Gaze-Based Assessments of Vigilance and Avoidance in Social Anxiety: a Review

Examining attentional avoidance in post-traumatic stress disorder: an exploratory 'Face in the Crowd' paradigm using eye-tracking

Background: Maladaptive patterns of attention to emotional stimuli are a clinical feature of posttraumatic stress disorder (PTSD). Using eye-tracking-based methodology, research points out the presence of sustained attention to threatening stimuli in individuals with PTSD. However, most eye-tracking studies in this field used free-viewing tasks on negative stimuli.Methods: PTSD patients (n = 38), trauma-exposed healthy controls (TEHC; n = 30), and non-trauma-exposed healthy controls (HC; n = 33) performed a Face in the Crowd (FiC) task. The FiC task was chosen to explore specific responses to emotional stimuli within a competitive visual environment, thus providing insights into visual search patterns. Both reaction time and gaze patterns (dwell time, scanpath length, first fixation duration, and latency) were recorded.Results: Individuals with a provisional PTSD diagnosis presented decreased dwell time on both positive and negative targets in comparison with HC and TEHC, as well as shorter scanpath length for all matrixes when no targets were present. No evidence of attentional bias was observed in the TEHC group based on reaction times or eye-tracking measures in response to positive, negative, or neutral cues.Discussion: We found an attentional avoidance pattern among PTSD patients, along with indexes of lowered perceptual threshold for all emotional information. This study allows raising the question of cognitive load on the emergence of differential attentional strategies presented by PTSD participants. We discuss the generalization of fear processes across different emotional stimuli and underscore the need for incorporating a variety of emotional stimuli in PTSD research.

The influence of (social) anxiety and visual exploration on threat responding and generalization

Fear generalization has been identified as an important mechanism that might contribute to the etiology and maintenance of anxiety disorders. It is, however, yet unclear to what degree attentional processes contribute to overgeneralization of fear in clinical samples. To address this issue, we utilized a set of facial photographs that was meticulously created such that pairs of faces could either be distinguished by looking into the eyes or the region around mouth and nose, respectively. These pairs were then employed as CS+ and CS- in a differential fear conditioning paradigm followed by a generalization test with morphs in steps of 20 %, creating a continuum between CS+ and CS-. In a sample with diverse levels of social and general anxiety (N = 87), we demonstrated that the amount of fear generalization depends on attentional orienting towards diagnostic facial features. While social anxiety did not affect the shape of generalization gradients, we observed altered visual exploration patterns and a distinct multi-phasic heart rate modulation in participants with higher social anxiety. General anxiety symptomatology was also related to these characteristics of visual exploration and additionally predicted a broad elevation of threat ratings. In summary, fear generalization depends on attentional deployment. Future work should build on these findings to further explore these processes in clinical populations.

Studying the influence of single social interactions on approach and avoidance behavior: A multimodal investigation in immersive virtual reality

When studying spontaneous or learned emotional responses to social stimuli, research has traditionally relied on simplified stimuli repeatedly presented on a computer screen in standardized laboratory environments. While these studies have provided important insights into social perception and cognition, their restricted ecological validity may impede the extrapolation of findings to everyday social contexts. Here, we developed a novel immersive virtual reality scenario that permits the examination of social approach and avoidance behavior under naturalistic circumstances while at the same time maintaining full experimental control. Using a combination of a social conditioning procedure with a social approach-avoidance test, we conducted two experiments (both with N = 48 female participants) to investigate how individuals differing in trait social anxiety adapt their behavior after a single encounter with an either friendly or unfriendly virtual agent. In addition to overt approach and avoidance behavior, we acquired subjective ratings, eye-tracking data, and autonomic responses. Overall, we observed significant effects of the social conditioning procedure on autonomic responses and participants' exploration behavior. After initially increased attention, participants exhibited avoidance of social threats as indicated by a higher interpersonal distance and decreased visual attention towards the negatively conditioned virtual agent in the test phase. We found no association between hypervigilance and trait social anxiety but observed higher fear ratings and enhanced avoidance of social threats in participants with elevated anxiety levels. Altogether, this study demonstrates the potential of immersive virtual environments for examining social learning processes under conditions resembling real-life social encounters.

In the eye of the beholder - validating the visual social anxiety scale (VSAS) in social anxiety disorder

The Visual Social Anxiety Scale (VSAS) is a novel picture-based self-report measure of social anxiety that shown promising psychometric properties among non-selected participants. The present study aimed to validate the VSAS among individuals with clinically diagnosed social anxiety disorder (SAD) and establish clinical cutoff scores. One-hundred-and-three adults with SAD completed the VSAS with a battery of additional self-report measures of social anxiety, depression, and general anxiety. Internal consistency, convergent and discriminant validities, were assessed. Clinical cutoff scores were established via a Receiver Operating Characteristics (ROC) analysis using a control group of individuals without any past or present psychopathology (n = 34). An Exploratory Factor Analysis (EFA) was performed to explore underlying thematic factors. The VSAS exhibited high internal consistency and adequate convergent and discriminant validities. The ROC analysis showed the area under the curve to be 0.95 and yielded an optimal cutoff score of 23.40, providing high accuracy (0.90), sensitivity (0.89), and specificity (0.91) for distinguishing SAD from non-SAD individuals. The EFA revealed a 3-factor structure representing the following themes: social interpersonal situations, formal interpersonal situations, and being the center of attention. The psychometric properties of the VSAS support its utility in assessing and identifying individuals with clinical SAD.

Differences in attentional bias between self-related information and external cues from others in individuals with social anxiety: An event-related potential study

Individuals with high social anxiety show a more considerable attentional bias toward self-relevant information and outwardly threatening stimuli than do those with low social anxiety. Some studies have investigated the attentional bias between self-relevant information and external social cues in people with high social anxiety but have not reached consistent conclusions. This study used a modified dot-probe task and collected temporal and electroencephalogram responses to three self-other face pairs among 15 people with high social anxiety and 20 people with low social anxiety. Both groups responded quicker to self-relevant information than external social cues. Others' emotional potencies moderated the attentional bias. Individuals with high social anxiety exhibited larger P1 amplitudes and smaller N170 amplitudes (mainly in the right hemisphere) for all face pairs and larger P2 amplitudes for the self-neutral and other-angry face pairs than those with low social anxiety. These findings suggest that people with social anxiety prioritize allocating attentional resources to self-relevant information, with others' angry faces having the greatest influence on the allocation. Individuals with high social anxiety initially exhibit more attentional vigilance and less structural coding for face pairs, followed by heightened engagement with threatening cues compared to those with low social anxiety.

Social Anxiety Reduces Visual Attention to the Eyes of Emotional Faces in Autistic Youth

Autism and social anxiety (SA) share behavioral features like reduced eye contact, variable social attention, and differences in social interactions. However, the impact of the co-occurrence of these conditions (e.g., autism with co-occurring SA) on social attention remains unknown. Therefore, we evaluated whether the degree of SA characteristics in autistic youth modulated (e.g., amplified or lessened) a core hallmark feature of autism: social attention, or looking at faces. Fifty-four autistic and 35 non-autistic children and adolescents completed a gaze-contingent eye-tracking (ET) paradigm, in which faces dynamically expressed happy or fearful expressions contingent on participant eye contact. SA characteristics were assessed via standardized self- and parent-report measures. Social attention was measured by calculating the average percent looking time at the face and eye regions of each emotional expression. Autistic participants looked less at faces than non-autistic participants, and higher self-report SA was associated with less looking at eyes in both autistic and non-autistic participants. SA features affect social attention similarly in autistic and non-autistic youth, highlighting the importance of considering co-occurring psychiatric characteristics when assessing social attention and eye contact in autistic individuals.

