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Research Paper:
How Cognitive Bias Impact Anxiety Disorders
Ava E. Dudley
Department of Psychology, Liberty University
PSYC 575: Cognitive Psychology
Dr. Carrie Wilmouth
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As individuals develop, many environmental changes can contribute to processing
information differently. Some may display anxious behaviors or be clinically diagnosed with
anxiety. Anxiety can influence a lot of thinking patterns, alter beliefs, and contribute to cognitive
biases. A cognitive bias can contribute to the thought process of irritating thinking, negative
patterned thinking or processing information to match your own beliefs. This allows for false
information to be processed, thus altering judgements and behaviors within an individual. It is
important for mental health and medical professionals to understand different cognitive biases
within anxiety. As cognitive biases such as anchoring, attention, confirmation, availability
heuristic and probability bias contribute to the developmental, maintenance and processing of
both negative and positive information within anxiety.
How can someone have a deep understanding of cognitive bias? The first step to this is
understanding anxiety. Anxiety is something that all individuals feel at a given time, but for
different reasons. Anxiety can stem from irrational thoughts, environmental settings, and the
overestimation of both good and bad outcomes. But what exactly is a cognitive bias? A cognitive
bias is a way to understand how negative thinking patterns affect information that is being
processed within the brain. What role does a cognitive bias have within anxiety, and how can this
be applicable to a real world situation? A cognitive bias allows for mental health professionals
and researchers to understand how negative thought patterns can affect why someone processes
information the way they do. Cognitive biases are applicable to real world situations in anxiety
due to their ability to differentiate harsh beliefs such as irrational thoughts, harmful thoughts, or
even thoughts that are not coherent to specific situations in everyday life. There is more than one
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type of cognitive bias within real world situations. Some of these biases include anchoring,
probability, attention, and availability heuristic biases.
One of the most popular biases within anxiety is anchoring. The anchoring effect can
allow individuals to fixate on specific negative thoughts that often “anchor” them down, which
often affects future decision making and judgements. A real-world situation discussed by Nelson
et al. (2024) mentioned how anchoring can occur with anxiety in the medical world. A patient the
age of eighteen with a diagnosis of PTSD and generalized had worsening symptoms of anxiety
such as increased heart rate, shakiness, and even shortness of breath (Nelson et al., 2024). This
patient also had a history of using cannabis daily to help their anxiety. They sought out medical
help as they did not understand why their symptoms were getting worse. The anchoring bias in
this situation for medical professionals is listed within their diagnosis chart, which would be
generalized anxiety disorder (Nelson et al., 2024). As Nelson et al. (2024) mentions anchoring
bias is the most influential bias within the medical field. As many clinician looked at the patients
chart, they could dismiss new symptoms as they anchor themselves to the anxiety diagnoses.
Thus believing this could be an anxiety spike or a flare up within the patient's life. Further
medical testing revealed that these new symptoms which could have been seen as an anxiety
flare up pointed to a serious health condition (Nelson et al., 2024). This is a small example of
how an anchoring bias could affect the medical world regarding a generalized anxiety disorder.
A research study conducted by Baryshevtev et al. (2020) investigated how anchoring
affects people who stutter (PSW). The stereotype of people who stutter suggests that these
individuals often stutter due to being anxious or being timid (Baryshevtev et al., 2020). Many
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people often relate to their own experiences of stuttering, often when anxious. Thus creating an
anchoring bias and stereotype of those who have been diagnosed with a speech disorder
(Baryshevtev et al., 2020).
Their study conducted 345 participants between the ages of 18 and 78 years old. The
average age of the study being 37 years old with 41% female and 51% males. All participants
were required to complete a 50 question survey and were required a 90% or higher score to
continue the study. Each survey took approximately six minutes to complete, those who
completed the survey too quickly were disqualified in the study. As a result there were a total of
307 participants in the study. Of the participants there were 38 who reported having a speech
disorder and 81 participants who reported having a close friend or family member with a speech
disorder (Baryshevtev et al., 2020). The procedure consisted of randomly assigning participants
to three different groups. These groups were asked to review hypothetical descriptions of a man
who has experienced disfluency, who has not experienced disfluency, and a man who stutters. All
participants were then asked to rate the hypothetical person on a 25 item scale that depicted
different personality traits. A Likert scale ranging from one to seven was then asked to be
completed. This scale represented how theory engaged in perspective taking during everyday
life. Scores ranged from 1 being extremely uncharacteristic of me to 7 being very characteristic
of me (Baryshevtev et al., 2020). The results indicated that men who stutter (MSW) and state
disfluent male (SDM) both scored higher on negative personality traits and were higher on
neuroticism. Overall it indicated that people still believe those who stutter often deal with anxiety
and have more shy characteristics due to the anchoring belief of their own experiences
(Baryshevtev et al., 2020). A limitation to this study would include adding other variables to the
study such as empathy. As those who answered the questionnaire could have sympathized with
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those who had a speech disorder. This could potentially be harmful to results as they could
potentially increase negative stereotyping within the results.
