Resolving Ambiguity: The Effect of Experience on Interpretation of Ambiguous Events in Generalized Social Phobia

Comparing evaluations of social situations for adults who do and do not stutter

PURPOSE

Numerous research studies indicate that stuttering is associated with increased risk for social anxiety disorder (SAD). Interpretation bias is one of four cognitive biases thought to maintain symptoms associated with SAD. Interpretation bias occurs when one evaluates social situations as more negative than they actually are. The purpose of this study was to investigate if adults who do and do not stutter interpret positive, ambiguous, mildly negative, and profoundly negative social situations similarly, or-if like individuals with SAD-adults who stutter exhibit negative interpretation biases.

METHOD

Forty-eight adults who stutter and 42 age-and gender-matched adults who do not stutter participated. Participants completed the Fear of Negative Evaluation (FNE) and were assigned to one of four groups: adults who stutter with high FNE (AWS-High), adults who stutter with low FNE (AWS-Low), adults who do not stutter with high FNE (AWNS-High), and adults who do not stutter with low FNE (AWNS-Low). All participants completed the trait scale of the State Trait Anxiety Inventory (STAI) and the Interpretation and Judgmental Questionnaire (IJQ). The IJQ contains descriptions of four types of social situations: positive, mildly negative, profoundly negative, and ambiguous. Within each situation type there are five different scenarios, for a total of 20 scenarios across the four situation types. Participants provided written responses to these 20 social scenarios. Qualitative analyses were used to understand how members of each group interpreted the different social scenarios.

RESULTS

Thematic analysis revealed that each group responded in similar ways to each of the social scenarios, regardless of the type of situation. Adults who do and do not stutter with low and high FNE agreed on many themes related to the 20 social scenarios, and they agreed across all four types of social situations. Somewhat surprisingly, the theme "stuttering" was mentioned infrequently by the adults who stutter.

CONCLUSIONS

Results suggested that adults who do and do not stutter with low and high FNE interpret social situations similarly, and that no group demonstrated a negative interpretation bias consistent with what is observed in adults with SAD. The interpretations provided by each group were appropriate to the specific scenarios being evaluated.

Empathy in Social Anxiety Disorder: The Association with Attention Deficit Hyperactivity Disorder

Objectives: Our main hypothesis in this study was that patients with social anxiety disorder (SAD) and comorbid attention deficit hyperactivity disorder (ADHD) had lower empathy levels than those without ADHD. Also, after controlling for the severity of SAD and depression, we hypothesized that ADHD symptoms contributed to lower levels of empathy in SAD patients.Methods: 72 patients (46 females, 32 males) with SAD between the ages of 18-65 years were divided into two groups as those with (n = 32) and those without ADHD (n = 40). Participants were evaluated using the Liebowitz Social Anxiety Scale (LSAS), Turgay's Adult Attention-Deficit/Hyperactivity Disorder, Beck Depression Inventory (BDI), and Empathy Quotient. In this study, Mann Whitney-U test, Spearman correlation test, logistic and multiple regression analysis were used.Results: Education level (U = 371.5, p = .002) and empathy scores (U = 259.5, p < .0001) of SAD patients with ADHD were significantly lower than those without ADHD. BDI (U = 206.5, p < .0001), LSAS total (U = 454.5, p = .036), fear (U = 457.0, p = .038), and avoidance scores (U = 453.0, p = .034) were higher in SAD patients with ADHD than those without ADHD. Low levels of empathy (B = - 0.119, Exp(B) = 0.895, p = .014) and high severity of current depression (B = 0.119, Exp(B) = 1.127, p = .001) were significantly associated with comorbidity between SAD and ADHD. ADHD-inattention (β = -0.369, Exp(B) = -0.541, p = .004), and depression (β = -0.262, Exp(B) = -0.212, p = .036) negatively predicted empathy levels.Conclusions: Our findings may provide some evidence for the contribution of ADHD-inattention and depression to poor empathy in SAD patients. Therefore, it is recommended that symptoms of ADHD-inattention and depression should be carefully evaluated in SAD patients with low empathy.

