Abstract
Interpretation biases are a core feature of social anxiety. Used to automatically train positive interpretation biases, the existing versions of Cognitive Bias Modification for Interpretation (CBM-I) render mixed results. The current study presents the development and testing of a one-session novel adaptation of CBM-I for social anxiety that provides an adaptive instead of a positive meaning to socially loaded situations. Informed by Rational-Emotive Behavior Therapy and latest theoretical upgrades, we argue that biases exist on a continuum from adaptive to maladaptive and defining them by valence may fuel unrealistic positive illusions. A hundred forty volunteers with high social anxiety were randomized to the CBM-I or to the sham-training condition. Baseline, post-training, and during impromptu speech assessments of self-reported anxiety were made, while adaptive interpretation bias was measured at baseline and post-training. First, near-transfer effects in favor of the CBM-I group were found. Second, no far-transfer effects were found regarding the anxiety experienced during the speech. Third, a main finding was that changes in interpretation bias fully mediated training effects on anxiety. To our knowledge, this is the first CBM-I study to evidence that experimentally induced changes in interpretation mediate changes in anxiety. The therapeutic potential of this new adaptation of CBM-I requires testing in clinical samples.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Notes
Not all traditional CBM-I vignettes are radically dichotomous in their positive–negative renditions of interpretation biases.
References
Abelson, R. P., & Rosenberg, M. J. (2007). Symbolic psycho-logic: A model of attitudinal cognition. Behavioral Science, 3(1), 1–13. https://doi.org/10.1002/bs.3830030102.
Abend, R., Dan, O., Maoz, K., Raz, S., & Bar-Haim, Y. (2014). Reliability, validity and sensitivity of a computerized visual analog scale measuring state anxiety. Journal of Behavior Therapy and Experimental Psychiatry, 45(4), 447–453. https://doi.org/10.1016/j.jbtep.2014.06.004.
Aderka, I. M., Hofmann, S. G., Nickerson, A., Hermesh, H., Gilboa-Schechtman, E., & Marom, S. (2012). Functional impairment in social anxiety disorder. Journal of Anxiety Disorders, 26(3), 393–400. https://doi.org/10.1016/j.janxdis.2012.01.003.
American Psychiatric Association, & American Psychiatric Association (Ed.). (2013). Diagnostic and statistical manual of mental disorders: DSM-5 (5th ed.). Washington, DC: American Psychiatric Association.
Amin, N., Foa, E. B., & Coles, M. E. (1998). Negative interpretation bias in social phobia. Behaviour Research and Therapy, 36(10), 945–957.
Amir, N., Beard, C., & Bower, E. (2005). Interpretation bias and social anxiety. Cognitive Therapy and Research, 29(4), 433–443. https://doi.org/10.1007/s10608-005-2834-5.
Amir, N., & Taylor, C. T. (2012). Interpretation training in individuals with generalized social anxiety disorder: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 80(3), 497–511. https://doi.org/10.1037/a0026928.
Bandelow, B., & Michaelis, S. (2015). Epidemiology of anxiety disorders in the 21st century. Dialogues in Clinical Neuroscience, 17(3), 327–335.
Baumeister, R. F., Campbell, J. D., Krueger, J. I., & Vohs, K. D. (2003). Does high self-esteem cause better performance, interpersonal success, happiness, or healthier lifestyles? Psychological Science in the Public Interest, 4(1), 1–44. https://doi.org/10.1111/1529-1006.01431.
Beadel, J. R., Smyth, F. L., & Teachman, B. A. (2014). Change processes during cognitive bias modification for obsessive compulsive beliefs. Cognitive Therapy and Research, 38(2), 103–119. https://doi.org/10.1007/s10608-013-9576-6.
Beard, C., & Amir, N. (2008). A multi-session interpretation modification program: Changes in interpretation and social anxiety symptoms. Behaviour Research and Therapy, 46(10), 1135–1141. https://doi.org/10.1016/j.brat.2008.05.012.
Beard, C., & Amir, N. (2010). Negative interpretation bias mediates the effect of social anxiety on state anxiety. Cognitive Therapy and Research, 34(3), 292–296. https://doi.org/10.1007/s10608-009-9258-6.
Beck, A. T. (1976). Cognitive therapy and the emotional disorders. New York: International Universities Press.
