Information processing in social phobia: a critical review

A Psycho-Behavioral Perspective on Modelling Obsessive-Compulsive Disorder (OCD) in Animals: The Role of Context

Obsessive-compulsive disorder is a heterogeneous and debilitating condition, characterized by intrusive thoughts and compulsive repetition. Animal models of OCD are important tools that have the potential to contribute significantly to our understanding of the condition. Although there is consensus that pre-clinical models are valuable in elucidating the underlying neurobiology in psychiatric disorders, the current paper attempts to prompt ideas on how interpretation of animal behavior can be expanded upon to more effectively converge with the human disorder. Successful outcomes in psychopharmacology involve rational design and synthesis of novel compounds and their testing in well-designed animal models. As part of a special journal issue on OCD, this paper will 1) review the psychobehavioral aspects of OCD that are of importance on how the above ideas can be articulated, 2) briefly elaborate on general issues that are important for the development of animal models of OCD, with a particular focus on the role and importance of context, 3) propose why translational progress may often be less than ideal, 4) highlight some of the significant contributions afforded by animal models to advance understanding, and 5) conclude by identifying novel behavioral constructs for future investigations that may contribute to the face, predictive and construct validity of OCD animal models. We base these targets on an integrative approach to face and construct validity, and note that the issue of treatment-resistance in the clinical context should receive attention in current animal models of OCD.

Social anxiety disorder and emotion regulation problems in adolescents

BACKGROUND

Social anxiety disorder (SAD) in adolescents may be associated with the use of maladaptive emotion regulation (ER) strategies. The present study examined the use of maladaptive and adaptive ER strategies in adolescents with SAD.

METHODS

30 adolescents with SAD (CLIN) and 36 healthy adolescents for the control group (CON) aged between 11 and 16 years were assessed with the standardized questionnaires PHOKI (Phobiefragebogen für Kinder und Jugendliche) for self-reported fears as well as FEEL-KJ (Fragebogen zur Erhebung der Emotionsregulation bei Kindern und Jugendlichen) for different emotion regulation strategies.

RESULTS

Compared to controls, adolescents with SAD used adaptive ER strategies significantly less often, but made use of maladaptive ER strategies significantly more often. There was a significant positive correlation between maladaptive ER and social anxiety in adolescents. Examining group differences of single ER strategy use, the CLIN and CON differed significantly in the use of the adaptive ER strategy reappraisal with CLIN reporting less use of reappraisal than CON. Group differences regarding the maladaptive ER strategies withdrawal and rumination, as well as the adaptive ER strategy problem-solving were found present, with CLIN reporting more use of withdrawal and rumination and less use of problem-solving than CON.

CONCLUSIONS

Promoting adaptive emotion regulation should be a central component of psychotherapy (cognitive behavioral therapy-CBT) for social anxiety in adolescents from the beginning of the therapy process. These findings provide rationale for special therapy programs concentrating on the establishment of different adaptive ER strategies (including reappraisal). As an increased use of maladaptive ER may be associated with SAD in adolescents, it may be paramount to focus on reduction of maladaptive ER (for example withdrawal and rumination) from the beginning of the psychotherapy process. Incorporating more ER components into psychotherapy (CBT) could increase the treatment efficacy. Further investigations of the patterns of emotion regulation in specific anxiety groups like SAD in adolescents is needed to continue to optimize the psychotherapy (CBT) concept.

Hypermentalizing in Social Anxiety: Evidence for a Context-Dependent Relationship

Social anxiety (SA) means fear of scrutiny and of others’ negative evaluation, thus indicating that hypermentalizing (HMZ) (i.e., the over-attribution of intentions and thoughts to others) might be the most common error of social cognition in SA. However, evidence for this is weak. One explanation is that HMZ is not stable in SA, but rather context-dependent. The first aim of the current study was testing this hypothesis. The second aim was analyzing whether the association between SA and HMZ is moderated by a negative self-image. One-hundred and thirteen young adults (85.8% females; M = 21.1 years old; SD = 2.7) were assessed on measures of SA, HMZ, and self-image. Given the over-representation of females, conclusions may not be safely extrapolated to males. Results revealed that HMZ is associated with SA only in the self-referential social situation [B = 2.68 (95% CI: 0.72–4.65), p = 0.007]. This supports that HMZ is not global in SA (i.e., a stable cognitive style), but rather is active only in some contexts. Implications for the conceptualization and treatment of SA are discussed. Contrary to predictions, neither self-esteem, nor positive or negative self-schema moderated the association between SA and self-referential HMZ. This contradicts findings in the field of paranoid delusion and requires replication, including measures of implicit self-esteem.

Social anxiety enhances recognition of task-irrelevant threat words

Past research is mixed regarding the conditions under which memory biases emerge in individuals with high levels of social anxiety. The current study examined whether high social anxiety would be associated with a memory bias for threatening, but task-irrelevant information, or whether it creates a memory bias for both threatening as well as neutral distractors. 60 undergraduate students were recruited, half classified as having high social anxiety and half as having low social anxiety according to the Social Phobia Inventory. Participants memorized a series of sequentially and visually presented target words that were either all neutral (e.g., patient) or all socially threatening (e.g., embarrassed). Simultaneously during encoding, participants also saw a distractor word on each trial that was either neutral or socially threatening. Memory for targets was then assessed using a recall and recognition test. Incidental recall and recognition tests for the distractors were also administered. There were no group differences in memory for threat versus neutral targets. However, recognition of socially threatening distractors was significantly enhanced in those with high relative to low levels of social anxiety, but only when targets were also socially threatening. Memory biases in high social anxiety were shown to be specific for threat-related distractors rather than general, for all distractors. This specific bias for threat emerged only when the to-be-remembered target information was also threatening. Findings suggest that when social anxiety is primed, attention to irrelevant, but socially threatening, information is heightened.

