Interpretation biases in anxiety: A three-level meta-analysis

Interpretation biases (IBs) play a central role in cognitive models of anxiety disorders and are considered a transdiagnostic feature across anxiety disorders and severity levels. However, the magnitude of this bias in anxiety and modulating factors are largely unknown. This three-level meta-analysis investigated the associations between IBs and symptoms of anxiety. Database searches (PsycINFO, PubMed, ProQuest Dissertations) led to 295 samples with 1450 contrasts. An overall medium effect size (g = 0.48, 95% CI [0.43, 0.52]) was found. Equivalent effect sizes were found for youths and adults as well as different disorder categories and clinical statuses. Effect sizes were larger for studies using direct measures, verbal stimuli, disorder-specific stimuli, and negative (as opposed to positive) stimuli. Overall, results are consistent with the view that anxiety is associated with IBs across different disorders and severity levels. These findings have implications for cognitive theories of anxiety as well as clinical interventions.