Information-processing bias in social phobia
Introduction
Why does social phobia persist for years and even decades, if left untreated? Although important, it seems unlikely that avoidance of social situations can provide a complete account of the persistence of the disorder. Most patients with social phobia have to enter at least some of their feared social situations on a regular basis. When doing so, they rarely receive unambiguous negative feedback from other people. Despite this naturalistic exposure, their fears persist. One possible explanation for such persistence is that patients with social phobia process social information in an excessively negative manner. In keeping with this, cognitive theorists (e.g., Beck et al., 1985, Clark & Wells, 1995, Hartman, 1983, Leary, 1983, Mellings & Alden, 2000, Rapee & Heimberg, 1997, Trower & Gilbert, 1989) suggest that biases in information processing may contribute to the maintenance of social phobia. An information-processing bias is evident when an individual is characterised by a particular way they process information in a given cognitive domain (e.g., memory, interpretation). In particular, it is suggested that biases in attention, interpretation, memory, and imagery may lead patients with social phobia to see social situations as much more threatening than they really are, and to motivate them to behave in ways that contribute to the maintenance of their fears. For example, enhanced threat appraisals generated by information-processing biases may motivate safety behaviours which augment symptoms and elicit less friendly behaviour from other people (see Clark & Wells, 1995, Rapee & Heimberg, 1997, for further details). The present article reviews experimental studies of information-processing biases in social phobia, delineates the main types of bias, and makes recommendations for future research.
Within an information-processing approach, there are at least six possible explanations for the fact that patients with social phobia view social interactions as threatening and these possibilities are not mutually exclusive. Patients with social phobia may (1) make excessively negative predictions about future social events; (2) interpret ongoing social events in an excessively negative manner; (3) selectively retrieve negative information about past social events; (4) have distorted negative images of their own social performance; (5) show reduced processing of social cues; and (6) within social cues, tend to focus on information that could be interpreted in a negative fashion. Possibilities 1 to 4 are reviewed in detail below. Possibilities 5 and 6 are discussed in Bögels and Mansell (2004) in another article in this issue.
It is not the intention of this review to examine particular cognitive models, but rather to review the empirical literature on information processing in social phobia. Social phobia is associated with information-processing biases that operate when patients with social phobia are anticipating a social event, during a social situation and after leaving the social situation, when reflecting upon it.
In this review, we will focus on research that investigates such biases in patients with social phobia and other research that uses analogue (high versus low social anxiety nonclinical populations) designs. It is generally assumed that individuals with social phobia have levels of social anxiety that lie at the more severe end of the social anxiety continuum. Consistent with this suggestion, in a recent review, Stopa and Clark (2001) noted that, thus far, information-processing biases evident in studies that contrast patients with social phobia and nonpatient controls, have also been evident in analogue studies (high versus low social anxiety). Of course, such similarity may not always be observed in the future. For this reason, findings that are initially reported in analogue studies need to be confirmed in patient versus nonpatient studies. Given this point, we have always made evident the type of design used in each study. The need to confirm findings from analogue design studies in patient studies raises the issue of whether analogue designs are useful at all. The main advantage is the ready availability of participants. Patients with social phobia have a low help seeking rate, so it can take a research group a long time to recruit patients for a study, especially if it involves complex factorial designs and as a consequence necessitates a large sample size. Hence, analogue research can help establish potential information-processing biases that may maintain social phobia, thus facilitating progress in the field.
Throughout this review, the criterion for statistical significance will be set at p<0.05. Hence, when interactions are not significant, but authors report follow-up analyses, these will not be discussed.
Section snippets
Subjective estimates of danger
The first issue that needs to be established when considering information processing is whether individuals with social phobia perceive social situations to be more dangerous than do other people. A number of studies have investigated this issue by assessing individuals' subjective estimates of the likelihood and potential cost of different social outcomes.
Lucock and Salkovskis (1988) asked social phobia patients and nonclinical controls to rate the likelihood that particular positive and
Interpretation
In order to circumvent the problem that any differences between groups were merely a reflection of different experiences, researchers into information-processing biases turned their attention to examining biases in interpretation of information, rather than subjective risk. If when the same information is presented, social phobia patients interpret it in a different way than other people, then this could provide more evidence of threat and thus increase anxiety and potentially perpetuate the
Memory
There are a variety of ways memory may operate to maintain social phobia. The selective retrieval of negative (as compared to neutral or positive) information about past social situations and/or one's public self could make individuals more anxious when anticipating social interactions and, consequently, more likely to avoid/cancel the situation. It could also make them more likely to interpret social interactions in a negative fashion both at the time and afterwards when ruminating about how
Imagery
A common cognitive phenomenon is mental imagery. Spontaneous mental images are common in anxiety disorders (Beck, Laude, & Bohnert, 1974), and often encapsulate patients' distorted beliefs about the dangerousness of feared situations. Given this, then it is likely that social phobia might also be associated with negative self-imagery.