Financial scarcity and financial avoidance: an eye-tracking and behavioral experiment

When having less money than needed, people experience financial scarcity. Here, we conducted a laboratory experiment to investigate whether financial scarcity increases financial avoidance - the tendency to avoid dealing with ones finances. Participants completed an incentivized task where they managed the finances of a household by earning income and paying expenses across multiple rounds. We manipulated participants' financial situation such that they either had sufficient (financial abundance) or insufficient (financial scarcity) financial resources. At the end of each round, participants received an additional expense in the form of a letter. To measure financial avoidance in the form of attentional disengagement, we used an eye-tracker and assessed whether participants in the financial scarcity condition avoided looking at the expense letters. As a behavioral measure of financial avoidance, participants had the option to delay the payment of these expenses until the end of the experiment at no additional cost. Results showed no effect of financial scarcity on the eye-tracking measure, but there was an effect on the behavioral measure: Participants that experienced financial scarcity were more likely to delay payments. The behavioral finding corroborates the notion that financial scarcity can lead to financial avoidance. We explore potential reasons for the null-effect on the eye-tracking measure and discuss how future research can build upon our findings.

Research hot topics and frontiers in social anxiety over the past decade: a CiteSpace bibliometric analysis based on Web of Science database from 2013 to 2023

Objective

To understand the current study of social anxiety (SA) over the past decade, and to analyze the research hot topics and frontiers in this field.

Methods

CiteSpace 6.2.R3 was used to analyze the literature on SA collected in the Web of Science Core Collection database from 2013 to 2023.

Results

A total of 9940 literature were included after the screening, and the annual publication volume showed a steady increase. The results emphasize that Zvolensky MJ, Pine DS, and Heimberg RG are important authors in the field of SA. The United States has the highest number of publications, with the University of California System contributing the most. Research hotspots include cognitive impairment, risk factors, complications, neuroimaging, and intervention strategies. SA related to the "theory of mind", "bullying victimization", "mobile phone", "network analysis", "technology", and "satisfaction" are emerging research foci.

Conclusion

This study identifies the current situation and trends of SA research, and provides a reference for future research topics and directions.

Paternal deprivation induces vigilance-avoidant behavior and accompanies sex-specific alterations in stress reactivity and central proinflammatory cytokine response in California mice (Peromyscus californicus)

RATIONALE

Early-life stress (ELS) can increase anxiety, reduce prosocial behaviors, and impair brain regions that facilitate emotional and social development. This knowledge greatly stems from assessing disrupted mother-child relationships, while studies investigating the long-term effects of father-child relationships on behavioral development in children are scarce. However, available evidence suggests that fathers may uniquely influence a child's behavioral development in a sex-specific manner. Rodent models examining mother-offspring interaction demonstrate relationships among ELS, neuroinflammatory mediators, and behavioral development; yet, the role paternal care may play in neuroimmune functioning remains unreported.

OBJECTIVES

Using the biparental California mouse (Peromyscus californicus), we examined to what extent paternal deprivation impairs social and anxiety-like behaviors, augments peripheral corticosterone (CORT) response, and alters central proinflammatory cytokine production following an acute stressor in adulthood.

METHODS

Biparentally reared and paternally deprived (permanent removal of the sire 24 h post-birth) adult mice were assessed for sociability, preference for social novelty, social vigilance, and social avoidance behaviors, followed by novelty-suppressed feeding (NSF) testing for general anxiety-like behavior. Following an acute stressor, circulating CORT concentrations and region-specific proinflammatory cytokine concentrations were determined via radioimmunoassay and Luminex multianalyte analysis, respectively.

RESULTS

In response to a novel same-sex conspecific, social vigilance behavior was associated with reduced sociability and increased avoidance in paternally deprived mice-an effect not observed in biparentally reared counterparts. Yet, in response to a familiar same-sex conspecific, social vigilance persisted but only in paternally deprived females. The latency to consume during NSF testing was not significantly altered by paternal deprivation. In response to an acute physical stressor, lower circulating CORT concentrations were observed in paternally deprived females. Compared to control-reared males, paternal deprivation increased hypothalamic interleukin-1β, but decreased hippocampal IL-6 protein concentration.

CONCLUSION

Greater social vigilance behavior was demonstrated in paternally deprived mice while they avoided social interaction with a novel same-sex conspecific; however, in response to a familiar same-sex conspecific, paternal deprivation increased social vigilance behavior but only in females. It is possible that different neurobiological mechanisms underlie these observed behavioral outcomes as sex-specific central proinflammatory cytokine and stress responsivity were observed in paternally deprived offspring.

Attentional bias toward negative stimuli in PTSD: an eye-tracking study

BACKGROUND

Research on biased processing of aversive stimuli in posttraumatic stress disorder (PTSD) has produced inconsistent results between response time (RT) and eye-tracking studies. Recent RT-based results of dot-probe studies showed no attentional bias (AB) for threat while eye-tracking research suggested heightened sustained attention for this information. Here, we used both RT-based and eye-tracking measures to explore the dynamics of AB to negative stimuli in PTSD.

METHODS

Twenty-three individuals diagnosed with PTSD, 23 trauma-exposed healthy controls, and 23 healthy controls performed an emotional dot-probe task with pairs of negative and neutral scenes presented for either 1 or 2 s. Analyses included eye movements during the presentation of the scenes and RT associated with target localization.

RESULTS

There was no evidence for an AB toward negative stimuli in PTSD from RT measures. However, the main eye-tracking results revealed that all three groups showed longer dwell times on negative pictures than neutral pictures at 1 s and that this AB was stronger for individuals with PTSD. Moreover, although AB disappeared for the two groups of healthy controls with prolonged exposure, it persisted for individuals with PTSD.

CONCLUSION

PTSD is associated with an AB toward negative stimuli, characterized by heightened sustained attention toward negative scenes once detected. This study sheds light on the dynamics of AB to negative stimuli in PTSD and encourages us to consider optimized therapeutic interventions targeting abnormal AB patterns.

Examination of gaze behaviour in social anxiety disorder using a virtual reality eye-tracking paradigm: protocol for a casecontrol study

INTRODUCTION

Social anxiety disorder (SAD) has an early onset, a high lifetime prevalence, and may be a risk factor for developing other mental disorders. Gaze behaviour is considered an aberrant feature of SAD. Eye-tracking, a novel technology device, enables recording eye movements in real time, making it a direct and objective measure of gaze behaviour. Virtual reality (VR) is a promising tool for assessment and diagnostic purposes. Developing an objective screening tool based on examination of gaze behaviour in SAD may potentially aid early detection. The objective of this current study is, therefore to examine gaze behaviour in SAD utilising VR.

