Interpretation bias in health anxiety: a systematic review and meta-analysis

Abstract

Interpretation bias (i.e. the selective negative interpretation of ambiguous stimuli) may contribute to the development and maintenance of health anxiety. However, the strength of the empirical evidence for this association remains a topic of debate. This study aimed to estimate the association between health anxiety and interpretation bias and to identify potential moderators of this association. Chinese-language databases (CNKI, VIP, and Wanfang), English-language databases (Web of Science, PubMed, PsycINFO, and Scopus), and German-language databases (Psyndex and PubPsych) were searched for relevant studies. There were 36 articles (39 studies) identified by this search (N = 8984), of which 32 articles (34 studies) were included in the meta-analysis (N = 8602). Results revealed a medium overall effect size (g = 0.67). Statistically equivalent effect sizes were observed for patients diagnosed with clinical health anxiety (g = 0.58) and subclinical health anxiety (g = 0.72). The effect sizes for threat stimuli that were health related (g = 0.68) and not health related (g = 0.63) did not differ significantly. The effect size for studies using an offline paradigm (g = 0.75) was significantly higher than that for studies using an online paradigm (g = 0.50). It is concluded that health anxiety is significantly and robustly associated with interpretation bias. These findings are of central importance for the advancement of models and treatment of health anxiety.

Interpretation Biases in Anxiety – A Three-Level Meta-Analysis

“…Consistent with earlier meta-analyses on the role of IBs in psychopathology (Chen et al, 2020;Du et al, 2023;Everaert et al, 2017), we found that direct measures were associated with considerably larger effect sizes compared to indirect measures (e.g., relying on reaction times), to the point that the effect size for indirect measures was not statistically significant. This suggests that the current evidence on IBs in anxiety is limited to direct measures while indirect measures suggest an absence of the association.…”

“…IBs are transdiagnostic (risk) factors and thus characterize multiple mental disorders, for instance depression (Everaert et al, 2017), disorders from the obsessive-compulsive spectrum such as health anxiety (Du et al, 2023), or eating disorders (e.g., Korn et al, 2020). Several studies testing whether (anxiety-disorder specific) IBs are present have compared anxious samples to non-anxious clinical samples in addition to healthy controls (e.g., .…”

Pandemic life in families with health anxiety symptoms, parental perspectives

“…A study on self-reported intentions to receive the covid-19 vaccine among vaccine hesitant individuals found similar worries about the vaccine safety and possible side-effects ( 37 ). Little trust in the reassurances and interventions by health authorities might occur in relation to HA ( 38 , 39 ). This lack of trust in health authorities may exacerbate insecurity and increased anxiety during the pandemic in families.…”

Illness Anxiety Disorder: A Review of the Current Research and Future Directions

“…A key contribution to this misinterpretation is an attentional bias towards health-threat related stimuli, which has shown to be strongly associated with health anxiety in a recent systematic review and meta-analysis [ 46 ]. Health-anxious individuals have also been shown to experience more frequent and intense illness-related intrusive thoughts [ 47 , 48 ], and to demonstrate a selective negative interpretation bias of these thoughts or sensations [ 49 ].…”