Interpretation Biases in Anxiety: A Three-Level Meta-Analysis

Felix Würtz; Marius Kunna; Simon E. Blackwell; Chiara Lindgraf; Elinor Abado; Yagmur Amanvermez; Jürgen Margraf; Jonas Everaert; Marcella L. Woud

doi:10.1177/21677026251392855

Interpretation Biases in Anxiety: A Three-Level Meta-Analysis

Felix Würtz
, Marius Kunna
, Simon E. Blackwell
, Chiara Lindgraf
, Elinor Abado
, Yagmur Amanvermez
, Jürgen Margraf
, Jonas Everaert
, Marcella L. Woud

Research output: Contribution to journal › Review article › peer-review

Abstract

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. In this three-level meta-analysis, we investigated the associations between IBs and symptoms of anxiety. Database searches (PsycINFO, PubMed, ProQuest Dissertations) led to 295 samples with 1,450 contrasts. An overall medium effect size (g = 0.48, 95% confidence interval = [0.43, 0.52]) was found. Equivalent effect sizes were found for youths and adults and 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 and clinical interventions.

Original language	English
Journal	Clinical Psychological Science
DOIs	https://doi.org/10.1177/21677026251392855
State	Accepted/In press - 2026
Externally published	Yes

Bibliographical note

Publisher Copyright:
© The Author(s) 2026. This article is distributed under the terms of the Creative Commons Attribution 4.0 License (https://creativecommons.org/licenses/by/4.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).

Keywords

anxiety disorders
cognitive models
interpretation bias
meta-analysis
open data
open materials
preregistration

ASJC Scopus subject areas

Clinical Psychology

Access to Document

10.1177/21677026251392855

Cite this

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title = "Interpretation Biases in Anxiety: A Three-Level Meta-Analysis",

abstract = "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. In this three-level meta-analysis, we investigated the associations between IBs and symptoms of anxiety. Database searches (PsycINFO, PubMed, ProQuest Dissertations) led to 295 samples with 1,450 contrasts. An overall medium effect size (g = 0.48, 95\% confidence interval = [0.43, 0.52]) was found. Equivalent effect sizes were found for youths and adults and 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 and clinical interventions.",

keywords = "anxiety disorders, cognitive models, interpretation bias, meta-analysis, open data, open materials, preregistration",

author = "Felix W{\"u}rtz and Marius Kunna and Blackwell, \{Simon E.\} and Chiara Lindgraf and Elinor Abado and Yagmur Amanvermez and J{\"u}rgen Margraf and Jonas Everaert and Woud, \{Marcella L.\}",

note = "Publisher Copyright: {\textcopyright} The Author(s) 2026. This article is distributed under the terms of the Creative Commons Attribution 4.0 License (https://creativecommons.org/licenses/by/4.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).",

year = "2026",

doi = "10.1177/21677026251392855",

language = "English",

journal = "Clinical Psychological Science",

issn = "2167-7026",

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}

TY - JOUR

T1 - Interpretation Biases in Anxiety

T2 - A Three-Level Meta-Analysis

AU - Würtz, Felix

AU - Kunna, Marius

AU - Blackwell, Simon E.

AU - Lindgraf, Chiara

AU - Abado, Elinor

AU - Amanvermez, Yagmur

AU - Margraf, Jürgen

AU - Everaert, Jonas

AU - Woud, Marcella L.

N1 - Publisher Copyright: © The Author(s) 2026. This article is distributed under the terms of the Creative Commons Attribution 4.0 License (https://creativecommons.org/licenses/by/4.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).

PY - 2026

Y1 - 2026

N2 - 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. In this three-level meta-analysis, we investigated the associations between IBs and symptoms of anxiety. Database searches (PsycINFO, PubMed, ProQuest Dissertations) led to 295 samples with 1,450 contrasts. An overall medium effect size (g = 0.48, 95% confidence interval = [0.43, 0.52]) was found. Equivalent effect sizes were found for youths and adults and 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 and clinical interventions.

AB - 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. In this three-level meta-analysis, we investigated the associations between IBs and symptoms of anxiety. Database searches (PsycINFO, PubMed, ProQuest Dissertations) led to 295 samples with 1,450 contrasts. An overall medium effect size (g = 0.48, 95% confidence interval = [0.43, 0.52]) was found. Equivalent effect sizes were found for youths and adults and 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 and clinical interventions.

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KW - cognitive models

KW - interpretation bias

KW - meta-analysis

KW - open data

KW - open materials

KW - preregistration

UR - https://www.scopus.com/pages/publications/105041699278

U2 - 10.1177/21677026251392855

DO - 10.1177/21677026251392855

M3 - Review article

AN - SCOPUS:105041699278

SN - 2167-7026

JO - Clinical Psychological Science

JF - Clinical Psychological Science

ER -

Interpretation Biases in Anxiety: A Three-Level Meta-Analysis

Abstract

Bibliographical note

Keywords

ASJC Scopus subject areas

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