Word Sentence Association Paradigm Research Articles

Adaptation and validation of a suicide-focused Word Sentence Association Paradigm to assess suicide-specific interpretation biases

The cognitive model of suicide proposes that biased cognitive processes contribute to suicidal thoughts and behaviors, and initial evidence suggests that attentional bias to suicide-congruent cues may predict suicidal behavior beyond established clinical risk factors. To date, much less work has explored the potential role of interpretation biases in the development and prediction of suicide risk. The present study assessed the psychometric properties, including reliability, concurrent validity, and predictive validity, of a novel adaptation of the Word Sentence Association Paradigm (WSAP) to assess suicide-suicide interpretation biases. In a sample of 239 psychiatric inpatients, including patients with no recent suicidal ideation or lifetime attempts (n = 35), those with recent suicide attempts (n = 29), and those with recent suicidal ideation (n = 174), participants completed the modified WSAP as well as self-reported suicidal ideation and attempts for the subsequent 6 months. Although the WSAP demonstrated good reliability, evidence of concurrent and prospective validity (in terms of self-reported suicidal ideation and attempts) was limited. Specifically, the clinical groups did not differ from one another on any measure of interpretation bias, nor did suicide-specific interpretation endorsements predict concurrent or future suicidal ideation when controlling for dysphoric interpretation bias. However, suicide-specific interpretation biases were uniquely associated with a history of a lifetime suicide attempt. Future work should further clarify the extent and specificity of the relationship between suicide-specific interpretation biases and clinical outcomes.

Evaluating the Reliability of the Word-Sentence Association Paradigm (WSAP) as an Interpretation bias Assessment across Ethnoracial Groups

Evaluating the Reliability of the Word-Sentence Association Paradigm (WSAP) as an Interpretation bias Assessment across Ethnoracial Groups

Social Evaluation in Emerging Adults: Associations with Interpretation Bias and Perceived Social Support.

Social anxiety symptoms are one of the most common mental health concerns across the lifespan (Bandelow and Michaelis in Dialogues Clin Neurosci 17(3):327-335, 2015. https://doi.org/10.31887/DCNS.2015.17.3/bbandelow ) and are especially relevant during emerging adulthood, when social feedback occurs daily (Auxier and Anderson in Social media use in 2021, 2021. https://www.pewresearch.org/internet/2021/04/07/social-media-use-in-2021/ ) as emerging adults navigate new social environments. Two cognitive processes have been identified as relevant to social anxiety: high threat interpretation bias (i.e., the tendency to appraise threat from ambiguity; Rozenman et al. in Behav Ther 45(5):594-605, 2014. https://doi.org/10.1016/j.beth.2014.03.009 ; J Anxiety Disord 45:34-42, 2017. https://doi.org/10.1016/j.janxdis.2016.11.004 ) is associated with high social anxiety, whereas high perceived social support is associated with low social anxiety. In this study, emerging adults (N = 303) completed an online adaptation of the Chatroom task (Guyer et al. in Arch Gener Psychiatry 65(11):1303-1312, 2008. https://doi.org/10.1001/archpsyc.65.11.1303 ), an experimental paradigm designed to simulate social acceptance and rejection, as well as a performance-based measure of interpretation bias (Word Sentence Association Paradigm; Beard and Amir in Behav Res Ther 46(10):1135-1141, 2008. https://doi.org/10.1016/j.brat.2008.05.012 ), and a self-report measure of perceived social support (Multidimensional Scale of Perceived Social Support; Zimet et al. in J Pers Assess 52(1), 30-41, 1988. https://doi.org/10.1207/s15327752jpa5201_2 ). Social anxiety symptoms did not increase as a function of acceptance or rejection during the Chatroom task. However, there were significant interactions between each cognitive predictor and social anxiety change: emerging adults with low interpretation bias towards threat and emerging adults with high perceived social support both experienced decreases in social anxiety from pre- to post-Chatroom task, regardless of whether they were accepted or rejected during the Chatroom task. If replicated, low interpretation bias and high perceived social support may serve as promotive factors in social interactions for emerging adults.

