Gaze avoidance in social phobia: objective measure and correlates. Behav Res Ther. 2010;48:147-151. [PMID: 19863948 DOI: 10.1016/j.brat.2009.09.012]

Early hypervigilance and sustained attention for the eye region in adolescents with social anxiety disorder

Social anxiety disorder (SAD) is a highly prevalent and debilitating affliction that typically manifests during childhood and adolescence. While theoretical models of adult SAD emphasize the role of attentional biases, little is known about maintaining factors during childhood and adolescence. The objective of our eye-tracking study was to determine whether youth with SAD exhibit a hypervigilance-avoidance pattern of visual attention for faces. To this end, we used a free-viewing paradigm to present angry, happy, and neutral faces, and non-social object stimuli to three groups of adolescents aged 10-15 years: SAD (n = 57), specific phobia (SP; n = 41), and healthy controls (HC; n = 65). A screen-based eye tracker recorded gaze behavior and pupil dilation. Among participants, only older adolescents with SAD exhibited shorter latencies of first fixation to the eye region compared to HC. Contrary to our expectations, there were no differences in duration of first fixation to the eye region among the groups. Instead, compared to HC, older adolescents with SAD showed longer dwell times on the eye region during the first 1000 - 3000 ms of stimulus presentation. No significant differences among the groups were found regarding scanpath length or pupillary reactivity. Taken together, our findings suggest early hypervigilance followed by sustained attention to the eye region in older adolescents with SAD, which may indicate difficulties in disengaging attention. We discuss the theoretical and practical implications in detail.

Impaired Social Attention and Cognitive Empathy in a Paediatric Sample of Children with Symptoms of Anxiety

Impairments in social cognition, in particular empathy, have been associated with childhood psychopathology, though previous investigations have yielded inconsistent results. Measures of social attention can reveal processes involved in responses to emotional stimuli and highlight deficits in empathy, or emotional biases in those with anxiety. The current study examined symptoms of anxiety, cognitive and affective empathy scores, and eye-gaze patterns in a pediatric sample of children (n = 178; 51-98 months-old) referred by their teachers for emerging psychopathology symptoms at school. We used eye-tracking metrics to capture gaze patterns during a dynamic video task designed to elicit empathic responses. Anxiety symptomology was reported by parents using the Screen for Child Anxiety Related Disorders scale (SCARED). Associations between eye-tracking variables, cognitive and affective empathy, and anxiety scores were analysed dimensionally in accordance with the Research and Domain Criteria (RDoC) framework. Higher levels of anxiety were associated with lower cognitive empathy and shorter first and total fixation durations to the eyes, across emotions (happiness, sadness, fear). No such associations were found between affective empathy and anxiety. Hierarchical multiple regression analyses revealed that across emotion conditions, first fixation duration negatively predicted anxiety scores. Our results indicate that children high in anxiety display cognitive empathy impairments and shorter attention to the eyes. These findings could inform early intervention programs for individuals at risk of developing anxiety disorders, as educating those high in anxiety on ways to identify emotions in others through changes in social attention could help to reduce 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.

Mutual eye gaze and vocal pitch in relation to social anxiety and depression: A virtual interaction task

BACKGROUND

Individuals with high social interaction anxiety (SIA) and depression often behave submissively in social settings. Few studies have simultaneously examined the associations between objectively assessed submissive behaviors and SIA or depression, despite their high comorbidity and unknown mechanisms regarding submissiveness.

METHODS

A sample of 45 young adults self-reported trait SIA and depression, state positive/negative affect (PA/NA) before and after a virtual social interaction. Participants engaged in a four-minute conversation with a confederate who was trained to behave neutrally. Mutual eye gaze, via eye-tracking, and vocal pitch were assessed throughout the interaction.

RESULTS

Depression and SIA were positively correlated with NA, poorer self-rated performance, and vocal pitch. Highly socially anxious women engaged in less mutual eye gaze than highly socially anxious men. Also, vocal pitch was inversely associated with mutual eye gaze and positively related to NA and (nonsignificantly) to self-ratings of poor performance. Finally, our data partially replicated past research on the use of vocal pitch during social stress to detect social anxiety disorder.

LIMITATIONS

The current sample is relatively homogenous in educational attainment, age, and race. All research confederates were women. Future research should examine whether these archival data replicate with the latest telecommunication technologies.

CONCLUSION

Our findings highlight nuanced relationships among SIA, depression, emotions, self-perceptions, and biobehavioral indicators of submissive behavior-in response to an ambiguously negative/positive social interaction. Sex/gender may interact with these effects, emphasizing considerations for research method designs.

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.

Attention to faces in images is associated with personality and psychopathology

Humans show a robust tendency to look at faces in images, but also differ consistently in the strength of this attentional preference. Previous research remained inconclusive as to how a stronger face preference may be indicative of an individual's personality or clinical characteristics. Here we investigated face preferences in 120 participants (primarily drawn from a student population) who freely viewed photos in an internet browser showing a person in the context of a visually rich environment while attention was assessed using a cursor-based technique. Participants differed consistently in the strength of their face preference across images. A stronger preference for faces was correlated positively with openness to experience, extraversion, agreeableness and empathizing and was correlated negatively with social anxiety, depression levels and alexithymia. Trait measures were linked through a strong common factor which was additionally correlated with face preference. We conclude that face preferences may be linked to personality traits and to psychopathology but that an attribution to a specific facet of psychopathology may not be warranted. Future research should investigate links between face preferences and personality features in more diverse samples and across differing social situations.

