The effects of modifying interpretation bias on worry in generalized anxiety disorder
Abstract
This study investigated whether facilitating a benign interpretive bias decreases negative thought intrusions in generalized anxiety disorder (GAD). Clients were randomly allocated to an interpretation modification condition in which they repeatedly accessed benign meanings of emotionally ambiguous homographs and scenarios, or to a control condition in which they accessed threat and benign meanings with equal frequency. Worry frequency was assessed using a breathing focus task that involved categorising the valence of thought intrusions before and after an instructed worry period. Interpretation bias was assessed during the modification tasks, and on a different measure of interpretation bias (sentence completion) following a period of worry. The experimental procedure modified interpretations made during training, and in the later sentence completion task. Furthermore, compared to the control group, the benign group showed fewer negative thought intrusions during breathing focus (as rated by both participants and an assessor). These findings show that it is possible to induce a more benign interpretive bias in GAD clients and that this reduces negative thought intrusions.
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Sample size was calculated a priori to detect effects similar to those observed in previous studies that have used this self-referential worry task.
“Sample size was calculated a priori to detect effects similar to those observed in previous studies that have used this self-referential worry task (e.g. Hayes et al., 2010: between-group difference on negative thought intrusions at post-test, f2 = 0.43).”
From Testing the differential effects of acceptance and attention-based psychological interventions on intrusive thoughts and worry (2017) · cites this paper as Hayes et al., 2010
The thought intrusions task has been widely used to examine thought intrusions and worry in non-clinical groups, individuals with elevated worry, GAD, and associated conditions.
“This task has been widely used to examine thought intrusions and worry in non-clinical groups (Krebs, Hirsch, & Mathews, 2010), individuals with elevated worry, and generalized anxiety disorder (Hayes et al., 2010, Hirsch et al., 2009) and associated conditions (i.e. insomnia symptoms, Baker, Baldwin, & Garner, 2015).”
From Testing the differential effects of acceptance and attention-based psychological interventions on intrusive thoughts and worry (2017) · cites this paper as Hayes et al., 2010
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“However, research using “cognitive bias modification” paradigms to train a certain interpretive style has found that changing interpretation bias may lead to corresponding changes in worry (Hayes et al., 2010; Hirsch et al., 2009) and rumination (Hertel et al.”
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“…an interaction between “top-down” and “bottom-up” processes (Hirsch & Mathews, 2012), future research may benefit from investigation of the combination of WMT with interventions which aim to reduce “bottom-up” biases, such as interpretation bias modification (Hayes, Hirsch, Krebs, & Mathews, 2010).”
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“After the anger induction, we expected a significant increase in the number of negative interpretations and a decrease in the number of positive interpretations relative to the control state (Barazzone & Davey, 2009; Hayes et al., 2010).”
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“From these catch items we calculated a positivity index reflecting the ratio of positively interpreted catch items on the total number of catch items (Hayes et al., 2010).”
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“There was not a significant interaction between group and time for negative interpretation where the effect was small ( V = 0.01, F (1,53) = 0.32, p = 0.58; d = 0.15).”
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“In addition, previous studies (Hayes et al., 2010; Hirsch et al., 2009) have shown that high worriers who were given consistently benign interpretations had fewer negative intrusions on a worry measure compared to controls after a single-session CBM-I program.”
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Self-citationThe Impact of Worry on Attention to Threat
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“Similarly, focusing on benign meanings of potentially aversive information reduces negative thought intrusions and anxiety in high worriers [67,68].”
BackgroundFelmingham, K. L., Stewart, L. F., Kemp, A. H., & Carr, A. R. (2016) · Biological Psychology · doi:10.1016/j.biopsycho.2016.04.001 · Cited by 23 · see citing works
Effects of interpretation bias modification on unregulated and regulated emotional reactivity
Bockstaele, B. V., Notebaert, L., Salemink, E., Clarke, P., MacLeod, C., Wiers, R. W. H. J., & Bögels, S. M. (2019) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2019.03.009 · Cited by 22 · see citing works
“Although there are several studies with similar results (e.g., see Hayes, Hirsch, Krebs, & Mathews, 2010; Lang, Moulds, & Holmes, 2009; Mackintosh, Mathews, Yiend, Ridgeway, & Cook, 2006; Tran, Siemer, & Joormann, 2011), these positive effects have not been replicated consistently.”
