Elsevier

Journal of Anxiety Disorders

Volume 22, Issue 8, December 2008, Pages 1462-1471
Journal of Anxiety Disorders

Interpretation bias and social anxiety in adolescents

https://doi.org/10.1016/j.janxdis.2008.02.010Get rights and content

Abstract

Interpretation bias, described as the tendency to interpret social situations in a negative or threatening manner, has been widely linked to social anxiety in adult populations. This study aimed to extend research on interpretation bias to an adolescent population. Thirty-seven high socially anxious and a control group of 36 non-socially anxious adolescents rated the likelihood of different interpretations of ambiguous social and non-social situations coming to mind and which interpretation they most believed. Results showed that negative interpretations of social situations were more common in the high anxious than control group. Such negative bias could not be accounted for by high levels of negative affect. The groups did not differ as to their positive interpretations. Furthermore, there was evidence for content specificity of interpretation bias; high anxious adolescents were not more negative than control participants in their interpretations of non-social situations. Findings are discussed in relation to the adult literature and their clinical relevance is considered.

Introduction

Individuals who are socially anxious are said to interpret ambiguous social situations in a negative or threatening manner (Heinrichs & Hofmann, 2001). They show an interpretation bias that likely has a role to play in the maintenance of social phobia/social anxiety disorder (e.g., Beck, Emery, & Greenberg, 1985; Clark & Wells, 1995). The vast majority of studies to date has investigated presence of this bias in adults (Amir, Foa, & Coles, 1998; Butler & Mathews, 1983; Franklin, Huppert, Langner, Leiberg, & Foa, 2005; Stopa & Clark, 2000; Voncken, Bögels, & de Vries, 2003; Wilson & Rapee, 2005). The aim of the current study was to extend findings concerning the existence of an interpretation bias to an adolescent population. The adolescent group is particularly important due to the fact that social anxiety, that is, fear of negative evaluation, appears to increase during the adolescent years (Weems & Costa, 2005; Westenberg, Drewes, Goedhart, Siebelink, & Treffers, 2004; Westenberg, Gullone, Bokhorst, Heyne, & King, 2007), and its clinical form, social phobia, usually has its onset in the early to mid teens (Rapee & Spence, 2004). Thus, despite adolescence being a critical period for investigation, to the authors’ best knowledge, no studies have, as yet, specifically examined the presence of an interpretation bias in socially anxious adolescents.

In the adult literature, quite a large body of evidence now exists to support the presence of an interpretation bias in both clinical (Amir et al., 1998, Franklin et al., 2005; Stopa & Clark, 2000; Voncken et al., 2003) and non-clinical populations (Brendle & Wenzel, 2004; Constans, Penn, Ihen, & Hope, 1999; Huppert, Foa, Furr, Filip, & Mathews, 2003). Individuals with higher levels of social anxiety rate negative interpretations of ambiguous social situations as more likely to come to mind than less anxious individuals. Negativity in explaining uncertain social situations also occurs when participants are asked to spontaneously produce an explanation (Franklin et al., 2005; Stopa & Clark, 2000). The bias has been reported in positive, mildly and profoundly negative social situations as well as ambiguous ones (Voncken et al., 2003), and in situations that are personally relevant (Amir et al., 1998, Constans et al., 1999).

Findings from the adult literature are linked to four main issues. These are: (a) whether interpretation bias reflects an outright negative bias or only a lack of positive thinking, (b) the importance of believing a certain explanation compared with how easily it comes to mind, (c) whether interpretation bias is particular to social anxiety or reflective of an underlying factor (such as negative affect) common to a broader range of disorders including, for example, depression and (d) whether the bias is present only in social situations or in all types of situations (this issue is referred to as content specificity of interpretation bias). These four issues are of central importance to the study of interpretation bias in adults and should therefore be taken into account when investigating the nature of this bias in an adolescent population. The four issues will be discussed in more detail below.