The impact of patients’ hostile attribution bias on aggression in doctor-patient interactions

BackgroundDoctor-patient conflict is trending in social attention research. However, the existing literature rarely explores whether a patient's hostile attribution bias (HAB) in the doctor-patient interaction affects the aggression level against doctors. ObjectiveThis study aimed to explore the relationship and mechanism between different types of HAB and aggression in patients. MethodIn Study 1, 80 patients completed the word sentence association paradigm for hostility (WSAP-Hostility), and their explicit and implicit aggression levels were measured using the hot sauce paradigm and the single-category implicit association test (SC-IAT), respectively. In Study 2, 63 patients were randomly divided into an experimental (rejection) and a control group. Their state hostile attribution bias (SHAB) was activated through social rejection materials. They completed the SHAB questionnaire and anger expression inventory, and their explicit and implicit aggression levels were measured as in Study 1. ResultsIn both studies, results indicated that patients' trait and state HAB were significantly related to explicit aggression but not implicit aggression. Hostile interpretation positively predicted explicit aggression, whereas benign interpretation had a negative predictive effect on explicit aggression. Patients’ anger played a mediating role between SHAB and explicit aggression. ConclusionsThese findings suggest that patients' HAB affects explicit aggression toward doctors and anger plays a mediating role.

French adaptation and further validation of the word sentence association paradigm to assess hostile attributional biases.

French adaptation and further validation of the word sentence association paradigm to assess hostile attributional biases.

Supplemental Material for French Adaptation and Further Validation of the Word Sentence Association Paradigm to Assess Hostile Attributional Biases

Supplemental Material for French Adaptation and Further Validation of the Word Sentence Association Paradigm to Assess Hostile Attributional Biases

Relationship between Harsh Parenting and Aggressive Behaviors in Male Juvenile Delinquents: Potential Mediating Roles of Peer Victimization and Hostile Attribution Bias.

Harsh parenting can be regarded as a harsh behaviors, feelings, and attitudes toward children in the process of parenting. According to the theory of intergenerational transmission of violence, harsh parenting is an important factor affecting children's aggressive behavior, but the theory does not clarify the specific action path between harsh parenting and aggressive behavior. In order to reveal the relationship between harsh parenting and the aggressive behavior of juvenile delinquents, 604 male juvenile delinquents (N = 604; Mage = 16.57 years; SD = 0.612 years) were investigated using the Harsh Parenting Questionnaire, the Buss-Perry Aggression Questionnaire, the Multidimensional Peer Victimization Scale, and the Word Sentence Association Paradigm for Hostility in Chinese. Analysis using structural equation modeling procedures showed that (a) all variables were positively associated with each other; (b) the partial indirect effect of harsh parenting on aggressive behaviors was determined through the mediators of peer victimization and hostile attribution bias independently; and (c) the partial indirect effect was determined through the mediators of peer victimization and hostile attribution bias sequentially. The results suggest that harsh parenting can explain the highly aggressive behavior of male juvenile delinquents. Moreover, harsh parenting may also predict the risk of peer victimization and hostile attribution bias, thereby predicting the development of highly aggressive behaviors.

Eyeing ambiguity: Pupillary reactivity during early automatic interpretations in major depressive disorder

Automatic interpretation biases (AIB) are theorized to be a risk factor for depression. However, documenting AIB in depressed persons has been challenging and the source (affective vs cognitive) of AIB remains unclear. We conducted a psychophysiological investigation of AIB in a sample of 25 clinical interview assessed individuals experiencing a current major depressive episode and 28 never-depressed control individuals. Participants completed the Word Sentence Association Paradigm for Depression while their pupil size was recorded. Repeated measures ANOVAs were used to examine behavioral response data and multilevel modeling was used to examine pupillary reactivity (change from trial baseline). Compared to controls, the depressed group was both more likely to endorse negative AIB (p = .001, d = 1.01) and less likely to endorse benign AIB (p = .011, d = 0.72). Further, the depressed group exhibited significantly increased pupil size while processing negative words when they endorsed a negative interpretation compared with controls (ps = .010–.037, ds = 0.69–0.87), but did not differ during other AIB trial types. Within group comparisons revealed greater differentiation between interpretations in the healthy control group in both reaction time and pupillary reactivity AIB measures. This depression-related pupillary reactivity pattern fits with an emotional salience-based explanation better than a cognitive effort-based hypothesis of negative AIB, while pupillary reactivity pattern within the control group is consistent with a benign bias. People with depression lack benign AIB and may be more emotionally engaged during negative AIB than healthy controls.

