The Longitudinal Interplay Between Attention Bias and Interpretation Bias in Social Anxiety in Adolescents

Cognitive Therapy and Research https://doi.org/10.1007/s10608-022-10304-1 ORIGINAL ARTICLE The Longitudinal Interplay Between Attention Bias and Interpretation Bias in Social Anxiety in Adolescents Lisan A. Henricks1 · Wolf-Gero Lange1 · Maartje Luijten1 · Yvonne H. M. van den Berg1 · Sabine E. M. J. Stoltz1 · Antonius H. N. Cillessen1 · Eni S. Becker1 Accepted: 5 April 2022 © The Author(s) 2022 Abstract Background Cognitive biases are found to play a role in the onset and maintenance of social anxiety. However, particularly in adolescence, the link between different biases and their role in predicting social anxiety is far from clear. This study therefore investigated the interplay between attention bias and interpretation bias in relation to social anxiety in adolescence across three years. Methods 816 adolescents in grade 7 to 9 participated at three yearly waves (52.8% boys, Mage grade7 = 12.60). Social anxiety was measured with a self-report questionnaire. Attention bias was measured with a visual search task with emotional faces. Textual vignettes assessed interpretation bias. Results Cross-lagged models showed that negative interpretation bias at grade 7 predicted an increase in social anxiety at grade 8. This effect was not found from grade 8 to 9. Attention bias did not predict social anxiety. Attention bias and interpretation bias were not longitudinally related to each other, nor did they interact with each other in predicting social anxiety. Conclusions Thus, no evidence was found for the Combined Cognitive Bias Hypothesis in social anxiety in adolescents. Instead, our results suggest that interpretation bias rather than attention bias contributes to the increase of social anxiety over time. Keywords Social anxiety · Attention bias · Interpretation bias · Longitudinal · Adolescence The Longitudinal Interplay Between Attention Bias and Interpretation Bias in Social Anxiety in Adolescents Social anxiety involves the fear to be negatively evaluated by others, and is often accompanied by the avoidance of social situations (American Psychiatric Association, 2013). Social anxiety has its onset in childhood (Beesdo et al., 2011), but symptoms increase during adolescence with a prevalence of 5–16% (Mesa et al., 2011). Youth with social anxiety experience severe consequences such as the increased risk of peer victimization (Erath et al., 2007), depression, and substance use (Beesdo et al., 2007). Early detection and treatment are therefore warranted, highlighting the necessity of research Lisan A. Henricks 1 Behavioural Science Institute, Radboud University, PO Box 9104, 6500 HE Nijmegen, The Netherlands on factors contributing to the onset and maintenance of social anxiety. Many cognitive models assume that biased cognitive processing is such a contributing factor (e.g., Beck et al., 2005; Wong & Rapee, 2016). Specifically, negative attention bias (i.e., the attentional preference for negative stimuli) and negative interpretation bias (i.e., the tendency to negatively interpret ambiguous social situations) increase the risk of experiencing social anxiety symptoms in children and adolescents (Dudeney et al., 2015; Stuijfzand et al., 2018). Most studies in children and adolescents so far have been crosssectional (e.g., Rozenman et al., 2014; Seefeldt et al., 2014; Vassilopoulos et al., 2009; Waters et al., 2011), making it difficult to draw conclusions about the long-term predictive impact of biases on social anxiety. Exceptions are made for two longitudinal studies. One of these studies showed that adolescents with a negative interpretation style are at higher risk for belonging to a high social anxiety trajectory (Miers et al., 2013). The other study provided evidence that social anxiety was able to predict negative interpretation bias two 13 Cognitive Therapy and Research years later. However, interpretation bias could not explain the pathway between shyness and social anxiety over time (Blöte et al., 2019). Longitudinal evidence about the role of attention bias is still lacking. At the same time, most studies in youth investigated the effect of either one of the biases on social anxiety (e.g., Bögels & Zigterman 2000; Miers et al., 2008; Salum et al., 2013), hereby ignoring the fact that biases may be interrelated or interact with each other (Hirsch et al., 2006). To overcome these limitations, the current study focuses on the interplay between attention bias and interpretation bias, and examines the longitudinal predictive ability of cognitive biases on social anxiety across three years in adolescence. Attention Bias, Interpretation Bias, and Social Anxiety Both attention and interpretation biases may play a role in the existence and development of social anxiety in adolescence. Following the theory of (Piaget, 1971), adolescence in particular, may be a critical period of time for the development of cognitive biases, as a result of socio-cognitive maturation. Adolescents become able to think and reason in an abstract way, and develop metacognitive beliefs (i.e., the ability to reflect on our own thoughts and behaviours; Weil et al., 2013). This cognitive maturation may result in heightened self-consciousness and concerns about self-presentation, and the development of cognitive biases (Rapee & Spence, 2004; Westenberg et al., 2004). Attention bias is a complex phenomenon consisting of multiple components. On the one hand, it is characterized by an enhanced engagement to threat as (socially) fearful individuals are faster to detect negative stimuli in the environment. On the other hand, it encompasses the delayed disengagement from threat, which is described as the difficulty to withdraw one’s attention from negative cues (Blicher et al., 2020). Most studies on attention bias in anxious youth focus on one specific attention bias component (e.g., enhanced engagement to threat; Shechner et al., 2013) or use a task which is not able to distinguish between the different attention bias components (e.g., the dot-probe task; Clarke et al., 2013). In this study, we aimed to examine both attention bias components by using a visual search task instead in which participants in different trials either have to detect or ignore a social threat. As such, we could investigate whether attention biases in social anxiety are associated with biases in engagement or disengagement (Donnelly et al., 2010). Despite the theoretical frameworks and the fact that adult studies continuously found evidence for the role of engagement and disengagement attention biases in social anxiety (Liang et al., 2017), the role of attention bias and its specific 13 components in youth is less clear. A review paper showed that some studies failed to detect a link between attention bias and anxiety in children, including social anxiety (Dudeney et al., 2015; Puliafico & Kendall, 2006), but others showed that socially anxious youth are faster at detecting threatening stimuli such as negative (...truncated)