Candidate Biological Markers for Social Anxiety Disorder: A Systematic Review

Social anxiety disorder (SAD) is a common psychiatric condition associated with a high risk of psychiatric comorbidity and impaired social/occupational functioning when not promptly treated. The identification of biological markers may facilitate the diagnostic process, leading to an early and proper treatment. Our aim was to systematically review the available literature about potential biomarkers for SAD. A search in the main online repositories (PubMed, ISI Web of Knowledge, PsychInfo, etc.) was performed. Of the 662 records screened, 61 were included. Results concerning cortisol, neuropeptides and inflammatory/immunological/neurotrophic markers remain inconsistent. Preliminary evidence emerged about the role of chromosome 16 and the endomannosidase gene, as well as of epigenetic factors, in increasing vulnerability to SAD. Neuroimaging findings revealed an altered connectivity of different cerebral areas in SAD patients and amygdala activation under social threat. Some parameters such as salivary alpha amylase levels, changes in antioxidant defenses, increased gaze avoidance and QT dispersion seem to be associated with SAD and may represent promising biomarkers of this condition. However, the preliminary positive correlations have been poorly replicated. Further studies on larger samples and investigating the same biomarkers are needed to identify more specific biological markers for SAD.

Gaze direction as a facial cue of memory retrieval state

Gaze direction is a powerful social cue that indicates the direction of attention and can be used to decode others' mental states. When an individual looks at an external object, inferring where their attention is focused from their gaze direction is easy. But when people are immersed in memories, their attention is oriented towards their inner world. Is there any specific gaze direction in this situation, and if so, which one? While trying to remember, a common behavior is gaze aversion, which has mostly been reported as an upward-directed gaze. Our primary aim was to evaluate whether gaze direction plays a role in the inference of the orientation of attention-i.e., external vs. internal-in particular, whether an upward direction is considered as an indicator of attention towards the internal world. Our secondary objective was to explore whether different gaze directions are consistently attributed to different types of internal mental states and, more specifically, memory states (autobiographical or semantic memory retrieval, or working memory). Gaze aversion is assumed to play a role in perceptual decoupling, which is supposed to support internal attention. We therefore also tested whether internal attention was associated with high gaze eccentricity because the mismatch between head and eye direction alters visual acuity. We conducted two large-sample (160-163 participants) online experiments. Participants were asked to choose which mental state-among different internal and external attentional states-they would attribute to faces with gazes oriented in different directions. Participants significantly associated internal attention with an upward-averted gaze across experiments, while external attention was mostly associated with a gaze remaining on the horizontal axis. This shows that gaze direction is robustly used by observers to infer others' mental states. Unexpectedly, internal attentional states were not more associated with gaze eccentricity at high (30°) than low (10°) eccentricity and we found that autobiographical memory retrieval, but not the other memory states, was highly associated with 10° downward gaze. This reveals the possible existence of different types of gaze aversion for different types of memories and opens new perspectives.

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.

An experimental test of the effects of acute sleep deprivation on affect and avoidance

BACKGROUND AND OBJECTIVES

Avoidance and sleep have been identified as mechanisms involved in the development and maintenance of many mental health disorders. However, there has been little research into the relation between sleep and avoidance.

METHODS

To address this, a randomized controlled experiment using behavioral and self-report measures of affect and avoidance was conducted. Compared to a control group, we hypothesized that sleep-deprived individuals would demonstrate increased negative, and decreased positive, affectivity, more avoidance behavior toward a negatively valenced stimulus, as well as increased self-reported avoidance. Fifty-two healthy individuals ages 18-30 years old were randomly assigned to a full night of sleep deprivation or normal sleep. They completed a baseline and post-manipulation behavioral avoidance task (BAT) using a disgusting stimulus and self-reports of avoidance and state affect.

RESULTS

Repeated measures ANOVAs demonstrated negative affectivity and self-reported avoidance increased, and positive affectivity decreased, from pre-to post-manipulation in the sleep loss condition as expected. However, there were no effects of sleep deprivation on avoidance behaviors.

LIMITATIONS

This study emphasized internal validity over generalizability. Additionally, the at-home sleep deprivation limited researcher control over the overnight activities of participants.

CONCLUSIONS

Results replicate prior work on the affective consequences of sleep deprivation and highlight a discrepancy between the effect of sleep deprivation on behavioral avoidance toward a specific stimulus compared to self-reported cognitive and social avoidance behaviors.

Emotional Threat Perception and Its Association with Neurocognition in Social Anxiety Disorder

BACKGROUND

The negative appraisal of emotional stimuli is a feature of social anxiety disorder (SAD). People with SAD demonstrate deficits in neurocognitive performance while performing tasks of attention. However, the relationship between attentional control, working memory, and threat perception in SAD has not been studied well. The present study aimed to identify patterns of threat perception in relation to performance on attention and visuospatial working memory tasks in individuals with SAD.

METHODS

Subjects with SAD (n = 27) and a healthy comparative (HC) group (n = 26) completed tasks of sustained and focused attention, visuospatial working memory, computerized emotion identification, and pictorial emotional Stroop.

RESULTS

The SAD group had decreased performance in the domains of sustained (P = 0.001) and focused attention (P = 0.04). They also had an enhanced threat perception as demonstrated by greater reaction time to anger (P = 0.03), lower emotion recognition accuracy (P = 0.05), and higher over-identification of the threat to neutral and nonthreatening faces. However, the Stroop effect was not demonstrated across the groups. No group difference was seen in the performance on the visuospatial working memory tasks. Lower focused attention was significantly correlated with higher emotional threat perception (ETP; P = 0.001) in the SAD group.

CONCLUSION

People with SAD have greater deficits in attention processing and ETP. The attention deficits were associated with enhanced ETP in social anxiety. The link between threat perception and cognitive functions would aid in a better understanding of SAD and in planning appropriate intervention.

