Feeling safe but appearing anxious: Differential effects of alcohol on anxiety and social performance in individuals with social anxiety disorder

Impact of eye movements and facial expressions on social performance during a collaborative problem-solving task

Social performance is associated with producing good relationships in social communication. In recent years, there has been a growing emphasis on the importance of collaborative problem- solving in social communication. Aiming to enhance collaborative problem-solving, we investigated the characteristics of behavioral signals that impact social performance. In this paper, we analyzed the eye movements and facial expressions of pairs of participants working on a collaborative problem-solving task online. Our eye movement analysis showed that the lower the percentage of looking at the conversation partner is and the higher the percentage of looking outside is, the lower is the social performance. Our facial expression analysis showed that the lower the intensity of expression is in inner brow raiser, the cheek raiser, and the lip corner puller, the lower is the social performance.

Alcohol outcomes on anxiety, impulsivity and spatial memory: Possible Omega-3 amelioration effects

Alcohol consumption is a worldwide concern that causes 5 % of the global disease burden and contributes to 3 million deaths per year. Several studies suggest an increase in alcohol drinking and alcohol related problems. Alcohol Use Disorder (formerly referred as alcoholism or alcohol addiction) is one of many possible outcomes of an early and prolonged alcohol consumption and it is highly comorbid with anxiety disorders, impulsivity and memory deficits among others. In this review we approach recent data about global and American prevalence of alcohol use and discuss different factors that contribute to alcohol consumption. Furthermore, we revise evidence of ethanol effects on anxiety-like behaviors, impulsivity and spatial memory. Lastly, we look at the Omega-3 fatty acid as a possible course of action in mitigating the aforementioned deleterious effects of alcohol consumption.

Measuring behavioral responses to a social stressor: Does the Social Performance Rating Scale have utility beyond social anxiety disorder?

The observer-rated Social Performance Rating Scale (SPRS) indexes anxious behaviors exhibited in social contexts. Although the SPRS has been used almost exclusively to study social anxiety disorder (SAD), other emotional disorders are also characterized by heightened responses to social stressors, hinting that the SPRS could serve as a transdiagnostic state measure of behavioral anxiety. To explore this possibility, adults with generalized anxiety disorder or major depressive disorder (n = 105) and adults with no psychopathology (n = 35) delivered a speech to a committee of mock behavioral experts. Behavioral anxiety observed during the speech was rated using the SPRS, then examined in relation to clinical and state measures of anxiety and depression. Contrary to our hypotheses, behavioral anxiety was not associated with clinician- or self-rated anxiety or depression severity. Instead, behavioral anxiety was heightened among individuals who specifically fear and avoid public speaking; who perceived the speech task to be more stressful; and who reported more emotional distress, somatic hyperarousal, and anxious and pessimistic thoughts at the time of the speech. The SPRS is a valid measure of anxious behavior in the many individuals, with and without SAD, who experience acute anxiety in social-evaluative contexts. As behavioral measures are resource-intensive to collect, research is needed to establish whether the SPRS predicts anxious behavior and functional impairment in real-world settings, over and above easier-to-obtain self-report measures.

Analysis of Social Performance and Action Units During Social Skills Training: Focus Group Study of Adults With Autism Spectrum Disorder and Schizophrenia

Background

Social communication is a crucial factor influencing human social life. Quantifying the degree of difficulty faced in social communication is necessary for understanding developmental and neurological disorders and for creating systems used in automatic symptom screening and assistive methods such as social skills training (SST). SST by a human trainer is a well-established method. Previous SST used a modified roleplay test to evaluate human social communication skills. However, there are no widely accepted evaluation criteria or social behavioral markers to quantify social performance during SST.

Objective

This paper has 2 objectives. First, we propose applying the Social Performance Rating Scale (SPRS) to SST data to measure social communication skills. We constructed a Japanese version of the SPRS already developed in English and French. Second, we attempt to quantify action units during SST for people with autism spectrum disorder (ASD) or schizophrenia.

Methods

We used videos of interactions between trainers, adults with ASD (n=16) or schizophrenia (n=15), and control participants (n=19) during SST sessions. Two raters applied the proposed scale to annotate the collected data. We investigated the differences between roleplay tasks and participant groups (ASD, schizophrenia, and control). Furthermore, the intensity of action units on the OpenFace toolkit was measured in terms of mean and SD during SST roleplaying.

Results

We found significantly greater gaze scores in adults with ASD than in adults with schizophrenia. Differences were also found between the ratings of different tasks in the adults with schizophrenia and the control participants. Action units numbered AU06 and AU12 were significantly deactivated in people with schizophrenia compared with the control group. Moreover, AU02 was significantly activated in people with ASD compared with the other groups.

