Abstract
Background: studies have demonstrated that interpretation bias (IB) occurs in a wide variety of people, particularly those with high levels of worry and affective disorders. Studies have also identified that interpretation bias may exists in people with physical health conditions although to date, no review has assessed this effect in general.Objectives: this review aims to clarify, (i) the presence of IB in people with physical health conditions relative to healthy controls, (ii) the association between IB and anxiety, (iii) the association between IB and physical illness symptom (including controlling for affective symptoms), (iv) whether IB can be altered through cognitive bias modification, and (v) whether methodological approaches may inform our understanding of this process in physical health conditions.
Method: we specifically identified studies that assessed interpretation bias across a range physical health conditions published in print or on-line up to April 2019. The review conducted searches from a range of platforms (PubMed, Web of Science and OvidSP) to identify peer reviewed journal articles and applied a quality assessment method developed by a previous systematic review of interpretation bias. Only quantitative studies that involved assessment of interpretation bias in adults were selected. Studies that only assessed other forms of cognitive bias and child/adolescents were excluded from the study.
Results: twelve studies were identified that directly investigated interpretation bias, of which eleven found evidence of bias in patients when compared to controls. Anxiety was found to be associated with interpretation bias in only one study, indicating that bias did not simply reflect affective state. Six studies investigated whether physical Illness severity was associated with interpretation bias, of which four papers found a significant positive effect. Only one study applied bias modification to participants with physical health conditions. This study presented an improvement in interpretation bias for patients with fear of cancer recurrence. Methodological considerations revealed that a wide variety of bias detection paradigms were used, each with their own implications for how 9 interpretation bias was examined and the results interpreted in terms of psychological processes.
Conclusion: the sample of studies that have investigated interpretation bias are small in size and largely focused on chronic pain and CFS with few studies in patients with more common physical health conditions. However, the studies identified consistently demonstrate interpretation bias in people with specific physical health conditions assessed relative to controls, regardless of the paradigms used. Further research is still required with a broader range of common physical health conditions to establish the scale of interpretation bias. While we did not find consistent evidence for an association between anxiety and IB, illness severity did have an effect in four studies. The review discusses some methodological and theoretical principles that may be relevant to the direction of future research.
| Date of Award | 1 Apr 2020 |
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| Original language | English |
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| Supervisor | Richard Brown (Supervisor) & Colette Hirsch (Supervisor) |