A Psychometric Evaluation of the Social Anxiety Scale for Adolescents in an Educational Setting

Social anxiety in adolescents oftentimes goes undetected because of the internalized nature of the disorder as well as adolescents’ reluctance to discuss their mental health. A reliable and valid self-report measure for assessing symptoms of social anxiety in adolescents for use in an educational setting is particularly important because of the burden that social anxiety can have in educational settings. This study aimed to test the previously proposed two-factor structure of the Social Anxiety Scale for Adolescents (SASA), Apprehension and Fear of Negative Evaluation and Tension and Inhibition in Social Contact, in an adolescent sample ( n = 215; 12-18 years; 90 female) in Ireland using confirmatory factor analysis (CFA). CFA validated the two-factor structure of the SASA previously found in Slovenian- and Spanish-speaking samples. Correlations with other measures of social anxiety also showed good validity for the SASA.

I Did OK, but Did I Like It? Using Ecological Momentary Assessment to Examine Perceptions of Social Interactions Associated With Severity of Social Anxiety and Depression

Socially anxious and depressed individuals tend to evaluate their social interactions negatively, but little is known about the specific real-time contributors to these negative perceptions. The current study examined how affect ratings during social interactions predict later perceptions of those interactions, and whether this differs by social anxiety and depression severity. Undergraduate participants (N = 60) responded to a smartphone application that prompted participants to answer short questions about their current affect and social context up to 6 times a day for 2 weeks. At the end of each day, participants answered questions about their perceptions of their social interactions from that day. Results indicated that the link between negative affective experiences reported during social interactions and the end-of-day report of enjoyment (but not effectiveness) of those experiences was more negative when social anxiety was more severe. The link between negative affective experiences rated during social interactions and the end-of-day report of effectiveness (but not enjoyment) during those social encounters was more negative when depression was more severe. These findings demonstrate the importance of examining self-perceptions of social interactions based both on the extent to which individuals think that they met the objective demands of an interaction (i.e., effectiveness, mastery) and the extent to which they liked or disliked that interaction (i.e., enjoyment, pleasure). These findings also highlight how real-time assessments of daily social interactions may reveal the key experiences that contribute to negative self-evaluations across disorders, potentially identifying critical targets for therapy.

Socially Anxious Tendencies Affect Impressions of Others' Positive and Negative Emotional Gazes

Socially anxious tendencies have potential to become social anxiety disorder (SAD), which is characterized by fear of social situations associated with being evaluated or embarrassed by others. In particular, others’ gazes induce social anxiety. People with SAD have a negative interpretation bias toward ambiguous emotions in others’ faces; however, negative interpretation bias toward ambiguous emotions in others’ gazes has not been fully investigated. We used an impression judgment task to examine negative interpretation bias toward others’ gazes among people with socially anxious tendencies. We generated emotionally ambiguous gazes (positive, negative, and neutral) using a morphing technique with 10% steps (neutral, 10–100% negative, and 10–100% positive). Participants (all male) were asked to judge whether the stimulus was positive or negative. Each participant’s level of social anxiety was examined using the Japanese version of the Social Phobia Inventory (SPIN-J), which measures three symptom dimensions: fear, avoidance, and physiological arousal. To examine the influence of socially anxious tendencies in the impression judgment task, we calculated the point of subjective equality (PSE) using a two-step logistic curve fitted to individual participant’s responses. The negative emotional intensity of the PSE became lower as the fear score became higher (p < 0.05). This result suggests individuals with a high tendency toward social anxiety tend to interpret subtle negative emotional gazes as a negative emotion and regard these gazes as a threat.

Attention to faces and gaze-following in social anxiety: preliminary evidence from a naturalistic eye-tracking investigation

Social attentional biases are a core component of social anxiety disorder, but research has not yet determined their direction due to methodological limitations. Here we present preliminary findings from a novel, dynamic eye-tracking paradigm allowing spatial-temporal measurement of attention and gaze-following, a mechanism previously unexplored in social anxiety. 105 participants took part, with those high (N = 27) and low (N = 25) in social anxiety traits (HSA and LSA respectively) entered into the analyses. Participants watched a video of an emotionally-neutral social scene, where two actors periodically shifted their gaze towards the periphery. HSA participants looked more at the actors' faces during the initial 2s than the LSA group but there were no group differences in proportion of first fixations to the face or latency to first fixate the face, although HSA individuals' first fixations to the face were shorter. No further differences in eye movements were found, nor in gaze-following behaviour, although these null effects could potentially result from the relatively small sample. Findings suggest attention is biased towards faces in HSA individuals during initial scene inspection, but that overt gaze-following may be impervious to individual differences in social anxiety. Future research should seek to replicate these effects.

Attentional control deficits in social anxiety: Investigating inhibition and shifting functions using a mixed antisaccade paradigm

BACKGROUND AND OBJECTIVES

Attentional control has recently been assumed to play a critical role in the generation and maintenance of threat-related attentional bias and social anxiety. The present study aimed to investigate whether socially anxious (SA) individuals show impairments in attentional control functions, particularly in inhibition and shifting.

METHODS

Forty-two SA and 41 non-anxious (NA) participants completed a mixed antisaccade task, a variant of the antisaccade task that is used to investigate inhibition as well as shifting functions.

RESULTS

The results showed that, overall, SA participants had longer antisaccade latencies than NA participants, but the two groups did not differ in their antisaccade error rates. Moreover, in the single-task block, SA participants had longer latencies than NA participants for antisaccade but not prosaccade trials. In the mixed-task block, the SA participants had longer latencies than the NA participants for both task types. The two groups did not differ in their latency switch costs in the mixed-task blocks.

LIMITATIONS

First, this study was conducted using a non-clinical sample of undergraduate students. Second, the antisaccade task measures primarily oculomotor inhibition. Third, this study did not include the measure of state anxiety to rule out the effects of state anxiety on the present findings.

CONCLUSIONS

This study suggests that SA individuals demonstrate diminished efficiency of inhibition function but show no significant impairment of shifting function. However, in the mixed-task condition, SA individuals may exhibit an overall reduction in processing efficiency due to the higher task difficulty.