Conclusions

The results suggest that the SPRS can be a useful tool for assessing social communication skills in different cultures and different pathologies when used with the modified roleplay test. Furthermore, facial expressions could provide effective social and behavioral markers to characterize psychometric properties. Possible future directions include using the SPRS for assessing social behavior during interaction with a digital agent.

Sociability Alcohol Expectancies Shape Predictions of Drinking Behavior and Anxiety in a Novel Affective Forecasting Task

Background: Existing work proposes that people with higher social anxiety symptoms and sociability alcohol expectancies believe alcohol can lower their anxiety. However, studies have primarily analyzed retrospective reports, not anticipatory motives. Since predictions of future emotion (i.e., affective forecasts) strongly influence behavior, it is critical to understand how people predict alcohol will influence their anxiety. Additionally, intolerance of uncertainty (IU) is related to the use of alcohol as a coping tool, but there is a dearth of work testing whether IU influences alcohol-related forecasts. Objectives: Utilizing a novel affective forecasting task, we tested the prediction that social anxiety symptoms, sociability alcohol expectancies, and IU would relate to predictions about alcohol use. In an initial study and preregistered replication, participants imagined themselves in stressful social scenarios and forecasted how anxious they would feel when drinking and when sober. In the replication, participants also forecasted whether they would drink in the imagined scenarios. Results: Contrary to hypotheses, social anxiety symptoms and IU did not significantly predict higher forecasted anxiety across studies, nor did they predict forecasted drinking. Exploratory analyses showed that participants with higher sociability alcohol expectancies forecasted being more likely to drink, and forecasted feeling less anxious when drinking (versus being sober). Even after statistically controlling for social anxiety, the effect of sociability expectancies remained significant in predicting forecasted anxiety and forecasted drinking. Conclusions: Clinicians could consider specifically targeting sociability expectancies for alcohol use difficulties, and future research should continue utilizing affective forecasting paradigms to test links between social anxiety, alcohol expectancies, and alcohol-use problems.

Social anxiety and alcohol consumption: The role of social context

Research has identified social anxiety as a risk factor for the development of alcohol use disorder. However, studies have produced equivocal findings regarding the relationship between social anxiety and drinking behaviors in authentic drinking environments. This study examined how social-contextual features of real-world drinking contexts might influence the relationship between social anxiety and alcohol consumption in everyday settings. At an initial laboratory visit, heavy social drinkers (N = 48) completed the Liebowitz Social Anxiety Scale. Participants were then outfitted with a transdermal alcohol monitor individually-calibrated for each participant via laboratory alcohol-administration. Over the next seven days, participants wore this transdermal alcohol monitor and responded to random survey prompts (6x/day), during which they provided photographs of their surroundings. Participants then reported on their levels of social familiarity with individuals visible in photographs. Multilevel models indicated a significant interaction between social anxiety and social familiarity in predicting drinking, b = -0.004, p =.003 Specifically, among participants higher in social anxiety, drinking increased as social familiarity decreased b = -0.152, p <.001, whereas among those lower in social anxiety, this relationship was non-significant, b = 0.007, p =.867. Considered alongside prior research, findings suggest that the presence of strangers within a given environment may play a role in the drinking behavior of socially anxious individuals.

The Influence of Alcohol on Rumination and Metacognitions in Major Depressive Disorder

Background and Objectives

Comorbidity between major depressive disorder (MDD) and alcohol use disorder (AUD) is highly prevalent but reasons for this association are unclear. Rumination may activate metacognitive beliefs that contribute to the development and maintenance of rumination and depression. Negative metacognitions can further lead to other dysfunctional coping strategies (i.e., consumption of alcohol). We examined whether alcohol reduces (state) metacognitions, rumination and other disorder-specific processes in a group of individuals suffering from MDD.

Method

In an experiment with three randomized conditions we investigated whether the consumption of alcohol, placebo or no alcohol (orange juice) affects (meta-)cognitions, depressive symptoms and / or psychophysiological variables while participants ruminate.

Results

Voluntary rumination increased self-reported sadness, tension and rumination, tensed facial muscles and increased heart rate, but did not affect (state) metacognitions and heart rate variability. The consumption of alcohol did not influence rumination, metacognitions, depressive or psychophysiological measures.

Limitations

We recruited a depressed population but excluded pathological alcohol use due to ethical considerations.

Conclusions

We found no evidence that alcohol consumption affects rumination, metacognitions and other disorder-specific processes in MDD. However, rumination had a negative effect on various depression-specific processes, although it did not activate (negative state) metacognitions.