Beck, A. T., & Haigh, E. A. P. (2014). Advances in cognitive theory and therapy: The generic cognitive model. Annual Review of Clinical Psychology, 10(1), 1–24. https://doi.org/10.1146/annurev-clinpsy-032813-153734.
Beck, A. T., & Rush, A. J. (Eds.). (1979). Cognitive therapy of depression (13. print). New York: Guilford Press.
Beck, A. T., Steer, R. A., Ball, R., & Ranieri, W. F. (1996). Comparison of beck depression inventories-IA and-II in psychiatric outpatients. Journal of Personality Assessment, 67(3), 588–597. https://doi.org/10.1207/s15327752jpa6703_13.
Blanchette, I., & Richards, A. (2010). The influence of affect on higher level cognition: A review of research on interpretation, judgement, decision making and reasoning. Cognition and Emotion, 24(4), 561–595. https://doi.org/10.1080/02699930903132496.
Boendermaker, W. J., Boffo, M., & Wiers, R. W. (2015). Exploring elements of fun to motivate youth to do cognitive bias modification. Games for Health Journal, 4(6), 434–443. https://doi.org/10.1089/g4h.2015.0053.
Bowler, J. O., Mackintosh, B., Dunn, B. D., Mathews, A., Dalgleish, T., & Hoppitt, L. (2012). A comparison of cognitive bias modification for interpretation and computerized cognitive behavior therapy: Effects on anxiety, depression, attentional control, and interpretive bias. Journal of Consulting and Clinical Psychology, 80(6), 1021–1033. https://doi.org/10.1037/a0029932.
Butler, E., Mobini, S., Rapee, R. M., Mackintosh, B., & Reynolds, S. A. (2015). Enhanced effects of combined cognitive bias modification and computerised cognitive behaviour therapy on social anxiety. Cogent Psychology. https://doi.org/10.1080/23311908.2015.1011905.
Chen, J., Milne, K., Dayman, J., & Kemps, E. (2019). Interpretation bias and social anxiety: Does interpretation bias mediate the relationship between trait social anxiety and state anxiety responses? Cognition and Emotion, 33(4), 630–645. https://doi.org/10.1080/02699931.2018.1476323.
Clark, D. M., & Wells, A. (1995). A cognitive model of social phobia. In R. G. Heimberg, M. R. Liebowitz, D. A., Hope & F. R. Schneier (Eds.), Social phobia: Diagnosis, assessment, and treatment (pp. 69–93). New York, NY: Guilford Press.
Cristea, I. A., Kok, R. N., & Cuijpers, P. (2015a). Efficacy of cognitive bias modification interventions in anxiety and depression: Meta-analysis. British Journal of Psychiatry, 206(01), 7–16. https://doi.org/10.1192/bjp.bp.114.146761.
Cristea, I. A., Mogoașe, C., David, D., & Cuijpers, P. (2015b). Practitioner review: Cognitive bias modification for mental health problems in children and adolescents: A meta-analysis. Journal of Child Psychology and Psychiatry, 56(7), 723–734. https://doi.org/10.1111/jcpp.12383.
David, D., & Dobrean, A. (2012). Inventarul de depresie Beck-(BDI-II). Romanian Psychological Testing Services.
David, D., Lynn, S. J., & Ellis, A. (Eds.). (2010). Rational and irrational beliefs: Research, theory, and clinical practice. New York: Oxford University Press.
David, D., & Szentagotai, A. (2006). Cognitions in cognitive-behavioral psychotherapies; toward an integrative model. Clinical Psychology Review, 26(3), 284–298. https://doi.org/10.1016/j.cpr.2005.09.003.
Egan, S. J., Piek, J. P., Dyck, M. J., & Rees, C. S. (2007). The role of dichotomous thinking and rigidity in perfectionism. Behaviour Research and Therapy, 45(8), 1813–1822. https://doi.org/10.1016/j.brat.2007.02.002.
Ellis, A. (1994). Reason and emotion in psychotherapy (Rev. and updated). Secaucus, NJ: Carol Publishing Group.
Ellis, A., & Dryden, W. (2007). The practice of rational emotive behavior therapy (Nachdr.). New York, NY: Springer.
Everaert, J., Duyck, W., & Koster, E. H. W. (2014). Attention, interpretation, and memory biases in subclinical depression: A proof-of-principle test of the combined cognitive biases hypothesis. Emotion, 14(2), 331–340. https://doi.org/10.1037/a0035250.