METHODS AND ANALYSIS

A case-control study design is employed in which a clinical sample of 29 individuals with SAD will be compared with a matched healthy control group of 29 individuals. In the VR-based eye-tracking paradigm, participants will be presented to stimuli consisting of high-res 360° 3D stereoscopic videos of three social-evaluative tasks designed to elicit social anxiety. The study will investigate between-group gaze behaviour differences during stimuli presentation.

ETHICS AND DISSEMINATION

The study has been approved by the National Committee on Health Research Ethics for the Capital Region of Denmark (H-22041443). The study has been preregistered on OSF registries: https://doi.org/10.17605/OSF.IO/XCTAKAll participants will be provided with written and oral information. Informed consent is required for all the participants. Participation is voluntarily, and the participants can at any time terminate their participation without any consequences. Study results; positive, negative or inconclusive will be published in relevant scientific journals.

Altered functional connectivity of the amygdala across variants of callous-unemotional traits: A resting-state fMRI study in children and adolescents

Over the past years, research has shown that primary (high callousness and low anxiety) and secondary (high callousness and anxiety) variants of CU traits may be associated with opposite amygdala activity (hypo- and hyper-reactivity, respectively). However, their differences in amygdala functional connectivity remains largely unexplored. We conducted a Latent Profile Analysis on a large sample of adolescents (n = 1416) to identify homogeneous subgroups with different levels of callousness and anxiety. We then performed a seed-to-voxel connectivity analysis on resting-state fMRI data to compare subgroups on connectivity patterns of the amygdala. We examined the results in relation to conduct problems to identify potential neural risk factors. The Latent Profile Analysis revealed four subgroups, including the primary and secondary variants, anxious, and typically developing adolescents. The seed-to-voxel analyses showed that the primary variant was mainly characterized by increased connectivity between the left amygdala and left thalamus. The secondary variant exhibited deficient connectivity between the amygdala and the dorsomedial prefrontal cortex, temporo-parietal junction, premotor, and postcentral gyrus. Both variants showed increased connectivity between the left amygdala and the right thalamus but exhibited opposite functional connectivity between the left amygdala and the parahippocampal gyrus. Dimensional analyses indicated that conduct problems may play a mediating role between callousness and amygdala-dmPFC functional connectivity across youths with already high levels of callousness. Our study highlights that both variants differ in the functional connectivity of the amygdala. Our results support the importance of disentangling the heterogeneity of adolescents at risk for conduct problems in neuroimaging.

Attention allocation in OCD: A systematic review and meta-analysis of eye-tracking-based research

INTRODUCTION

Cognitive models of obsessive-compulsive disorder (OCD) implicate heightened attention allocation to stimuli related to one's obsessions in the disorder. Recently, to overcome several limitations of reaction time-based measures, eye-tracking methodology has been increasingly used in attentional research.

METHODS

A meta-analysis of studies examining attention allocation towards OCD-related vs. neutral stimuli, using eye-tracking methodology and a group-comparison design, was conducted conforming to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Separate meta-analyses were performed for attentional vigilance (both latency and location of first fixations) and maintenance (total dwell time and total fixation count, conjointly). Each meta-analysis was conducted twice - once including all studies (main analysis) and once only including studies using the free-viewing paradigm (secondary analysis).

RESULTS

The systematic search yielded a total of nine studies. Of those, eight provided the needed data to be included in the meta-analysis. No evidence emerged for vigilance via latency to first fixation. Vigilance reflected via first fixation location emerged in the main analysis, but not in the secondary one. Evidence for attentional maintenance was found only when analyzing free-viewing studies exclusively (the secondary analysis).

LIMITATIONS

To increase the accuracy of the research question, correlational studies were excluded, resulting in a small number of available studies.

CONCLUSIONS

OCD may be characterized by vigilance, but mainly in tasks entailing specific demands and/or goals. Conversely, attentional maintenance may be evident only when using tasks that pose no requirements or demands for participants.

Robotic gaze and human views: A systematic exploration of robotic gaze aversion and its effects on human behaviors and attitudes

Similar to human-human interaction (HHI), gaze is an important modality in conversational human-robot interaction (HRI) settings. Previously, human-inspired gaze parameters have been used to implement gaze behavior for humanoid robots in conversational settings and improve user experience (UX). Other robotic gaze implementations disregard social aspects of gaze behavior and pursue a technical goal (e.g., face tracking). However, it is unclear how deviating from human-inspired gaze parameters affects the UX. In this study, we use eye-tracking, interaction duration, and self-reported attitudinal measures to study the impact of non-human inspired gaze timings on the UX of the participants in a conversational setting. We show the results for systematically varying the gaze aversion ratio (GAR) of a humanoid robot over a broad parameter range from almost always gazing at the human conversation partner to almost always averting the gaze. The main results reveal that on a behavioral level, a low GAR leads to shorter interaction durations and that human participants change their GAR to mimic the robot. However, they do not copy the robotic gaze behavior strictly. Additionally, in the lowest gaze aversion setting, participants do not gaze back as much as expected, which indicates a user aversion to the robot gaze behavior. However, participants do not report different attitudes toward the robot for different GARs during the interaction. In summary, the urge of humans in conversational settings with a humanoid robot to adapt to the perceived GAR is stronger than the urge of intimacy regulation through gaze aversion, and a high mutual gaze is not always a sign of high comfort, as suggested earlier. This result can be used as a justification to deviate from human-inspired gaze parameters when necessary for specific robot behavior implementations.

No evidence that gaze anxiety predicts gaze avoidance behavior during face-to-face social interaction

Eye contact is an indispensable social signal, yet for some individuals it is also a source of discomfort they fear and avoid. However, it is still unknown whether gaze anxiety actually produces avoidant gaze behavior in naturalistic, face-to-face interactions. Here, we relied on a novel dual eye-tracking setup that allows us to assess interactive gaze behavior. To investigate the effect of gaze anxiety on gaze behavior, we a priori created groups of participants reporting high or low levels of gaze anxiety. These participants (n = 51) then performed a semi-standardized interaction with a previously unknown individual reporting a medium level of gaze anxiety. The gaze behavior of both groups did not differ in either classical one-way, eye-tracking parameters (e.g. unilateral eye gaze), or interactive, two-way ones (e.g. mutual gaze). Furthermore, the subjective ratings of both participants' interaction did not differ between groups. Gaze anxious individuals seem to exhibit normal gaze behavior which does not hamper the perceived quality of interactions in a naturalistic face-to-face setup. Our findings point to the existence of cognitive distortions in gaze anxious individuals whose exterior behavior might be less affected than feared by their interior anxiety.

Social anxiety does not impair attention inhibition: An emotion anti-saccade task

BACKGROUND AND OBJECTIVES

Attention avoidance and attention vigilance are two typical attentional biases in individuals with social anxiety disorder (SAD). Attention inhibition is a type of attention control, which may be the key factor affecting attention vigilance and attention avoidance. However, previous studies have not examined the difference between the attention inhibition in individuals with SAD and healthy controls.

