Dynamic changes in interpretation bias as predictors of social anxiety symptom change during CBT

This is the first study to examine within and between session changes in interpretation biases as mechanisms of change in individual cognitive-behavioral therapy for social anxiety disorder (SAD). Twenty-eight patients completed multiple interpretation bias assessments, measured using both strategic (sentence completion, self-report) and automatic (grammatical decision) tasks and weekly measures of SAD symptoms. Preregistered Bayesian analyses results yielded strong evidence for bidirectional, time-lagged, weekly associations between changes in positive and negative interpretation biases and symptom reduction over the course of CBT. The effect of interpretations on subsequent symptoms were more consistent than the effect of symptoms on interpretations, suggesting an important unidirectional and potentially causal link. Increases in earlier, strategic positive biases and decreases in later, negative strategic biases were most consistently associated with symptom reduction. Together, these findings provide strong support for cognitive models that highlight the importance of interpretation biases as mechanisms of change in treatment of SAD.