It is also mentioned that more demographics such as race and sex within the hypothetical
person being reviewed could alter results (Baryshevtev et al., 2020). How can this scenario be
applied to a real-world situation? This can be applied by understanding how anchoring bias can
affect people with a speech disorder or a stutter. Due to the anchoring bias that all people with a
stutter suffer from anxiety or timid characteristics can have a negative impact on lives. Such as
negativity within the work place, education system, medical system, and even one’s personal
image.
Another popular bias that has an effect on anxiety is the confirmation bias. The
confirmation bias allows for individuals to favor events and information that further supports
their own beliefs. Confirmation bias is a cognitive trait that many people often reason with and
many times has consequences (Melinder et al., 2020). What could confirmation bias look like in
anxiety? Confirmation can worsen anxiety by one believing false information, seeking out false
information, and even having a selective memory. A research performed by Dibbets et al. (2021)
divided confirmation bias surrounding fruits and vegetables, and found it created a link to
understand food neophobia and anxiety disorders. Their research proves a confirmation bias has
formed around food due to people actively seeking out imperfections within foods such as fruit
and vegetables (Dibbets et al., 2021). Their study began with 135 participants but only 117
participants went through with the research study. There were 87 female participants, 27 males,
and 3 identified as other within the study. The average age for participants was 21 years old and
was offered college credit as a reward for participating. It was shown that 92% of participants
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were psychology majors (Dibbets et al., 2021). All participants were then given a food neophobia
scale 10 item questionnaire to fill out. Scoring was determined on a Likert seven point scale
ranging from strongly disagree to strongly agree.
Participants were then shown pictures of four different fruits that were unfamiliar to them.
They then were asked to rate each picture of fruit on a 0-100 rating scale pertaining to
tastefulness, valence, and familiarity and willingness to eat. All participants were then given a
confirmation task to complete. This task consisted of a search for additional information scale
(SAIS). They were then asked a series of questions regarding additional information they would
like to know about the fruit. This consisted of 14 given statements, half were negative and half
were positive statements. For each statement provided, participants rated each one from 0-100
(Dibbets et al., 2021). The results indicated that the fruit most similar looking to a fig was rated
the highest out of the unfamiliar fruits. When participants gave statements about what
information they wanted to know in the confirmation bias task, more participants sought out
negative information about the fruit. The overall results indicated that confirmation bias was
present in all participants regardless of food neophobia or anxiety disorder (Dibbets et al., 2021).
Evidence that was found conflicting within the study suggested that those with higher neophobia
and anxiety would show more negative signs throughout the questionnaire and scoring. As the
results showed confirmation bias happened regardless of previous anxieties. A limitation within
this study could be not actually tasting the fruit. Although all pictures of fruit were unfamiliar
and participants were asked to score them, they never tasted them. If they had tasted the different
fruits this could have changed scores such as willingness to taste and tastefulness. Thus affecting
this study’s scores heavily. This study can be applied to a real world situation by having a better
understanding of how conformative bias could be linked to anxious behaviors around food and
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food neophobia. Many individuals such as mental health professionals, medical professionals,
and even pediatricians can benefit from this study and apply this research to their own
profession.