METHODS

To further explore this question, the current study used the single anti-saccade task with emotional facial stimuli to assess attention inhibition in 27 individuals with SAD and 22 healthy controls.

RESULTS

Regardless of the emotional valence of the facial stimuli, error rates in the social anxiety group were lower than that of the healthy control group, but there was no significant group difference in the saccade latency.

LIMITATIONS

This research only examined the attentional inhibition process highly related to attention avoidance and attention vigilance. Future research may benefit from adopting different research paradigms for more robust and generalizable conclusions.

CONCLUSIONS

Results suggest that individuals with SAD have better attention inhibition abilities than healthy control. Such enhanced attention inhibition may underlie their avoidance of threatening social cues.

Looks interesting: Attention allocation in depression when using a news website - An eye tracking study

BACKGROUND

Eye-tracking-based attention research has shown attentional biases toward dysphoric and away from positive stimuli in depression. However, most research used prototypical stimuli (co-presented contrasting emotional faces/pictures), less reflective of real-life situations. The current study addressed this limitation by examining participants' attentional allocation patterns while freely viewing a news website containing dysphoric and positive news articles.

METHODS

Participants with high levels of depression (HD; n = 30) and with minimal levels of depression (MD; n = 30) freely viewed a fictitious news website for 3.5 min, containing six articles (picture + text) with dysphoric content and six with positive content. Gaze patterns on corresponding areas of interest (AOIs) were compared. Following the task, participants rated each article's valence, authenticity, and interest.

RESULTS

Compared to MD participants, HD participants spent more time dwelling on dysphoric articles and less time dwelling on positive articles. Within group analyses showed that while HD participants spent more time dwelling on dysphoric compared to positive articles, MD participants showed no preference, allocating their attention equally to both article types. Echoing within-group gaze patterns, HD participants rated the dysphoric articles as being more interesting than the positive articles, while MD participants rated both types of articles as being equally interesting.

CONCLUSION

Attentional biases in depression were also evident when using a more ecologically valid task such as viewing a news website, manifesting as increase attention allocation to dysphoric over positive content. This attention pattern may be related to corresponding differences in the level of interest participants found in each article type.

How to choose the size of facial areas of interest in interactive eye tracking

Advances in eye tracking technology have enabled the development of interactive experimental setups to study social attention. Since these setups differ substantially from the eye tracker manufacturer's test conditions, validation is essential with regard to the quality of gaze data and other factors potentially threatening the validity of this signal. In this study, we evaluated the impact of accuracy and areas of interest (AOIs) size on the classification of simulated gaze (fixation) data. We defined AOIs of different sizes using the Limited-Radius Voronoi-Tessellation (LRVT) method, and simulated gaze data for facial target points with varying accuracy. As hypothesized, we found that accuracy and AOI size had strong effects on gaze classification. In addition, these effects were not independent and differed in falsely classified gaze inside AOIs (Type I errors; false alarms) and falsely classified gaze outside the predefined AOIs (Type II errors; misses). Our results indicate that smaller AOIs generally minimize false classifications as long as accuracy is good enough. For studies with lower accuracy, Type II errors can still be compensated to some extent by using larger AOIs, but at the cost of more probable Type I errors. Proper estimation of accuracy is therefore essential for making informed decisions regarding the size of AOIs in eye tracking research.

Selective visual attention during public speaking in an immersive context

It has recently become feasible to study selective visual attention to social cues in increasingly ecologically valid ways. In this secondary analysis, we examined gaze behavior in response to the actions of others in a social context. Participants (N = 84) were asked to give a 5-minute speech to a five-member audience that had been filmed in 360° video, displayed in a virtual reality headset containing a built-in eye tracker. Audience members were coached to make movements that would indicate interest or lack of interest (e.g., nodding vs. looking away). The goal of this paper was to analyze whether these actions influenced the speaker's gaze. We found that participants showed reliable evidence of gaze towards audience member actions in general, and towards audience member actions involving their phone specifically (compared with other actions like looking away or leaning back). However, there were no differences in gaze towards actions reflecting interest (like nodding) compared with actions reflecting lack of interest (like looking away). Participants were more likely to look away from audience member actions as well, but there were no specific actions that elicited looking away more or less. Taken together, these findings suggest that the actions of audience members are broadly influential in motivating gaze behaviors in a realistic, contextually embedded (public speaking) setting. Further research is needed to examine the ways in which these findings can be elucidated in more controlled laboratory environments as well as in the real world.

Attentional processes during emotional face perception in social anxiety disorder: A systematic review and meta-analysis of eye-tracking findings

Background In recent years, a growing body of eye-tracking research has investigated gaze behavior in individuals with social anxiety during the visual perception of emotional stimuli. The aim of this article was to review and synthesize studies examining attention orientation in patients with clinical social anxiety by means of eye-tracking methodology. Methods Through a systematic search, 30 articles were identified, including 11 studies in which single emotional faces were used as stimuli and seven eligible studies in which threatening faces were paired with neutral stimuli. Meta-analyses were conducted to compare prolonged eye-contact behavior and early attentional biases to threats in individuals with social anxiety disorder (SAD) and healthy controls. Results Moderate group differences were revealed for single face viewing studies, with SAD patients showing significantly reduced eye contact with negative (Hedges' g = -0.67) and positive emotional faces (g = -0.49) compared to that of healthy participants. Type of task and duration of stimulus presentation were (marginally) significant moderators of between-study variance in effect size. Small but significant group differences were found for early attentional biases toward angry faces versus neutral stimuli (g = 0.21) but not toward happy faces versus neutral stimuli (g = 0.05). Preliminary evidence for a hyperscanning strategy in SAD patients relative to healthy controls emerged (g = 0.42). Limitations The number of included studies with face pairings was low, and two studies were excluded due to unavailable data. Conclusions Our results suggest that eye contact avoidance with emotional faces is a prominent feature in SAD patients. Patients might benefit from guidance to learn to make adequate eye contact during therapeutic interventions, such as exposure therapy. SAD patients demonstrated slightly heightened attention allocation toward angry faces relative to that of healthy participants during early processing stages. Threat biases can be potential targets for attention modification training as an adjuvant to other treatments. Future research on early attentional processes may benefit from improved arrangements of paired stimuli to increase the psychometric properties of initial attention indices.

Adults with higher social anxiety show avoidant gaze behaviour in a real-world social setting: A mobile eye tracking study

Attentional biases are a core characteristic of social anxiety (SA). However, research has yielded conflicting findings and failed to investigate these biases in real, face-to-face social situations. Therefore, this study examined attentional biases in SA by measuring participants’ eye gaze within a novel eye-tracking paradigm during a real-life social situation. Student participants (N = 30) took part in what they thought was a visual search study, when a confederate posing as another participant entered the room. Whilst all participants avoided looking at the confederate, those with higher SA fixated for a shorter duration during their first fixation on him, and executed fewer fixations and saccades overall as well as exhibiting a shorter scanpath. These findings are indicative of additional avoidance in the higher SA participants. In contrast to previous experimental work, we found no evidence of social hypervigilance or hyperscanning in high SA individuals. The results indicate that in unstructured social settings, avoidance rather than vigilance predominates, especially in those with higher SA.