Am I really seeing what's around me? An ERP study on social anxiety under speech induction, uncertainty and social feedback

Cognitive models of social anxiety propose that socially anxious individuals engage in excessive self-focusing attention when entering a social situation. In the present study, speech anxiety was induced to socially anxious and control participants. Event-related potentials were recorded while participants performed a perceptual judgment task using distinct or ambiguous stimuli, before and after social feedback. Disputed feedback led to more revisions and decreased levels of confidence, especially among socially anxious individuals. Prior feedback, greater occipital P1 amplitudes in both groups for ambiguous probes indicated heightened sensory facilitation to ambiguous information, and greater anterior N1 amplitudes for ambiguous stimuli in highly anxious participants suggested anticipation of negative feedback in this group. Post-feedback, P1, N1 and LPP amplitudes were reduced overall among socially anxious individuals indicating a reduction in sensory facilitation of visual information. These results suggest excessive self-focusing among socially anxious individuals, possibly linked to anticipation of an anxiety-provoking social situation.

Frozen with Fear? Attentional Mechanisms in Children with Selective Mutism

Background

Children with selective mutism (SM) are consistently unable to speak in certain social situations. Due to an overlap between SM and social anxiety disorder (SAD) in children, similar mechanisms could apply to both disorders. Especially biased attentional processing of threat and fear-induced reduced visual exploration (referred to as attentive freezing) appear promising in SM.

Methods

A total of N = 84 children (8–12 years, SM: n = 28, SAD: n = 28, typical development (TD): n = 28) participated in an eye-tracking paradigm with videos of a social counterpart expressing a question, a social evaluation or a neutral statement. We investigated gaze behavior towards the social counterpart’s eye-region and the extent of visual exploration (length of scanpath), across conditions.

Results

There were no group differences regarding gaze behavior on the eye region. Neither gaze behavior with respect to the eye region nor visual exploration were dependent on the video condition. Compared to children with TD, children with SM generally showed less visual exploration, however children with SAD did not.

Conclusion

Reduced visual exploration might be due to the mechanism of attentive freezing, which could be part of an extensive fear response in SM that might also affect speech-production. Interventions that counteract the state of freezing could be promising for the therapy of SM.

Avoidance behaviour generalizes to eye processing in posttraumatic stress disorder

BACKGROUND

Avoidance describes any action designed to prevent an uncomfortable situation or emotion from occurring. Although it is a common reaction to trauma, avoidance becomes problematic when it is the primary coping strategy, and plays a major role in the development and maintenance of posttraumatic stress disorder (PTSD). Avoidance in PTSD may generalize to non-harmful environmental cues that are perceived to be unsafe.

OBJECTIVE

We tested whether avoidance extends to social cues (i.e. emotional gazes) that are unrelated to trauma.

METHOD

A total of 159 participants (103 who had been exposed to the 2015 Paris terrorist attacks and 56 who had not) performed a gaze-cueing task featuring sad, happy and neutral faces. Attention to the eye area was recorded using an eyetracker. Of the exposed participants, 52 had been diagnosed with PTSD (PTSD+) and 51 had not developed PTSD (PTSD-). As a result of the preprocessing stages, 52 PTSD+ (29 women), 50 PTSD- (20 women) and 53 nonexposed (31 women) participants were included in the final analyses.

RESULTS

PTSD+ participants looked at sad eyes for significantly less time than PTSD- and nonexposed individuals. This effect was negatively correlated with the intensity of avoidance symptoms. No difference was found for neutral and happy faces.

CONCLUSIONS

These findings suggest that maladaptive avoidance in PTSD extends to social processing, in terms of eye contact and others' emotions that are unrelated to trauma. New therapeutic directions could include targeting sociocognitive deficits. Our findings open up new and indirect avenues for overcoming maladaptive avoidance behaviours by remediating eye processing.Trial registration: ClinicalTrials.gov identifier: NCT02810197.

HIGHLIGHTS

Avoidance is a key symptom of posttraumatic stress disorder (PTSD).Avoidance is often viewed as limited to reminders linked to the trauma.Results show that attention to the eyes of sad faces is also affected by PTSD. This effect is correlated with avoidance symptoms in PTSD.

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.

Impact of Face Masks and Viewers' Anxiety on Ratings of First Impressions from Faces

Face mask is now a common feature in our social environment. Although face covering reduces our ability to recognize other's face identity and facial expressions, little is known about its impact on the formation of first impressions from faces. In two online experiments, we presented unfamiliar faces displaying neutral expressions with and without face masks, and participants rated the perceived approachableness, trustworthiness, attractiveness, and dominance from each face on a 9-point scale. Their anxiety levels were measured by the State-Trait Anxiety Inventory and Social Interaction Anxiety Scale. In comparison with mask-off condition, wearing face masks (mask-on) significantly increased the perceived approachableness and trustworthiness ratings, but showed little impact on increasing attractiveness or decreasing dominance ratings. Furthermore, both trait and state anxiety scores were negatively correlated with approachableness and trustworthiness ratings in both mask-off and mask-on conditions. Social anxiety scores, on the other hand, were negatively correlated with approachableness but not with trustworthiness ratings. It seems that the presence of a face mask can alter our first impressions of strangers. Although the ratings for approachableness, trustworthiness, attractiveness, and dominance were positively correlated, they appeared to be distinct constructs that were differentially influenced by face coverings and participants’ anxiety types and levels.

Apprehension about the future: Investigating the phenomenological characteristics of episodic future thinking in socially anxious adolescents

BACKGROUND AND OBJECTIVES

Social anxiety is a future-oriented mood characterized by apprehension about others' negative evaluations in anxiety-provoking social situations that may occur in the future. Episodic future thinking (EFT) is a form of future-oriented cognition that allows a pre-experiencing of our personal futures. The literature suggests that anxious individuals show increased negative expectancies about future events. However, few studies have been conducted on EFT in social anxiety. The current study investigated the phenomenological characteristics of EFT in adolescents with high and low social anxiety.