Although it seems many cognitive biases stem from the observation of an object such as
confirmation bias. But, when individuals tend to overestimate a piece of information that was
given to them or that can be recalled is known as availability heuristic. This bias is often
associated with probability bias, which can be the overestimation of events and the possibility of
positive and negative events. As probability bias has often been attributed to the availability
heuristic (Booth & Sharma 2021). A study that was conducted by Booth and Sharma (2021) used
availability heuristic and probability bias to help better understand how individuals with anxiety
and depression often overestimate events to be negative. Their study consisted of a total of 278
undergraduate students with an average age of 19 years old. Researchers then measured anxiety
and depression bias by interviewing the participants. This was to help the consideration of an
arising mood due to talking negatively in the study. Anxiety was measured by using a state trait
anxiety scale. All participants were given a 20 questionnaire to answer and then rate of a Likert
scale rating from 1-4. Depression was then measured by assigning 21 groups to read four
statements. All statements represented sadness, anhedonia, and changes in sleep patterns. The
judgement task introduced 12 possible events, half the events were positive and half of the events
were negative. All events appeared in random order to each participant. All participants were
then assigned to elaborate on each statement (Booth & Sharma 2021). The results of this study
indicated that individuals with higher anxiety and depression levels did seek out more negative
events. They also found that they believed that a positive event would have negative
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consequences due to probability bias and availability biases (Booth & Sharma 2021). A
contradicting evidence found within the study could be considered how availability did not fully
explain probability bias in individuals and how easily they came up with negative events.
Although the results indicated that all groups with anxiety and depression displayed this, it
was not able to explain this link within the study. A limitation within this study could be
considered how the replication with the patient groups would impact the research study heavily
by adding more data collection. It was also mentioned how defining different concepts of
availability could change the results (Booth & Sharma 2021). These limitations could impact
results heavily as it alters the depression and anxiety measurements as well as the judgments of
patients. This research can be applied to a real world situation in many different ways. One way
can be in understanding why people anxiety and depression seek out negative events in different
settings such as educational and work. This could help professionals understand why people do
not take opportunities, recluse from others, and even spread negativity amongst others within
these settings.
Probability bias is one of the most influential biases over decision making in individuals,
especially within anxiety disorders (Benbow & Anderson, 2018). Another study that focuses on
probability bias in anxiety was conducted by Benbow and Anderson. (2018). Their goal was to
help determine how cognitive behavioral therapy (CBT) can help reduce probability bias and
cost bias in those with an anxiety disorder long after therapy treatments. They organized a study
of 65 participants who were clinically diagnosed with an anxiety disorder. Out of the 65
participants only 24 were able to complete self reporting biases, treatments, and post treatments
after five and a half years later. Most participants were female being 71% leaving the rest of the
participants 29% male. The average age range for participants was 22-69 years old. All
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participants were required to either pick one of two types of therapy session such as, exposure
group therapy or virtual reality therapy.
Licensed psychologists and doctoral students then compared each group to the measures
they were keeping track of. These measures included 12 self reported questionnaires that
indicated the likelihood of negative events to occur and how upset they would be if they did
occur. All participants answered these questions on a Likert nine point scale ranging from zero
not likely to eight being very likely. The results indicated that before both groups had a similar
cost bias and that they were more likely to think of negative events occurring. After treatments
both scores within the group did lower, and testing seemed to be successful within the groups.
The long term effects of therapy sessions indicated that participants kept their improved thinking
habits over the period of time. The psychologist also found that both types of therapy had an
equal effect on participants in redirected negative thinking patterns (Benbow & Anderson, 2018).
A conflicting piece of evidence within this study would be the type of therapies and their
results. Because both therapists performed equally as well, it is not certain which one had the
greatest effect on individuals. Although the results were deemed positive, research could benefit
from adding another therapy option in this study. A limitation within this study could be the
group participant size. Out of 65 participants, only 24 went through with participation in the
study. A bigger group size could alter the results by adding more participants to the different
studies and have a larger variety of negative thinking patterns. A situation where one could apply
this research to the real world could be in supporting cognitive behavior therapy testing and
research. It could also benefit from others applying virtual therapy sessions and group exposure
sessions to themselves for long term positive results. Cognitive behavioral therapy (CBT) is a
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great way many psychologists have found to help combat cognitive bias thinking. This has been
found in both adult patients and child patients.
A common cognitive bias that is common in both children, adolescence, and adults is the
attention bias. An attention bias is where individuals will only process selective information
altering their thinking patterns and decision making. This often being focusing on one aspect and
then ignoring another. Research has discovered that based on cognitive theories supporting
information suggests that anxiety is related to a bias of information processing (Fadardi et al.,
2022). This means that anxiety and social anxiety are often related due to attention and
information processing biases.