Examining Individual Differences in Social Reward Valuation: a Person-Based Approach

Social reward refers to the motivational and pleasurable aspects of our interactions with other people. While some people experience social encounters as pleasurable, others experience them as aversive. However, the current knowledge on individual differences in social reward valuation in relation to pro- and antisocial personality characteristics is limited. The Social Reward Questionnaire (SRQ) was developed to assess individual differences in the value of different types of social rewards. First, the present study examined the validity and reliability of the Dutch version of the SRQ in a Dutch and Flemish community sample (N = 1892). Second, using latent profile analysis (LPA), it was investigated whether subgroups of participants existed with distinctive patterns of social reward valuation, and whether these subgroups differed in their level of psychopathic traits, aggression, and social anxiety. The results confirmed the original six-factor structure and showed good reliability and validity. The LPA identified four classes of individuals, labelled as: Low Social Interest, High Social Interest, Undifferentiated Social Reward-seekers, and Socially Cruel. These classes were further typified by distinct levels of psychopathy, reactive and proactive aggression, and social anxiety. The present findings contribute to our understanding of individual variability in the underlying motives of social behaviors.

Increased attention allocation to socially threatening faces in social anxiety disorder: A replication study

BACKGROUND

Threat-related attention bias has been implicated in the etiology and maintenance of social anxiety disorder (SAD), with attentional research increasingly using eye-tracking methodology to overcome the poor psychometric properties of response-time-based tasks and measures. Yet, extant eye-tracking research in social anxiety has mostly failed to report on psychometrics and attempts to replicate past results are rare. Therefore, we attempted to replicate a previously published eye-tracking study of gaze patterns in socially anxious and nonanxious participants as they viewed social threatening and neutral faces, while also exploring the psychometric properties of the attentional measures used.

METHODS

Gaze was monitored as participants freely viewed 60 different matrices comprised of eight socially-threatening and eight neutral faces, presented for 6000 ms each. Gaze patterns directed at threat and neutral areas of interest (AOIs) were compared by group. Internal consistency and test-retest reliability were also evaluated.

RESULTS

Relative to healthy controls, socially anxious patients dwelled significantly longer on threat faces, replicating prior findings with the same task. Internal consistency of total dwell time on threat and neutral AOIs was high, and two-week test-retest reliability was acceptable.

LIMITATIONS

Test-retest reliability was only examined for the control group, which had a small sample size.

CONCLUSION

Increased dwell time on socially threatening stimuli is a reliable, stable, and generalizable measure of attentional bias in adults with social anxiety.

Visual Attention Patterns of Socially Anxious Individuals When Using Facebook: An Eye Tracking Study

Social networking sites (SNSs) are an increasingly used medium for social interactions. For socially anxious individuals, SNS-based communication is often preferred over traditional face-to-face socializing. Yet, research on SNSs usage and social anxiety is still less common, with extant studies being mostly correlational among healthy nonanxious participants. Conversely, here, we examined differences in actual gaze patterns to social and nonsocial stimuli between socially anxious and nonanxious individuals while using Facebook. Socially anxious and nonanxious student participants freely viewed a genuine Facebook profile page designed for the present study, for 3.5 minutes, containing 12 social and 12 nonsocial picture stimuli. Gaze patterns on social and nonsocial areas of interest (AOIs) were explored. Subjective uneasiness experienced when viewing the social pictures and state anxiety were also assessed. Finally, 2 weeks following the task, we evaluated participants' willingness to participate in a follow-up (fictitious) study that required them to passively view their own Facebook profile, and then to actively use it. Results showed that compared with nonanxious participants, socially anxious participants demonstrated a viewing pattern less favoring social pictures, reflecting an attentional avoidance tendency. A significant inverse correlation between subjective uneasiness and percent of dwell time spent on the social AOI emerged. Socially anxious participants also reported higher levels of state anxiety, which was significantly positively correlated with uneasiness scores. Finally, socially anxious participants were also less willing to actively use their Facebook profile page. This study suggests that social anxious individuals are characterized by attentional and behavioral avoidance tendencies when using Facebook.

Autistic Traits Mediate Reductions in Social Attention in Adults with Anorexia Nervosa

Anorexia nervosa (AN) is associated with difficulties in social and emotional functioning. A significant proportion of individuals with AN show autistic traits, which may influence social attention. This study examined attention to faces and facial features in AN, recovered AN (REC), and healthy controls, as well as relationships with comorbid psychopathology. One hundred and forty-eight participants' eye movements were tracked while watching a naturalistic social scene. Anxiety, depression, alexithymia, and autistic traits were assessed via self-report questionnaires. Participants with AN spent significantly less time looking at faces compared to REC and controls; patterns of attention to individual facial features did not differ across groups. Autistic traits mediated the relationship between group and time spent looking at faces.

Effects of mask-wearing on social anxiety: an exploratory review

BACKGROUND

A unique feature of the global coronavirus pandemic has been the widespread adoption of mask-wearing as a public health measure to minimize the risk of contagion. Little is known about the effects of increased mask-wearing on social interactions, social anxiety, or overall mental health.

OBJECTIVES

Explore the potential effects of mask-wearing on social anxiety.

DESIGN

We review existing literatures to highlight three preselected sets of factors that may be important in shaping the effects of mask-wearing on social anxiety. These are: (a) people's perceptions of the social norms associated with wearing masks; (b) people's experiences of the degree to which masks prevent accurate interpretation of social and emotional cues; and (c) people's use of masks as a type of safety behavior that enables self-concealment.

METHODS

APA PsycNet and PubMed were searched principally between September and November 2020 for articles describing the relationship between social anxiety, intolerance of uncertainty, ambiguous feedback, and safety behavior use and for research on the relationship between mask-wearing and social norms and social interactions. Information identified as relevant from articles of interest was extracted and included in our review.

RESULTS & CONCLUSIONS

The effects of mask-wearing on social anxiety are likely to be substantial and clinically relevant.

Vigilant or avoidant? Children's temperamental shyness, patterns of gaze, and physiology during social threat

Temperamental shyness is characterized by fear, wariness, and the perception of threat in response to social novelty. Previous work has been inconsistent regarding attentional patterns to social threat among shy children, with evidence for both avoidance and vigilance. We examined relations between children's shyness and gaze aversion during the approach of a stranger (i.e., a context of social novelty), and tested whether these patterns of gaze moderated relations between shyness and autonomic reactivity and recovery. Participants included 152 typically-developing children (M_age  = 7.82 years, SD = 0.44 years) who had their respiratory sinus arrhythmia (RSA) recorded during baseline, social novelty, and recovery. Children's shyness correlated with increases in self-reported nervousness from baseline to social novelty, providing support for perceived threat. Results revealed that children's proportion of gaze aversion from social novelty was related to shyness in a U-shape pattern such that both low levels of gaze aversion (i.e., attentional vigilance) and high levels of gaze aversion (i.e., attentional avoidance) were related to higher levels of shyness. Further, we found that children's shyness was directly related to decreases in RSA from baseline to social novelty, whereas quadratic gaze to social novelty moderated the relation between shyness and RSA recovery. Specifically, shyness was related to greater RSA recovery among children who exhibited attentional vigilance during the novel social interaction. Our findings provide support for both avoidance of, and vigilance to, social threat among different shy children, and these gaze strategies may be differentially related to physiological regulation during novel social encounters.

