Cognitive Therapy and Research

, Volume 37, Issue 1, pp 173–182 | Cite as

Clinical Implications of Cognitive Bias Modification for Interpretative Biases in Social Anxiety: An Integrative Literature Review

  • Sirous Mobini
  • Shirley Reynolds
  • Bundy Mackintosh
Original Article


Cognitive theories of social anxiety indicate that negative cognitive biases play a key role in causing and maintaining social anxiety. On the basis of these cognitive theories, laboratory-based research has shown that individuals with social anxiety exhibit negative interpretation biases of ambiguous social situations. Cognitive Bias Modification for interpretative biases (CBM-I) has emerged from this basic science research to modify negative interpretative biases in social anxiety and reduce emotional vulnerability and social anxiety symptoms. However, it is not yet clear if modifying interpretation biases via CBM will have any enduring effect on social anxiety symptoms or improve social functioning. The aim of this paper is to review the relevant literature on interpretation biases in social anxiety and discuss important implications of CBM-I method for clinical practice and research.


Interpretative bias Social anxiety Social phobia Cognitive bias modification (CBM) Cognitive-behavioral therapy (CBT) 


  1. Alden, L. E., Taylor, C. T., Mellings, T. M. J. B., & Laposa, J. M. (2008). Social anxiety and the interpretation of positive social events. Journal of Anxiety Disorders, 22, 577–590.PubMedCrossRefGoogle Scholar
  2. American Psychiatric Association. (2004). Diagnostic and statistical manual of mental disorders, 4th ed. (DSM-IV). Washington, DC: APA.Google Scholar
  3. Amir, N., Beard, C., & Bower, E. (2005). Interpretation bias and social anxiety. Cognitive Therapy and Research, 29, 433–443.CrossRefGoogle Scholar
  4. Amir, N., Foa, E. B., & Coles, M. E. (1998). Negative interpretation bias in social phobia. Behaviour Research and Therapy, 36, 945–957.CrossRefGoogle Scholar
  5. Asmundson, G. J. G., & Stein, M. B. (1994). Selective processing of social threat in patients with generalized social phobia: Evaluation using a dot-probe paradigm. Journal of Anxiety Disorders, 8, 107–117.CrossRefGoogle Scholar
  6. Bar-Haim, Y. (2010). Research review: Attention bias modification (ABM): a novel treatment for anxiety disorders. Journal of Child Psychology and Psychiatry, 51, 859–870.PubMedCrossRefGoogle Scholar
  7. Beard, C. (2011). Cognitive bias modification for anxiety: Current evidence and future directions. Expert Review of Neurotherapeutics, 11, 299–311.PubMedCrossRefGoogle Scholar
  8. Beard, C., & Amir, N. (2008). A multi-session interpretation modification program: Changes in interpretation and social anxiety symptoms. Behaviour Research and Therapy, 46, 1135–1141.PubMedCrossRefGoogle Scholar
  9. Beard, C., Weisberg, R. B., & Amir N. (2011). Combined cogntive bias modification treatment for social anxiety disorder: A pilot trial. Depression and Anxiety, 28, 981–988.PubMedCrossRefGoogle Scholar
  10. Beard, C., Weisberg, R. B., & Primack, J. (2011). Socially anxious primary care patients’ attitudes toward cognitive bias modification (CBM): A qualitative study. Behavioural and Cognitive Psychotherapy, 30, 1–16. doi: 10.1017/S1352465811000671.Google Scholar
  11. Beck, A. T., & Clark, D. A. (1997). An information processing model of anxiety: Automatic and strategic processes. Behaviour Research and Therapy, 35, 49–58.PubMedCrossRefGoogle Scholar