Changes in Decentering Across Cognitive Behavioral Group Therapy for Social Anxiety Disorder

To further improve treatments, we need to better understand potential common treatment mechanisms, such as decentering, or the ability to observe thoughts and feelings as objective events in the mind rather than personally identifying with them (Safran & Segal, 1990). Therefore, this study examined whether 12 sessions of Cognitive Behavioral Group Therapy (CBGT) for 63 clients (57.6% female, 50.8% White) diagnosed with social anxiety disorder led to increases in decentering and whether increased decentering was associated with improved outcome. Furthermore, this study examined whether decentering was associated with outcome over and above a competing mechanism-cognitive reappraisal. Overall, results indicated that CBGT in this study led to similar outcomes compared to previous studies and decentering increased over CBGT (d's from 0.81 to 2.23). Change in decentering predicted improvement on most, but not all, measures of outcome and those who no longer met criteria for social anxiety disorder at posttreatment had significantly greater change in decentering across therapy and significantly higher decentering scores at post-treatment compared to those who retained a social anxiety disorder diagnosis at posttreatment. Finally, changes in decentering predicted outcome over and above changes in reappraisal on all outcome measures. These results largely support the role of decentering in CBGT for social anxiety; however, the implications of the inconsistencies in results based on which outcome measure was used are discussed.

Children with social anxiety disorder show blunted pupillary reactivity and altered eye contact processing in response to emotional faces: Insights from pupillometry and eye movements

Cognitive models and adult research associate social anxiety disorder (SAD) with hypervigilant-avoidant processing of social information, such as eye contact. However, processing biases in childhood SAD remain mostly unexplored. We examined 10- to 13-year-old children's eye contact processing and pupil dilation in response to happy, neutral, and angry faces in three groups: SAD (n = 31), mixed anxiety disorders (MAD; n = 30), and healthy controls (HC; n = 32). Compared to HC, SAD children showed faster first fixations on the eye region of neutral faces and shorter first fixation durations on the eye region of all faces. No differences between the two clinical groups emerged in eye movement results. SAD girls showed reduced pupil dilation in response to happy and angry faces compared to MAD and to happy faces compared to HC. SAD boys showed reduced pupil dilation in response to neutral faces compared to HC. Dimensionally, reduced pupil dilation was linked to social anxiety severity while eye movements were correlated with mixed anxiety and depressive severity. Results suggest that hypervigilant-avoidant eye contact processing and a blunted pupillary reactivity characterize children with SAD. Both transdiagnostic and disorder-specific processing biases are relevant for the understanding of childhood SAD.

Clinical and functional outcomes of cannabis use among individuals with anxiety disorders: A 3-year population-based longitudinal study

BACKGROUND

Cannabis use has been reported to negatively affect the course and outcome of various psychiatric disorders, yet little is known on its effect on rates of remission from anxiety disorders and associated clinical and functional outcomes.

METHODS

In this study, data were drawn from Waves 1 and 2 of the National Epidemiologic survey on Alcohol and Related Conditions, focusing on individuals who qualified for a diagnosis of any anxiety disorder (social anxiety, panic disorder, generalized anxiety disorder, and specific phobias) at Wave 1 (N = 3,723). Cannabis users and individuals with cannabis use disorders (CUDs) throughout a 4-year period were compared to nonusers in rates of remission, suicidality, general functioning, and quality of life at Wave 2, while controlling for baseline confounders.

RESULTS

Although rates of remission decreased with level of cannabis use, this was not maintained in adjusted models. Aside from specific outcomes (individuals with CUDs were significantly more prone to report breaking up from a romantic relationship; adjusted odds ratio [AOR] = 3.85, 95% confidence interval [CI] = 1.66-8.97) and repeatedly quitting school (AOR = 6.02, 95% CI = 2.65-13.66)), following adjustment no additional differences were found in outcome measures.

CONCLUSIONS

These findings add to previous reports suggesting that poorer outcome of anxiety disorders among cannabis users may be attributed mainly to differences in baseline factors and not cannabis use.

The impact bias in self and others: Affective and empathic forecasting in individuals with social anxiety

People tend to overestimate the intensity and duration of affect (i.e., impact bias) when making predictions about their own and others' responding, termed affective and empathic forecasting, respectively. Research links impact biases to clinical symptoms of affective disorders, but little work has been done to examine how social anxiety is related to affective and empathic forecasting biases. The current investigation included two studies examining these associations in independent samples of young adults with dimensionally distributed social anxiety symptoms. Study 1 (N = 100) examined the associations between social anxiety and affective and empathic forecasts in response to a series of novel hypothetical vignettes in which a second-person narrator (i.e., the self) elicited anger, disgust, or happiness from another person (i.e., the other). Study 2 utilized an innovative experimental paradigm involving N = 68 participant dyads. Overall, results supported the existence of affective and empathic forecasting biases. Further, symptoms of social anxiety were associated with the tendency to overestimate one's own and others' negative affect and underestimate others' positive affect. Such forecasting biases may help to explain the avoidance that is characteristic of individuals with social anxiety and could represent a fruitful target of cognitive behavioral intervention.

Social Anxiety and the Quality of Everyday Social Interactions: The Moderating Influence of Alcohol Consumption

Most research on the link between social anxiety and alcohol consumption has examined problematic outcomes without consideration of potential adaptive functions. Alcohol is an anxiolytic that has the short-term benefit of reducing anxiety; consumption may act as a social lubricant that facilitates higher quality social interactions. Using experience-sampling methodology, we examined how consuming alcohol attenuates the adverse effects of social anxiety in naturally occurring social interactions. Participants (N = 160) completed demographic and trait measures, then completed daily assessments for 14 consecutive days. Results from multilevel model analyses revealed that during face-to-face social interactions, state social anxiety was inversely related to 10 indicators of healthy social interactions (e.g., enjoyment, laughter, feelings of acceptance). Alcohol consumption moderated seven of these associations, such that when participants consumed alcohol in social situations, state social anxiety was no longer associated with social interaction quality. The quantity of alcoholic drinks consumed moderated two of these associations. Furthermore, we found evidence for directionality, such that social anxiety in a given social interaction predicted alcohol consumption in a subsequent social interaction, but not the reverse (i.e., alcohol consumption did not prospectively predict state social anxiety). In social situations that involved alcohol, experiences of social anxiety no longer thwarted one's ability to derive social benefits. These results should be interpreted in the context of a participant sample with relatively low levels of trait social anxiety and frequency of alcohol use. Nonetheless, obtaining social rewards may be a reinforcement mechanism that maintains the link between social anxiety and alcohol consumption.

