A large review of research has found a consistent association between anxiety and the tendency to interpret uncertain situations negatively. The relationship appeared across diagnosed anxiety disorders, subclinical symptoms and groups considered at risk.
At the same time, the findings do not show that anxiety causes negative interpretations, or that changing those interpretations would necessarily prevent anxiety or improve symptoms. The strength of the association varied considerably across studies and settings.
What the review found
Würtz and colleagues conducted a three-level meta-analysis that combined evidence from 265 studies, 295 independent samples, more than 50,000 participants and 1,450 comparisons. The researchers searched three major databases, checked reference lists from earlier reviews and sought unpublished datasets through professional networks.
Overall, higher anxiety was associated with more negative interpretation bias. The average effect was statistically significant and in the medium range (g = 0.48, 95% confidence interval 0.43 to 0.52).
This was an average across a diverse body of research, not a result that applies equally to every person or situation. The wide prediction interval, from -0.43 to 1.38, indicates that the relationship could be much weaker or much stronger in individual studies and contexts.
How the measurement method mattered
The size of the association differed depending on how interpretation was assessed. Studies that asked participants to explicitly rate possible meanings of scenarios found substantially larger effects than studies using indirect reaction-time tasks.
Effects were also stronger when scenarios reflected concerns specific to an anxiety disorder rather than using more general threat-related material. Verbal scenarios produced larger effects than nonverbal stimuli.
Studies focused specifically on negative interpretations reported the largest effect (g = 0.60). Measures comparing negative and positive interpretations produced an effect of g = 0.51, while measures focused on positive interpretations produced a smaller effect of g = 0.22.
A pattern seen across different groups
The researchers found no clear evidence that age, clinical status, anxiety disorder type, exclusion of depression or the presence of other anxiety disorders changed the association. This supports the idea that interpretation bias may be relevant across different anxiety presentations and levels of symptom severity.
However, substantial variation remained unexplained. The review could not examine ethnicity and socioeconomic status in detail because too little information was available. That limits how confidently the findings can be extended to all populations.
Why the findings need careful interpretation
The review identified limitations involving participant representativeness, the reliability and validity of interpretation-bias measures and the control of possible confounding factors. Direct and indirect tasks may also measure different aspects of interpretation, so their differing results should not be treated as a simple ranking of better and worse methods.
A worst-case analysis restricted to studies without positive results reduced the overall effect to close to zero (g = 0.05), although it remained statistically significant. This result reinforces the importance of considering how study quality and selective findings may affect the overall estimate.
The review followed PRISMA guidance, was preregistered and used independent screening and coding by multiple reviewers. The researchers also formally assessed risk of bias and made the data and analysis code openly available.
What this means for treatment and research
The findings support existing cognitive approaches to anxiety rather than introducing an immediate change to clinical practice. Earlier reviews of cognitive bias modification suggest that changing interpretation processes may influence emotional outcomes, but those results remain mixed.
Digital interventions, school-based programmes and lower-intensity services could be areas for future research. More longitudinal and experimental studies are needed to establish whether anxiety shapes threat-focused interpretations, whether those interpretations contribute to anxiety or whether the two processes influence each other over time.
For now, the clearest conclusion is that negative interpretation bias and anxiety are closely linked across a broad range of studies, while the meaning and direction of that link remain unresolved.
AI tools were used to assist with the preparation of this article.
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