Longitudinal relationships among interpersonal openness trait, hostile attribution bias, and displaced aggressive behaviour: Big Five treated as covariates

Displaced aggressive behaviour is associated with many negative outcomes. Although certain personality traits predict displaced aggressive behaviour, the uniquely longitudinal effect of indigenous interpersonal traits on displaced aggressive behaviour is ignored. To address this gap, we explored the longitudinal relationship among an indigenously interpersonal trait of China (interpersonal openness), hostile attribution bias, and self-reported displaced aggressive behaviour. Additionally, we tested whether hostile attribution bias mediated the relationship between interpersonal openness and self-reported displaced aggressive behaviour. The Interpersonal Self-Support Scale for Undergraduate Students, Word Sentence Association Paradigm for Hostility, Displaced Aggression Questionnaire, and the NEO Personality Inventory-3 were administered to 942 undergraduates on two occasions, 6months apart. A cross-lagged model showed that, after controlling for the Big Five personality traits, interpersonal openness predicted subsequent hostile attribution bias, and hostile attribution bias predicted self-reported displaced aggressive behaviour 6months later. Hostile attribution bias at time 2 mediated the relationship between interpersonal openness at time 1 and self-reported displaced aggressive behaviour at time 2. These results were consistent with the interpersonal self-support theory's appraisals of interpersonal openness, and they extended the social information processing and general aggression models to explain displaced aggressive behaviour.

Interpretation Bias Across Body Dysmorphic, Social Anxiety and Generalized Anxiety Disorder\u2014A Multilevel, Diffusion Model Account

BackgroundInterpretation biases are suggested to be transdiagnostic phenomena, but have rarely been compared across different disorders and current concerns.MethodsWe investigated explicit, decision-based, and more implicit, reaction time-based interpretation bias in individuals with body dysmorphic disorder (BDD; N = 29), social anxiety disorder (SAD; N = 36), generalized anxiety disorder (GAD; N = 22), and non-clinical controls (NC; N = 32), using an adapted Word Sentence Association Paradigm (WSAP).ResultsResults indicated that interpretation bias occurred transdiagnostically, while content-specific bias patterns varied meaningfully across groups. BDD and SAD shared explicit and, more inconsistently, implicit interpretation biases for appearance-related and social situations. The GAD group exhibited an explicit and implicit negative interpretation bias for general situations, and an additional implicit lack of positive bias. Mechanistic Wiener diffusion model analyses revealed that interpretation bias patterns were mainly driven by speeded information uptake, potentially mirroring disorder-specific associative memory organization.ConclusionsThese findings have important implications for understanding interpretation biases as both etiological and treatment factors.

Associations among interpretation bias, craving, and abstinence self-efficacy in adults with substance use disorders

ObjectiveInterpretation bias is a crucial therapeutic target in emotional disorders. However, few studies have examined the role of interpretation bias in substance use disorders (SUDs). Our specific aims were: (1) to examine whether interpretation bias was associated with craving and abstinence self-efficacy, and (2) explore potential moderators of these associations, including anxiety severity, sex, and substance type. MethodsAdults attending an inpatient SUD treatment program (N = 224; mean age = 38.95; 67% male/33% female; 68% primary alcohol use disorder/29% primary opioid use disorder) completed the Word-Sentence Association Paradigm (WSAP) with ambiguous situations related to general anxiety domains (e.g., daily stress, health, relationships), as well as measures of craving (Craving Scale), abstinence self-efficacy (Brief Situational Confidence Scale), and anxiety symptoms (Overall Anxiety Severity and Impairment Scale [OASIS] and Anxiety Sensitivity Index-3). ResultsNegative interpretation bias was modestly associated with more craving (r = .23, p = .001) and less confidence to resist using substances (r = -0.23, p = .001). In multiple linear regression models that included the anxiety measures, interpretation bias was the most robust predictor of craving and abstinence self-efficacy. Sex (N = 224) and substance type (opioid vs. alcohol; n = 219) did not moderate these relationships. ConclusionsThese findings suggest that interpretation bias might be an important individual difference within SUD populations.

