Developing a novel assessment of interpretation flexibility: Reliability, validity and clinical implications

Interpretation bias and inflexibility have been implicated in a wide range of psychopathologies, including affective disorders and disorders involving persecutory ideation. Existing tasks that measure both interpretation bias and inflexibility (which is essential as bias can make individuals appear inflexible) rely heavily on verbal stimuli, which may be suboptimal for certain applications, including neuroimaging and developmental studies. To overcome these limitations, a picture-based task, the Interpretation Inflexibility Task (IIT) was developed to simultaneously assess interpretation bias and inflexibility. The present manuscript demonstrates the strong convergent validity of the IIT and an existing, verbal measure of interpretation bias and inflexibility (the Emotional BADE task), in a general population sample (N = 247). Across both tasks, inflexible negative interpretations (above and beyond interpretation bias) were associated with symptoms of depression, social anxiety, and paranoia. The consistency of this association across stimulus modalities suggests the existence of higher-level cognitive deficits that increase interpretation inflexibility and thereby increase risk for both affective and psychotic symptoms. The IIT provides an innovative and reliable paradigm to investigate this transdiagnostic factor, particularly given its superior suitability for neuroimaging studies.