Research avenues to pursue
This review has reported a number of studies that clearly indicate that information-processing biases exist in social phobia. Further research, however, is required in the area, involving both replications of previous findings to confirm what is already known, but more importantly to forge new ground in our understanding of social phobia. There are a number of important research issues that still need to be addressed.
Although some studies have included anxious control patients, many biases in
Conclusions
It is clear that information-processing biases exist in social phobia, particularly in relation to probability and cost estimates for social situations, interpretation of ambiguous and mildly negative social information and imagery. These biases may increase or maintain social anxiety. Furthermore, research is needed on the interaction between information-processing domains, the extent to which the negative biases can be ameliorated and the role of such biases in the maintenance and development
References (75)
- et al.
Social phobia and social appraisal in successful and unsuccessful social interactions
Behaviour Research and Therapy
(1995) - et al.
Memory bias does not generalize across anxiety disorders
Behaviour Research and Therapy
(1995) - et al.
Effects of varying levels of anxiety within social situations: Relationship to memory perspective and attributions in social phobia
Behaviour Research and Therapy
(2001) - et al.
Interpretive biases for ambiguous stimuli in social anxiety
Behaviour Research and Therapy
(1999) - et al.
Self-focused attention and public speaking anxiety
Personality and Individual Differences
(1989) - et al.
Memory bias in generalized social phobia: Remembering negative emotional expressions
Journal of Anxiety Disorders
(2000) - et al.
Recurrent images and early memories in social phobia
Behaviour Research and Therapy
(2000) A metacognitive model of social anxiety: Implications for treatment
Clinical Psychology Review
(1983)- et al.
Interpretative inferences when reading about emotional events
Behaviour Research and Therapy
(1997) - et al.
Negative self-imagery block inferences
Behaviour Research and Therapy
(2003)
Cognitive factors in social anxiety and its treatment
Behaviour Research and Therapy
Recognition bias for critical faces in social phobia
Behaviour Research and Therapy
Explicit and implicit memory bias in social phobia. The role of subdiagnostic type
Behaviour Research and Therapy
Cognitive processes in social anxiety: The effects of self-focus, rumination and anticipatory processing
Behaviour Research and Therapy
Fear of blushing: Fearful preoccupation irrespective of facial coloration
Behaviour Research and Therapy
Selective attention in social phobia and the moderating effect of a concurrent depressive disorder
Behaviour Research and Therapy
Memory for facial expressions in social phobia
Behaviour Research and Therapy
Change in danger cognitions in agoraphobia and social phobia during treatment
Behaviour Research and Therapy
Post-event processing in social anxiety
Behaviour Research and Therapy
A cognitive–behavioral model of anxiety in social phobia
Behaviour Research and Therapy
Memory bias in social phobia
Behaviour Research and Therapy
Interpretations for anxiety symptoms in social phobia
Behaviour Research and Therapy
Cognitive processes in social phobia
Behaviour Research and Therapy
Social phobia and interpretation of social events
Behaviour Research and Therapy
New theoretical conceptions of social anxiety and social phobia
Clinical Psychology Review
Interpretation and judgmental biases in social phobia
Behaviour Research and Therapy
How do I look with my minds eye: Perspective taking in social phobic imagery
Behaviour Research and Therapy
The observer perspective: Biased imagery in social phobia, agoraphobia, and blood/injury phobia
Behaviour Research and Therapy
Interpersonal Processes in Social Phobia
Framing social information and generalized social phobia
Behaviour Research and Therapy
The effect of practice on recall of emotional information in individuals with generalized social phobia
Journal of Abnormal Psychology
Negative interpretation bias in social phobia
Behaviour Research and Therapy
Automatic activation and strategic avoidance of threat-relevant information in social phobia
Journal of Abnormal Psychology
Implicit memory bias for threat-relevant information in individuals with generalized social phobia
Journal of Abnormal Psychology
Anxiety disorders and phobias: A cognitive perspective
Ideational components of anxiety neurosis
Archives of General Psychiatry
Explicit memory in anxiety disorders
Journal of Abnormal Psychology
Cited by (243)
The legacy of social anxiety-linked negative expectancy: A pathway from pre-event negative expectancies to post-event negative thinking
2024, Journal of Behavior Therapy and Experimental PsychiatryVulnerabilities in social anxiety: Integrating intra- and interpersonal perspectives
2024, Clinical Psychology ReviewExamining social reinforcement learning in social anxiety
2023, Journal of Behavior Therapy and Experimental PsychiatryDorsal anterior cingulate cortex activity during cognitive challenge in social anxiety disorder
2023, Behavioural Brain ResearchPsychometric properties of the state Probability and Consequences Questionnaire for social anxiety disorder
2022, Journal of Anxiety Disorders