Faul, F., Erdfelder, E., Lang, A.-G., & Buchner, A. (2007). G*Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behavior Research Methods, 39(2), 175–191. https://doi.org/10.3758/BF03193146.
Fodor, L. A., Cosmoiu, A., & Podina, I. R. (2017). Cognitive bias modification interventions for attention to and approach of appetitive food stimuli: A meta-analysis. Journal of Evidence-Based Psychotherapies, 17(2), 85–104. https://doi.org/10.24193/jebp.2017.2.5.
Forgas, J. P. (1998a). On being happy and mistaken: Mood effects on the fundamental attribution error. Journal of Personality and Social Psychology, 75(2), 318–331. https://doi.org/10.1037/0022-3514.75.2.318.
Forgas, J. P. (1998b). On feeling good and getting your way: Mood effects on negotiator cognition and bargaining strategies. Journal of Personality and Social Psychology, 74(3), 565–577. https://doi.org/10.1037/0022-3514.74.3.565.
Forgas, J. P., & East, R. (2008). On being happy and gullible: Mood effects on skepticism and the detection of deception. Journal of Experimental Social Psychology, 44(5), 1362–1367. https://doi.org/10.1016/j.jesp.2008.04.010.
Fox, E., Mackintosh, B., & Holmes, E. A. (2014). Travellers’ tales in cognitive bias modification research: A commentary on the special issue. Cognitive Therapy and Research, 38(2), 239–247. https://doi.org/10.1007/s10608-014-9604-1.
Fresco, D. M., Coles, M. E., Heimberg, R. G., Liebowitz, M. R., Hami, S., Stein, M. B., et al. (2001). The Liebowitz Social Anxiety Scale: A comparison of the psychometric properties of self-report and clinician-administered formats. Psychological Medicine. https://doi.org/10.1017/S0033291701004056.
Fritz, M. S., & MacKinnon, D. P. (2007). Required sample size to detect the mediated effect. Psychological Science, 18(3), 233–239. https://doi.org/10.1111/j.1467-9280.2007.01882.x.
Gkika, S., Wittkowski, A., & Wells, A. (2018). Social cognition and metacognition in social anxiety: A systematic review. Clinical Psychology & Psychotherapy, 25(1), 10–30. https://doi.org/10.1002/cpp.2127.
Goldenberg, L., & Forgas, J. P. (2012). Can happy mood reduce the just world bias? Affective influences on blaming the victim. Journal of Experimental Social Psychology, 48(1), 239–243. https://doi.org/10.1016/j.jesp.2011.07.007.
Hayes, A. F., & Preacher, K. J. (2014). Statistical mediation analysis with a multicategorical independent variable. British Journal of Mathematical and Statistical Psychology, 67, 451–470. https://doi.org/10.1111/bmsp.12028
Hayes, A. F., & Rockwood, N. J. (2017). Regression-based statistical mediation and moderation analysis in clinical research: Observations, recommendations, and implementation. Behaviour Research and Therapy, 98, 39–57. https://doi.org/10.1016/j.brat.2016.11.001.
Hickey, M. (2019). REBT and anxiety disorders. In W. Dryden & M. E. Bernard (Eds.), REBT with diverse client problems and populations (pp. 3–21). New York, NY: Springer. https://doi.org/10.1007/978-3-030-02723-0_1.
Hirsch, C. R., & Clark, D. M. (2004). Information-processing bias in social phobia. Clinical Psychology Review, 24(7), 799–825. https://doi.org/10.1016/j.cpr.2004.07.005.
Hirsch, C. R., Meeten, F., Krahé, C., & Reeder, C. (2016). Resolving ambiguity in emotional disorders: The nature and role of interpretation biases. Annual Review of Clinical Psychology, 12(1), 281–305. https://doi.org/10.1146/annurev-clinpsy-021815-093436.
Hofmann, S. G., Asmundson, G. J. G., & Beck, A. T. (2013). The science of cognitive therapy. Behavior Therapy, 44(2), 199–212. https://doi.org/10.1016/j.beth.2009.01.007.