  12. Beck, A. T., Emery, G., & Greenberg, R. (1985). Anxiety disorders and phobia: A cognitive perspective. New York: Basic Books.Google Scholar
  13. Brosan, L., Hoppitt, L., Sillence, A., Shelfer, L., & Mackintosh, B. (2011). Cognitive bias modification for attention and interpretation reduces trait and state anxiety study in a clinically anxious population. Journal of Behavior Therapy and Experimental Psychiatry, 42, 258–264.PubMedCrossRefGoogle Scholar
  14. Clark, D. M., & McManus, F. (2002). Information processing in social phobia. Biological Psychiatry, 51, 92–100.PubMedCrossRefGoogle Scholar
  15. Clark, D. M., & Wells, A. (1995). A cognitive model of social phobia. In R. G. Heimberg, M. R. Liebowitz, D. A. Hope, F. R., & Schneier (Eds.), Social phobia: diagnosis, assessment, and treatment (pp. 69–93). New York: The Guilford Press.Google Scholar
  16. Constans, J. I., Penn, D. L., Ihen, G. H., & Hope, D. A. (1999). Interpretive biases for ambiguous stimuli in social anxiety. Behaviour Research and Therapy, 37, 643–651.PubMedCrossRefGoogle Scholar
  17. Dalgleish, T. J., & Watts, F. N. (1990). Biases of attention and memory in disorders of anxiety and depression. Clinical Psychology Review, 10, 589–604.CrossRefGoogle Scholar
  18. Fehma, L., Pelissolob, A., Furmarkc, T., & Wittchend, H.-U. (2005). Size and burden of social phobia in Europe. European Neuropsychopharmacology, 15, 453–462.CrossRefGoogle Scholar
  19. Foa, E. B., Franklin, M. E., Perry, K. J., & Herbert, J. D. (1996). Cognitive biases in generalized social phobia. Journal of Abnormal Psychology, 105, 433–439.PubMedCrossRefGoogle Scholar
  20. Grey, S., & Mathews, A. (2000). Effects of training on interpretation of emotional ambiguity. Quarterly Journal of Experimental Psychology: Human Experimental Psychology, 53(A), 1143–1162.Google Scholar
  21. Heinrichs, N., & Hofman, S. G. (2001). Information processing in social phobia: A critical review. Clinical Psychology Review, 21, 751–770.PubMedCrossRefGoogle Scholar
  22. Hertel, P. H., Brozovich, F., Joormann, J., & Gotlib, I. H. (2008). Biases in interpretation and memory in generalized social phobia. Journal of Abnormal Psychology, 117, 278–288.PubMedCrossRefGoogle Scholar
  23. Hirsch, C. R., & Clark, D. M. (2004). Information-processing bias in social phobia. Clinical Psychology Review, 24, 799–825.PubMedCrossRefGoogle Scholar
  24. Holmes, E. A., Lang, T. J., & Shah, D. M. (2009). Developing interpretation bias modification as a “cognitive vaccine” for depressed mood—Imagining positive events makes you feel better than thinking about them verbally. Journal of Abnormal Psychology, 118, 76–88.PubMedCrossRefGoogle Scholar
  25. Holmes, E. A., Mathews, A., Dalgleish, T., & Mackintosh, B. (2006). Positive interpretation training: Effects of mental imagery versus verbal training on positive mood. Behaviour Therapy, 37, 237–247.CrossRefGoogle Scholar
  26. Hoppitt, L., Mathews, A., Yiend, J., & Mackintosh, B. (2010). Cognitive bias modification: The critical role of active training in modifying emotional responses. Behavior Therapy, 41, 73–81.PubMedCrossRefGoogle Scholar
  27. Huppert, J. D., Foa, E. B., Furr, J. M., Filip, J. C., & Mathews, A. (2003). Interpretation bias in social anxiety: A dimensional perspective. Cognitive Therapy and Research, 27, 569–577.CrossRefGoogle Scholar
