Comorbid interpretation and expectancy bias in social anxiety and alcohol use

ABSTRACT

Background: In two studies, the present research examined whether being high in both social anxiety and alcohol use disorder symptoms is associated with a comorbid interpretation and expectancy bias that reflects their bidirectional relationship.

Design: Cross-sectional, quantitative surveys.

Methods: Measures of social anxiety and alcohol use disorder symptoms, as well as an interpretation and expectancy bias task assessing biases for social anxiety, drinking, and comorbid social anxiety and drinking.

Results: In Study 1 (N = 447), individuals high (vs. low) in social anxiety had stronger social threat bias and individuals high (vs. low) in alcohol use disorder symptoms had stronger drinking bias. Those high in both social anxiety and alcohol use disorder symptoms endorsed interpretations and expectancies linking social interaction with alcohol use. Comorbid bias predicted membership into the high social anxiety/drinking group, even after taking into account single-disorder biases. In Study 2 (N = 325), alcohol use disorder symptoms predicted drinking bias and social anxiety symptoms predicted social anxiety bias. Alcohol use disorder symptoms, social anxiety symptoms, and their interaction predicted comorbid interpretation and expectancy bias.

Conclusion: Results indicate unique cognitive vulnerability markers for persons with comorbid social anxiety and alcohol use disorder symptoms, which may improve detection and treatment of this serious comorbidity.

KEYWORDS:

• Social anxiety
• alcohol
• comorbid
• interpretation bias
• expectancy bias

Disclosure statement

No potential conflict of interest was reported by the authors.

ORCID

Philip I. Chow http://orcid.org/0000-0001-6428-1540

Elske Salemink http://orcid.org/0000-0002-6885-2598

Notes

1 The materials reported here are part of a larger study that examined associations between social anxiety, drinking, and cognitive variables. The present research is the first using this dataset to examine how social anxiety and drinking are associated with interpretation and expectancy biases, and no interpretation/expectancy bias variables were excluded from this report. A full list of materials and tasks is available by contacting the lead author.

2 We want to note that the p-value selected to indicate the threshold for statistical significance varies across the 2 studies. The reason this occurred is that we had initially set the significance threshold at .05 in Study 1, but based on reviewer feedback we subsequently changed it to p <. 01. Separately, we had decided to use Bonferroni correction to determine the significance threshold for Study 2 (given a different number of tests are conducted in Study 2 vs. Study (1). We elected to leave the slight difference in significance thresholds across studies so we would not be making further changes post hoc simply to make them match. We also have tried to attend to magnitude of effects to help guide our interpretation of the results.

3 Because some scenarios presented in the comorbid bias task could be seen as coping with social anxiety via alcohol use whereas others could be seen as pertaining to the negative social effects of drinking, we created two new comorbid interpretation bias scores; one for coping with social anxiety via alcohol use and one for the social effects of drinking. Despite not sharing any common items, the two bias scores were strongly correlated (r = .512, p < .001). Importantly, we were able to replicate the pattern of results reported in the manuscript. Comorbid bias reflecting coping with social anxiety via alcohol misuse was significantly predicted by a greater severity of comorbid symptoms (B = .11, t = 2.02, p = .044), as well as social anxiety (B = .26, t = 4.86, p < .001) and alcohol use disorder symptoms (B = .46, t = 8.69, p < .001) symptoms. In addition, comorbid bias reflecting the impact of alcohol misuse on social functioning was significantly predicted by a greater severity of comorbid symptoms (B = .12, t = 2.11, p = .036), as well as social anxiety (B = .45, t = 8.14, p < .001) and alcohol use disorder (B = .49, t = 8.78, p < .001) symptoms. Thus, the findings are consistent for biases around social anxiety leading to alcohol misuse and for biases around alcohol misuse worsening social anxiety.

Additional information

Funding

This work was supported in part by National Institute of Mental Health (NIMH) grants (R34MH106770 and R01MH113752), as well as a University of Virginia Hobby Grant, to B. Teachman. B. Teachman has a significant financial interest in Project Implicit, Inc., which provided services in support of this project under contract with the University of Virginia.