A one-month behavioral treatment for social anxiety lowers hostile interpretations of others

People who experience high levels of social anxiety tend to view neutral or ambiguous interactions as intentionally hostile, but treating the anxiety can effectively reduce this aggressive perception, according to a recent paper published in Cognitive Behaviour Therapy. These findings suggest that addressing underlying anxiety can lead to meaningful improvements in how people understand the intentions of those around them.

Social anxiety involves an intense fear of being watched and judged by others in everyday social situations. This fear often leads people to avoid social events or act in ways designed to protect themselves from perceived embarrassment. Scientists recognize that people with social anxiety often assume others are judging them negatively, a pattern known as a social-evaluative bias.

A related psychological pattern, called hostile interpretation bias, specifically involves interpreting neutral or unclear social cues as signs of anger, disrespect, or aggression. For example, if a person does not reply to a greeting, someone with a hostile interpretation bias might assume the silence is an intentional insult. While a social-evaluative bias involves feeling generally judged, a hostile bias involves assuming the other person actively wishes them harm.

Previous work links this hostile bias to problematic anger and aggression. Individuals with social anxiety often report experiencing persistent anger throughout the day, even when they are alone. Because of this connection, scientists at Florida State University wanted to understand the exact relationship between social anxiety and hostile interpretations.

“One of the primary goals of our work is to better understand and treat social anxiety disorder,” said study authors Tapan Patel and Jesse Cougle, a PhD candidate and a professor of psychology, respectively.

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“Individuals with social anxiety disorder tend to interpret ambiguous situations as threatening, and for some they may interpret situations or others with hostile intent. While this bias is common for those who may struggle with anger, these issues haven’t been directly studied in individuals with social anxiety disorder. We explored whether social anxiety maintains these biases.”

The researchers conducted two separate studies. In the first study, they recruited 120 undergraduate students from a large public university. The participants completed virtual questionnaires measuring their levels of social anxiety and their tendencies to interpret situations as hostile or benign.

To measure interpretation biases, the participants read short, ambiguous social scenarios, such as someone bumping into them in a hallway. They then rated how strongly hostile words, like aggressive, or benign words, like accidental, applied to the situation. Approximately one month later, 68 of the original participants completed the same questionnaires a second time.

The researchers found that higher social anxiety was linked to higher levels of hostile interpretations at both the initial assessment and the one-month follow-up. However, a person’s initial level of social anxiety did not predict whether their hostile interpretations would worsen or improve over the following month. Social anxiety was also not significantly associated with benign interpretations at any point.

“Individuals with high social anxiety may be prone to interpret certain situations with others in a hostile light,” Patel and Cougle told PsyPost. “They may think others’ behavior is often fueled by hostile intent, meanness, or aggression.”

The second study included 69 university students who reported elevated levels of social anxiety. The scientists randomly assigned these participants to either a behavioral intervention group or a waitlist control group. The intervention group consisted of 35 students, while the control group included 34 students.

The intervention was designed to help participants reduce their use of safety behaviors over a 28-day period. Safety behaviors are subtle actions socially anxious people use to try to prevent negative outcomes, such as avoiding eye contact, speaking softly, or repeatedly asking others for reassurance. These actions tend to keep people feeling anxious because they prevent individuals from learning that social situations are actually safe.

When individuals constantly rely on safety behaviors, they trick themselves into thinking these actions are the only reason they survived a social event. By dropping the behaviors, people are forced to confront the situation and eventually learn that their worst fears will not actually come true. The active treatment group in the study selected five specific safety behaviors they frequently used and committed to avoiding them for one month.

Every morning, they received a text message reminding them to drop these behaviors, along with a link to a checklist to track their progress. The control group simply waited for a month before being offered the treatment at a later date. Both groups completed assessments of their social anxiety and interpretation biases before and after the 28-day period.

At the end of the month, the group that actively reduced their safety behaviors reported much lower levels of social anxiety compared to the waitlist group. This reduction in safety behaviors also led to reductions in hostile interpretation bias. The scientists found that the drop in hostile interpretations was directly explained by the drop in social anxiety.

“We were surprised that the effect of our treatment on hostile interpretations was fully explained by the effect on social anxiety,” Patel and Cougle said. “We anticipated that there would be some unique effect of treatment left over after accounting for the change in social anxiety, but this finding further supports that social anxiety may play a role in the tendency to interpret situations as a hostile.”

These outcomes provide evidence that social anxiety helps maintain the tendency to view others as hostile. The researchers suggest that mental health professionals should pay close attention to these aggressive assumptions when treating patients. Reducing social anxiety can lead to meaningful changes in how people perceive the world, potentially protecting them from chronic frustration and anger.

While the findings offer a new perspective on treating social anxiety, the scientists noted a few limitations. Both studies relied on relatively homogeneous samples of college students, which means the results might not automatically apply to the general public. Additionally, while the second study selected students with high social anxiety, it is unclear how many of them would meet the formal medical criteria for a clinical diagnosis.

The use of a waitlist control group in the second study means the researchers cannot entirely rule out the possibility that simply being in a treatment program caused the improvements. The studies also did not directly measure feelings of anger, which would have provided more context about how reducing hostile biases impacts emotional well-being.

“Reducing social anxiety may lead to meaningful changes in the tendency to interpret situations as hostile, but it is important to note that other factors cannot be ruled out for the size of this effect,” Patel and Cougle noted. “Practically speaking, future research should measure these biases and clinicians should assess for them given they are often associated with problematic anger.”

“The next steps will be to continue to examine this effect in more varied populations such as community members with social anxiety disorder. Additionally, we will want to examine this effect in our behavioral treatment compared to an active control group. It would also be interesting to examine if reductions in this hostile bias would affect anger in people with social anxiety.”

The study, “A multi-method analysis of the role of social anxiety in hostile interpretation bias,” was authored by Tapan A. Patel, Matthew C. Sala, James M. Zech & Jesse R. Cougle.