Cognitive biases in social anxiety

Abstract

Accumulated evidence has implicated the role of cognitive biases in the development and maintenance of social anxiety. These biases selectively prioritise the processing of information in a negative manner, reinforcing emotional dysfunction in a self-perpetuating cycle. However, the underlying mechanism of these processing biases is yet to be fully understood. This thesis reports four studies investigating the complex framework of emotional processes in social anxiety by specifically focusing on attention, interpretation and memory bias. Chapter 1 introduces the literature on biased cognition in social anxiety. Chapter 2 (Study 1, n = 12) qualitatively explores the cognitive processes of individuals with elevated social anxiety in two main anxiety-provoking social events – social interaction and performance-orientated situations. Chapter 3 (Study 2) reports a systematic review and meta-analysis of the combined cognitive bias hypothesis to gain a broad understanding of the reciprocal nature of cognitive biases in anxiety. Chapter 4 (Study 3, n = 188) examines the relationship of cognitive biases in social anxiety cross-sectionally with facial stimuli. Chapter 5 (Study 4, n = 99) investigates the clinical efficacy among different approaches of text-based cognitive bias modification (CBM), including CBM that targets attention (CBM-A), interpretation (CBM-I) and combined intervention (CCBM). Chapter 6, the General Discussion, integrates the findings with the current literature and discusses the theoretical and clinical implications. Findings of this thesis complement the existing conceptualisation of cognitive bias in social anxiety by suggesting qualitative differences in attentional processing involved in different social situations and providing empirical support to the combined cognitive bias hypothesis. Cognitive biases were found to be related to each other, both in terms of correlation and transfer effect after CBM training. Specifically, the relationships appeared to be more pronounced under the context in which cognitive biases are assessed and manipulated with matching stimulus properties. CBM-I was evident as an effective intervention in attenuating cognitive biases. The obtained data also highlight methodological issues to be addressed by researchers. These findings enable researchers to further illuminate the information processing mechanism that underlies social anxiety. This thesis also sheds light on the future development of cognitive bias measurements/modifications.