Holmes, E. A., Lang, T. J., & Shah, D. M. (2009). Developing interpretation bias modification as a “cognitive vaccine” for depressed mood: Imagining positive events makes you feel better than thinking about them verbally. Journal of Abnormal Psychology, 118(1), 76–88. https://doi.org/10.1037/a0012590.
Hoppitt, L., Illingworth, J. L., MacLeod, C., Hampshire, A., Dunn, B. D., & Mackintosh, B. (2014). Modifying social anxiety related to a real-life stressor using online cognitive bias modification for interpretation. Behaviour Research and Therapy, 52, 45–52. https://doi.org/10.1016/j.brat.2013.10.008.
Hyland, P., & Boduszek, D. (2012). Resolving a difference between cognitive therapy and rational emotive behaviour therapy: Towards the development of an integrated CBT model of psychopathology. Mental Health Review Journal, 17(2), 104–116. https://doi.org/10.1108/13619321211270425.
Jones, E. B., & Sharpe, L. (2017). Cognitive bias modification: A review of meta-analyses. Journal of Affective Disorders, 223, 175–183. https://doi.org/10.1016/j.jad.2017.07.034.
Kampmann, I. L., Emmelkamp, P. M. G., & Morina, N. (2016). Meta-analysis of technology-assisted interventions for social anxiety disorder. Journal of Anxiety Disorders, 42, 71–84. https://doi.org/10.1016/j.janxdis.2016.06.007.
Kazdin, A. E. (2007). Mediators and mechanisms of change in psychotherapy research. Annual Review of Clinical Psychology, 3(1), 1–27. https://doi.org/10.1146/annurev.clinpsy.3.022806.091432.
Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., & Walters, E. E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62(6), 593–602. https://doi.org/10.1001/archpsyc.62.6.593.
Killam, K. M., & Kim, Y.-H. (2014). Positive psychological interventions and self-perceptions: A cautionary tale. In A. C. Parks & S. M. Schueller (Eds.), The Wiley Blackwell handbook of positive psychological interventions (pp. 450–461). Oxford, UK: Wiley Blackwell. https://doi.org/10.1002/9781118315927.ch26.
Kim, Y.-H., & Chiu, C.-Y. (2011). Emotional costs of inaccurate self-assessments: Both self-effacement and self-enhancement can lead to dejection. Emotion, 11(5), 1096–1104. https://doi.org/10.1037/a0025478.
Krebs, G., Pile, V., Grant, S., Degli Esposti, M., Montgomery, P., & Lau, J. Y. F. (2017). Research review: Cognitive bias modification of interpretations in youth and its effect on anxiety: A meta-analysis. Journal of Child Psychology and Psychiatry. https://doi.org/10.1111/jcpp.12809.
Lee, J.-S., Mathews, A., Shergill, S., Yiu Chan, D. K., Majeed, N., & Yiend, J. (2015). How can we enhance cognitive bias modification techniques? The effects of prospective cognition. Journal of Behavior Therapy and Experimental Psychiatry, 49, 120–127. https://doi.org/10.1016/j.jbtep.2015.03.007.
Lester, K. J., Mathews, A., Davison, P. S., Burgess, J. L., & Yiend, J. (2011). Modifying cognitive errors promotes cognitive well being: A new approach to bias modification. Journal of Behavior Therapy and Experimental Psychiatry, 42(3), 298–308. https://doi.org/10.1016/j.jbtep.2011.01.001.
Liebowitz, M. R. (1987). Social phobia. In D. F. Klein (Ed.), Modern trends in pharmacopsychiatry (Vol. 22, pp. 141–173). New York, NY: Karger. https://doi.org/10.1159/000414022.
Liu, H., Li, X., Han, B., & Liu, X. (2017). Effects of cognitive bias modification on social anxiety: A meta-analysis. PLoS ONE, 12(4), e0175107. https://doi.org/10.1371/journal.pone.0175107.
MacLeod, C., & Mathews, A. (2012). Cognitive bias modification approaches to anxiety. Annual Review of Clinical Psychology, 8(1), 189–217. https://doi.org/10.1146/annurev-clinpsy-032511-143052.
Mathews, A., & Mackintosh, B. (2000). Induced emotional interpretation bias and anxiety. Journal of Abnormal Psychology, 109(4), 602–615.