Specificity of trait anxiety in anxiety and depression: Meta-analysis of the State-Trait Anxiety Inventory

The State-Trait Anxiety Inventory - Trait version (STAI-T) was developed to measure an individual's tendency to experience anxiety, but it may lack discriminant evidence of validity based on strong observed relationships with measures of depression. The present series of meta-analyses compares STAI-T scores among individuals with depressive disorders, anxiety disorders, and nonclinical comparison groups, as well as correlations with measures of anxiety and depressive symptom severity, in order to further examine discriminant and convergent validity. A total of 388 published studies (N = 31,021) were included in the analyses. Individuals with an anxiety disorder and those with a depressive disorder displayed significantly elevated scores on the STAI-T compared to nonclinical comparison groups. Furthermore, anxiety and depressive symptom severity were similarly strongly correlated with the STAI-T (mean r = .59 - .61). However, individuals with a depressive disorder had significantly higher STAI-T scores than individuals with an anxiety disorder (Hedges's g = 0.27). Given these findings, along with previous factor analyses that have observed a depression factor on the STAI-T, describing the scale as a measure of 'trait anxiety' may be a misnomer. It is proposed that the STAI-T be considered a non-specific measure of negative affectivity rather than trait anxiety per se.

Ethnicity's Role in the Relationship Between Anxiety and Negative Interpretation Bias Among Clinically Anxious Youth: A Pilot Study

Negative interpretation bias, a correlate of anxiety, is defined as an individual's tendency to interpret ambiguous events as negative or threatening. The current study examined associations between interpretation bias and anxiety symptoms in clinically anxious youth and potential moderators of these relationships. Thirty anxious youth and their parents participated in a clinical interview and reported on child anxiety symptoms. Youth completed implicit, explicit-personally irrelevant, and explicit-personally relevant interpretation bias measures. Child-reported anxiety was only associated with negative interpretation bias on the explicit-personally relevant measure and parent-reported social anxiety was negatively associated with positive bias on this measure. Hispanic individuals displayed marginally higher anxiety symptoms and significantly more intense negative interpretation on the implicit measure. While this pilot study revealed preliminary findings that Hispanic ethnicity may play a role in relationships between interpretation bias and anxiety, future work may further elucidate associations between interpretation bias, anxiety, and ethnicity in anxious youth.

Fear of Negative Evaluation, Trait Anxiety, and Judgment Bias in Adults who Stutter

PURPOSE

Persons who stutter (PWS) and those with social anxiety disorder may exhibit fear of negative evaluation (FNE) and anxiety in social situations. However, the information processing biases that perpetuate these characteristics have had limited investigation. This study investigated judgment bias in social situations.

METHOD

Participants included 50 adults who stutter and 45 age- and gender-matched fluent persons who do not stutter (PWNS), who made up the control group. Participants completed the Interpretation and Judgmental Questionnaire (Voncken, Bögels, & deVries, 2003), and threat scores were calculated.

RESULTS

There were no significant differences between PWS and PWNS in social threat or nonsocial threat scores. When the PWS group was divided on the basis of FNE and compared with PWNS participants without heightened anxiety (n = 35), the PWS with high FNE had significantly higher total social threat scores than the PWS with low FNE. The three groups did not differ in threat ratings for ambiguous or profoundly negative social situations.

CONCLUSIONS

Judgment bias in PWS is mediated by the magnitude of FNE present; not all PWS exhibit judgment bias for social situations. Treatment implications include the need for psychosocial support addressing the negative impacts on quality of life and restrictions on social engagement that stuttering may cause in some individuals.

Unexpected Acceptance? Patients with Social Anxiety Disorder Manifest their Social Expectancy in ERPs During Social Feedback Processing