Burnout is associated with a depressive interpretation style.

The aim of this 188-participant study (65% female; mean age = 40.31) was to examine whether burnout and depression are associated with similar interpretation biases in the processing of emotional information. Burnout symptoms were assessed with the Maslach Burnout Inventory-General Survey and depressive symptoms with the 9-item depression module of the Patient Health Questionnaire. Interpretation bias toward emotional information was examined using an amended version of the Word-Sentence Association Paradigm (WSAP). In the WSAP, participants are asked to decide whether emotionally-valenced words are related to ambiguous sentences. Burnout and depression were each associated with a higher endorsement of negative interpretations and a higher ratio of negative interpretations to positive interpretations. Negative word endorsement and positive word endorsement interacted in such a way that negative word endorsement was predictive of burnout and depression only when positive word endorsement levels were relatively low. Our findings suggest that burnout and depression are associated with similar alterations in the interpretation of ambiguous information. This study supports the view that burned out individuals perceive the world with "depressive glasses." Cognitive bias modification techniques employed in the treatment of depressive conditions may constitute relevant therapeutic options for "burned out" individuals.

Brain structure links trait hostile attribution bias and attitudes toward violence

The majority of research regarding hostile attribution bias focuses on its effect on aggression. However, little is known about the brain structure associated with trait hostile attribution bias and the mediating mechanism underlying this link. The current study uses voxel-based morphometry (VBM) to identify the brain regions related to individual differences in trait hostile attribution bias, measured by a Word Sentence Association Paradigm — Hostility in a sample of 176 undergraduate students. Subsequently, two mediation models with regard to brain structure, trait hostile attribution bias, and attitudes toward violence (measured by the Attitudes toward Violence Scale) were analyzed. The results reveal that trait hostile attribution bias is positively correlated with gray matter volume (GMV) in the left orbitofrontal cortex (OFC) and negatively associated with the left lingual gyrus (LG). Furthermore, attitudes toward violence acted as a mediator underlying the association between the left OFC volume and trait hostile attribution bias. Such bias also mediated the relationship between the left OFC and attitudes toward violence. We argue that attitudes toward violence and trait hostile attribution bias seem to predict each other, and the GMV in the left OFC may involve the underlying cognitive mechanism of the bidirectional relationship between the two variables. These results and ideas may shed light on the current understanding of the relationships of the brain's anatomical features, attitudes toward violence, and trait hostile attribution bias.

The relationship between hostile attribution bias and aggression and the mediating effect of anger rumination

Aggression is one of the most serious social problems worldwide. The cognitive mechanisms of aggression have been frequently studied, and hostile attribution bias has been regarded as an important cognitive factor influencing the formation and development of aggression. However, the longitudinal relationship between hostile attribution and aggression among undergraduate students has not yet been tested, and the psychological mechanism underlying the effect of hostile attribution on aggression has not yet been explored. This study aimed to address these two issues through two studies. The Hostility subscale of the Word Sentence Association Paradigm for Hostility and the Buss-Perry Aggression Questionnaire were administered to 505 undergraduate students twice with an interval of 6 months in Study 1. The cross-lagged analyses demonstrated a reciprocal relationship between hostile attribution bias and aggression. Another 437 participants were recruited for Study 2. The analyses via structural equation modeling support the view that anger rumination plays a mediating role in the relationship between hostile attribution bias and aggression. This study expands our understanding regarding the relationship between hostile attribution bias and aggression and suggests an interaction between aggressive cognition and aggressive behavior. In addition, certain aggressive cognitive factors may predict other aggression-related cognitive factors.