Restricted Visual Scanpaths During Emotion Recognition in Childhood Social Anxiety Disorder

Background: Social anxiety disorder (SAD) has its typical onset in childhood and adolescence. Maladaptive processing of social information may contribute to the etiology and maintenance of SAD. During face perception, individuals execute a succession of visual fixations known as a scanpath which facilitates information processing. Atypically long scanpaths have been reported in adults with SAD, but no data exists from pediatric samples. SAD has also been linked to atypical arousal during face perception. Both metrics were examined in one of the largest eye-tracking studies of pediatric SAD to date. Methods: Participants were children and adolescents with SAD (n = 61) and healthy controls (n = 39) with a mean age of 14 years (range 10-17) who completed an emotion recognition task. The visual scanpath and pupil dilation (an indirect index of arousal) were examined using eye tracking. Results: Scanpaths of youth with SAD were shorter, less distributed, and consisted of a smaller number of fixations than those of healthy controls. These findings were supported by both frequentist and Bayesian statistics. Higher pupil dilation was also observed in the SAD group, but despite a statistically significant group difference, this result was not supported by the Bayesian analysis. Conclusions: The results were contrary to findings from adult studies, but similar to what has been reported in neurodevelopmental conditions associated with social interaction impairments. Restricted scanpaths may disrupt holistic representation of faces known to favor adaptive social understanding.

Gaze behavior is associated with the cortisol response to acute psychosocial stress in the virtual TSST

BACKGROUND

The Trier Social Stress Test (TSST) is a reliable tool for psychobiological stress induction. Because of its socio-evaluative nature, it has been useful for investigating gaze behavior. It has been shown that healthy people avoid looking toward faces when under stress, a finding that corroborates studies demonstrating avoidance of eye contact in social anxiety disorder. Yet, little is known about the relationship between gaze behavior and the biological stress response.

METHODS

In a final sample of 74 healthy males, a virtual reality version of the Trier Social Stress Test (TSST-VR) with an integrated eye tracker was implemented to investigate gaze behavior during acute stress induction. Stress response measures were collected via saliva samples and subjective stress ratings. Additional questionnaires were administered for examining the influence of social anxiety traits.

RESULTS

The TSST-VR elicited a significant psychobiological stress response. Overall, higher gaze times on judges compared to surroundings were found in the speech task while this pattern was reversed in the arithmetic task. Critically, there was a significant negative association between gaze time on judges and cortisol output in cortisol responders.

CONCLUSIONS

In a non-clinical sample, avoidance of gaze is associated with a stronger cortisol response to acute stress. This study demonstrates the potential of eye tracking to disentangle the effects of acute stress on social interaction, warranting further investigation in clinical populations characterized by high levels of anxiety in social situations, such as social anxiety and autism spectrum disorder.

Social anxiety is associated with heart rate but not gaze behavior in a real social interaction

BACKGROUND AND OBJECTIVES

Much of our current understanding of social anxiety rests on the use of highly restricted laboratory experiments. Latest technological developments now allow the investigation of eye movements and physiological measures during real social interactions. Considering the wealth of conflicting findings on gaze behavior in social anxiety, the current study aimed at elucidating the modulation of gaze patterns in a naturalistic setting.

METHODS

We introduced 71 participants with differing social anxiety symptoms to a waiting room situation while recording heart rate, electrodermal activity and eye movements using mobile technology.

RESULTS

We observed fewer fixations on the head of the confederate in the initial waiting phase of the experiment. These head fixations increased when the confederate was involved in a phone call and subsequently initiated an actual conversation. Contrary to gaze-avoidance models of social anxiety, we did not observe any correlations between social anxiety and visual attention but an elevated heart rate in participants with high social anxiety.

LIMITATIONS

Although social anxiety varied considerably in the current sample and reached clinically relevant levels in one third of participants, formal clinical diagnoses were not available.

CONCLUSIONS

The current findings suggest that gaze avoidance might only occur in specific situations or very high levels of social anxiety. Fear of eye contact could at times represent a subjectively experienced rather than an objectively measurable feature of the disorder. The observation of elevated heart rate throughout the entire experiment indicates that physiological hyperactivity might constitute a cardinal feature of social anxiety.

Attention allocation in posttraumatic stress disorder: an eye-tracking study

BACKGROUND

Eye-tracking-based attentional research implicates sustained attention to threat in posttraumatic stress disorder (PTSD). However, most of this research employed small stimuli set-sizes, small samples that did not include both trauma-exposed healthy participants and non-trauma-exposed participants, and generally failed to report the reliability of used tasks and attention indices. Here, using an established eye-tracking paradigm, we explore attention processes to different negatively-valenced cues in PTSD while addressing these limitations.

METHODS

PTSD patients (n = 37), trauma-exposed healthy controls (TEHC; n = 34), and healthy controls (HC; n = 30) freely viewed three blocks of 30 different matrices of faces, each presented for 6 s. Each block consisted of matrices depicting eight negatively-valenced faces (anger, fear, or sadness) and eight neutral faces. Gaze patterns on negative and neural areas of interest were compared. Internal consistency and test-retest reliability were evaluated for the entire sample and within groups.

RESULTS

The two trauma-exposed groups dwelled longer on negatively-valenced faces over neutral faces, while HC participants showed the opposite pattern. This attentional bias was more prominent in the PTSD than the TEHC group. Similar results emerged for first-fixation dwell time, but with no differences between the two trauma-exposed groups. No group differences emerged for first-fixation latency or location. Internal consistency and 1-week test-retest reliability were adequate, across and within groups.

CONCLUSIONS

Sustained attention on negatively-valenced stimuli emerges as a potential target for therapeutic intervention in PTSD designed to divert attention away from negatively-valenced stimuli and toward neutral ones.

Self-focused attention vs. negative attentional bias during public speech task in socially anxious individuals

Enhanced self-focused attention (SFA) and negative attentional bias (NAB) towards social cues are characteristic hallmarks of social anxiety. It is essential to investigate these two attentional phenomena under socially relevant situations using comparable stimuli. In the present study, individuals with high social anxiety (HSA, n = 32) and low social anxiety (LSA, n = 29) were compared according to their attention toward self-related stimuli and toward positive, neutral, and negative feedback related stimuli. Video stimuli of moving indicators of self-anxiety-status and positive, neutral, and negative feedback from an audience were presented during an impromptu speech task (high anxiety condition) and a re-watching phase (low anxiety condition). Eye movements in response to the different stimuli served as readouts for attentional preference. An interaction effect suggested that the HSA group directed more attention to self-related stimuli relative to other stimuli and the LSA group only during the high anxiety condition. The LSA group exhibited a general attentional preference toward positive feedback, especially during the low anxiety condition. Meanwhile, only the total duration of fixation on positive feedback negatively correlated with subjective anxiety rating. Our results point to increased SFA rather than NAB in HSA individuals under social threats.