In a study by Constans et al. (1999), socially anxious university students were found to interpret statements concerning interpersonal evaluation in response to an ambiguous social situation (e.g., in the context of a date one person says to the other “You’re certainly not what I expected”), less positively than their non-anxious peers. Constans et al. then raised the question of whether socially anxious individuals actually lack a positive bias rather than show an explicit negative bias. In contrast, Amir et al. (1998) and Stopa and Clark (2000) reported an outright negative bias. Differences in methodology may account for these disparities, the most important one being that Constans et al. scaled their interpretation scores from low to high positive, and the other two studies from low to high negative. Hence, the way in which the scores were scaled may have influenced finding a positive or negative bias.

Huppert et al. (2003) examined the relative contribution of positive and negative interpretation biases to social anxiety. In their measure of interpretation bias, ambiguous social and non-social scenarios were presented to respondents (students and employees of a university). After a few minutes respondents were given four interpretations of each scenario and asked to rate how similar each sentence was to the original scenario. Interpretations were either positively or negatively worded and consistent or inconsistent with the scenario (termed bias and foil, respectively), creating four types of explanation. In a regression analysis which included both positive and negative biases of social scenarios only the negative bias significantly predicted social anxiety. These results stipulate that, in an adult population, social anxiety is associated not with an absence of positive interpretations but rather with a propensity to have more negative explanations.

Clark et al. (1997) stated that how much individuals believe different explanations of an ambiguous situation is as important as how easily these interpretations come to mind. A couple of studies that have included belief in their measure of interpretation bias have shown inconsistent results. For example, Clark et al. found that patients with panic disorder were more likely to believe in negative interpretations of bodily sensations, for example, heart racing, compared to patients with other anxiety disorders. In contrast, Stopa and Clark (2000) found that belief did not discriminate a socially phobic group from a group of participants with other anxiety disorders, that is, the social phobic group did not have a higher score for believing the negative interpretation of social situations, whereas the likelihood of negative interpretations coming to mind did discriminate. The potential dissociation between strength of believing negative interpretations and the ease with which such explanations come to mind thus remains an open question.

Three studies have controlled for the effect of depression or negative affect on the relationship between interpretation bias and social anxiety (Constans et al., 1999, Franklin et al., 2005, Huppert et al., 2003). Constans et al. accounted for negative affect in predicting interpretation bias. Their findings showed that participants’ ratings of social interpretation items were predicted solely by their trait social anxiety and not negative affect. In a similar vein Huppert et al. reported a significant positive correlation between social anxiety and negative bias of interpretations, after controlling for both state anxiety and depression.

More recently Franklin et al. (2005) suggested that social interpretation bias is in fact a feature of a general cognitive style common to other disorders such as depression and is not particular to social anxiety. Correlations between their participants’ social anxiety and social interpretation bias on the one hand and depression and social interpretation bias on the other, were similar in magnitude; this held after controlling for the effect of depression and social anxiety scores, respectively. Thus, interpretation bias of social situations was equally associated with social anxiety and depression. In sum, contradictory findings have been reported between studies that address the issue of whether interpretation bias is particular to social anxiety.

With regard to the content specificity issue a number of studies have found that socially anxious individuals make significantly more negative interpretations of social situations compared to their non-anxious peers but do not differ in their interpretations of non-social situations (Amir et al., 1998, Constans et al., 1999, Huppert et al., 2003, Voncken et al., 2003; Wilson & Rapee, 2005). These studies cover both clinical and non-clinical populations, and employ different methodologies, such as rank order and rating scales, to tap into the interpretation bias. Two other studies do, however, in fact show a more general negative bias that extends to social and non-social scenarios (Franklin et al., 2005, Stopa and Clark, 2000). According to Franklin et al. the discrepancy in findings may be attributed to differences in levels of depression in the respective patient samples, with more highly depressed samples showing a more general negative bias. A second possibility is the use of different instruments, which all vary with regard to the social and non-social situations included.

A number of studies has investigated whether a threat interpretation bias is present in anxious children (e.g., Barrett, Rapee, Dadds, & Ryan, 1996; Bögels, Snieder, & Kindt, 2003; Bögels & Zigterman, 2000; Chorpita, Albano, & Barlow, 1996; Creswell, Schniering, & Rapee, 2005; Micco & Ehrenreich, 2008; Muris, Merckelbach, & Damsma, 2000; Muris, Rapee, Meesters, Schouten, & Geers, 2003). These studies consistently show that children aged between 7 and 15 years with an anxiety disorder, or with high levels of trait anxiety, interpret ambiguous situations as more threatening (negative) than non-anxious peers. In contrast to the adult literature, however, most studies do not focus on social anxiety in relation to interpretation bias, and instead pool together participants with different types of anxious symptoms or anxiety disorders (cf. Bögels et al., 2003, Muris et al., 2000). Furthermore, content of ambiguous scenarios varies across studies (e.g., physical, social, separation anxiety or generalized anxiety related) and findings are often based on children's interpretation of all types of situations, precluding the possibility of drawing conclusions about the specificity of interpretation bias.