Malivoire, B. L., Marcos, M., Pawluk, E., Tallon, K., Kusec, A., & Koerner, N. (2018) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2018.1508247 · Cited by 15 · see citing works
“…Zuellig, & Borkovec, 2003) and the mean and SD were comparable to those reported in samples of individuals identified as meeting criteria for GAD by diagnostic interview (e.g. Anderson et al., 2012; Fracalanza, Koerner, & Antony, 2014; Hayes et al., 2010; Mennin, Fresco, Ritter, & Heimberg, 2015).”
ResultRowlands, K., Wilson, E., Simic, M., Harrison, A., & Cardi, V. (2020) · Frontiers in Psychology · doi:10.3389/fpsyg.2020.538527 · Cited by 21 · see citing works
Cardi, V., Turton, R., Brazil, C., Harrison, A., Rowlands, K., Treasure, J. L., & Hirsch, C. R. (2019) · Cognitive Therapy and Research · doi:10.1007/s10608-019-10034-x · Cited by 21 · see citing works
Self-citationCognitive-behavior therapy resolves implicit fear associations in generalized anxiety disorder
Reinecke, A., Rinck, M., Becker, E. S., & Hoyer, J. (2012) · Behaviour Research and Therapy · doi:10.1016/j.brat.2012.10.004 · Cited by 19 · see citing works
Gole, M., Köchel, A., Schäfer, A., & Schienle, A. (2011) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2011.07.002 · Cited by 18 · see citing works
Rogers, J., & Sicouri, G. (2022) · Behavior Therapy · doi:10.1016/j.beth.2022.04.006 · Cited by 16 · see citing works
Ogniewicz, A., Dugas, M. J., Langlois, F., Gosselin, P., & Koerner, N. (2014) · Journal of Experimental Psychopathology · doi:10.5127/jep.00 · Cited by 13 · see citing works
Repetitive negative thinking and interpretation bias in pregnancy
Hirsch, C. R., Meeten, F., Gordon, C., Newby, J. M., Bick, D., & Moulds, M. L. (2020) · Clinical Psychology in Europe · doi:10.32872/cpe.v2i4.3615 · Cited by 16 · see citing works
“For example, training individuals with GAD to interpret ambiguous information as benign (rather than nega‐ tive) reduced worry frequency (Hayes et al., 2010).”
BackgroundSelf-citationWhen We Should Worry More: Using Cognitive Bias Modification to Drive Adaptive Health Behaviour
Notebaert, L., Chrystal, J., Clarke, P., Holmes, E. A., & MacLeod, C. (2014) · PLoS ONE · doi:10.1371/journal.pone.0085092 · Cited by 17 · see citing works
“Since it has been shown that a negative interpretation bias causally contributes to worry symptoms [10,11], the aim of the current study was to investigate whether adopting a negative interpretation bias, as compared to a positive interpretation bias, can increase worry elicited by a health campaign video, and consequ…”
BackgroundMiloff, A., Savva, A., & Carlbring, P. (2015) · Internet Interventions · doi:10.1016/j.invent.2015.03.006 · Cited by 17 · see citing works
Ainsworth, B., Bolderston, H., & Garner, M. (2017) · Behaviour Research and Therapy · doi:10.1016/j.brat.2017.01.012 · Cited by 16 · see citing works
An exploration of Intolerance of Uncertainty and memory bias.
Francis, K., Dugas, M. J., & Ricard, N. (2016) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2016.03.011 · Cited by 15 · see citing works
Tallon, K., Koerner, N., & Yang, L.-X. (2016) · Journal of Experimental Psychopathology · doi:10.5127/jep.045714 · Cited by 15 · see citing works
Moving towards the benign: automatic interpretation bias modification in dysphoria
Cowden Hindash, A. H., & Rottenberg, J. A. (2017) · Behaviour Research and Therapy · doi:10.1016/j.brat.2017.09.005 · Cited by 15 · see citing works
Reinecke, A., & Harmer, C. J. (2015) · Psychopathology Review · doi:10.5127/pr.035113 · Cited by 13 · see citing works
Nieto, I., & Vázquez, C. (2021) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2021.102459 · Cited by 14 · see citing works
Emotional reactivity and executive control: A pathway of risk for the development of childhood worry
Gramszlo, C., & Woodruff‐Borden, J. (2015) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2015.07.005 · Cited by 15 · see citing works
Lau, J., & Pile, V. (2015) · Clinical Psychological Science · doi:10.1177/2167702614549596 · Cited by 22 · see citing works
Cox, P., Bamford, G. M., & Lau, J. Y. F. (2016) · Anxiety, Stress, & Coping · doi:10.1080/10615806.2015.1058367 · Cited by 14 · see citing works
Rucker, J., Berry, B., & Sharp, C. (2024) · Journal of Personality Disorders · doi:10.1521/pedi.2024.38.2.171 · Cited by 14 · see citing works
Krahé, C., Mathews, A., Whyte, J., & Hirsch, C. R. (2016) · BMJ Open · doi:10.1136/bmjopen-2016-013404 · Cited by 13 · see citing works
Self-citationWorry and Generalized Anxiety Disorder: A Review
Newman, M. G., Cho, S.-I. T., & Kim, H. (2017) · Elsevier eBooks · doi:10.1016/b978-0-12-809324-5.05108-7 · Cited by 14 · see citing works
“repeated accessing of benign meanings led to worry reduction in high worriers (Hayes et al., 2010; Hirsch et al., 2009).”