The structure of social-evaluative threat detection in social anxiety disorder

The integrated aetiological and maintenance (IAM) model of social anxiety disorder (SAD) conceptualises four social-evaluative cognitive processes (anticipatory processing, attention to the self, attention to threat in the environment, and post-event processing) as facets of a social-evaluative threat detection construct. The current study tested this by examining potential factor structures underlying the four social-evaluative cognitive processes. Baseline data from two randomised controlled trials, consisting of 306 participants with SAD who completed measures of the four social-evaluative cognitive processes in relation to a speech task, were subjected to confirmatory factor analysis. Model fit indices and bifactor model indices showed that the optimal factor structure was a bifactor model with a Social-evaluative Threat Detection General Factor and two group factors corresponding to anticipatory processing and post-event processing. Analyses also indicated that the Social-evaluative Threat Detection General Factor had moderate to large associations with other constructs in the IAM model, whereas the two group factors only had small associations with these constructs. These findings suggest that the four social-evaluative cognitive processes can be unified as facets of a social-evaluative threat detection process, consistent with the IAM model, although group factors for anticipatory processing and post-event processing need to be taken into account.

Pain-related attentional processes: A systematic review of eye-tracking research

Biases in the way that people direct their attention towards or away from pain-related information are hypothesised to contribute to the onset and severity of pain-related disorders. This systematic review summarised 24 eye-tracking studies (N = 1424) examining effects of chronic pain, stimulus valence, individual differences in pain-related constructs such as fear of pain and pain catastrophising, and experimentally-induced pain or pain-related threat on attentional processing of visual stimuli. The majority of studies suggest that people with and without chronic pain do not differ in their eye movements on pain-related stimuli, although there is preliminary evidence that gaze biases vary across subtypes of chronic pain and may be evident only for certain stimuli. In contrast, participants with and without chronic pain exhibit a general tendency to allocate more first fixations and total fixations upon pain-related compared to neutral stimuli. Fear of pain was found to have limited effects on eye movements, whereas the tendency to catastrophise about pain, the anticipation of pain, and actual experimental pain stimulation have had stronger associations with eye movements, although results have been mixed. Methodological limitations and future research directions are discussed.

A systematic review of visual avoidance of faces in socially anxious individuals: Influence of severity, type of social situation, and development

Although visual avoidance of faces is a hallmark feature of social anxiety disorder (SAD) on clinical and theoretical grounds, empirical support is equivocal. This review aims to clarify under which conditions socially anxious individuals display visual avoidance of faces. Through a systematic search in Web of Science and PubMed up to March 2019 we identified 61 publications that met the inclusion criteria. We discuss the influence of three factors on the extent to which socially anxious individuals avoid looking at faces: (a) severity of social anxiety symptoms (diagnosed SAD versus High Social Anxiety levels in community samples [HSA] or related characteristics [Shyness, Fear of Negative Evaluation]), (b) three types of social situation (computer facial-viewing tasks, speaking tasks, social interactions), and (c) development (age-group). Adults with SAD exhibit visual avoidance across all three types of social situations, whereas adults with HSA exhibit visual avoidance in speaking and interaction tasks but not in facial-viewing tasks. The relatively few studies with children and adolescents suggest that visual avoidance emerges during adolescence. The findings are discussed in the context of cognitive-behavioral and skills-deficit models. Suggestions for future research include the need for developmental studies and more fine-grained analyses of specific areas of the face.

Avoidance of all feedback? Attention allocation during and after public speech in social anxiety

BACKGROUND AND OBJECTIVES

Attention avoidance of feedback-related stimuli is proposed to be associated with and maintain social anxiety. However, previous research has mainly focused on comparing the attention bias between two types of stimuli, while little is known about attention distribution patterns among positive, neutral, and negative feedback and non-feedback stimuli in individuals with high trait social anxiety (HSA) or low trait social anxiety (LSA).

METHODS

The current study assessed eye movement pattern of participants with HSA or LSA during a speech task (high anxiety condition) or while solely watching audience feedback of the speech (low anxiety condition). A pre-recorded audience who displayed approving, neutral, or disapproving gestures was presented as feedback stimuli, while neutral facial photos were used as non-feedback stimuli.

RESULTS

Only in the high anxiety condition, participants with HSA exhibited longer total fixation on non-feedback stimuli compared to those with LSA; whereas in the low anxiety condition, both groups paid more attention to emotional feedback stimuli.

LIMITATIONS

The final sample size was modest due to a high suspicion rate of the reality of the audience.

CONCLUSIONS

These findings suggest that only in highly anxious social situations, socially anxious individuals lack the attentional preference toward positive feedback that individuals with low anxious have.

Gaze Behavior in Social Fear Conditioning: An Eye-Tracking Study in Virtual Reality

The vigilance-avoidance hypothesis of selective attention assumes that socially anxious persons initially direct their attention toward fear-related stimuli and subsequently avoid these social stimuli to reduce emotional distress. New technical developments provide tools to implicit measure overt attention on fear-related stimuli via eye-tracking in ecological valid virtual environments presented via a head-mounted display. We examined in 27 low (LSA) and 26 high socially anxious (HSA) individuals fear ratings, physical behavior (duration of approach), hypervigilance (time to first fixation), and attentional avoidance (count of fixations) toward virtual female and male agents (CS) during social fear conditioning (SFC) and extinction in virtual reality (VR). As hypothesized, generally SFC was successfully induced and extinguished concerning the fear ratings. Our findings partly support the vigilance-avoidance hypothesis as HSA directed especially at the first half of the fear acquisition their initial attention more at CS+ than CS- agents, and avoided subsequently the CS+ more than the CS- agents during the fear acquisition. In contrast, in LSA participants initial and sustained attention did not differ between CS+ and CS- agents during fear acquisition. We conclude that HSA individuals guide their initial attention to emotionally threatening stimuli and subsequently avoid the threatening stimuli to possibly reduce their emotional distress, whereas LSA individuals regulate themselves less in their (fear) responses during SFC. Measuring implicit gaze behavior within a well-controlled virtual environment is an interesting innovative tool to in deeply investigate the impact of attention on emotional learning processes.

Visual attention to emotional faces in adolescents with social anxiety disorder receiving cognitive behavioral therapy

Social anxiety disorder (SAD) is a psychiatric condition that often onsets in childhood. Cognitive models underline the role of attention in the maintenance of SAD, but studies on youth populations are few, particularly those using eye tracking to measure attention. Cognitive behavioral therapy (CBT) for SAD includes interventions targeting attention, like exposure to eye contact, but the link between CBT and attention bias is largely unexplored. This study investigated attention bias in youth with SAD and the association with outcome from CBT. Latency to attend to pictures of faces with different emotions (vigilance) and latency to disengage from social stimuli (avoidance) was examined in N = 25 adolescents (aged 13–17) with SAD in relation to treatment outcome. Vigilance was operationalized as the time it took to relocate the gaze from a central position to a peripherally appearing social stimulus. The latency to disengage from a centrally located social stimulus, when a non-social stimulus appeared in the periphery, was used as a proxy for avoidance. Attention characteristics in the SAD group were compared to non-anxious (NA) controls (N = 22). Visual attention was measured using eye tracking. Participants in both the SAD and NA groups were vigilant towards angry faces, compared to neutral and happy faces. Similarly, both groups disengaged attention faster from angry faces. Adolescents with SAD who disengaged faster from social stimuli had less social anxiety after CBT. The results indicate that anxious youth display a vigilant-avoidant attention pattern to threat. However, partly inconsistent with previous research, the same pattern was observed in the NA group.