Delta-beta correlation as a candidate endophenotype of social anxiety: A two-generation family study

BACKGROUND

Social anxiety disorder (SAD) is characterized by an extreme and intense fear and avoidance of social situations. In this two-generation family study we examined delta-beta correlation during a social performance task as candidate endophenotype of SAD.

METHODS

Nine families with a target participant (diagnosed with SAD), their spouse and children, as well as target's siblings with spouse and children performed a social performance task in which they gave a speech in front of a camera. EEG was measured during resting state, anticipation, and recovery. Our analyses focused on two criteria for endophenotypes: co-segregation within families and heritability.

RESULTS

Co-segregation analyses revealed increased negative delta-low beta correlation during anticipation in participants with (sub)clinical SAD compared to participants without (sub)clinical SAD. Heritability analyses revealed that delta-low beta and delta-high beta correlation during anticipation were heritable. Delta-beta correlation did not differ between participants with and without (sub)clinical SAD during resting state or recovery, nor between participants with and without SAD during all phases of the task.

LIMITATIONS

It should be noted that participants were seen only once, they all performed the EEG tasks in the same order, and some participants were too anxious to give a speech.

CONCLUSIONS

Delta-low beta correlation during anticipation of giving a speech might be a candidate endophenotype of SAD, possibly reflecting increased crosstalk between cortical and subcortical regions. If validated as endophenotype, delta-beta correlation during anticipation could be useful in studying the genetic basis, as well as improving treatment and early detection of persons at risk for developing SAD.

A multi-method analysis of distress tolerance in body dysmorphic disorder

Distress tolerance (DT) is a transdiagnostic construct linked to multiple psychiatric disorders. We conducted three studies using different methods to investigate the relationship between DT and body dysmorphic disorder (BDD). Study 1 found a significant relationship between low DT and more severe BDD symptoms in an adult community sample (N=81). In Study 2, we found a similar relationship between lower DT and greater BDD symptoms in a student sample (N=192). Furthermore, we found a unique relationship between greater BDD symptoms and lower self-reported tolerance of anger and sadness mood induction tasks. Greater BDD symptoms were not significantly associated with lower self-reported tolerance of a fear mood induction task. In Study 3, a clinical sample of individuals with BDD (N=40) reported lower DT than a sample of healthy controls (N=36). Findings suggest that low DT is a broad vulnerability factor related to BDD.

Behavioral and EEG responses to social evaluation: A two-generation family study on social anxiety

Social anxiety disorder is an invalidating psychiatric disorder characterized by extreme fear and avoidance of one or more social situations in which patients might experience scrutiny by others. The goal of this two-generation family study was to delineate behavioral and electrocortical endophenotypes of social anxiety disorder related to social evaluation. Nine families of patients with social anxiety disorder (their spouse and children, and siblings of these patients with spouse and children) performed a social judgment paradigm in which they believed to be evaluated by peers. For each peer, participants indicated their expectation about the evaluative outcome, after which they received social acceptance or rejection feedback. Task behavior, as well as the feedback-related EEG brain potentials (N1, FRN, P3) and theta power were tested as candidate endophenotypes based on two criteria: co-segregation with social anxiety disorder within families and heritability. Results indicated that reaction time for indicating acceptance-expectations might be a candidate behavioral endophenotype of social anxiety disorder, possibly reflecting increased uncertainty or self-focused attention and vigilance during the social judgment paradigm. N1 in response to expected rejection feedback and P3 in response to acceptance feedback might be candidate electrocortical endophenotypes of social anxiety disorder, although the heritability analyses did not remain significant after correcting for multiple tests. Increased N1 possibly reflects hypervigilance to socially threatening stimuli, and increased P3 might reflect that positive feedback is more important for, and/or less expected by, participants with social anxiety disorder. Finally, increased feedback-related negativity and theta power in response to unexpected rejection feedback compared to the other conditions co-segregated with social anxiety disorder, but these EEG measures were not heritable. The candidate endophenotypes might play a new and promising role in future research on genetic mechanisms, early detection and/or prevention of social anxiety disorder.

Altered brain activity and the effect of personality traits in excessive smartphone use during facial emotion processing

Excessive smartphone use is a phenomenon related to maladaptive smartphone use, leading to negative consequences. This study set out with the aim of assessing the effects of excessive smartphone use on behavioral and neural responses during facial emotional processing. We examined 25 excessive smartphone users and 27 normal control users using functional MRI during facial emotion processing and investigated Behavioral Inhibition System/Behavioral Activation System (BIS/BAS). The excessive smartphone use group (SP) showed neural deactivation in the dorsolateral prefrontal cortex (DLPFC) and dorsal anterior cingulate cortex (dACC) during the presentation of an angry face and emotional transition compared to that of the normal control group (NC). Additionally, the SP revealed neural deactivation of the superior temporal sulcus and temporo-parietal junction related to social interaction during emotional transition compared to the NC. We found that BAS-Reward Responsiveness level was correlated with behavioral responses during repeated happy faces related to emotional reward in SP compared to NC. It can thus be suggested that excessive smartphone use is likely to fail on cognitive control during emotional processing, and this impairment might be influenced on emotional processing related to social interaction.

Putative EEG measures of social anxiety: Comparing frontal alpha asymmetry and delta-beta cross-frequency correlation

The goal of the present study was to examine whether frontal alpha asymmetry and delta-beta cross-frequency correlation during resting state, anticipation, and recovery are electroencephalographic (EEG) measures of social anxiety. For the first time, we jointly examined frontal alpha asymmetry and delta-beta correlation during resting state and during a social performance task in high (HSA) versus low (LSA) socially anxious females. Participants performed a social performance task in which they first watched and evaluated a video of a peer, and then prepared their own speech. They believed that their speech would be videotaped and evaluated by a peer. We found that HSA participants showed significant negative delta-beta correlation as compared to LSA participants during both anticipation of and recovery from the stressful social situation. This negative delta-beta correlation might reflect increased activity in subcortical brain regions and decreased activity in cortical brain regions. As we hypothesized, no group differences in delta-beta correlation were found during the resting state. This could indicate that a certain level of stress is needed to find EEG measures of social anxiety. As for frontal alpha asymmetry, we did not find any group differences. The present frontal alpha asymmetry results are discussed in relation to the evident inconsistencies in the frontal alpha asymmetry literature. Together, our results suggest that delta-beta correlation is a putative EEG measure of social anxiety.