A research study composed by Stuijfzand et al., (2020) wanted to understand if younger
kids had biases to help better understand anxiety. Their study dived into the depths of
understanding how eye tracking in ages four to eight years old helped to better understand
attention bias in anxiety (Stuijfzand et al., 2020). There were a total of 104 participants between
the age ranges of four to eight years old. All participants were asked to identify different pictures
of facial features such as anger. The results indicated that all children were able to detect more
emotionally driven faces than faces without emotion. However, this study discovered that age
played a huge factor in understanding anxiety and attention bias (Stuijfzand et al., 2020). The
conflict of evidence within this study could be within the results. While all children experienced
anxiety, age factor is what contributed to understanding the bias more. Therefore it is conflicting
because anxiety scores were similar but age showed the difference. A limitation to this study
would be their demographic of participants. As they mentioned many participants joined due to
an advertisement within the area. Because of this most participants were from the same
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demographic, which made it hard to find children with an anxiety diagnosis. A real world
application of this study could benefit by helping schools better understand anxiety in elementary
schools.
It could also benefit pediatric medical centers in treating young children with trauma. This
study could also help the mental health world in understanding the role in which attention bias
plays in social anxiety. Understanding anxious trauma in young children is especially important
as it can also help many different situations for professionals. As attention bias plays a
contributing factor for the development and the maintenance of social anxiety to only focusing
on specific cues and information (Wang et al., 2024). As this study helps us understand
A study that focused on attention bias and social anxiety was conducted by Wang et al.
(2024). Their goal was to better understand how college students with social anxiety used
attentional bias to focus on facial expressions. Their study began with 536 college students
signing up to participate in the study, but only a total of 216 students participated in the study. All
students were shown images of different faces displaying different emotions such as happy, sad,
and angry. Each trial of displaying pictures lasted between five to six minutes. Participants were
then prompted to give their response. The researchers found that those who displayed higher
amounts of social anxiety did show attention bias towards. A limitation within this study could
potentially be only using a demographic of college students. Although the results were very
insightful, the results might not be the same in a different environment.
A real world application of this study could help contribute to understanding college
environments and how it affects those with social anxiety. It could also help in understanding
how adolescence processes faces that display emotions. As the previous research by Stuijfzand et
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al.( 2020) explained how age differences showed different cases of anxiety, especially as children
who had anxious behavior got older. This research helps to further support data on information,
memory, and attention biases in those with an anxiety disorder.
It is important to understand the impactful role of attention bias due to the harsh effects
that it can cause at such key developmental points in one's life, especially in childhood and early
adulthood. Attention bias in anxiety has also been linked to memory bias. A memory bias can
allow for individuals to not remember events correctly or alter the stimulus and environment that
it remembers. As many biases build upon one another it can create harmful impacts to an
individual. Thus creating a spiral event of mixing a combination of biases such as anchoring and
probability.
Studies also show that. as medical professions gain a better understanding of cognitive
biases, they can also uncover other mental illnesses that are often linked to anxiety. Some of
these mental illnesses can include post traumatic stress disorder (PTSD). Research has proven
that the influence of negative thoughts can contribute to the development and the maintenance of
post traumatic stress disorder (Ouhmad et al., 2023). As this can be measured by biases within
depression and anxiety (Ouhmad et al., 2023). Thus supporting the mental health field and its
research.
Individuals who have been diagnosed with a standard anxiety disorder have clinically been
shown to attend to more negative information than positive (Packard et al., 2022). It has also
been proven that they also interpret information as threatening and can display memory bias
towards remembering experiences more negatively than what they really were (Packard et al.,
2022). All different biases such as probability, attention, confirmation, and availability are similar
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to the development and maintenance of anxiety within individuals. Within gathering information
for this research it is clear that they can either have common characteristics or more than one bias
affect anxiety.
Overall without understanding the different biases not only within anxiety, understanding
the process of negative information would be nothing. As many would fall into their own
thinking pattern, disregarding true and false information.It is also important to understand the
limitations within these studies as they apply to realworld situations. As well as conflicting
evidence within the research study being conducted. As the goal of research is to understand the
question and hypothesis, it is also important to understand how it could have complications.such
as only studying one demographic, declining participants, and the use of one environment. As
this could have a major impact on results in either a positive or a negative way.
Due to biases being so complicated it is important for a researcher to consider many
different variables as they search within this topic. As the previous research above sets prime
examples of how to be cautious of being biased, attempting to understand a bias. It is also
important to understand other cognitive biases within other scenarios and other mental health
disorders. As the previous research (Ouhmad et al., 2023) supported evidence that biases in post
traumatic disorders can also help in understanding other mental disorders such as depression and
anxiety. It is important to not limit an understanding on how cognitive biases affect all areas and
aspects of one’s life, thinking pattern, and information processing.