Translating CBM-I Into Real-World Settings: Augmenting a CBT-Based Psychiatric Hospital Program

Cognitive bias modification for interpretation (CBM-I) is an appealing augmentation to cognitive-behavioral therapy (CBT) because it targets cognitive bias efficiently via computerized training. Few studies have tested the combination of CBM-I and CBT, and none have translated lab-based CBM-I protocols to an acute psychiatric setting. The present study describes the development and implementation of CBM-I as an augmentation to a CBT-based partial hospital. We developed a transdiagnostic CBM-I based on the word–sentence association paradigm (WSAP), which reinforces individuals for endorsing benign interpretations and rejecting negative interpretations of ambiguous sentences. Over two iterations of development, we randomly assigned patients (N = 127; M age = 34.21; 58% female, 40% male, 2% nonbinary) to either CBM-I or a control group (Phase 1: neutral WSAP task; Phase 2: treatment as usual). CBM-I comprised daily sessions (10 minutes) completed during program hours, and number of sessions varied naturalistically according to patient length of stay. Primary outcomes included feasibility, acceptability, and target engagement (interpretation bias). CBM-I was feasible and acceptable to acute psychiatric patients, and successfully shifted interpretation for novel stimuli. Patient feedback suggested that participants viewed CBM-I as bolstering their primary CBT-based care. Exploratory analyses examining clinical benefit revealed a small between-group effect on anxiety severity (d = 0.378), but no group differences on depression outcomes (d = 0.008). Findings indicate that CBM-I is a feasible and acceptable augmentation to CBT-based partial hospital care. Future studies are warranted to determine who is most likely to benefit from this low-intensity approach.

Effects of induced appearance-related interpretation bias: A test of the cognitive-behavioral model of body dysmorphic disorder

Background and objectivesInterpretation biases are hypothesized to maintain body dysmorphic disorder (BDD). Although their existence and malleability have been investigated in clinical studies, their causal status in the maintenance of BDD remains unclear. This study examined the effects of a single-session appearance-related interpretation bias training (CBM-I) on bias indices and stress reactivity (i.e., distress, appearance dissatisfaction, self-esteem, perceived physical attractiveness), exploring the causality predicted in cognitive-behavioral models. MethodsWe used a modified version of the Word Sentence Association Paradigm (WSAP), assessing explicit (i.e., decision rates) and more implicit interpretation bias components (i.e., reaction times). Mentally healthy students (N = 112) were randomized to training conditions enhancing positive interpretation patterns (PT) vs. negative interpretation patterns (NT) vs. a no-feedback control condition (CC). Stress reactivity was assessed during the Cyberball Paradigm. ResultsThe PT showed a pre-post increase in adaptive bias patterns regarding decision and a differential pre-post decrease in reaction times for the rejection of negative interpretations, compared to the other groups. There were no condition-congruent post-training differences in stress reactivity. However, residual interpretation bias change was significantly correlated with state distress, self-esteem and appearance dissatisfaction during stressor exposure. LimitationsLimitations pertaining to sample characteristics, training and assessment overlap, and stressor task design are discussed. ConclusionsFindings suggest that appearance-related interpretation bias is modifiable both explicitly and more implicitly via CBM-I in a mentally healthy sample. The causal status of interpretation bias in BDD maintenance warrants further investigation.

Characteristics of interpretation bias and relationship with suicidality in a psychiatric hospital sample