Cognitive behavioural therapy attenuates the enhanced early facial stimuli processing in social anxiety disorders: an ERP investigation

Background

Previous studies of patients with social anxiety have demonstrated abnormal early processing of facial stimuli in social contexts. In other words, patients with social anxiety disorder (SAD) tend to exhibit enhanced early facial processing when compared to healthy controls. Few studies have examined the temporal electrophysiological event-related potential (ERP)-indexed profiles when an individual with SAD compares faces to objects in SAD. Systematic comparisons of ERPs to facial/object stimuli before and after therapy are also lacking. We used a passive visual detection paradigm with upright and inverted faces/objects, which are known to elicit early P1 and N170 components, to study abnormal early face processing and subsequent improvements in this measure in patients with SAD.

Methods

Seventeen patients with SAD and 17 matched control participants performed a passive visual detection paradigm task while undergoing EEG. The healthy controls were compared to patients with SAD pre-therapy to test the hypothesis that patients with SAD have early hypervigilance to facial cues. We compared patients with SAD before and after therapy to test the hypothesis that the early hypervigilance to facial cues in patients with SAD can be alleviated.

Results

Compared to healthy control (HC) participants, patients with SAD had more robust P1–N170 slope but no amplitude effects in response to both upright and inverted faces and objects. Interestingly, we found that patients with SAD had reduced P1 responses to all objects and faces after therapy, but had selectively reduced N170 responses to faces, and especially inverted faces. Interestingly, the slope from P1 to N170 in patients with SAD was flatter post-therapy than pre-therapy. Furthermore, the amplitude of N170 evoked by the facial stimuli was correlated with scores on the interaction anxiousness scale (IAS) after therapy.

Conclusions

Our results did not provide electrophysiological support for the early hypervigilance hypothesis in SAD to faces, but confirm that cognitive-behavioural therapy can reduce the early visual processing of faces. These findings have potentially important therapeutic implications in the assessment and treatment of social anxiety.

Trial registration HEBDQ2014021

Facial and prosodic emotion recognition in social anxiety disorder

INTRODUCTION

Patients with social anxiety disorder (SAD) have a cognitive preference to negatively evaluate emotional information. In particular, the preferential biases in prosodic emotion recognition in SAD have been much less explored. The present study aims to investigate whether SAD patients retain negative evaluation biases across visual and auditory modalities when given sufficient response time to recognise emotions.

METHODS

Thirty-one SAD patients and 31 age- and gender-matched healthy participants completed a culturally suitable non-verbal emotion recognition task and received clinical assessments for social anxiety and depressive symptoms. A repeated measures analysis of variance was conducted to examine group differences in emotion recognition.

RESULTS

Compared to healthy participants, SAD patients were significantly less accurate at recognising facial and prosodic emotions, and spent more time on emotion recognition. The differences were mainly driven by the lower accuracy and longer reaction times for recognising fearful emotions in SAD patients. Within the SAD patients, lower accuracy of sad face recognition was associated with higher severity of depressive and social anxiety symptoms, particularly with avoidance symptoms.

CONCLUSION

These findings may represent a cross-modality pattern of avoidance in the later stage of identifying negative emotions in SAD. This pattern may be linked to clinical symptom severity.

Fear of Negative Evaluation, Trait Anxiety, and Judgment Bias in Adults who Stutter

PURPOSE

Persons who stutter (PWS) and those with social anxiety disorder may exhibit fear of negative evaluation (FNE) and anxiety in social situations. However, the information processing biases that perpetuate these characteristics have had limited investigation. This study investigated judgment bias in social situations.

METHOD

Participants included 50 adults who stutter and 45 age- and gender-matched fluent persons who do not stutter (PWNS), who made up the control group. Participants completed the Interpretation and Judgmental Questionnaire (Voncken, Bögels, & deVries, 2003), and threat scores were calculated.

RESULTS

There were no significant differences between PWS and PWNS in social threat or nonsocial threat scores. When the PWS group was divided on the basis of FNE and compared with PWNS participants without heightened anxiety (n = 35), the PWS with high FNE had significantly higher total social threat scores than the PWS with low FNE. The three groups did not differ in threat ratings for ambiguous or profoundly negative social situations.

CONCLUSIONS

Judgment bias in PWS is mediated by the magnitude of FNE present; not all PWS exhibit judgment bias for social situations. Treatment implications include the need for psychosocial support addressing the negative impacts on quality of life and restrictions on social engagement that stuttering may cause in some individuals.

Response bias-related impairment of early subjective face discrimination in social anxiety disorders: An event-related potential study

Considerable research has shown that social anxiety disorder (SAD) is accompanied by various negative cognitive biases, such as social feedback expectancy bias, memory bias, and interpretation bias. However, whether the memory bias in individuals with SAD is actually a manifestation of response bias, and whether such response bias is associated with deficits in face discrimination, remains unclear. In the present study, we investigated response bias (i.e., a tendency to recognize more negative evaluations) to faces with positive (social acceptance) or negative (social rejection) social evaluations in individuals with SAD and healthy controls (HCs) using event-related potentials (ERPs). Behavioral results revealed significant group differences in response bias in the forced-choice recall task, but no difference in overall memory accuracy. ERP results demonstrated that HCs showed a larger N170 to faces that had rejected them as compared to those that had accepted them, but this effect was not evident in the SAD group. Further analysis showed that response bias was correlated with the ΔN170 (rejected - accepted) amplitude. We concluded that the response bias in individuals with SAD is resulted from impairments in early discrimination of social faces, as reflected by the absent early N170 differentiation effect, which was associated with their combined negative biases.

