Resolving Ambiguity in Emotional Disorders: The Nature and Role of Interpretation Biases

Abstract

People with emotional disorders, such as social anxiety disorder (SAD), generalized anxiety disorder (GAD), and depression, demonstrate a consistent tendency, or bias, to generate negative interpretations of ambiguous material. This is different from people without emotional disorders who tend, in general, to make positive interpretations of ambiguity. If central components of an emotional disorder have high levels of inherent ambiguity (e.g., concern about the negative perceptions of others in SAD, or worry in GAD), then interpretive bias may have a causal maintaining role, and this has been demonstrated in studies using cognitive bias modification techniques. This research has also shown that interpretation biases combine with other cognitive processes, such as imagery and memory, which could exacerbate distress. Psychological interventions will benefit from effectively targeting negative interpretations, and future experimental research can inform ways to improve facilitation of more benign inferential processing to maximize amelioration of key components of emotional disorders.

Cognitive bias modification for interpretation with and without prior repetitive negative thinking to reduce worry and rumination in generalised anxiety disorder and depression: protocol for a multisession experimental study with an active control condition

“…Negative interpretations are prevalent in GAD and depression10–13 (for a review, see ref. 14). Its causal impact on worry and rumination has been examined using cognitive bias modification for interpretations (CBM-I), an experimental paradigm which repeatedly resolves ambiguous situations (often realistic scenarios capturing situations occurring in daily life) to favour certain (eg, positive) interpretations and thus aims to train a particular interpretive style (see refs.…”

“…Its causal impact on worry and rumination has been examined using cognitive bias modification for interpretations (CBM-I), an experimental paradigm which repeatedly resolves ambiguous situations (often realistic scenarios capturing situations occurring in daily life) to favour certain (eg, positive) interpretations and thus aims to train a particular interpretive style (see refs. 14–16 for a review). In single experimental CBM-I sessions in clinical participants with GAD and non-clinical participants with high levels of trait worry, selectively training benign interpretations reduces worry,17 18 while consistently reinforcing negative interpretations increases state rumination 19.…”

“…26 It is possible that repeated exposure even to 50% positive interpretations may lead to an incidental training effect over time and to reductions in anxiety and depression symptoms26 27 (see ref. 14, online supplementary materials, for considerations regarding the design of CBM-I studies). Thus, active control conditions which are closely matched to aspects of CBM-I (structure of sessions, number of sessions, experimenter contact, etc) but do not target resolution of ambiguity may be needed to demonstrate that effects of CBM-I are indeed driven by changes in interpretations.…”

“…In the present study, we tailor our CBM-I (and control) materials to common worry and rumination concerns with the hope of training interpretations made in the context of RNT (see also ref. 14 regarding the necessity to closely match materials used to assess or modify interpretation bias to ambiguity related to the key constructs—in this case RNT—being investigated).…”

“…We focus on negative interpretation bias, a transdiagnostic cognitive process prevalent in GAD and depression (see ref. 14) and shown to play a causal role in influencing levels of worry17 and rumination19 in single-session experimental studies. Using CBM-I, we investigate whether repeatedly training positive interpretations over multiple sessions (vs an active control condition) leads to a sustained reduction in worry and rumination in the disorders in which they play central maintaining roles, namely GAD and depression.…”