METHODS

Twenty-two high social anxiety (HSA) and 24 low social anxiety (LSA) adolescents simulated one anxiety-provoking social event and one neutral event. They then rated the phenomenological characteristics of the events.

RESULTS

HSA adolescents imagined anxiety-provoking social events from an observer perspective more than LSA adolescents. HSA adolescents also imagined anxiety-provoking social events as more negative and containing less clear contextual details than LSA adolescents. In contrast, no group differences were found for neutral events. Moreover, participants imagined more self-referential information for anxiety-provoking social events than neutral events. HSA participants imagined less other-referential information than LSA participants, regardless of the event type.

LIMITATIONS

This study used a subclinical sample with high and low social anxiety. The sample size was small, and only adolescents aged 15-17 years were included. It is difficult to generalize the present findings across different anxiety-provoking social events. The specificity of EFT was not evaluated.

CONCLUSIONS

Our findings highlight the importance of EFT in the psychopathology of adolescent social anxiety.

Communication Apprehension and Eye Contact Anxiety in Video Conferences Involving Teleoperated Robot Avatars: A Subjective Evaluation Study

Communication apprehension (CA), defined as anxiety in oral communication, and anxiety in eye contact (AEC), defined as the discomfort felt in communication while being stared at by others, limit communication effectiveness. In this study, we examined whether using a teleoperated robot avatar in a video teleconference provides communication support to people with CA and AEC. We propose a robotic telecommunication system in which a user has two options to produce utterance for own responses in online interaction with interviewer i.e., either by a robot avatar that faces the interviewer, or by self. Two imagination-based experiments were conducted, in which a total of 400 participants were asked to watch videos for interview scenes with or without the proposed system; 200 participants for each experiment. The participants then evaluated their impressions by imagining that they were the interviewee. In the first experiment, a video conference with the proposed system was compared with an ordinary video conference, where the interviewer and interviewee faced each other. In the second experiment, it was compared with an ordinary video conference where the interviewer’s attentional focus was directed away from the interviewee. A significant decrease in the expected CA and AEC of participants with the proposed system was observed in both experiments, whereas a significant increase in the expected sense of being attended (SoBA) was observed in the second experiment. This study contributes to the literature in terms of examining the expected impact of using a teleoperated robot avatar for better video conferences, especially for supporting individuals with CA and AEC.

Psychiatric Assessment of Social Impairment Across the Lifespan

Although autism spectrum disorder (ASD) is the prototypical psychiatric disorder of social impairment, several if not most psychiatric disorders are characterized by prominent impairments in social functioning. A challenge in clinically assessing and describing social impairment is that it has been variably defined and can be difficult to measure. In this article we consider the psychiatric differential diagnosis of social impairment within the DSM-5 framework. We describe the features of social impairment in 13 DSM-5 disorders from a developmental perspective and highlight diagnostic factors that differentiate among the disorders, including the main features of social impairment, verbal communication, nonverbal communication, course of social impairment, social cognition, and key features of accompanying neuropsychiatric symptoms. We conclude by describing an approach for assessing social impairment across the lifespan.

Eye Direction Detection and Perception as Premises of a Social Brain: A Narrative Review of Behavioral and Neural Data

The eyes and the gaze are important stimuli for social interaction in humans. Impaired recognition of facial identity, facial emotions, and inference of the intentions of others may result from difficulties in extracting information relevant to the eye region, mainly the direction of gaze. Therefore, a review of these data is of interest. Behavioral data demonstrating the importance of the eye region and how humans respond to gaze direction are reviewed narratively, and several theoretical models on how visual information on gaze is processed are discussed to propose a unified hypothesis. Several issues that have not yet been investigated are identified. The authors tentatively suggest experiments that might help progress research in this area. The neural aspects are subsequently reviewed to best describe the low-level and higher-level visual information processing stages in the targeted subcortical and cortical areas. A specific neural network is proposed on the basis of the literature. Various gray areas, such as the temporality of the processing of visual information, the question of salience priority, and the coordination between the two hemispheres, remain unclear and require further investigations. Finally, disordered gaze direction detection mechanisms and their consequences on social cognition and behavior are discussed as key deficiencies in several conditions, such as autism spectrum disorder, 22q11.2 deletion, schizophrenia, and social anxiety disorder. This narrative review provides significant additional data showing that the detection and perception of someone's gaze is an essential part of the development of our social brain.

Social anxiety tendency and autism spectrum disorder in Japanese adolescence

BACKGROUND

In Japanese high schools, understanding of school non-attendance and students with developmental disabilities, including autism spectrum disorder (ASD), is gradually improving. On the other hand, few people recognize social anxiety disorder (SAD), the onset of which commences during youth. Social anxiety disorder and ASD share various overlapping characteristics but have different diagnostic criteria. The anxiety caused by these disorders sometimes appears as school non-attendance. This study examines the relationship between SAD, ASD, and history of school non-attendance in high school students.

METHODS

One hundred and fifty-eight students at one Japanese high school that accepts school non- attending students were investigated. To understand the features of ASD and how it relates to SAD tendencies, the Liebowitz Social Anxiety Scale - Japanese (LSAS-J) and Autism-Spectrum Quotient - Japanese (AQ-J) were used. Based on the LSAS-J cutoff point, participants were divided into high and low anxiety groups and then data were compared between the two groups. Potential factors associated with a high-SAD trend were evaluated using multivariate logistic regression.

