psychological Bulletin

    (2007)
  • P.M. Barrett et al.

    Family enhancement of cognitive style in anxious and aggressive children

    Journal of Abnormal Child Psychology

    (1996)
  • Cited by (32)

    • The combined cognitive bias hypothesis in anxiety: A systematic review and meta-analysis

      2022, Journal of Anxiety Disorders
      Citation Excerpt :

      Similar to studies of depression, the current body of anxiety research can address the questions raised by Everaert et al. (2012). For example, some findings have demonstrated significant associations between attention and memory biases (LeMoult & Joormann, 2012; Reid, Salmon, & Lovibond, 2006) as well as between attention and interpretation biases (Richards, French, Nash, Hadwin, & Donnelly, 2007; Rozenman, Amir, & Weersing, 2014). Likewise, there is emerging evidence addressing the causal link between biases where manipulation of attention bias resulted in a change to interpretation bias (Bowler et al., 2017; de Voogd, Wiers, & Salemink, 2017) and vice versa (Amir, Bomyea, & Beard, 2010; Mobini et al., 2014).

    • Like parent, like child: Is parent interpretation bias associated with their child's interpretation bias and anxiety? A systematic review and meta-analysis

      2021, Journal of Affective Disorders
      Citation Excerpt :

      More recent conceptualizations of interpretation bias have focused on this cognitive process as fast, uncontrolled, and likely occurring automatically and without awareness (Amir et al., 2005; Rozenman et al., 2014). In the last decade, investigators have demonstrated that performance-based interpretation bias tasks in which individuals are required to respond to stimuli as quickly as bias is proposed to occur (e.g., ~3 seconds; Beard and Amir, 2008; Rozenman et al., 2017) capture a greater proportion of variance and therefore may be better indicators of interpretation bias than self-reports (e.g., Rozenman et al., 2014). However, every single study included in this meta-analysis utilized either self-reports or tasks that allowed for unlimited time to respond, increasing the possibility that the biases assessed involve higher-level processing (Lau et al., 2013; Rozenman et al., 2014; MacLeod & Mathews, 2012).

    • A systematic review of the word sentence association paradigm (WSAP)

      2019, Journal of Behavior Therapy and Experimental Psychiatry
    • Thinking anxious, feeling anxious, or both? Cognitive bias moderates the relationship between anxiety disorder status and sympathetic arousal in youth

      2017, Journal of Anxiety Disorders
      Citation Excerpt :

      A better understanding of potential relationships between these implicated processes would provide more direct cognitive and biological prevention and treatment targets. Anxious youth have also been shown to demonstrate an attention bias, or selectively attend to threat (e.g., Bar-Haim, Lamy, & Pergamin, 2007) and an interpretation bias, or interpret threat from ambiguous information (e.g., Cannon & Weems, 2010; Rozenman, Amir, & Weersing, 2014), using performance-based tasks. The attention bias literature in youth is mixed, suggesting that selective attention to threat may be quite heterogeneous and not necessarily a ubiquitous phenomenon in youth (e.g., Bar-Haim, Kerem, Lamy, & Zakay, 2010; Eldar, Apter, Lotan, & Edgar, 2012; Waters, Bradley, & Mogg, 2014).

    View all citing articles on Scopus
    View full text