BackgroundInterpretation bias, the tendency to interpret ambiguous situations negatively (or to lack a positive bias), is a cognitive vulnerability associated with psychopathology. However, there is a lack of research characterizing this bias in psychiatric samples, including whether it is also a risk factor for suicidality. This study characterized interpretation bias in a psychiatric sample at risk for suicide and examined the relationship between interpretation bias and suicidality cross-sectionally and prospectively. MethodsPatients (N=65) attending a partial hospital program completed the Word-Sentence Association Paradigm (WSAP), which results in four variables reflecting different types of interpretation bias: endorsement rates and reaction time bias scores for negative and benign interpretations. We conducted logistic regression models to predict high suicidality (ideation, plans, attempts, etc. assessed via a structured interview at admission) and suicidal ideation (assessed via self-report at admission and discharge). ResultsLogistic regression models predicting suicide outcomes upon admission and discharge indicated that benign interpretation endorsement was the most robust predictor of suicidality concurrently and prospectively, controlling for baseline suicidal ideation. LimitationsLack of gold standard self-report suicide assessment. Unable to assess additional constructs such as hopelessness or perfectionism, which may better elucidate how lacking a benign bias influences suicidality. Modest sample size. ConclusionsA lower endorsement of positive interpretations was the strongest predictor of prospective suicidal ideation, even after controlling for baseline suicidal ideation. Future research should examine how targeting interpretation bias influences suicidality.

Measuring Hostile Interpretation Bias: The WSAP-Hostility Scale.

Hostile interpretation biases are central to the development and maintenance of anger, yet have been inconsistently assessed. The Word Sentence Association Paradigm (WSAP) was used to develop a new measure of hostile interpretation biases, the WSAP-Hostility. Study 1 examined the factor structure and internal consistency of the WSAP-Hostility, as well as its relationship with trait anger. Study 2 provided convergent and divergent validity data by examining its associations with trait anger, aggression, depression, and anxiety. Study 3 examined the relationship between WSAP-Hostility and another measure of hostile interpretation biases, as well as another word sentence association measure, in a sample of community participants. Study 4 also used a sample of community participants to offer further evidence of convergent validity. Across the studies, the WSAP-Hostility demonstrated convergent and divergent validity and internal consistency, supporting its use as a measure of hostile interpretation biases.

A Pilot Open Trial of Cognitive Bias Modification for Panic Disorder

Although cognitive biases are involved in the maintenance of panic disorder (PD), cognitive bias modification (CBM) has not been tested in PD. The current study developed and piloted a combined CBM-attention/CBM-interpretation PD treatment to determine initial acceptability and efficacy. Ten individuals diagnosed with PD (nine with Agoraphobia) were asked to complete 8, 20-min sessions of a CBM-A (Dot Probe task with fearful faces) and CBM-I (Word-Sentence Association Paradigm) intervention. Cognitive bias, panic symptom severity, and anxiety during interoceptive exercises were assessed at pre- and post-assessments. At post-treatment, participants showed increased benign interpretations, reduced threat interpretations of ambiguous panic situations, and reported significantly less severe panic symptoms with six individuals meeting criteria for remission. Anticipatory anxiety for interoceptive exercises decreased following treatment, but duration of exercises and anxiety following the exercises did not. Results suggest that further testing of the treatment and putative mechanisms of action is warranted.

Refilling the half-empty glass – Investigating the potential role of the Interpretation Modification Paradigm for Depression (IMP-D)

Background and objectivesCognitive biases are known to cause and maintain depression. However, little research has been done on techniques targeting interpretation tendencies found in depression, despite the promising findings of anxiety studies. This paper presents two experiments, investigating the suitability of an Interpretation Modification Paradigm for Depression (IMP-D) in healthy individuals, which has already proven its effectiveness in anxiety (Beard & Amir, 2008). Different from other paradigms, the IMP-D aims at modifying an interpretation bias on response- and on a more implicit reaction time-level, making this task less susceptible to demand effects. MethodsThe Word–Sentence Association Paradigm for Depression (Hindash & Amir, 2011) was modified and administered in healthy volunteers (experiment I: N = 81; experiment II: N = 105). To enhance a positive interpretation bias, endorsing benign and rejecting negative interpretations of ambiguous scenarios was reinforced through feedback. This intervention was compared to the opposite training (both experiments) and a control training (experiment II only). ResultsBoth experiments revealed a significant increase in bias towards benign interpretations on the level of overt decisions, while only in the first experiment a change was found on a reaction time level. These modifications are not reflected in group-differences in emotional vulnerability. LimitationsPossible limitations regarding the reliability of inter-dependent response and reaction time measures are discussed. ConclusionsThe IMP-D is able to modify interpretation biases, but adaptations are required to maximize its beneficial effects.