RESULTS

The results showed that students with high ASD scores were more likely to have SAD and that a lack of "social skill," a subscale of ASD, was closely associated with a social anxiety trend. However, the relationship between school non-attendance and social anxiety could not be confirmed.

CONCLUSIONS

Focusing on the lack of social skills in ASD may provide an opportunity to identify students with high SAD tendencies. This study will contribute to the understanding of high school students with high SAD tendencies in Japan.

Experimental control of conflict in a predictive visual probe task: Highly reliable bias scores related to anxiety

Concerns have been raised about the low reliability of measurements of spatial attentional bias via RT differences in dot-probe tasks. The anticipatory form of the bias, directed towards predicted future stimuli, appears to have relatively good reliability, reaching around 0.70. However, studies thus far have not attempted to experimentally control task-related influence on bias, which could further improve reliability. Evoking top-down versus bottom-up conflict may furthermore reveal associations with individual differences related to mental health. In the current study, a sample of 143 participants performed a predictive Visual Probe Task (predVPT) with angry and neutral face stimuli online. In this task, an automatic bias is induced via visually neutral cues that predict the location of an upcoming angry face. A task-relevant bias was induced via blockwise shifts in the likely location of target stimuli. The bias score resulting from these factors was calculated as RTs to target stimuli at locations of predicted but not actually presented angry versus neutral faces. Correlations were tested with anxiety, depression, self-esteem and aggression scales. An overall bias towards threat was found with a split-half reliability of 0.90, and 0.89 after outlier removal. Avoidance of threat in blocks with a task-relevant bias away from threat was correlated with anxiety, with correction for multiple testing. The same relationship was nominally significant for depression and low self-esteem. In conclusion, we showed high reliability of spatial attentional bias that was related to anxiety.

Processing of emotional faces in sexual offenders with and without child victims: An eye-tracking study with pupillometry

Socio-affective dysfunction is a risk-factor for sexual offense recidivism. However, it remains unknown whether men who have sexually offended with and without child victims show differences in eye scan paths and autonomic responsivity while viewing facial expressions of emotion. We examined differences in accuracy of emotion recognition, eye movements, and pupil dilation responses between sex offenders with child victims, sex offenders without child victims, and a group of non-offenders living in the community. Sex offenders without child victims looked for longer at the eyes than sex offenders with child victims and non-offenders. Men without child victims also scored higher for psychopathy linked disinhibition, and these traits were associated with looking longer at the eyes of afraid faces. We found no evidence for group differences in accuracy, visual attention to the mouth, or pupil dilation responses. Our findings have implications for understanding the nature of socio-affective dysfunction in sexual offenders.

Group-level physiological synchrony and individual-level anxiety predict positive affective behaviors during a group decision-making task

Joint performance can lead to the synchronization of physiological processes among group members during a shared task. Recently, it has been shown that synchronization is indicative of subjective ratings of group processes and task performance. However, different methods have been used to quantify synchronization, and little is known about the effects of the choice of method and level of analysis (individuals, dyads, or triads) on the results. In this study, participants performed a decision‐making task in groups of three while physiological signals (heart rate and electrodermal activity), positive affective behavior, and personality traits were measured. First, we investigated the effects of different levels of analysis of physiological synchrony on affective behavior. We computed synchrony measures as (a) individual contributions to group synchrony, (b) the average dyadic synchrony within a group, and (c) group‐level synchrony. Second, we assessed the association between physiological synchrony and positive affective behavior. Third, we investigated the moderating effects of trait anxiety and social phobia on behavior. We discovered that the effects of physiological synchrony on positive affective behavior were particularly strong at the group level but nonsignificant at the individual and dyadic levels. Moreover, we found that heart rate and electrodermal synchronization showed opposite effects on group members' display of affective behavior. Finally, trait anxiety moderated the relationship between physiological synchrony and affective behavior, perhaps due to social uncertainty, while social phobia did not have a moderating effect. We discuss these results regarding the role of different physiological signals and task demands during joint action.

Impact Statement

Despite the inherent multilevel structure of groups, little is known regarding how physiological coupling between group members relates to their behaviors during joint group tasks at multiple levels (individual, dyadic, and group). We showed that the relationship between physiological synchrony and smiling/laughing behaviors made by group members were particularly strong at the group level but nonsignificant at the individual and dyadic levels. By using innovative quantification methods—Multidimensional Recurrence Quantification Analysis—we highlight the importance of modeling data in a way that allows for multilevel considerations within groups.

Attention Deployment to the Eye Region of Emotional Faces among Adolescents with and without Social Anxiety Disorder

BACKGROUND

Avoidance of the eye region, especially of faces showing anger, may maintain social anxiety symptoms by negatively reinforcing expectations and fears associated with social situations. Eye-tracking research, however, has yet to explicitly examine differences in attention allocation to the eye region of emotional faces among adolescents with social anxiety disorder (SAD).

METHODS

Gaze patterns were explored in a sample of youth with and without SAD matched on age and sex.

RESULTS

Adolescents with SAD were quicker to fixate, and maintained their initial gaze longer, to the eye region, regardless of emotion, relative to teens without SAD. Group-level differences also emerged for initial fixation duration directed to the eye region of angry faces (when compared with happy faces).

CONCLUSIONS

These findings suggest that vigilance to the eye region of faces, especially angry faces, (when compared with happy faces) is characteristic of adolescents with SAD. Adolescents with SAD seem drawn to the eye region, more so than teens without SAD.