BackgroundCognitive Bias Modification: A New Frontier in Cognition and Emotion Research
MacLeod, C., & Clarke, P. (2013) · UWA Profiles and Research Repository (UWA) · Cited by 13 · see citing works
Attentional Bias for Threat and Anxiety: The Role of Loneliness
Wei, M., Roodenrys, S. J., & Miller, L. M. (2020) · Psychiatry · doi:10.1080/00332747.2020.1762400 · Cited by 13 · see citing works
“…broad range of topics, a defining feature of anxiety (Hirsch et al., 2013), has been associated with extended decision-making times (Masi et al., 2004), heightened needs for reassurance (Beesdo-Baum et al., 2012), and a tendency to interpret events in the worst possible light (Hayes et al., 2010).”
BackgroundFrench, N. J., Eberle, J. W., & Teachman, B. A. (2021) · Anxiety Stress & Coping · doi:10.1080/10615806.2021.1977797 · Cited by 12 · see citing works
“Negative interpretation bias is associated with more severe symptoms in social anxiety (Chen et al., 2020), panic disorder (Teachman et al., 2007), and generalized anxiety disorder (Hayes et al., 2010).”
BackgroundKuckertz, J. M., & Amir, N. (2017) · Elsevier eBooks · doi:10.1016/b978-0-12-803457-6.00019-2 · Cited by 12 · see citing works
Evidence for distinct genetic and environmental influences on fear acquisition and extinction
Purves, K. L., Krebs, G., McGregor, T., Constantinou, E., Lester, K. J., Barry, T. J., Craske, M. G., Young, K. S., Breen, G. D., & Eley, T. C. (2021) · Psychological Medicine · doi:10.1017/s0033291721002580 · Cited by 14 · see citing works
Self-citationWhite, L. K., Suway, J. G., Pine, D., Field, A., Lester, K., Muris, P., Bar-Haim, Y., & Fox, N. (2016) · Journal of Experimental Psychopathology · doi:10.5127/jep.053615 · Cited by 12 · see citing works
van der Ploeg, M. M., BROSSCHOT, J. F., Verkuil, B., Gillie, B. L., Williams, D. P., Koenig, J., Vasey, M. W., & Thayer, J. F. (2017) · Psychophysiology · doi:10.1111/psyp.12891 · Cited by 11 · see citing works
Lubbers, J., Geurts, D. E. M., Spinhoven, P., Cladder-Micus, M. B., Ennen, D., Speckens, A. E. M., & Spijker, J. (2024) · Depression and Anxiety · doi:10.1155/da/3511703 · Cited by 10 · see citing works
Modifying interpretation bias leads to congruent changes in gratitude
Watkins, P. C., Munger, P., Hutton, B. R., Elliot, K., & Mathews, A. (2021) · The Journal of Positive Psychology · doi:10.1080/17439760.2021.1940249 · Cited by 10 · see citing works
“From previous research (Hayes et al., 2010; Mathews & Mackintosh, 2000) we expected a medium to large effect size for interpretation bias.”
MethodSelf-citationYang, Z., Han, S., Zhang, L., Sun, M., Hu, Q., Hu, Y., & Wu, B. (2024) · AIDS and Behavior · doi:10.1007/s10461-024-04290-6 · Cited by 9 · see citing works
“From these two perspectives, anxiety symptoms were considered “choice”, whereas depression symptoms were considered “how to achieve better results” [46, 47].”
