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.
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Health-anxious individuals experience more frequent and intense illness-related intrusive thoughts and demonstrate a selective negative interpretation bias of these thoughts or sensations.
“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].”
From Illness Anxiety Disorder: A Review of the Current Research and Future Directions (2024) · cites this paper as [49]
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Illness Anxiety Disorder: A Review of the Current Research and Future Directions
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“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].”
Background
- Authors
- Du, X., Witthöft, M., Zhang, T., Shi, C., & Ren, Z.
- Affiliations
- Central China Normal University (CN)
- Johannes Gutenberg University Mainz (DE)
- Corresponding author
- Ren, Zhihong
- Venue
- Psychological Medicine
- Publisher
- Cambridge University Press (CUP)
- Published
- 2022-11-09
- Volume
- 53
- Issue
- 1
- Pages
- 34-45
- ISSN
- 0033-2917 (ISSN-L)
- 1469-8978
- OpenAlex
- W4308603382
- Cited by
- 30
- References
- 80
- Citations by year
- 2026: 9 · 2025: 11 · 2024: 8 · 2023: 2
- FWCI
- 0.77
- Type
- journal article
- Language
- en
- Update notices
- correction (2022-11-09)
- Open access
- closed
- Locations
- Psychological Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Social Sciences › Psychology › Clinical Psychology › COVID-19 and Mental Health
- Keywords
- interpretation bias, health anxiety, threat interpretation, ambiguous stimuli, threat appraisal
- MeSH terms
- Anxiety, Anxiety Disorders, Humans, Bias
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