Motives and Consequences of Alcohol Use in People With Social Anxiety Disorder: A Daily Diary Study

People with social anxiety disorder (SAD) are at increased risk for alcohol-related problems. Most research exploring social anxiety and alcohol use has examined negative drinking consequences, with less consideration of positive consequences-namely positive social experiences-that may reinforce alcohol use. In this daily diary study, we examined how adults diagnosed with SAD (N = 26) and a psychologically healthy control group (N = 28) experienced positive drinking consequences in naturally occurring drinking episodes during the study period. For 14 consecutive days, participants answered questions about alcohol use, motives for drinking, and positive consequences of drinking. On days when participants drank, those with SAD were more likely than healthy controls to perceive a reduction in anxiety, but the two groups did not differ in their likelihood of experiencing positive social drinking consequences. For both groups, on days when they were more motivated to drink to enhance social experiences (affiliation motives) or cope with distress (coping motives), they were more likely to obtain positive consequences from drinking. Compared to controls, participants with SAD endorsed stronger trait and daily coping motives (anxiety-coping, social anxiety-coping, and depression-coping). Results are discussed in the context of reinforcement mechanisms that may maintain social anxiety and alcohol use.

Biopsychosocial Model Social Anxiety and Substance Use Revised

PURPOSE OF REVIEW

To review data published in the past 5 years to evaluate the utility of our biopsychosocial model of social anxiety's relation to substance misuse to evaluate the model's utility and update it.

RECENT FINDINGS

Data support the utility of our revised model-e.g., socially anxious persons report using substances to manage subjective anxiety, despite evidence that some substances may not have a direct effect on physiological responding. Other factors with promise include social influence, cognitive processes (e.g., post-event processing), and avoidance. Data highlight the importance of context as socially anxious persons use some substances more in some high-risk situations, despite lack of relation between social anxiety and use generally. Sociocultural factors remain understudied. This updated model is a theory- and data-driven model of the relations between social anxiety and substance misuse that can inform future work to improve substance-related outcomes among this especially vulnerable group.

Effects of conditioned social fear on ethanol drinking and vice-versa in male mice

RATIONALE

Social anxiety disorder (SAD) is highly comorbid with alcohol use disorders, but the complex relationship between social fear and alcohol drinking is poorly understood due to the lack of specific animal models.

OBJECTIVES

We investigated whether social fear alters ethanol drinking under both stress-free and stress-inducing conditions and whether ethanol alleviates symptoms of social fear.

METHODS

We used the social fear conditioning (SFC) paradigm, an animal model with face and predictive validity to SAD, to induce specific social fear in male CD1 mice, i.e., without comorbid depression or anxiety-like behavior. Plasma corticosterone (CORT) levels were measured in conditioned (SFC⁺) and unconditioned (SFC^-) mice after exposure to non-social or social stimuli. Ethanol drinking was assessed in the two-bottle free-choice paradigm (1) for 16 days under stress-free conditions and (2) for 6 h after exposure to social stimuli. The effects of ethanol drinking and social fear on anxiety-like behavior and taste preference were tested in the elevated plus-maze and sucrose and quinine preference tests.

RESULTS

We show that exposure to social but not non-social stimuli leads to higher plasma CORT levels in SFC⁺ compared with SFC^- mice. We also show that social fear decreases voluntary ethanol consumption under stress-free conditions, but increases ethanol consumption after exposure to social stimuli. Ethanol drinking, on the other hand, reduces social fear without altering anxiety-like behavior, locomotor activity, and taste preference.

CONCLUSIONS

These results have important clinical connotations as they suggest that voluntary ethanol drinking might specifically reverse symptoms of social fear in a SAD-relevant animal model.

Polysubstance use by psychiatry inpatients with co-occurring mental health and substance use disorders

BACKGROUND

Polysubstance use, the consumption of more than one substance over a defined period, is common and associated with psychiatric problems and poor treatment adherence and outcomes. This study examined past-month polysubstance use at intake among psychiatry inpatients with co-occurring mental health and substance use disorders, and outcomes 3 months later.

METHODS

Participants (n=406 psychiatry inpatients with documented mental health and substance use disorders) completed a baseline and a 3-month follow-up (84%) interview. With baseline data, a latent class analysis was conducted on substances used in the past 30days. Analyses of covariance tested for differences among classes on outcomes at 3-month follow-up.

RESULTS

At baseline, three classes were estimated: Cannabis+Alcohol (35.1%), Alcohol (49.3%), and Polysubstance, notably, cocaine plus alcohol and marijuana (15.7%). At follow-up, the Polysubstance class had more severe alcohol and drug use, support for abstinence, and motivation for help-seeking, but less abstinence self-efficacy; it was most likely to attend 12-step groups. The Cannabis+Alcohol class was least likely to obtain outpatient substance use treatment, and had the lowest percent days abstinent.

CONCLUSIONS

Psychiatry inpatients with co-occurring substance use and mental health disorders have varying substance use patterns that correspond to substance-related outcomes concurrently and over time. Many patients achieved abstinence for most days of the 3-month post-hospitalization period. To further increase abstinence, providers could build on polysubstance-using patients' high motivation to increase self-efficacy. In addition, because patients using mainly cannabis plus alcohol may perceive little harm from cannabis use, providers may consider modifying risk perceptions through effective education.