Gaze aversion in conversational settings: An investigation based on mock job interview

We report the results of an empirical study on gaze aversion during dyadic human-to-human conversation in an interview setting. To address various methodological challenges in assessing gaze-to-face contact, we followed an approach where the experiment was conducted twice, each time with a different set of interviewees. In one of them the interviewer’s gaze was tracked with an eye tracker, and in the other the interviewee’s gaze was tracked. The gaze sequences obtained in both experiments were analyzed and modeled as Discrete-Time Markov Chains. The results show that the interviewer made more frequent and longer gaze contacts compared to the interviewee. Also, the interviewer made mostly diagonal gaze aversions, whereas the interviewee made sideways aversions (left or right). We discuss the relevance of this research for Human-Robot Interaction, and discuss some future research problems.

Meeting another's gaze shortens subjective time by capturing attention

Gaze directed at the observer (direct gaze) is an important and highly salient social signal with multiple effects on cognitive processes and behavior. It is disputed whether the effect of direct gaze is caused by attentional capture or increased arousal. Time estimation may provide an answer because attentional capture predicts an underestimation of time whereas arousal predicts an overestimation. In a temporal bisection task, observers were required to classify the duration of a stimulus as short or long. Stimulus duration was selected randomly between 988 and 1479 ms. When gaze was directed at the observer, participants underestimated stimulus duration, suggesting that effects of direct gaze are caused by attentional capture, not increased arousal. Critically, this effect was limited to dynamic stimuli where gaze appeared to move toward the participant. The underestimation was present with stimuli showing a full face, but also with stimuli showing only the eye region, inverted faces and high-contrast eye-like stimuli. However, it was absent with static pictures of full faces and dynamic nonfigurative stimuli. Because the effect of direct gaze depended on motion, which is common in naturalistic scenes, more consideration needs to be given to the ecological validity of stimuli in the study of social attention.

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.

Delayed gaze shifts away from others' eyes in children and adolescents with social anxiety disorder

BACKGROUND

Social anxiety disorder (SAD) is linked to atypical attention to other's eyes. Empirical literature about this phenomenon in childhood and adolescence is scarce. Previous studies in adults have suggested that SAD may be characterized by either rapid avoidance of eye contact, or by impaired shifting of attention away from eyes once eye contact has been established. SAD has also been linked to quick orienting towards eyes, indicating vigilant monitoring of perceived threat.

METHODS

In the largest eye-tracking study of youth with SAD to date, 10 to 17 year-olds with SAD (n = 88) and healthy controls (n = 62) were primed to look at either the eyes or the mouth of human faces. The latency and likelihood of a first gaze shift from, or to the eyes, was measured.

RESULTS

Individuals with SAD were slower to shift their gaze away from the eye region of faces than controls, but did not differ in orienting toward eyes.

LIMITATIONS

Participants were assessed once after the onset of SAD symptoms, meaning that the longitudinal predictive value of delayed gaze shifts from others' eyes could not be examined.

CONCLUSIONS

Youth with SAD may be impaired in shifting attention from other's eyes. This could contribute to the experience of eye contact as aversive, and may be a maintaining factor of childhood SAD.

No preference for direct versus averted gaze in autistic adults: a reinforced preferential looking paradigm

Background

With the overarching objective to gain better insights into social attention in autistic adults, the present study addresses three outstanding issues about face processing in autism. First, do autistic adults display a preference for mouths over eyes; second, do they avoid direct gaze; third, is atypical visual exploration of faces in autism mediated by gender, social anxiety or alexithymia?

Methods

We used a novel reinforced preferential looking paradigm with a group of autistic adults (n = 43, 23 women) pairwise matched on age with neurotypical participants (n = 43, 21 women). Participants watched 28 different pairs of 5 s video recordings of a speaking person: the two videos, simultaneously displayed on the screen, were identical except that gaze was directed at the camera in one video and averted in the other. After a 680 ms transition phase, a short reinforcement animation appeared on the side that had displayed the direct gaze.

Results

None of the groups showed a preference for mouths over eyes. However, neurotypical participants fixated significantly more the stimuli with direct gaze, while no such preference emerged in autistic participants. As the experiment progressed, neurotypical participants also increasingly anticipated the appearance of the reinforcement, based on the location of the stimulus with the direct gaze, while no such anticipation emerged in autistic participants.

Limitations

Our autistic participants scored higher on the social anxiety and alexithymia questionnaires than neurotypicals. Future studies should match neurotypical and autistic participants on social anxiety and alexithymia and complement questionnaires with physiological measures of anxiety.

Conclusions

The absence of preference for direct versus averted gaze in the autistic group is probably due to difficulties in distinguishing eye gaze direction, potentially linked to a reduced spontaneous exploration or avoidance of the eye region. Social attention and preference for direct versus averted gaze correlated with alexithymia and social anxiety scores, but not gender.

Molecular and neurocircuitry mechanisms of social avoidance

Humans and animals live in social relationships shaped by actions of approach and avoidance. Both are crucial for normal physical and mental development, survival, and well-being. Active withdrawal from social interaction is often induced by the perception of threat or unpleasant social experience and relies on adaptive mechanisms within neuronal networks associated with social behavior. In case of confrontation with overly strong or persistent stressors and/or dispositions of the affected individual, maladaptive processes in the neuronal circuitries and its associated transmitters and modulators lead to pathological social avoidance. This review focuses on active, fear-driven social avoidance, affected circuits within the mesocorticolimbic system and associated regions and a selection of molecular modulators that promise translational potential. A comprehensive review of human research in this field is followed by a reflection on animal studies that offer a broader and often more detailed range of analytical methodologies. Finally, we take a critical look at challenges that could be addressed in future translational research on fear-driven social avoidance.

