Cognitive bias modification of interpretation in children with social anxiety disorder

Faith Orchard,Adela Apetroaia,Kiri Clarke,Cathy Creswell

doi:10.1016/j.janxdis.2016.10.012

Abstract

Negative (or a lack of positive) interpretation of ambiguous social situations has been hypothesised to maintain social anxiety disorder in children, yet there is currently limited evidence to support this. Cognitive Bias Modification of Interpretation (CBM-I) provides a means to explore the causal influence of interpretation bias on social anxiety disorder, and has been associated with a reduction in social anxiety symptoms in adults. Seven to twelve year old children with a diagnosis of social anxiety disorder completed CBM-I training, adapted from materials designed for socially anxious children in the community, or no training. Effects on interpretation bias and social anxiety were assessed. The adapted CBM-I training was not associated with significant changes in benign or negative interpretation. Unsurprisingly given the lack of successful interpretation training, there were no significant changes in child or parent reported social anxiety symptoms, clinician-rated severity or diagnoses and change in interpretation was not significantly associated with change in social anxiety. These findings contrast with some studies with community populations although it is possible that more intensive CBM-I training is required to fully test this hypothesis among clinical groups.

Highlights

Social anxiety disorder is common in children (Beesdo et al, 2007), causes significant functional impairment (Erath, Flanagan, & Bierman, 2007; Van Ameringen, Mancini, & Farvolden, 2003) and is associated with long term risk of adult social anxiety as well as other mental health difficulties (Pine, Cohen, Gurley, Brook, & Ma, 1998; Zimmermann et al, 2003)
This helpful positive bias is lacking in adults with social anxiety disorder (Hirsch & Mathews, 2000; Stopa & Clark, 2000) and it is hypothesised that a lack of positive interpretation bias may play a fundamental role in the maintenance of social anxiety disorder (Hirsch & Clark, 2004)
We aimed to address whether Cognitive Bias Modification of Interpretation (CBM-I) is associated with more benign interpretation and less negative interpretation of ambiguous social scenarios, a reduction in social anxiety symptoms and severity, and whether change in social anxiety was mediated by changes in interpretation

Summary

Introduction

Social anxiety disorder is common in children (Beesdo et al, 2007), causes significant functional impairment (Erath, Flanagan, & Bierman, 2007; Van Ameringen, Mancini, & Farvolden, 2003) and is associated with long term risk of adult social anxiety as well as other mental health difficulties (Pine, Cohen, Gurley, Brook, & Ma, 1998; Zimmermann et al, 2003). Social information is often ambiguous, yet adults without social anxiety disorder often interpret this information in a positive manner. It is far from clear that interpretation biases have a maintaining role in childhood social anxiety disorder as studies to date have typically examined cross-. Social anxiety disorder in adults is characterised by a lack of positive bias Hirsch & Mathews, 2000; Garner, Mogg & Bradley, 2006), studies with children have typically failed to distinguish between increased positive and reduced negative interpretations, instead tending to treat these as on a continuum There has been limited examination of the prospective relationship between cognitions and social anxiety in children (Muris, Huijding, Mayer, Remmerswaal, & Vreden, 2009)

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