Previous studies on social anxiety have demonstrated negative-expectancy bias in social contexts. In this study, we used a paradigm that employed self-relevant positive or negative social feedback, in order to test whether this negative expectancy manifests in event-related potentials (ERPs) during social evaluation among socially anxious individuals. Behavioral data revealed that individuals with social anxiety disorder (SAD) showed more negative expectancy of peer acceptance both in the experiment and in daily life than did the healthy control participants. Regarding ERP results, we found a overally larger P2 for positive social feedback and also a group main effect, such that the P2 was smaller in SAD group. SAD participants demonstrated a larger feedback-related negativity (FRN) to positive feedback than to negative feedback. In addition, SAD participants showed a more positive ΔFRN (ΔFRN = negative – positive). Furthermore, acceptance expectancy in daily life correlated negatively with ΔFRN amplitude, while the Interaction Anxiousness Scale (IAS) score correlated positively with the ΔFRN amplitude. Finally, the acceptance expectancy in daily life fully mediated the relationship between the IAS and ΔFRN. These results indicated that both groups could differentiate between positive and negative social feedback in the early stage of social feedback processing (reflected on the P2). However, the SAD group exhibited a larger FRN to positive social feedback than to negative social feedback, demonstrating their dysfunction in the late stage of social feedback processing. In our opinion, such dysfunction is due to their greater negative social feedback expectancy.

Performance-based interpretation bias in clinically anxious youths: relationships with attention, anxiety, and negative cognition

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.

Maintaining perceptual constancy while remaining vigilant: left hemisphere change blindness and right hemisphere vigilance

A considerable literature suggests that the right hemisphere is dominant in vigilance for novel and survival-related stimuli, such as predators, across a wide range of species. In contrast to vigilance for change, change blindness is a failure to detect obvious changes in a visual scene when they are obscured by a disruption in scene presentation. We studied lateralised change detection using a series of scenes with salient changes in either the left or right visual fields. In Study 1 left visual field changes were detected more rapidly than right visual field changes, confirming a right hemisphere advantage for change detection. Increasing stimulus difficulty resulted in greater right visual field detections and left hemisphere detection was more likely when change occurred in the right visual field on a prior trial. In Study 2 an intervening distractor task disrupted the influence of prior trials. Again, faster detection speeds were observed for the left visual field changes with a shift to a right visual field advantage with increasing time-to-detection. This suggests that a right hemisphere role for vigilance, or catching attention, and a left hemisphere role for target evaluation, or maintaining attention, is present at the earliest stage of change detection.

Lack of a benign interpretation bias in social anxiety disorder

Cognitive models of social anxiety posit that recurrent interpretation of ambiguous information as threatening maintains symptoms (e.g. Clark & Wells, 1995, pp. 69-93, Social phobia: Diagnosis, assessment, and treatment. New York: Guilford Press; Rapee & Heimberg, 1997, pp. 741-756, Behavior Research and Therapy, 35). However, biased interpretation may also be represented as a failure to make a benign interpretation of the ambiguous event. Furthermore, interpretation bias can be characterized by both an online (automatic) component and an offline (effortful) component (Hirsch & Clark, 2004, pp. 799-825, Clinical Psychology Review, 24). To measure both benign and threat biases, as well as examine the effect of social anxiety on offline versus online interpretations, Beard and Amir (2009, pp. 1135-1141, Behaviour Research and Therapy, 46) developed the Word Sentence Association Paradigm (WSAP). In the current study, we administered the WSAP to a group of participants diagnosed with social anxiety disorder (SAD) as well as to a group of non-anxious control (NAC) participants. We found that participants with SAD demonstrated a lack of benign online bias, but not an online threat bias when compared to NACs. However, when examining offline biases, SAD patients endorsed social threat interpretations and rejected benign social interpretations to a greater degree than non-anxious individuals. Our results, when taken together, clearly implicate the role of reduced bias toward benign information in SAD.

Emerging interventions for PTSD: future directions for clinical care and research

Efficacious therapeutic approaches for treating Posttraumatic Stress Disorder (PTSD) are needed given the significant psychosocial and physical impairment associated with the disorder (e.g., Hidalgo and Davidson, 2000; Jaycox and Foa, 1999; Stein et al., 2000). Although variations of cognitive behavioral therapy (CBT) effectively treat PTSD, non-response rates and dropout rates remain relatively high (Bradley et al., 2005; Schottenbauer et al., 2008). Thus, treatment outcome research is needed to improve the effectiveness of existing protocols, particularly within specific populations, develop new approaches for treating individuals who cannot access or do not benefit from traditional treatments, and evaluate the types of treatment that may be effective for particular individuals. The present review provides an overview of emerging treatment approaches for PTSD that attempt to address these remaining issues in the treatment outcome literature. This article is part of a Special Issue entitled 'Post-Traumatic Stress Disorder'.