Lubbers, J., Geurts, D. E. M., Hanssen, I., Huijbers, M. J., Spijker, J., Speckens, A. E. M., & Cladder-Micus, M. B. (2022) · International Journal of Bipolar Disorders · doi:10.1186/s40345-022-00269-1 · Cited by 9 · see citing works
Horton, A. B., Pring, A. M., Rudaizky, D., & Clarke, P. (2024) · Anxiety Stress & Coping · doi:10.1080/10615806.2024.2308673 · Cited by 9 · see citing works
“This method of worry induction has been shown to be highly e ff ective in inducing a brief worry state across a number of studies (Hayes et al., 2010; Hirsch et al., 2011).”
Interpretive Bias Modification for Disgust
Whitton, A., Grisham, J., Henry, J., & Palada, H. (2013) · Journal of Experimental Psychopathology · doi:10.5127/jep.030812 · Cited by 8 · see citing works
Facilitating Episodic Simulation in Anxiety: Role of Sensory Scaffolding and Scenario Modality
Ji, J., Meyer, M., & Teachman, B. (2020) · International Journal of Cognitive Therapy · doi:10.1007/s41811-020-00070-x · Cited by 7 · see citing works
“Though some studies have presented scenarios aurally (Hayes et al. 2010; Murphy et al. 2007), the majority of CBM-I training use visually presented scenarios (see Menne-Lothmann et al.”
BackgroundPathological Worry in Children: What is Currently Known?
Wilson, C. E. (2010) · Journal of Experimental Psychopathology · doi:10.5127/jep.008110 · Cited by 8 · see citing works
Biased interpretation in perfectionistic concerns: an experimental investigation
Howell, J. A., McEvoy, P. M., Grafton, B., Macleod, C., Kane, R. T., Anderson, R. A., & Egan, S. J. (2019) · Anxiety, Stress, & Coping · doi:10.1080/10615806.2019.1586888 · Cited by 7 · see citing works
Modifying insecure attachment style with cognitive bias modification
Doolan, E. L., & Bryant, R. A. (2021) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2021.101664 · Cited by 8 · see citing works
Looking on the bright side reduces worry in pregnancy: Training interpretations in pregnant women
Hirsch, C. R., Meeten, F., Newby, J. M., O’Halloran, S., Gordon, C., Krzyzanowski, H., & Moulds, M. L. (2021) · Clinical Psychology in Europe · doi:10.32872/cpe.3781 · Cited by 6 · see citing works
“Worry is a form of RNT that is predominantly verbal, difficult to control and involves entertaining potential negative outcomes of future situations (Borkovec 1994; Hayes et al., 2010).”
BackgroundInfluentialSelf-citationModifying thought-action fusion via a single-session computerized interpretation training
Siwiec, S. G., Davine, T. P., Kresser, R. C., Rohde, M. M., & Lee, H.-J. (2017) · Journal of Obsessive-Compulsive and Related Disorders · doi:10.1016/j.jocrd.2016.11.005 · Cited by 6 · see citing works
- Authors
- Hayes, S., Hirsch, C. R., Krebs, G., & Mathews, A.
- Affiliations
- King's College London (GB)
- The University of Western Australia (AU)
- University of California, Davis (US)
- Corresponding author
- Hayes, Sarra
- Venue
- Behaviour Research and Therapy
- Publisher
- Elsevier BV
- Published
- 2010-03
- Volume
- 48
- Issue
- 3
- Pages
- 171-178
- ISSN
- 0005-7967 (ISSN-L)
- OpenAlex
- W2092460488
- Cited by
- 167
- References
- 34
- Citations by year
- 2026: 8 · 2025: 4 · 2024: 10 · 2023: 5 · 2022: 7 · 2021: 13 · 2020: 12 · 2019: 13 · 2018: 7 · 2017: 11 · 2016: 17 · 2015: 10 · 2014: 9 · 2013: 15 · 2012: 12
- FWCI
- 10.98
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Behaviour Research and Therapy (publishedVersion)
- PubMed (publishedVersion)
- Research Portal (King's College London) (submittedVersion)
- Funders
- Medical Research Council
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Psychological Treatments and Assessments
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Keywords
- generalized anxiety disorder, interpretation bias modification, worry, homographs, sentence completion, cognitive bias modification
- MeSH terms
- Adult, Analysis of Variance, Anxiety Disorders, Emotions, Female, Humans, Interviews as Topic, Male, Perception, Psychological Tests, Surveys and Questionnaires, Thinking, Cognitive Behavioral Therapy, Treatment Outcome
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