Socially anxious individuals perform better using low spatial frequency information to process facial expressions and objects

BACKGROUND AND OBJECTIVES

It is well known that socially anxious individuals show biased processing towards threatening faces and better performance with low spatial frequencies information (LSF). It is unclear whether this bias is confined to facial processing or can be extended to other types of information.

METHODS

Two experimental phases involving discrimination tasks considering neutral and angry facial expressions and everyday objects in two different spatial frequency conditions were conducted to compare the performance of "socially and non-socially anxious individuals".

RESULTS

Findings showed that highly socially anxious individuals (HSAi) were faster in decision processing for LSF neutral faces than LSF angry faces and responded more slowly to LSF angry faces than unfiltered angry faces. Moreover, they responded more quickly to LSF object images than low socially anxious individuals (LSAi).

LIMITATIONS

The fact that the participants were not diagnosed with social anxiety disorder limits the relevance of clinical findings. The study is further limited because it compared and contrasted only two emotional expressions and two frequency bands.

CONCLUSIONS

Study results showed that HSAi better process LSF neutral information and that this advantage is not limited to neutral faces alone, but extends across other domains.

Pupil dilation to emotional expressions in adolescent social anxiety disorder is related to treatment outcome

Atypical attention to potential social threats, such as emotional faces, may be one of the core mechanisms underlying social anxiety disorder (SAD). Pupil dilation is an index of locus coreuleus-noradrenergic activity, and closely linked to attention. In the present study, pupil dilation was studied in adolescents with SAD (N = 26; 22 Female) before the onset of a 12-week cognitive behavioral treatment, and in healthy controls (N = 23). Stimuli were faces with angry or happy emotional expressions. Contrary to our hypothesis, the SAD group did not show hyper-responsiveness to angry compared to happy faces. Instead, an atypical time course of the pupil dilation response was found, resulting in an attenuated response during late time stages. Larger pupil dilation amplitude to happy faces before treatment was related to worse treatment response. These results contribute significantly to our understanding of the mechanisms underlying adolescent SAD.

Anxiety-Linked Attentional Bias: Is It Reliable?

There is substantial evidence that heightened anxiety vulnerability is characterized by increased selective attention to threatening information. The reliability of this anxiety-linked attentional bias has become the focus of considerable recent interest. We distinguish between the potential inconsistency of anxiety-linked attentional bias and inconsistency potentially reflecting the psychometric properties of the assessment approaches used to measure it. Though groups with heightened anxiety vulnerability often exhibit, on average, elevated attention to threat, the evidence suggests that individuals are unlikely to each display a stable, invariant attentional bias to threat. Moreover, although existing assessment approaches can differentiate between groups, they do not exhibit the internal consistency or test-retest reliability necessary to classify individuals in terms of their characteristic pattern of attentional responding to threat. We discuss the appropriate uses of existing attentional bias assessment tasks and propose strategies for enhancing classification of individuals in terms of their tendency to display an attentional bias to threat.

A comprehensive evaluation of emotional responsiveness in borderline personality disorder: a support for hypersensitivity hypothesis

BACKGROUND

Many experimental studies have evaluated Linehan's biological emotional vulnerability in Borderline Personality Disorder (BPD). However, some inconsistencies were observed in operationalizing and supporting its components. This study aims at clarifying which aspects of Linehan's model are altered in BPD, considering a multimodal evaluation of processes concerned with emotional responsiveness (self-report, psychophysiology and eye-tracking).

METHODS

Forty-eight socio-emotional pictures were administered to 28 participants (14 BPD, 14 Healthy Controls, HCs), gender- and age-matched, by employing two different lengths of stimuli exposure (5 s and 15 s).

RESULTS

Our results supported the hypersensitivity hypothesis in terms of faster physiological responses and altered visual processing. Furthermore, hypersensitivity was associated with detailed socio-emotional contents. Hyperreactivity assumption was not experimentally sustained by physiological and self-report data. Ultimately, the slow return to emotional baseline was demonstrated as an impaired emotional modulation.

CONCLUSIONS

Our data alternatively supported the hypersensitivity and the slow return to emotional baseline hypotheses, postulated by Linehan's Biosocial model, rather than the hyperreactivity assumption. Results have been discussed in light of other BPD core psychopathological processes.

Eye-tracking research in eating disorders: A systematic review

OBJECTIVE

Those with eating disorders (EDs) show attentional biases to disorder-relevant stimuli, such as food and body shape information. However, attentional bias research in EDs largely relies on reaction time based measures, which are limited in their ability to assess different components and the time course of attention. Eye-tracking paradigms have therefore been utilized to provide greater ecological validity, and directly capture the detailed sequence of processes in perception and attention. While numerous studies have examined eye movements in the mood, anxiety, and psychotic disorders, there has been a lack of studies in EDs. The purpose of this qualitative review is to provide a summary of eye-tracking studies in clinical ED populations.

METHOD

The review was conducted using the PRISMA guidelines. Electronic databases were systematically searched to identify studies examining gaze parameters in ED compared to healthy controls (HCs). Thirty-one studies met inclusion criteria.

RESULTS

Across ED diagnoses, there was evidence of attentional biases towards food and body stimuli. In addition, differential patterns of attention to social information, and differences in smooth pursuit and saccadic eye movements were found in anorexia nervosa (AN).

DISCUSSION

Findings are discussed in relation to research in other psychiatric disorders, and recommendations for future studies using eye-tracking in EDs are given. The findings add to the wider literature on attentional biases in EDs, and provide potential avenues for treatment. IJED-18-0331.R1. Investigación de seguimiento ocular en trastornos de la conducta alimentaria: una revisión sistemática.

Self-report questionnaires, behavioral assessment tasks, and an implicit behavior measure: do they predict social anxiety in everyday life?

Social anxiety is commonly assessed with self-report measures. This study aimed to investigate whether maximum anxiety levels during in vivo and virtual reality behavioral assessment tasks (BATs), and implicit approach-avoidance tendencies during the approach-avoidance task (AAT) explain more variation as predictors of daily social anxiety than self-report measures. A total of 62 university students (Mage = 20.79; SD = 4.91) with high levels of social anxiety completed self-report measures on fear of negative evaluation (FNE-B) as well as fear and avoidance in social situations (Liebowitz social anxiety scale-self report), in vivo and virtual reality BATs, and the AAT (independent variables) in the laboratory. On seven consecutive days, social anxiety, experiential avoidance, and negative social events (dependent variables) were assessed. The results revealed that fear of negative evaluation predicted everyday social anxiety and experiential avoidance. Fear and avoidance in social situations only predicted experiential avoidance. Neither implicit approach-avoidance tendencies during the AAT nor maximum anxiety levels during the in vivo and virtual reality BATs predicted any outcome variable. Our results support the use of self-report questionnaires in the assessment of social anxiety.

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.