Interpretation in Social Anxiety: When Meaning Precedes Ambiguity

Cognitive models of anxiety posit that negative beliefs influence socially anxious individuals' interpretation of ambiguous social cues. However, paradigms used to assess interpretation bias in social anxiety have not addressed such beliefs. Furthermore, studies have assessed interpretation with either self-report or reaction time paradigms, rather than using both methods. In the current study, socially anxious and non-anxious participants completed the Word Sentence Association Paradigm (WSAP). In the WSAP, participants decide whether or not a word (implying a threat or benign interpretation) is related to an ambiguous sentence. Threat or benign meanings preceded the ambiguity in order to examine the influence of positive and negative beliefs on interpretation of ambiguous information. The WSAP results in two types of interpretation indices: (1) response latency to make relatedness decisions for threat and benign interpretations, and (2) endorsement rates of the relatedness of threat and benign interpretations to ambiguous sentences. Results revealed a threat interpretation bias and a lack of a benign interpretation bias in both reaction time and self-report data. Threat and benign biases were not strongly correlated. These findings support the distinction between threat and benign interpretation biases.

When cancer is associated with illness but no longer with animal or zodiac sign: investigation of biased semantic networks in obsessive-compulsive disorder (OCD)

Building upon semantic network models, it is proposed that individuals with obsessive-compulsive disorder (OCD) process ambiguous words (e.g., homographs such as cancer) preferably in the context of the OC meaning (i.e., illness) and connect them to a lesser degree to other (neutral) cognitions (e.g., animal). To investigate this assumption, a new task was designed requiring participants to generate up to five associations for different cue words. Cue words were either emotionally neutral, negative or OC-relevant. Two thirds of the items were homographs, while the rest was unambiguous. Twenty-five OCD and 21 healthy participants were recruited via internet. Analyses reveal that OCD participants produced significantly more negative and OC-relevant associations than controls, supporting the assumption of biased associative networks in OCD. The findings support the use of psychological interventions such as Association Splitting that aim at restructuring associative networks in OCD by broadening the semantic scope of OC cognitions.

Happy but not so approachable: the social judgments of individuals with generalized social phobia

BACKGROUND

We examined social approachability judgments in a psychiatric population that frequently experiences interpersonal difficulties and reduced social satisfaction, individuals with generalized social phobia (gSP).

METHODS

Our objective was to broaden the understanding of the social cognitive tendencies of individuals with gSP by systematically investigating their interpretation of positive facial expressions. We hypothesized that approachability ratings would be lower for positive as well as negative emotional faces in the gSP group compared to the healthy comparison group. Each participant evaluated 24 emotional faces presented on a computer screen. Participants first labeled the faces as either happy, disgust, or angry in emotional expression, and then they rated each face's approachability. Analysis of variance and post hoc analyses were used to identify group, emotion, and group by emotion rating differences.

RESULTS

Happy face approachability ratings were higher than disgust and anger in both groups. The central finding was that individuals with gSP rated happy faces as less approachable than the healthy participants and that degree of social anxiety was associated with lower approachability ratings within the gSP sample. Explicit approachability judgments of negative faces did not differ as predicted.

CONCLUSIONS

Consistent with earlier indirect evidence of interpretation biases of positive social emotional information, this study reveals that individuals with gSP demonstrate explicit, subjective social interpretation biases of overtly positive social feedback. The therapeutic relevance of these results is discussed.

Interpretation biases in social anxiety: Response generation, response selection, and self-appraisals

Cognitive theories propose that the resolution of ambiguity is related to the maintenance of social anxiety. A sentence completion task was used to examine how individuals high (n=26) and low (n=23) in social anxiety resolve ambiguous social sentences. Individuals were asked to generate as many responses as came to mind for each sentence, and then to endorse the response that best completes the sentence. Total responses, first responses, and endorsed responses were examined separately. Results indicated that high anxious individuals had more negative and anxious responses and fewer positive and neutral responses than low anxious individuals on all sentence completion measures. In contrast, a self-report measure of interpretation bias indicated that more of negative and anxious appraisals were related to social anxiety, while positive and neutral appraisals were not. Results are discussed in terms of a multi-stage processing model of interpretation biases.