Neurophysiological correlates of visuospatial attention and the social dynamics of gaze processing

The reflexive orienting response triggered by nonpredictive gaze cues is thought to be driven by a dedicated social neural network responsible for directing attention toward socially salient information. However, atypical processing of eye gaze using concomitant perceptual features has been proposed to underlie attentional orienting in groups with impairments in social cognition. Here, we examined the neurophysiological indices of visuospatial attention during a spatial cueing task, considering individual variability in social cognition in typically developing individuals, and the relative salience of social gaze and perceptual motion cues. We found enhanced neural activation to incongruent cues, wherein modulation of the N2b serves as a marker of the allocation of attention in the spatial domain. Our findings suggest the social gaze cue is less salient for those with greater autistic traits. An attentional bias toward perceptual motion cues correlated with greater social anxiety and alexithymia, and thus may reflect reduced sensitivity to social stimuli. These results provide evidence for likely neurophysiological mechanisms underlying gaze cueing and offer insight into the use of qualitatively different cognitive mechanisms used to access social information. Such paradigms provide potential insight into normative orienting responses reported in atypical groups and would benefit investigations of gaze following abilities in clinical populations.

Understanding visual attention to face emotions in social anxiety using hidden Markov models

Theoretical models propose that attentional biases might account for the maintenance of social anxiety symptoms. However, previous eye-tracking studies have yielded mixed results. One explanation is that existing studies quantify eye-movements using arbitrary, experimenter-defined criteria such as time segments and regions of interests that do not capture the dynamic nature of overt visual attention. The current study adopted the Eye Movement analysis with Hidden Markov Models (EMHMM) approach for eye-movement analysis, a machine-learning, data-driven approach that can cluster people's eye-movements into different strategy groups. Sixty participants high and low in self-reported social anxiety symptoms viewed angry and neutral faces in a free-viewing task while their eye-movements were recorded. EMHMM analyses revealed novel associations between eye-movement patterns and social anxiety symptoms that were not evident with standard analytical approaches. Participants who adopted the same face-viewing strategy when viewing both angry and neutral faces showed higher social anxiety symptoms than those who transitioned between strategies when viewing angry versus neutral faces. EMHMM can offer novel insights into psychopathology-related attention processes.

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.

Culture modulates face scanning during dyadic social interactions

Recent studies have revealed significant cultural modulations on face scanning strategies, thereby challenging the notion of universality in face perception. Current findings are based on screen-based paradigms, which offer high degrees of experimental control, but lack critical characteristics common to social interactions (e.g., social presence, dynamic visual saliency), and complementary approaches are required. The current study used head-mounted eye tracking techniques to investigate the visual strategies for face scanning in British/Irish (in the UK) and Japanese adults (in Japan) who were engaged in dyadic social interactions with a local research assistant. We developed novel computational data pre-processing tools and data-driven analysis techniques based on Monte Carlo permutation testing. The results revealed significant cultural differences in face scanning during social interactions for the first time, with British/Irish participants showing increased mouth scanning and the Japanese group engaging in greater eye and central face looking. Both cultural groups further showed more face orienting during periods of listening relative to speaking, and during the introduction task compared to a storytelling game, thereby replicating previous studies testing Western populations. Altogether, these findings point to the significant role of postnatal social experience in specialised face perception and highlight the adaptive nature of the face processing system.

Therapeutic strategies for social anxiety disorder: where are we now?

Introduction: Classical well-established treatments of social anxiety disorder (SAD) are now complemented by more recent therapeutic strategies. This review aims to summarize available therapies for SAD and discuss recent evidence-based findings on the management of this disorder.Areas covered: Recent guidelines recommend psychotherapy, particularly cognitive-behavioral therapy (CBT), and pharmacotherapy, as first-line treatments of patients with SAD, without a clear superiority of one option over the other. CBT includes classical approaches such as in vivo exposure to social situations and cognitive therapy, but new modalities and techniques have been recently developed: third-wave approaches, internet-delivered therapy, virtual reality exposure, and cognitive bias modification. Selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors have been also extensively studied and shown to be effective in SAD. Two alternative strategies have been developed to treat SAD with disappointing results: cognitive bias modification, and pharmacological augmentation of psychotherapy using D-cycloserine during exposure sessions.Expert opinion: Personalized treatments for SAD patients are now available. Innovative strategies such as online psychotherapy and virtual reality exposure are useful alternatives to CBT and SSRIs. Future developments and optimization of attention bias modification and of pharmacological augmentation of psychotherapy can be promising.

Facial expressions and eye tracking in individuals with social anxiety disorder: a systematic review

Social anxiety disorder (SAD) is characterized by the fear of being judged negatively in social situations. Eye-tracking techniques have been prominent among the methods used in recent decades to investigate emotional processing in SAD. This study offers a systematic review of studies on eye-tracking patterns in individuals with SAD and controls in facial emotion recognition tasks. Thirteen articles were selected from the consulted databases. It was observed that the subjects with SAD exhibited hypervigilance-avoidance in response to emotions, primarily in the case of negative expressions. There was avoidance of conspicuous areas of the face, particularly the eyes, during observations of negative expressions. However, this hypervigilance did not occur if the stimulus was presented in virtual reality. An important limitation of these studies is that they use only static expressions, which can reduce the ecological validity of the results.

Social anxiety modulates visual exploration in real life - but not in the laboratory

In clinical reports, individuals high on social anxiety are often described to avoid gaze at other people, whereas several experimental studies employing images of persons yielded conflicting results. Here, we show that gaze avoidance crucially depends on the possibility of social interactions. We examined gaze behaviour in individuals with varying degrees of social anxiety in real‐life and in a second group of participants using a closely matched laboratory condition. In the real‐life situation, individuals with a higher degree of social anxiety had a reduced bias to look at near persons compared to individuals with a lower degree of social anxiety, while gaze behaviour in the laboratory group was not modulated by social anxiety. This effect was specific to social attention since there was no corresponding effect regarding fixations on objects. The presence of anxiety effects in real‐life but not in the laboratory condition, where participants do not expect to be evaluated by gazed‐at conspecifics, points to critical deficits of current laboratory research paradigms in eliciting authentic social attentional mechanisms, possibly leading to spurious results.

