Interpretation bias refers to the tendency to perceive ambiguous social information negatively. In social anxiety disorder, individuals often misinterpret neutral or ambiguous facial expressions as threatening or disapproving.
This bias can exacerbate anxiety in social situations and lead to avoidance behaviors, further maintaining the disorder.
Choi, J., Kim, G., & Yang, J. W. (2024). A single‐session feedback training modifies interpretation bias in individuals with high social anxiety: A randomized controlled trial. British Journal of Clinical Psychology. https://doi.org/10.1111/bjc.12512
Key Points
- A single-session feedback training significantly reduced interpretation bias for happy and angry faces in individuals with high social anxiety compared to a control group.
- The training group showed decreased social anxiety symptoms after the training, but the difference was not statistically significant compared to the control group.
- This feedback training paradigm, which provides individualized feedback on dimensional ratings of facial emotions, may be a promising option for modifying interpretation bias in socially anxious individuals.
- Limitations include using a non-clinical Korean student sample, lack of long-term follow-up, and reliance on trait anxiety measures. Future research should examine multiple training sessions and effects on representative clinical populations.
Rationale
Facial expressions convey crucial information during social interactions, and accurately interpreting them is important for adaptive social functioning (Adams et al., 2013).
However, individuals with social anxiety disorder tend to misinterpret ambiguous or neutral faces as negative, such as angrier (Maoz et al., 2016) or less trustworthy (Gutiérrez-García & Calvo, 2016).
This interpretation bias contributes to the maintenance of social anxiety (Chen et al., 2020).
Previous studies have shown that feedback training can modify interpretation bias in individuals with depressive symptoms (Penton-Voak et al., 2012), at high risk for delinquency (Penton-Voak et al., 2013), with disruptive mood dysregulation disorder (Stoddard et al., 2016), and socially anxious adolescents (Rawdon et al., 2018). However, these studies used forced-choice paradigms that lack ecological validity.
A recent non-clinical study (Leitzke et al., 2022) introduced a paradigm where participants rated emotional intensity on a visual analog scale and received feedback comparing their ratings to the actual intensity.
The current study aimed to apply this paradigm to socially anxious individuals and test its effects on interpretation bias and social anxiety symptoms.
Method
The study used a single-session randomized controlled trial to investigate the effects of feedback training on interpretation bias and social anxiety symptoms in individuals with high social anxiety.
Procedure
Eligible participants were randomly assigned to a training or control condition. They completed pre-training questionnaires, participated in either the experimental or control task, and completed post-training questionnaires.
The experimental task provided immediate individualized feedback on participants’ perceptual bias, while the control task did not provide feedback.
Sample
69 Korean undergraduate and graduate students with high social anxiety (SPS/SIAS scores ≥21) were recruited.
71% were female, mean age was 22.55 years (SD=3.26). Participants were randomly assigned to training (n=37) or control (n=32) conditions.
Measures
- Social Interaction Anxiety Scale (SIAS) and Social Phobia Scale (SPS): 20-item self-report measures of social anxiety. 6-item versions were used for screening.
- Center for Epidemiologic Studies Depression Scale (CES-D): 20-item self-report measure of depressive symptoms, used as a covariate.
Statistical measures
Mixed-design repeated measures ANOVAs were conducted to examine the effects of time (pre vs post) and condition (training vs control) on interpretation bias and social anxiety symptoms.
Baseline social anxiety and depression were controlled for.
Results
- The training group showed a significant reduction in interpretation bias for happy and angry faces from pre to post-training, while the control group did not.
- Although the training group’s social anxiety symptoms decreased post-training, the difference was not statistically significant compared to the control group.
Insight
This study demonstrates that a single session of feedback training can successfully modify the interpretation bias of facial emotions in socially anxious individuals.
The training provided participants with immediate, individualized feedback on the magnitude and direction of their perceptual bias, which may enhance motivation and attention to reduce error (Leitzke et al., 2022).
Interestingly, before training, participants perceived happy faces as less happy than the actual intensity. Surprisingly, they also perceived angry faces as less angry than the actual intensity.
This unexpected finding may reflect a general tendency to perceive negative information less negatively, cultural factors related to suppressing angry expressions in Asian cultures (Matsumoto et al., 2010), or the non-clinical student sample’s lack of experience with hostile environments.
Future studies should include low socially anxious participants for comparison.
Although promising, the training did not significantly reduce trait social anxiety symptoms compared to the control group.
This may be because cumulative life experiences shape trait anxiety, making it difficult to change with a brief intervention.
Using state anxiety measures could provide a more sensitive assessment of immediate changes.
Future research should investigate the paradigm’s effectiveness for other emotions like disgust, which also signals social threat (Staugaard, 2010).
Multiple training sessions and long-term follow-up with representative clinical populations are needed to establish the intervention’s efficacy and durability.
As an easily adaptable computerized task, this paradigm has potential for accessible remote delivery to help socially anxious individuals.
