Comorbid interpretation and expectancy bias in social anxiety and alcohol use

Abstract

Background: In two studies, the present research examined whether being high in both social anxiety and alcohol use disorder symptoms is associated with a comorbid interpretation and expectancy bias that reflects their bidirectional relationship. Design: Cross-sectional, quantitative surveys. Methods: Measures of social anxiety and alcohol use disorder symptoms, as well as an interpretation and expectancy bias task assessing biases for social anxiety, drinking, and comorbid social anxiety and drinking. Results: In Study 1 (N=447), individuals high (vs. low) in social anxiety had stronger social threat bias and individuals high (vs. low) in alcohol use disorder symptoms had stronger drinking bias. Those high in both social anxiety and alcohol use disorder symptoms endorsed interpretations and expectancies linking social interaction with alcohol use. Comorbid bias predicted membership into the high social anxiety/drinking group, even after taking into account single-disorder biases. In Study 2 (N=325), alcohol use disorder symptoms predicted drinking bias and social anxiety symptoms predicted social anxiety bias. Alcohol use disorder symptoms, social anxiety symptoms, and their interaction predicted comorbid interpretation and expectancy bias. Conclusion: Results indicate unique cognitive vulnerability markers for persons with comorbid social anxiety and alcohol use disorder symptoms, which may improve detection and treatment of this serious comorbidity.

Acceptability and Co‐Development of an Online Cognitive Bias Modification Intervention for Emerging Adults With Hazardous Alcohol Use and Social Anxiety: A Mixed Methods Study

“…In addition, the study does not contain an evaluation of acceptability after participant feedback was incorporated to ensure the changes met with their approval. While this study focused on alcohol approach biases and anxiety interpretation biases due to the relatively strong evidence base for their modification in clinical samples via CBM (see Fodor et al, 2020, regarding data on training interpretations for anxiety), it would also be interesting to test how intervening on the same cognitive processes across disorders impacts outcomes (for instance, Chow et al, 2018 provided initial evidence that comorbid alcohol use and social anxiety are strongly associated with comorbid interpretation and expectancy biases). One could imagine synergistic effects when interpretations, for example, are trained in both the anxiety and alcohol domains, but one could also imagine more generalizability when multiple cognitive processes are targeted.…”

Alcohol use in late adolescence and early adulthood: The role of generalized anxiety disorder and drinking to cope motives

“…For example, there may be situational or individual difference variables which moderate the extent to which individuals with anxiety drink more or more frequently. Perhaps at the most severe forms of drinking, there may be common biological (Agoglia and Herman, 2018), cognitive (Chow et al, 2018) and/or environmental vulnerabilities (Jones et al, 2018) that increase the risk of both anxiety disorders and alcohol problems.…”

A Web-Based Cognitive Bias Modification Intervention (Re-train Your Brain) for Emerging Adults With Co-occurring Social Anxiety and Hazardous Alcohol Use: Protocol for a Multiarm Randomized Controlled Pilot Trial

“…Interpretation and expectancy biases for co-occurring social anxiety and alcohol use will be assessed by the self-report Comorbid Social Anxiety and Alcohol Interpretation Bias task [ 59 ]. Participants are presented with a set of eight ambiguous social scenarios, followed by three possible explanations for the situation.…”

“…The feasibility of the program will be assessed according to the percentage of successfully recruited participants who agree to participate (ie, uptake), commence training, and decline participation. At postintervention, feasibility will be measured by the number of sessions completed; reporting of adverse events via spontaneous reports in open-feedback questions or to the study team or deterioration of social anxiety or alcohol use symptoms (see Multimedia Appendix 1 [54,55,[57][58][59][60][61][62][63][64][65][66] for full details) [57,58]; and the proportion of participants who (1) complete the 10-session protocol (as a proportion of those who commence at least one session of training, ie, treatment adherence or compliance), (2) complete the mean optimum number of six sessions, based on ApBM research [67], and (3) drop out before training is completed. Survey or cognitive assessment follow-up rates will also be recorded as a measure of the feasibility of the RCT methodology at the 6-week and 3-month time points.…”