Cognitive Bias Modification of Interpretations in Children: Processing Information About Ambiguous Social Events in a Duo - Vassilopoulos, Brouzos (2015) - Article

Introduction

There is a big effect of cognitions on social anxiety symptoms. For example, children with social anxiety often interpret ambiguous social information in a negative and anxiety-provoking manner. So, if a socially anxious person sees a companion yawn, he or she is likely to interpret this yawning in a negative self-confirmatory way. So, the person might think: “I must be boring”. This is different from a person without social anxiety, who might think: “Oh, my friend must have had a long day”.

Negative cognitions (thoughts) are also a risk factor for developing social anxiety. Therefore, it is necessary to develop effective, tailored to developmental level and easy-to-administer interventions for people who show symptoms of early social anxiety.

In the past 15 years, there are new training programs that have been developed. These training programs are called Cognitive Bias Modification of Interpretations (CBM-I). These trainings are effective for modifying negative interpretations when confronted with ambiguous cues. In a study conducted by Vassilopoulos and colleague’s, children who reported high levels of social anxiety were presented with a few ambiguous scenarios, followed by a benign. An example of an ambiguous scenario is: “During arts education, you ask your classmate for one of his/her crayons but he/she refuses”. Then, the socially anxious children get to choose between two explanations: a benign or a negative interpretation such as: “He or she needs the crayons to finish his/her own painting” or “He or she dislikes you”. The children have to choose the benign that reflects the way that they would think in a situation like that. After the children chose a benign, they got feedback on what was the “correct” interpretation, which was always the benign interpretation. This training reduced the negative interpretations of the children and also reduced their social anxiety. Also, the trained group showed lower anxiety when they were anticipating a social encounter. The results of this study suggest that the negative thoughts that children have, are malleable and that training can have beneficial effects on this part of social anxiety.

Even though training programs seem to be effective, lately research has been interested in how interpretation training paradigms can be made more effective in inducing the relevant bias. So, they want to know how social anxiety can be induced. In most interpretation programs that are developed for children, the participants work on their own with a few hypothetical scenarios. The experimenter provides feedback on the ‘correct’ response. But, these training programs have some problems, such as that participants rate them as boring, meaningless or strange. Also, often there is no explanation provided for the ‘correct’ response. Some children also are not fully convinced when they hear the feedback from the experimenter or find it difficult to identify themselves with the positive outcomes that are described during the training.

Matthews, a researcher, modified training material so that it is easier for adults to accept the positive interpretations. He did this by introducing positive outcomes in a more graded fashion, with a nonnegative begin and gradually becoming very positive. Lau and colleagues wanted to maximize the effects of positive CBM-I on children by involving the parents. What they did was that they studies multisession CBM-I training which was administered by parents as bedtime stories. The children who underwent this kind of training showed higher acceptance of benign interpretations, a non-significant reduction in endorsement of negative interpretations and reduced social anxiety symptoms compared to a control (no-intervention) group!

However, there is some literature that suggests that involving peers instead of parents might be beneficial too, if not more beneficial. During early adolescence, boys and girls show a strong preference for forming groups with same-sex peers. These groups, in turn, exert a lot of influence on their attitudes and behaviors. Also, even though research suggests that parenting practices can affect children’s cognitive development, it is possible that pre-adolescents’ attributional style is influences by their peers. Also, when the aim is to implement evidence-based techniques in school settings, it is easier to engage peers than to engage parents. This is because parents are often difficult to reach and are often unavailable or unwilling to participate in such a training. The last reason for involving peers is that when children are instructed to participate in joint discussions with same-sex peers, the interpretation training might become more appealing, engaging and intuitive. It seems that problem-solving group interventions are one of the most effective counselling and psychotherapy strategies with children and adolescents. Also, there is evidence that when children are asked to rate a potential threat after that they had a brief discussion with their same-sex peer, a fear-suppression effect occurs. More specifically, in a study conducted by Muris and Rijke, nine to twelve year-old boys and girls were given ambiguous and positive information about novel animals and were then asked to provide a subjective fear rating of the animals. This procedure was conducted under two conditions: for one animal, the child provided a rating of the subjective fear. For another animal, the child rated the subjective fear after a brief discussion with a same gender peer. The results of this study showed that children who evaluated the fear level after a discussion with a same gender peer, showed lower levels of fear than children who evaluated the fear level of the animals on their own. So, it seems that when children are asked to talk about fear with their same gender peers, this may lead to lower levels of fear.

The current study

This study was conducted to develop a new variant of the CBM-I and to test its impact on interpretation bias and social anxiety symptoms. This new variant, which is called duo CBM-I, instructs the participant to select a negative or benign interpretation after that they had a brief discussion with a same gender peer. Based on the results of the study conducted by Muris and Rijke, the researchers hypothesized that a duo CBM-I training would lead to less social anxiety symptoms and changed interpretation bias, which is more in the positive direction. The other goal of this study was to determine the effects of interpretation training on performance and emotional vulnerability through a real stress-evoking task in which participants have to complete an insoluble anagram. There is evidence that inducing an interpretation bias can affect participants’ performance on this measure. So, the authors wanted to replicate these findings by testing the hypothesis that the effects of the new training variant on cognition and social anxiety symptoms would translate into associated change in objective and subjective performance during a stress-evoking task.

Method

Participants

The participants in this study were 38 primary school children which were in the 5^th grade class from two public schools in the southwest of Greece. They were from a predominantly middle-class SES background. All the participants were Caucasian and were in the ages of ten to eleven. This specific group was selected because of findings that suggest that preadolescents show a strong preference for same-sex peers.

Interpretation Bias

In this study, eighteen ambiguous social scenarios were shown. These scenarios were representative for common occurring events which are relevant for the age group in question, such as inviting classmates to your birthday party and getting no reply, or approaching a group of peers who stop talking when they see you coming up or going to your classmate’s house to play together but having nobody open the door. Each of these scenarios were followed by two thoughts which socially anxious people may have. One of these thoughts is a negative interpretation about oneself and the other is a benign interpretation of oneself or the situation. The children rated the explanations based on what they would think if these scenarios were to happen in real life.

Discussion

This study was conducted to evaluate a new variant of the CBMI-I and to test its effectiveness. This study differs from others, because in this study the participant has an active discussion with a peer and during the discussion there is no feedback provided on the ‘correct’ response. In most other cognitive bias modification training, the participant is trained in isolation and receives feedback regarding the ‘correct’ response. So, in this study, the role of same gender peers was taken into account. This was done with the idea that involving same-gender peers would lead to a procedure that is more meaningful and engaging.

The results of this study are promising: they suggest that the duo CBM-I was successful in decreasing negative interpretations as well as negative emotional consequence estimates. Such a change was not seen in the control condition. Also, the data showed that the experimental intervention could reduce social anxiety symptoms. So, by making the CBM-I more active through discussions with same-sex peers, seems effective. The other aim of this study was to examine whether the positive effects of the duo CBM-I would generalize to performance and vulnerability in response to a real-life stressful task. In line with expectations, it was found that children who participate in joint-discussions with a same-sex peer, were much less frustrated after completing the second anagram task.

The results of this study suggest that in further cognitive bias modification trainings, it would be more effective to instruct the children to form same-sex pairs and jointly discuss a few hypothetical ambiguous social stories to determine which of the two interpretations that follow is the most helpful or rational one. This also leads to that the whole procedure is more enjoyable and engaging and it also enhances children’s communication skills, complex reasoning and critical thinking.

So, the conclusion of this study is that it is effective to implement joint discussions with same-sex peers. It also seems that the effects of the training were also transferred to other, real-life stress-evoking tasks.