  28. Huppert, J. D., Pasupuleti, R. V., Foa, E. B., & Mathews, A. (2007). Interpretation biases in social anxiety: Response generation, response selection, and self-appraisals. Behaviour Research and Therapy, 45, 1505–1515.PubMedCrossRefGoogle Scholar
  29. Kessler, R. C., Berglund, P., Demler, O., Jin, R., & Walters, E. E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the national comorbidity survey replication. Archives of General Psychiatry, 62, 593–602.PubMedCrossRefGoogle Scholar
  30. Khalili-Torghabeh, S., Mobini, S., Salehi Fadardi, J., Mackintosh, B., & Reynolds, S. (2012): Effects of a multi-session cognitive bias modification program on negative interpretation biases and social anxiety in a sample of Iranian socially-anxious individuals. (Manuscript in preparation).Google Scholar
  31. Ledley, D. R., & Heimberg, R. G. (2006). Cognitive vulnerability to social anxiety. Journal of Social and Clinical Anxiety, 25, 755–778.Google Scholar
  32. Mackintosh, B., Mathews, A., Yiend, J., Ridgeway, V., & Cook, E. (2006). Induced biases in emotional interpretation influence stress vulnerability and endure despite changes in context. Behavior Therapy, 37, 209–222.PubMedCrossRefGoogle Scholar
  33. MacLeod, C., Koster, E. H. W., & Fox, E. (2009). Whither cognitive bias research? Commentary on the special section articles. Journal of Abnormal Psychology, 118, 89–99.PubMedCrossRefGoogle Scholar
  34. Mathews, A., & Mackintosh, B. (2000). Induced emotional interpretation bias and anxiety. Journal of Abnormal Psychology, 109, 602–615.PubMedCrossRefGoogle Scholar
  35. Mathews, A., & MacLeod, C. (2002). Induced processing biases have causal effects on anxiety. Cognition and Emotion, 16, 331–354.CrossRefGoogle Scholar
  36. Mathews, A., Ridgeway, V., Cook, E., & Yiend, J. (2007). Inducing a benign interpretational bias reduces trait anxiety. Journal of Behavior Therapy and Experimental Psychiatry, 38, 225–236.PubMedCrossRefGoogle Scholar
  37. McManus, F., Clark, D. M., & Hackmann, A. (2000). Specificity of cognitive biases in social phobia and their role in recovery. Behavioural and Cognitive Psychotherapy, 28, 201–209.CrossRefGoogle Scholar
  38. Mobini, S., & Grant, A. (2007). Clinical implications of attentional bias in anxiety disorders: an integrative literature review. Psychotherapy: Theory, Research, Practice, Training, 44, 450–462.CrossRefGoogle Scholar
  39. Mobini, S., Mackintosh, B., Hoppitt, L., Illingworth, J., Langdon, P., Gega, L. (2012). Effects of implicit and explicit cognitive bias modification and computer-aided cognitive-behaviour therapy on modifying cognitive biases in social anxiety. (Manuscript in preparation).Google Scholar
  40. Murphy, R., Hirsch, C. R., Mathews, A., Smith, K., & Clark, D. M. (2007). Facilitating a benign interpretation bias in a high socially-anxious population. Behaviour Research and Therapy, 45, 1517–1529.PubMedCrossRefGoogle Scholar
  41. Musa, C. Z., & Lépine, J. P. (2000). Cognitive aspects of social phobia: a review of theories and experimental research. European Psychiatry, 15, 59–66.PubMedCrossRefGoogle Scholar
  42. Pineles, S. L., & Mineka, S. (2005). Attentional biases to internal and external sources of potential threat in social anxiety. Journal of Abnormal Psychology, 114, 314–318.PubMedCrossRefGoogle Scholar
  43. Pishyar, R., Harris, L. M., & Menzies, R. G. (2004). Attentional bias for words and faces in social anxiety. Anxiety, Stress, & Coping, 17, 23–36.CrossRefGoogle Scholar