Facing two faces: Defense activation varies as a function of personal relevance

It can be unsettling to be watched by a group of people, and when they express anger or hostility, this can prime defensive behavior. In contrast, when others smile at us, this may be comforting. This study tested to which degree the impact of facial expressions (happy, neutral, and angry) varies with the personal relevance of a social situation. Modelling a triadic situation, two faces looked either directly at the participant, faced each other, or they were back to back. Results confirmed that this variation constitutes a gradient of personal relevance (directed frontally > towards > away), as reflected by corresponding defensive startle modulation and autonomic nervous system activity. This gradient was particularly pronounced for angry faces and it was steeper in participants with higher levels of social anxiety. Thus, sender-recipient constellations modulate the processing of facial emotions in favor of adequate behavioral responding (e.g., avoidance) in group settings.

Implications of fear of negative evaluation, state anxiety, and implied level of target-dominance on perceptions of personality traits

Fear of negative evaluation (FNE), state anxiety (SA), and dominance have consequences for social functioning. The present study assessed how FNE, SA, and a target's dominance-relevant label are related to perceptions of personality. One hundred seventy-eight participants who scored high or low on FNE underwent a laboratory manipulation of SA, viewed a photograph of a target with a high or low dominance-relevant label, and rated the target on the Big Five personality traits and dominance. FNE and SA were unrelated to perceptions, but the high-dominance label was associated with perceptions of higher dominance, conscientiousness, and openness. In conclusion, judges did use information about others when making initial judgments of personality, but these judgments were not impacted by trait or state psychological distress.

Social Anxiety and Interpretation Bias

This study examined how positive-scale assessment of ambiguous social stimuli affects interpretation bias in social anxiety. Participants with high and low social anxiety ( N = 60) performed a facial expression discrimination task to assess interpretation bias. Participants were then randomly assigned to assess the emotion of briefly presented faces either on a negative or on a positive scale. They subsequently repeated the facial expression discrimination task. Participants with high versus low social anxiety made more negative interpretations of ambiguous facial expressions. However, those in the positive-scale assessment condition subsequently showed reduced negative interpretations of ambiguous facial expressions. These results suggest that interpretation bias in social anxiety could be mediated by positive priming rather than an outright negative bias.

Generalized Anxiety Disorder and Social Anxiety Disorder, but Not Panic Anxiety Disorder, Are Associated with Higher Sensitivity to Learning from Negative Feedback: Behavioral and Computational Investigation

Anxiety disorders, including generalized anxiety disorder (GAD), social anxiety disorder (SAD), and panic anxiety disorder (PAD), are a group of common psychiatric conditions. They are characterized by excessive worrying, uneasiness, and fear of future events, such that they affect social and occupational functioning. Anxiety disorders can alter behavior and cognition as well, yet little is known about the particular domains they affect. In this study, we tested the cognitive correlates of medication-free patients with GAD, SAD, and PAD, along with matched healthy participants using a probabilistic category-learning task that allows the dissociation between positive and negative feedback learning. We also fitted all participants' data to a Q-learning model and various actor-critic models that examine learning rate parameters from positive and negative feedback to investigate effects of valence vs. action on performance. SAD and GAD patients were more sensitive to negative feedback than either PAD patients or healthy participants. PAD, SAD, and GAD patients did not differ in positive-feedback learning compared to healthy participants. We found that Q-learning models provide the simplest fit of the data in comparison to other models. However, computational analysis revealed that groups did not differ in terms of learning rate or exploration values. These findings argue that (a) not all anxiety spectrum disorders share similar cognitive correlates, but are rather different in ways that do not link them to the hallmark of anxiety (higher sensitivity to negative feedback); and (b) perception of negative consequences is the core feature of GAD and SAD, but not PAD. Further research is needed to examine the similarities and differences between anxiety spectrum disorders in other cognitive domains and potential implementation of behavioral therapy to remediate cognitive deficits.

Attentional mechanisms of social perception are biased in social phobia

Previous studies of social phobia have reported an increased vigilance to social threat cues but also an avoidance of socially relevant stimuli such as eye gaze. The primary aim of this study was to examine attentional mechanisms relevant for perceiving social cues by means of abnormalities in scanning of facial features in patients with social phobia. In two novel experimental paradigms, patients with social phobia and healthy controls matched on age, gender and education were compared regarding their gazing behavior towards facial cues. The first experiment was an emotion classification paradigm which allowed for differentiating reflexive attentional shifts from sustained attention towards diagnostically relevant facial features. In the second experiment, attentional orienting by gaze direction was assessed in a gaze-cueing paradigm in which non-predictive gaze cues shifted attention towards or away from subsequently presented targets. We found that patients as compared to controls reflexively oriented their attention more frequently towards the eyes of emotional faces in the emotion classification paradigm. This initial hypervigilance for the eye region was observed at very early attentional stages when faces were presented for 150ms, and persisted when facial stimuli were shown for 3s. Moreover, a delayed attentional orienting into the direction of eye gaze was observed in individuals with social phobia suggesting a differential time course of eye gaze processing in patients and controls. Our findings suggest that basic mechanisms of early attentional exploration of social cues are biased in social phobia and might contribute to the development and maintenance of the disorder.

What does the facial dot-probe task tell us about attentional processes in social anxiety? A systematic review

BACKGROUND/OBJECTIVES

Current models of SAD assume that attentional processes play a pivotal role in the etiology and maintenance of social anxiety disorder. Social anxiety is supposedly associated with an attentional bias towards disorder related stimuli such as threatening faces. Using the facial dot probe task in socially anxious individuals has, however, revealed inconsistent findings.

METHODS

The current systematic review aims at disentangling the heterogeneous findings using effect sizes across results by systematically taking into account potential moderating variables (stimulus type, stimulus duration, situational anxiety, disorder severity).

RESULTS

Results provide some evidence that socially anxious individuals preferentially allocate their attention towards threat faces compared to non-anxious controls. This bias seems to depend on the type of reference stimulus, stimulus duration and clinical level of social anxiety. Avoidance of threat was neither found at early, nor at later stages of attentional processing.