Androstadienone, a putative chemosignal of dominance, increases gaze avoidance among men with high social anxiety

Socially anxious individuals show increased sensitivity toward social threat signals, including cues of dominance. This sensitivity may account for the hypervigilance and gaze avoidance commonly reported in individuals with social anxiety. This study examines visual scanning behavior in response to androstadienone (androsta-4,16,-dien-3-one), a putative chemosignal of dominance. We tested whether exposure to androstadienone would increase hypervigilance and gaze avoidance among individuals with high social anxiety. In a double-blind, placebo-controlled, within-subject design, 26 participants with high social anxiety and 26 with low social anxiety were exposed to androstadienone and a control solution on two separate days. On each day, an eye-tracker recorded their spontaneous scanning behavior while they viewed facial images of men depicting dominant and neutral poses. The results indicate that among participants with high social anxiety, androstadienone increased gaze avoidance by reducing the percentage of fixations made to the eye-region and the total amount of time spent gazing at the eye-region of the faces. Participants with low social anxiety did not show this effect. These findings indicate that androstadienone serves as a threatening chemosignal of dominance, further supporting the link between hypersensitivity toward social threat cues and the perpetuation of social anxiety.

Separate contributions of autistic traits and anxious apprehension, but not alexithymia, to emotion processing in faces

Reduced eye fixation has been commonly reported in autistic samples but may be at least partially explained by alexithymia (i.e., difficulty understanding and describing one’s emotional state). Because anxiety is often elevated in autism, and emotion-processing differences have also been observed in anxious samples, anxiety traits may also influence emotion processing within autism. This study tested the contribution of dimensional traits of autism, anxious apprehension, and alexithymia in mediating eye fixation during face processing. Participants included 105 adults from three samples: autistic adults (AS; n = 30), adults with clinically elevated anxiety and no autism (HI-ANX; n = 29), and neurotypical adults without elevated anxiety (NT; n = 46). Experiment 1 used an emotion identification task with dynamic stimuli, while Experiment 2 used a static luminance change detection task with emotional- and neutral-expression static photos. The emotions of interest were joy, anger, and fear. Dimensional mixed-effects models showed that autism traits, but not alexithymia, predicted reduced eye fixation across both tasks. Anxious apprehension was negatively related to response time in Experiment 1 and positively related to eye fixation in Experiment 2. Attentional avoidance of negative stimuli occurred at lower levels of autism traits and higher levels of worry traits. The results highlight the contribution of autism traits to emotional processing and suggest additional effects of worry-related traits.

Differential impact of trait, social, and attachment anxiety on the stare-in-the-crowd effect

Eye gaze conveys crucial information for social interactions, with straight versus averted gaze triggering distinct emotional and cognitive processes. The "stare-in-the-crowd" effect exemplifies such differential visual processing of gaze direction, in more recent reports also in interaction with head orientation. Besides aiming at replicating the "stare-in-the-crowd" effect by means of an eye gaze by head orientation interaction, the present study intended to for the first time testing its susceptibility to inter-individual differences in trait, social, and attachment anxiety. Our findings reveal a significant relation between the "stare-in-the-crowd" effect and social and attachment, but not trait anxiety, and therefore provide preliminary cues for personality influences on visual processing of eye gaze and head orientation.

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.

Studying "natural" eye movements in an "unnatural" social environment: The influence of social activity, framing, and sub-clinical traits on gaze aversion

Experimental psychologists frequently present participants with social stimuli (videos or pictures) and measure behavioural responses. Such designs are problematic in that they remove the potential for social interaction and inadvertently restrict our eyes multifaceted nature as a tool to both perceive and communicate with others. The aim of this study was to develop a new paradigm within which we can easily and reliably measure the influence of top-down processes (belief), social activity (talking and listening), and possible clinical traits (gaze anxiety, and social interaction difficulties) onto gaze behaviours. Participants were engaged in a "real" or pre-recorded Skype conversation. Findings suggest that participants who believed they were engaging in a real conversation spent less time looking at the speaker's eyes, but no differences were found for dwell time onto the whole face. Within our non-clinical sample, higher levels of gaze anxiety resulted in reduced dwell time onto the whole face but not eyes, whereas social interaction difficulties produced reduced dwell time onto the eyes only. Finally, talking consistently produced reduced dwell time onto the whole face and eyes regardless of any other conditions.

Affective Eye Contact: An Integrative Review

In recent years, many studies have shown that perceiving other individuals' direct gaze has robust effects on various attentional and cognitive processes. However, considerably less attention has been devoted to investigating the affective effects triggered by eye contact. This article reviews research concerning the effects of others' gaze direction on observers' affective responses. The review focuses on studies in which affective reactions have been investigated in well-controlled laboratory experiments, and in which contextual factors possibly influencing perceivers' affects have been controlled. Two important themes emerged from this review. First, explicit affective evaluations of seeing another's direct versus averted gaze have resulted in rather inconsistent findings; some studies report more positive subjective feelings to direct compared to averted gaze, whereas others report the opposite pattern. These contradictory findings may be related, for example, to differences between studies in terms of the capability of direct-gaze stimuli to elicit feelings of self-involvement. Second, studies relying on various implicit measures have reported more consistent results; they indicate that direct gaze increases affective arousal, and more importantly, that eye contact automatically evokes a positively valenced affective reaction. Based on the review, possible psychological mechanisms for the positive affective reactions elicited by eye contact are described.