Mobini, S., Mackintosh, B., Illingworth, J., Gega, L., Langdon, P., & Hoppitt, L. (2014). Effects of standard and explicit cognitive bias modification and computer-administered cognitive-behaviour therapy on cognitive biases and social anxiety. Journal of Behavior Therapy and Experimental Psychiatry, 45(2), 272–279. https://doi.org/10.1016/j.jbtep.2013.12.002.
Mogg, K., & Bradley, B. P. (2016). Anxiety and attention to threat: Cognitive mechanisms and treatment with attention bias modification. Behaviour Research and Therapy, 87, 76–108. https://doi.org/10.1016/j.brat.2016.08.001.
Rapee, R. M., & Heimberg, R. G. (1997). A cognitive-behavioral model of anxiety in social phobia. Behaviour Research and Therapy, 35(8), 741–756.
Rude, S. S., Wenzlaff, R. M., Gibbs, B., Vane, J., & Whitney, T. (2002). Negative processing biases predict subsequent depressive symptoms. Cognition and Emotion, 16(3), 423–440. https://doi.org/10.1080/02699930143000554.
Salemink, E., van den Hout, M., & Kindt, M. (2010). How does cognitive bias modification affect anxiety? Mediation analyses and experimental data. Behavioural and Cognitive Psychotherapy, 38(01), 59. https://doi.org/10.1017/S1352465809990543.
Stopa, L., & Clark, D. M. (2000). Social phobia and interpretation of social events. Behaviour Research and Therapy, 38(3), 273–283.
Stuhldreher, N., Leibing, E., Leichsenring, F., Beutel, M. E., Herpertz, S., Hoyer, J., et al. (2014). The costs of social anxiety disorder: The role of symptom severity and comorbidities. Journal of Affective Disorders, 165, 87–94. https://doi.org/10.1016/j.jad.2014.04.039.
Urech, A., Krieger, T., Chesham, A., Mast, F. W., & Berger, T. (2015). Virtual reality-based attention bias modification training for social anxiety: A feasibility and proof of concept study. Frontiers in Psychiatry. https://doi.org/10.3389/fpsyt.2015.00154.
Vîslă, A., Flückiger, C., Grosse Holtforth, M., & David, D. (2016). Irrational beliefs and psychological distress: A meta-analysis. Psychotherapy and Psychosomatics, 85(1), 8–15. https://doi.org/10.1159/000441231.
Wenzlaff, R. M., & Bates, D. E. (1998). Unmasking a cognitive vulnerability to depression: How lapses in mental control reveal depressive thinking. Journal of Personality and Social Psychology, 75(6), 1559–1571.
Williams, A. D., O’Moore, K., Blackwell, S. E., Smith, J., Holmes, E. A., & Andrews, G. (2015). Positive imagery cognitive bias modification (CBM) and internet-based cognitive behavioral therapy (iCBT): A randomized controlled trial. Journal of Affective Disorders, 178, 131–141. https://doi.org/10.1016/j.jad.2015.02.026.
Yang, M.-L., Chuang, H.-H., & Chiou, W.-B. (2009). Long-term costs of inflated self-estimate on academic performance among adolescent students: A case of second-language achievements. Psychological Reports, 105(3), 727–737. https://doi.org/10.2466/PR0.105.3.727-737.
Yang, R., Cui, L., Li, F., Xiao, J., Zhang, Q., & Oei, T. P. S. (2017). Effects of cognitive bias modification training via smartphones. Frontiers in Psychology. https://doi.org/10.3389/fpsyg.2017.01370.
Yiend, J., Lee, J.-S., Tekes, S., Atkins, L., Mathews, A., Vrinten, M., et al. (2014). Modifying interpretation in a clinically depressed sample using ‘cognitive bias modification-errors’: A double blind randomised controlled trial. Cognitive Therapy and Research, 38(2), 146–159. https://doi.org/10.1007/s10608-013-9571-y.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
All authors declare that they have no conflict of interest.
Ethical Approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed Consent
Informed consent was obtained from all individual participants included in the study.
Human and Animal Rights
No animal studies were carried out by the authors for this article.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Podina, I.R., Cosmoiu, A., Rusu, P. et al. Positive Thinking is Not Adaptive Thinking: A Cognitive-Behavioral Take on Interpretation Bias Modification for Social Anxiety. J Rat-Emo Cognitive-Behav Ther 38, 424–444 (2020). https://doi.org/10.1007/s10942-020-00344-5
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10942-020-00344-5