LIMITATIONS

Importantly, the results have to be considered in the light of the only few studies available. Given the heterogeneity of results and some methodological restrictions of the studies included, the picture of attentional bias seems to be much less clear than suggested in the recent social anxiety literature.

CONCLUSIONS

Methodologically, combined measures of dot-probe and eye movement measures might be beneficial to detect overt attentional biases. Importantly, our results show that preferential processing of threat cues might guide early attentional processes in social anxiety, depending however on several contextual and situational factors. Clinically, patients with greater severity of SAD may be more prone to such an attentional bias, thus therapists should take this into account when planning behavioral experiments and exposure therapy.

An empirical analysis of Moscovitch's reconceptualised model of social anxiety: How is it different from fear of negative evaluation?

Cognitive-behavioural models propose that excessive fear of negative evaluation is central to social anxiety. Moscovitch (2009) instead proposes that perceived deficiencies in three self attributes: fears of showing signs of anxiety, deficits in physical appearance, or deficits in social competence are at the core of social anxiety. However, these attributes are likely to overlap with fear of negative evaluation. Responses to an online survey of 286 participants with a range of social anxiety severity were analysed using hierarchical multiple regression to identify the overall unique predictive value of Moscovitch's model. Altogether, Moscovitch's model provided improvements in the prediction of safety behaviours, types of fears and cognitions; however only the fear of showing anxiety subscale provided unique information. This research supports further investigations into the utility of this revised model, particularly related to utility of explicitly assessing and addressing fears of showing anxiety.

The Effect of Affective Context on Visuocortical Processing of Neutral Faces in Social Anxiety

It has been demonstrated that verbal context information alters the neural processing of ambiguous faces such as faces with no apparent facial expression. In social anxiety, neutral faces may be implicitly threatening for socially anxious individuals due to their ambiguous nature, but even more so if these neutral faces are put in self-referential negative contexts. Therefore, we measured event-related brain potentials (ERPs) in response to neutral faces which were preceded by affective verbal information (negative, neutral, positive). Participants with low social anxiety (LSA; n = 23) and high social anxiety (HSA; n = 21) were asked to watch and rate valence and arousal of the respective faces while continuous EEG was recorded. ERP analysis revealed that HSA showed elevated P100 amplitudes in response to faces, but reduced structural encoding of faces as indexed by reduced N170 amplitudes. In general, affective context led to an enhanced early posterior negativity (EPN) for negative compared to neutral facial expressions. Moreover, HSA compared to LSA showed enhanced late positive potentials (LPP) to negatively contextualized faces, whereas in LSA this effect was found for faces in positive contexts. Also, HSA rated faces in negative contexts as more negative compared to LSA. These results point at enhanced vigilance for neutral faces regardless of context in HSA, while structural encoding seems to be diminished (avoidance). Interestingly, later components of sustained processing (LPP) indicate that LSA show enhanced visuocortical processing for faces in positive contexts (happy bias), whereas this seems to be the case for negatively contextualized faces in HSA (threat bias). Finally, our results add further new evidence that top-down information in interaction with individual anxiety levels can influence early-stage aspects of visual perception.

Gray matter abnormalities in patients with social anxiety disorder: A voxel-based morphometry study

The main objective of this study was to investigate the gray matter volume (GMV) differences between the patients with social anxiety disorder (SAD) and healthy controls, using VBM analysis. A total of 27 consecutive patients (15 women and 12 men) with SAD and 27 age and sex-matched healthy control subjects were included in this study. With magnetic resonance imaging, we examined GMV differences between SAD and healthy control groups. We found that GMV in the right middle and inferior temporal, left superior parietal, left precuneus and right fusiform areas were significantly greater in patients with SAD than in healthy controls. In addition, GMV in the right inferior and middle temporal regions were positively correlated with the social avoidance and total social anxiety scores of the participants in the SAD group. Lastly, greater GMV in the left superior parietal and precuneal regions were correlated with the higher disability in the social life of the patients with SAD. Our results suggest that the regions that showed significant GMV differences between the two groups play an important role in the pathophysiology of SAD and increased GMV in these regions might reflect a pathological process of neural abnormalities in this disorder.

Interpretative bias in spider phobia: Perception and information processing of ambiguous schematic stimuli

This study investigates the interpretative bias in spider phobia with respect to rapid visuomotor processing. We compared perception, evaluation, and visuomotor processing of ambiguous schematic stimuli between spider-fearful and control participants. Stimuli were produced by gradually morphing schematic flowers into spiders. Participants rated these stimuli related to their perceptual appearance and to their feelings of valence, disgust, and arousal. Also, they responded to the same stimuli within a response priming paradigm that measures rapid motor activation. Spider-fearful individuals showed an interpretative bias (i.e., ambiguous stimuli were perceived as more similar to spiders) and rated spider-like stimuli as more unpleasant, disgusting, and arousing. However, we observed no differences between spider-fearful and control participants in priming effects for ambiguous stimuli. For non-ambiguous stimuli, we observed a similar enhancement for phobic pictures as has been reported previously for natural images. We discuss our findings with respect to the visual representation of morphed stimuli and to perceptual learning processes.

Updating the emotional content of working memory in social anxiety

BACKGROUND AND OBJECTIVES

Cognitive accounts suggest that information processing biases have an important role in the etiology and maintenance of social anxiety (SA). Empirical evidence support this notion has been established in variety of cognitive domains. Yet, it is still not known how social anxious individuals process emotional content in working memory (WM). Maladaptive WM updating may influence emotion regulation and anxiety during social situations in SA. Thus, the aim of the present study was to explore biases when updating emotional content in SA.

METHODS

31 participants with high SA and 34 control participants performed an emotional 2-back task. Biases were assessed by intrusion cost in reaction times, which reflects the conflict between the inhibition of irrelevant content and the activation of relevant content.

RESULTS

Results revealed a diminished intrusion cost in reaction times for irrelevant positive content in the high, but not in the low SA group. No differences were found for negative or neutral content.

LIMITATIONS

In the present study we used an analogue sample of students with high SA rather than a true clinical sample. Further research is needed to examine WM updating in clinical population.

