Perception of Threat in Children With Social Phobia: Comparison to Nonsocially Anxious Children Before and After Treatment

Abstract

The present study investigated interpretation bias and reduced evidence for danger (RED) bias in 49 children with social phobia and 49 nonsocially anxious children between the ages of 8 and 14 years, using an ambiguous stories task. A posttreatment and follow-up measure was included for 26 of the socially phobic children to examine whether there would be a change in interpretation and RED bias after a 12-week behavior therapy program. Ambiguous scenarios were presented sentence by sentence. Participants gave interpretations and fear ratings after each sentence, and they rated negative emotions after each complete scenario. Compared to the nonsocially anxious children, children with social phobia displayed both a RED bias and an interpretation bias. After the treatment program, the children with social phobia displayed a reduced tendency to make biased interpretations, but there were no significant posttreatment changes in the RED bias. At 1 year follow-up there was a significant reduction in both interpretation and RED bias and clinical children no longer differed from nonsocially anxious controls.

Acknowledgments

This study was supported by grants from the Swedish Council for Working Life and Social Research (F0129/2001) and from the Swedish Research Council (421-2001-4740). We gratefully acknowledge the help from Lisa Alexandersson and Evelina Pärnerud in collecting the normal group data, the valuable comments on the manuscript from Kia Åsberg and Jonas Ramnerö, and the thorough work of the anonymous reviewers.

Notes

¹Internal consistency for the Threshold, Frequency, Threat Rating, and Negative Emotions scales across each story was calculated using data from Study 1. Cronbach's alpha for the seven items of each scale was .75 for Threshold, .82 for Frequency, .83 for Ratings, and .91 for Negative Emotions. A discriminant function analyses was carried out to investigate to what extent the four scales would predict group membership (social phobia or nonsocially anxious). Overall prediction accuracy was 80% for Story 1, 76% for Story 2, 80% for Story 3, 72% for Story 5, 88% for Story 6, and 70% for Story 7. Story 5 was created to be unambiguously threatening, hence it was excluded from the analysis.

²Because the children's ratings of fear, shyness, being at a loss, and worry were significantly correlated, r(96) = .75–.82 for Study 1, and r(50) = .62–.76 for Study 2, the ratings were averaged to one Negative Emotions index by summing the child's four ratings and dividing them by 4.

Note: RED = reduced evidence for danger.

^a N = 49.

^b N = 49.

^c Higher scores indicate less anxiety.

**p < .01. ***p < .001.

^a n = 26.

^b Higher scores indicate less anxiety.

^c Pre- to postsignificant difference (p < .05 or lower).

^d Pre- to follow-up significant difference (p < .05 or lower).