As this research paper has proven and research studies above, it is important to understand
how cognitive biases play a role in the development and the maintenance of anxiety disorders. As
they have many real world applications such as bettering the education system, furthering
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medical research, uncovering underlying medical issues, understanding possible traumas for
anxiety, and how individuals of all ages respond to biases in anxiety. Researchers still continue to
educate themselves and contribute to supporting evidence on cognitive biases and cognitive
distortions within anxiety disorders.
References
Baryshevtsev, M., Zhong, L., Lloyd, R., & McGlone, M. (2020b). Trait perspective-taking and
need for cognition in the formation of stereotypes about people who stutter. Journal of
Fluency Disorders, 65, 105778. https://doi.org/10.1016/j.jfludis.2020.105778
Benbow, A. A., & Anderson, P. L. (2018b). Long-Term improvements in probability and cost
biases following brief cognitive behavioral therapy for social anxiety disorder. Cognitive
Therapy and Research, 43(2), 412–418. https://doi.org/10.1007/s10608-018-9947-0
Booth, R. W., & Sharma, D. (2021c). Biased probability estimates in trait anxiety and trait
depression are unrelated to biased availability. Journal of Behavior Therapy and
Experimental Psychiatry, 73, 101672. https://doi.org/10.1016/j.jbtep.2021.101672
Dibbets, P., Borger, L., & Nederkoorn, C. (2021b). Filthy fruit! Confirmation bias and novel
food. Appetite, 167, 105607. https://doi.org/10.1016/j.appet.2021.105607
Fadardi, J. S., Memarian, S., Parkinson, J., Cox, W. M., & Stacy, A. W. (2022c). Scary in the eye
of the beholder: Attentional bias and attentional retraining for social anxiety. Journal of
Psychiatric Research, 157, 141–151. https://doi.org/10.1016/j.jpsychires.2022.11.005
Kennett, J., Friedrich, C., Chiocchia, V., Blackwell, S. E., Furukawa, T., Carlbring, P., Tonia, T.,
Homiar, A., Wright, S., Opiepie, K., Mojica, R., Schenk, P., Michie, S., Hastings, J.,
COGNITIVE BIAS IN ANXIETY
15
Dehdarirad, H., Stansfield, C., Thomas, J., Potts, J., Salanti, G., & Cipriani, A. (2025b).
Cognitive bias modification for social anxiety: protocol for a living systematic review of
human studies and meta-analysis. Wellcome Open Research, 9, 657.
https://doi.org/10.12688/wellcomeopenres.23278.2
Melinder, A., Brennen, T., Husby, M. F., & Vassend, O. (2020d). Personality, confirmation bias,
and forensic interviewing performance. Applied Cognitive Psychology, 34(5), 961–971.
https://doi.org/10.1002/acp.3674
Nelson, J. E., Kravitz, A., & Anderson-Burnett, S. A. (2024b). Case 2: Worsening Anxiety in an
adolescent: The role of Anchoring Bias. Pediatrics in Review, 45(9), 509–512.
https://doi.org/10.1542/pir.2022-005947
Ouhmad, N., Deperrois, R., Hage, W. E., & Combalbert, N. (2023b). Cognitive distortions,
anxiety, and depression in individuals suffering from PTSD. International Journal of
Mental Health, 53(4), 336–352. https://doi.org/10.1080/00207411.2023.2219950
Packard, G., Molloy, A., & Anderson, P. L. (2022c). Trait mindfulness is related to attention bias
toward threat and attention bias variability in social anxiety disorder. Current Psychology,
42(18), 15287–15294. https://doi.org/10.1007/s12144-022-02817-5
Stuijfzand, S., Stuijfzand, B., Reynolds, S., & Dodd, H. (2020c). Anxiety-Related Attention Bias
in Four- to Eight-Year-Olds: An Eye-Tracking Study. Behavioral Sciences, 10(12), 194.
https://doi.org/10.3390/bs10120194
Wang, Y., Liang, J., Zhu, Z., Gao, J., Yao, Q., & Ding, X. (2024c). Attentional Bias of
Individuals with Social Anxiety towards Facial and Somatic Emotional Cues in a Holistic
COGNITIVE BIAS IN ANXIETY
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Manner. Behavioral Sciences, 14(3), 244. https://doi.org/10.3390/bs14030244