CONCLUSIONS

These findings suggest that individuals with SA are better at inhibiting irrelevant positive information, a maladaptive cognitive bias that may prevent positive feedback from entering the cognitive system. This cognitive bias in WM may play a role in the etiology and maintenance of SA.

Biases in probabilistic category learning in relation to social anxiety

Instrumental learning paradigms are rarely employed to investigate the mechanisms underlying acquired fear responses in social anxiety. Here, we adapted a probabilistic category learning paradigm to assess information processing biases as a function of the degree of social anxiety traits in a sample of healthy individuals without a diagnosis of social phobia. Participants were presented with three pairs of neutral faces with differing probabilistic accuracy contingencies (A/B: 80/20, C/D: 70/30, E/F: 60/40). Upon making their choice, negative and positive feedback was conveyed using angry and happy faces, respectively. The highly socially anxious group showed a strong tendency to be more accurate at learning the probability contingency associated with the most ambiguous stimulus pair (E/F: 60/40). Moreover, when pairing the most positively reinforced stimulus or the most negatively reinforced stimulus with all the other stimuli in a test phase, the highly socially anxious group avoided the most negatively reinforced stimulus significantly more than the control group. The results are discussed with reference to avoidance learning and hypersensitivity to negative socially evaluative information associated with social anxiety.

[The effects of interpretation bias for social events and automatic thoughts on social anxiety]

Many studies have demonstrated that individuals with social anxiety interpret ambiguous social situations negatively. It is, however, not clear whether the interpretation bias discriminatively contributes to social anxiety in comparison with depressive automatic thoughts. The present study investigated the effects of negative interpretation bias and automatic thoughts on social anxiety. The Social Intent Interpretation-Questionnaire, which measures the tendency to interpret ambiguous social events as implying other's rejective intents, the short Japanese version of the Automatic Thoughts Questionnaire-Revised, and the Anthropophobic Tendency Scale were administered to 317 university students. Covariance structure analysis indicated that both rejective intent interpretation bias and negative automatic thoughts contributed to mental distress in social situations mediated by a sense of powerlessness and excessive concern about self and others in social situations. Positive automatic thoughts reduced mental distress. These results indicate the importance of interpretation bias and negative automatic thoughts in the development and maintenance of social anxiety. Implications for understanding of the cognitive features of social anxiety were discussed.

Neural correlates of emotional interference in social anxiety disorder

Disorder-relevant but task-unrelated stimuli impair cognitive performance in social anxiety disorder (SAD); however, time course and neural correlates of emotional interference are unknown. The present study investigated time course and neural basis of emotional interference in SAD using event-related functional magnetic resonance imaging (fMRI). Patients with SAD and healthy controls performed an emotional stroop task which allowed examining interference effects on the current and the succeeding trial. Reaction time data showed an emotional interference effect in the current trial, but not the succeeding trial, specifically in SAD. FMRI data showed greater activation in the left amygdala, bilateral insula, medial prefrontal cortex (mPFC), dorsal anterior cingulate cortex (ACC), and left opercular part of the inferior frontal gyrus during emotional interference of the current trial in SAD patients. Furthermore, we found a positive correlation between patients' interference scores and activation in the mPFC, dorsal ACC and left angular/supramarginal gyrus. Taken together, results indicate a network of brain regions comprising amygdala, insula, mPFC, ACC, and areas strongly involved in language processing during the processing of task-unrelated threat in SAD. However, specifically the activation in mPFC, dorsal ACC, and left angular/supramarginal gyrus is associated with the strength of the interference effect, suggesting a cognitive network model of attentional bias in SAD. This probably comprises exceeded allocation of attentional resources to disorder-related information of the presented stimuli and increased self-referential and semantic processing of threat words in SAD.

The Yin and Yang of support from significant others: Influence of general social support and partner support of avoidance in the context of treatment for social anxiety disorder

Support from social networks is generally considered to protect against mental disorder but in some circumstances support for negative behaviours (such as avoidance) may be counterproductive. Given the critical interplay between social anxiety disorder and social interactions, it is surprising that the relationship of support from significant others to this disorder has received so little attention. The current study evaluated the reciprocal relationships between perceived social support and perceived partner support for avoidance behaviours (avoidance support) among a sample of 131 participants with social anxiety disorder who were assessed three times within the context of a treatment outcome study. A new measure of partner support for avoidance behaviours was developed, called the Avoidance Support Measure, and showed adequate internal consistency and construct validity. Correlations at baseline showed significant negative relationships between perceived social support and social anxiety and significant positive relationships between avoidance support and social anxiety. Path analysis showed that perceived social support at Times 1 and 2 negatively predicted future social anxiety at Times 2 and 3. On the other hand, only a single predictive relationship involving avoidance support was significant and showed that social anxiety at Time 1 positively predicted avoidance support at Time 2. These early results point to the different ways that support from significant others might relate to social anxiety and suggest that further work in this area may be fruitful.

Socially anxious individuals discriminate better between angry and neutral faces, particularly when using low spatial frequency information

BACKGROUND AND OBJECTIVES

Social anxiety is associated with biased processing of threatening faces. Earlier research indicated that socially anxious individuals are biased towards processing low spatial frequency (LSF) information when judging facial expressions. However, it remains unclear whether this bias reflects better performance for LSF-information, worse performance for high spatial frequency (HSF) information that needs to be compensated for, or both.

METHODS

To answer this question, we used frequency-filtered neutral and angry face stimuli in a speeded classification task to compare the performance of socially anxious and non-anxious individuals for different spatial frequency bands.

RESULTS

Across all spatial frequency bands, socially anxious individuals were faster in judging facial expressions. Importantly, this performance advantage was larger for LSF-filtered stimuli and most pronounced for those stimuli with the lowest frequency band. Analyzing inverse efficiency scores showed the same pattern, ruling out speed-accuracy trade-off differences between groups.

LIMITATIONS

The study uses rather artificial (bandpass-filtered) stimuli and is limited towards contrasting the discrimination of neutral and angry faces. Further, only participants with subclinical anxiety were part of the study, so clinical relevance remains to be shown.

CONCLUSIONS

Our results show that social anxiety is not characterized by deficits in judging emotions from HSF-information, but by advantages when processing LSF-information.