Implications
The study provides preliminary evidence for the effectiveness of a novel feedback training paradigm in modifying interpretation bias, a maintaining factor of social anxiety disorder.
With further validation, this approach could inform the development of accessible interventions in clinical practice.
Future research should examine multiple training sessions, long-term effects, and impact on clinical populations to establish its utility as a treatment adjunct for social anxiety disorder.
Strengths
This study had several methodological strengths, including:
- Randomized controlled design
- Controlled for baseline social anxiety and depression symptoms
- Used an ecologically valid paradigm with dimensional ratings and individualized feedback
- First demonstration of this paradigm’s effectiveness for socially anxious individuals
Limitations
This study also had several methodological limitations, including:
- Non-clinical university student sample limits generalizability to clinical populations
- Lack of low socially anxious control group
- No clinical interviews to confirm social anxiety disorder diagnosis
- Assessed only immediate training effects, not long-term outcomes
- Used trait measures which may be less sensitive to change than state measures
References
Primary reference
Choi, J., Kim, G., & Yang, J. W. (2024). A single‐session feedback training modifies interpretation bias in individuals with high social anxiety: A randomized controlled trial. British Journal of Clinical Psychology. https://doi.org/10.1111/bjc.12512
Other references
Adams, S., Penton-Voak, I. S., Harmer, C. J., Holmes, E. A., & Munafò, M. R. (2013). Effects of emotion recognition training on mood among individuals with high levels of depressive symptoms: Study protocol for a randomised controlled trial. Trials, 14, 161. https://doi.org/10.1186/1745-6215-14-161
Chen, J., Short, M., & Kemps, E. (2020). Interpretation bias in social anxiety: A systematic review and meta-analysis. Journal of Affective Disorders, 276, 1119–1130. https://doi.org/10.1016/j.jad.2020.07.121
Gutiérrez-García, A., & Calvo, M. G. (2016). Social anxiety and trustworthiness judgments of dynamic facial expressions of emotion. Journal of Behavior Therapy and Experimental Psychiatry, 52, 119–127. https://doi.org/10.1016/j.jbtep.2016.04.003
Leitzke, B. T., Plate, R. C., & Pollak, S. D. (2022). Training reduces error in rating the intensity of emotions. Emotion, 22(3), 479–492. https://doi.org/10.1037/emo0000763
Maoz, K., Eldar, S., Stoddard, J., Pine, D. S., Leibenluft, E., & Bar-Haim, Y. (2016). Angry-happy interpretations of ambiguous faces in social anxiety disorder. Psychiatry Research, 241, 122–127. https://doi.org/10.1016/j.psychres.2016.04.100
Matsumoto, D., Yoo, S. H., & Chung, J. (2010). The expression of anger across cultures. In M. Potegal, G. Stemmler, & C. Spielberger (Eds.), International handbook of anger (pp. 125–137). Springer. https://doi.org/10.1007/978-0-387-89676-2_8
Penton-Voak, I. S., Bate, H., Lewis, G., & Munafò, M. R. (2012). Effects of emotion perception training on mood in undergraduate students: Randomised controlled trial. The British Journal of Psychiatry, 201(1), 71–72. https://doi.org/10.1192/bjp.bp.111.107086
Penton-Voak, I. S., Thomas, J., Gage, S. H., McMurran, M., McDonald, S., & Munafò, M. R. (2013). Increasing recognition of happiness in ambiguous facial expressions reduces anger and aggressive behavior. Psychological Science, 24(5), 688–697. https://doi.org/10.1177/0956797612459657
Rawdon, C., Murphy, D., Motyer, G., Munafò, M. R., Penton-Voak, I., & Fitzgerald, A. (2018). An investigation of emotion recognition training to reduce symptoms of social anxiety in adolescence. Psychiatry Research, 263, 257–267. https://doi.org/10.1016/j.psychres.2018.02.023
Staugaard, S. R. (2010). Threatening faces and social anxiety: A literature review. Clinical Psychology Review, 30(6), 669–690. https://doi.org/10.1016/j.cpr.2010.05.001
Stoddard, J., Sharif-Askary, B., Harkins, E. A., Frank, H. R., Brotman, M. A., Penton-Voak, I. S., Maoz, K., Bar-Haim, Y., Munafo, M., Pine, D. S., & Leibenluft, E. (2016). An open pilot study of training hostile interpretation bias to treat disruptive mood dysregulation disorder. Journal of Child and Adolescent Psychopharmacology, 26(1), 49–57. https://doi.org/10.1089/cap.2015.0100
Keep Learning
- How might cultural differences in emotional expression and perception influence the effectiveness of this training paradigm across diverse populations?
- What are some potential advantages and disadvantages of delivering this type of intervention remotely versus in-person?
- How could this training be adapted or combined with other therapeutic techniques (e.g., cognitive restructuring, exposure) to optimize outcomes for individuals with social anxiety disorder?
- What ethical considerations should guide the development and implementation of computerized interventions that aim to modify cognitive biases?
- How might this study inform our understanding of the cognitive mechanisms underlying social anxiety and their malleability?