One study which has looked at the content specificity of interpretations in a child population (aged 7–12 years) included a generalized anxious, social phobic and separation anxious group (Bögels et al., 2003). Instead of using social and non-social situations this study compared children's interpretations of different situations reflecting social, separation and generalized anxiety. Partial support was found for content specificity; children in the social phobia group made significantly more negative interpretations of social situations and significantly fewer negative interpretations of separation stories compared to the separation anxiety group. However, no differences were found between the three anxiety groups on the generalized stories. Thus, the socially phobic group's interpretations were not wholly specific to social situations. Unfortunately, as no control group was included in this study it is difficult to draw firm conclusions about the specificity of interpretation bias in a child population.

The present study sought to take a first look at the relationship between interpretation bias and social anxiety in an adolescent population. In line with other work using adult (Brendle & Wenzel, 2004; Constans et al., 1999, Huppert et al., 2003) and child (Bögels et al., 2003, Muris et al., 2000, Muris et al., 2003) samples the current study included a non-clinical population. In light of the fact that gender differences are often found on self-report measures of social anxiety (Rapee & Spence, 2004) the potential effects of gender on the relationship between social anxiety and interpretation bias were controlled. Based on the issues described here, four research questions were formulated, these are: (1) Do high socially anxious adolescents have more negative interpretations and/or less positive interpretations in socially ambiguous situations? (2) Do socially anxious adolescents believe negative interpretations of social situations more than non-socially anxious adolescents? (3) Could a high level of negative affect account for the possible presence of a more negative interpretation style among socially anxious adolescents or is this style specifically related to social anxiety symptoms? (4) Is a negative interpretation bias, if it occurs, specific to social situations or is it also found in the presence of non-social situations? We hypothesized that high socially anxious adolescents would rate negative interpretations of social situations as more likely to come to mind than non-socially anxious adolescents, however these groups would not differ on positive interpretations (Amir et al., 1998, Huppert et al., 2003; Stopa & Clark, 2000). In addition, we tentatively expected to find no difference between high and non-anxious adolescents on negative interpretations of non-social situations (Amir et al., 1998, Constans et al., 1999, Huppert et al., 2003, Voncken et al., 2003; Wilson & Rapee, 2005). Due to the lack of consistent evidence in previous studies specific hypotheses could not be formulated with regards to the strength of belief in negative interpretations and whether social anxiety has a unique relationship with negative interpretations, whilst accounting for negative affect.

Section snippets

Participants

A total of 416 adolescents was initially invited to take part in this study. Parents of the adolescents were informed about the study by letter and their consent requested. Forty-seven adolescents were ill or absent at the time of testing, 10 had refused participation and parental consent was not received for three adolescents. The final data set consisted of 356 secondary school children attending one of the first 4 years of secondary school in The Netherlands (equivalent to American grades

Interpretations and belief in social situations

A 2 (social anxiety group) × 2 (gender) MANOVA was conducted with positive and negative interpretations, and belief of interpretations for social situations as the dependent variables (Table 2 presents the M's and SD's of this analysis). The MANOVA tested the first two research questions (“Do high socially anxious adolescents have more negative interpretations and/or less positive interpretations in socially ambiguous situations?” and “Do socially anxious adolescents believe negative

Discussion

In the adult literature, it has quite consistently been shown that individuals with social phobia or high levels of social anxiety display a negative bias in the way in which they interpret and give meaning to ambiguous social situations. The present study's aim was to take an initial look into whether an interpretation bias could be found in an adolescent population. Drawing from the adult literature four issues were taken into account. The study's findings will be discussed below in relation

Acknowledgement

The authors would like to thank Ingrid van der Lecq for her help with collecting the data used in this study.

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