  44. Rapee, R. M., & Heimberg, R. G. (1997). A cognitive-behavioral model of anxiety in social phobia. Behaviour Research and Therapy, 35, 741–756.PubMedCrossRefGoogle Scholar
  45. Salemink, E., van den Hout, M. A., & Kindt, M. (2009). Effects of positive interpretive bias modification in highly anxious individuals. Journal of Anxiety Disorders, 23, 676–683.PubMedCrossRefGoogle Scholar
  46. Sareen, J., & Stein, M. (2000). A review of the epidemiology and approaches to the treatment of social anxiety disorder. Disease Management, 59, 497–509.Google Scholar
  47. Schofield, C. A., Coles, M. E., & Gibb, B. E. (2007). Interpretation of facial expressions and social anxiety: Specificity and source of biases. Cognition and Emotion, 22, 1159–1173.Google Scholar
  48. Spokas, M. E., Rodebaugh, T. L., & Heimberg, R. G. (2007). Cognitive biases in social phobia. Psychiatry, 6, 204–210.CrossRefGoogle Scholar
  49. Stopa, L. (2009). Why is the self important in understanding and treating social phobia? Cognitive Behaviour Therapy, 38, 48–54.PubMedCrossRefGoogle Scholar
  50. Stopa, L., Brown, M. A., Luke, M. A., & Hirsch, C. R. (2010). Constructing a self: The role of self-structure and self-certainty in social anxiety. Behaviour Research and Therapy, Behaviour Research and Therapy, 48, 955–965.CrossRefGoogle Scholar
  51. Stopa, L., & Clark, D. M. (2000). Social phobia and interpretation of social events. Behaviour Research and Therapy, 38, 759–777.CrossRefGoogle Scholar
  52. Taylor, C. T., & Alden, L. E. (2005). Social interpretation bias and generalized social phobia: the influence of developmental experiences. Behaviour Research and Therapy, 43, 273–283.CrossRefGoogle Scholar
  53. Tran, T. B., Siemer, M., & Joormann, T. (2011). Implicit interpretation biases affect emotional vulnerability: A training study. Cognition and Emotion, 25, 546–558.PubMedCrossRefGoogle Scholar
  54. Turner, R., Hoppitt, L., Hodgekin, J., Mackintosh, B., & Fowler, D. (2011). Cognitive bias modification in the treatment of social anxiety in early psychosis: a single case series. Behavioural and Cognitive Psychotherapy, 39, 341–347.PubMedCrossRefGoogle Scholar
  55. Vassilopoulos, S. P. (2006). Interpretation and judgmental biases in socially-anxious and nonanxious individuals. Behavioural and Cognitive Psychotherapy, 34, 243–254.CrossRefGoogle Scholar
  56. Voncken, M. J., Bögels, S. M., & de Vries, K. (2003). Interpretation and judgmental biases in social phobia. Behavior Research and Therapy, 41, 1481–1488.CrossRefGoogle Scholar
  57. Williams, J. M. G., Watts, F. N., MacLeod, C., & Mathews, A. (1997). Cognitive psychology and emotional disorders. New York: Wiley.Google Scholar
  58. Wilson, E., MacLeod, C., Mathews, A., & Rutherford, E. (2006). The causal role of interpretive bias in anxiety reactivity. Journal of Abnormal Psychology, 115, 103–111.PubMedCrossRefGoogle Scholar
  59. Yiend, J., Mackintosh, B., & Mathews, A. (2005). The enduring consequences of experimentally induced biases in interpretation. Behaviour Research and Therapy, 43, 779–797.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Sirous Mobini
    • 1
    • 2
  • Shirley Reynolds
    • 1
  • Bundy Mackintosh
    • 1
  1. 1.Doctoral Programme in Clinical Psychology, Department of Psychological SciencesNorwich Medical School, University of East AngliaNorwichUK
  2. 2.School of PsychologyUniversity of NewcastleCallaghanAustralia

Personalised recommendations