Emotions in social anxiety disorder: A review

Anger in social anxiety disorder

The present study focused on the emotional experience of anger among individuals with and without social anxiety disorder (SAD). Eighty-eight participants took part in the study, half (n = 44) met diagnostic criteria for SAD and half (n = 44) did not meet criteria for SAD. Participants completed a 21-day experience sampling measurement (ESM) in which they reported on daily social interactions and emotions. Using multilevel linear modeling we found that individuals with SAD experienced more anger compared to individuals without SAD. We also found a Diagnosis × Social Context interaction such that interactions with distant others were associated with elevated anger compared to interactions with close others for individuals with SAD but not for individuals without SAD. Finally, we found that for individuals with SAD (but not those without SAD) anger on a given day (day t) was associated with elevated anxiety on the following day (day t + 1), above and beyond previous anxiety, sadness and guilt (i.e. anxiety, sadness and guilt reported on day t). This suggests that anger may play a unique role in maintaining or exacerbating anxiety among individuals with SAD. Additional implications of our findings for models of psychopathology and for treatment of SAD are discussed.

Exploring joint decision-making and family dynamics to identify barriers and enablers for early adolescent medical circumcision (EAMC) uptake in Zambia for HIV prevention: An innovative methodology

Voluntary medical male circumcision (VMMC) to protect against sexual transmission of HIV is a key part of HIV prevention interventions in 15 priority countries in Southern and Eastern Africa. Ensuring that VMMC programs reach adolescent males is important in countries with large young populations. We designed a methodology to explore the joint decision-making dynamics among caregivers and adolescents aged 10-19, and the drivers and barriers for circumcision, in order to identify levers which can drive uptake of VMMC. Our approach was grounded in behavioral science to address some of the limitations of survey-based research (e.g., the "say-do gap," social desirability bias, respondent fatigue). Our methods included 1) interviews with adolescent boys and their caregivers to understand how adolescents interact with their families, other key stakeholders, and the healthcare system; 2) journey mapping to understand how boys and caregivers move through the stages of progress toward the decision for VMMC, and the influence of context, family, and community members; and 3) Ethnolab, a decision-making game that tests behavioral hypotheses in hypothetical situations mimicking the real-life context of decision-making about VMMC, enabling an understanding of boys' and caregiver's motivators, barriers, and mental models via observation as well as questioning. Factors influencing the decision for VMMC included anticipated pain of the surgical procedure, mistrust about safety, the boy's uncertainty about his caregiver's consent, and caregiver's uncertainty about the adolescent's assent, and caregiver's concern about their adolescent boy's maturity level and ability to deal with VMMC, among others. Conversely, in-group seeking, the belief that being circumcised is appreciated by women, and improved hygiene were among the positive factors motivating decisions for VMMC. Demand generation should involve the whole family unit, encouraging discussion and trust within and among households, and recognizing and addressing the ways decision dynamics change as the boy ages through adolescence.

Atypical subcortical involvement in emotional face processing in major depressive disorder with and without comorbid social anxiety

Previous research on major depressive disorder (MDD) has largely focused on cognitive biases and abnormalities in cortico-limbic circuitry during emotional face processing. However, it remains unclear whether these abnormalities start at early perceptual stages via subcortical pathways and how comorbid social anxiety influences this process. Here, we investigated subcortical mechanisms in emotional face processing using a psychophysical method that measures monocular advantage (i.e., superior discrimination performance when two stimuli are presented to the same eye than to different eyes). Participants included clinical patients diagnosed with MDD (n = 32), patients with MDD comorbid with social anxiety (comorbid MDD-SAD, n = 32), and a control group of healthy participants (HC, n = 32). We assessed monocular advantage across different emotions (neutral, sad, angry) and among groups. Results indicated that individuals with MDD showed a stronger monocular advantage for sad expressions compared to neutral and angry expressions. In contrast, HC and comorbid MDD-SAD groups showed a greater monocular advantage for neural over negative expressions. Cross-group comparisons revealed that MDD group had a stronger monocular advantage for sad expressions than both HC and comorbid MDD-SAD groups. Additionally, self-reported depressive symptoms were positively correlated with monocular advantage for sad expressions, while social anxiety symptoms were negatively correlated with monocular advantage for negative expressions. These findings suggest atypical early perceptual processing of sadness in individuals with MDD via subcortical mechanisms, with comorbid social anxiety potentially counteracting this effect. This study may inform novel interventions targeting sensory processing and expand beyond cognitive bias modification.

Multidisciplinary characterization of embarrassment through behavioral and acoustic modeling

Embarrassment is a social emotion that shares many characteristics with social anxiety (SA). Most people experience embarrassment in their daily lives, but it is quite overlooked in research. We characterized embarrassment through an interdisciplinary approach, introducing a behavioral paradigm and applying machine learning approaches, including acoustic analyses. 33 participants wrote about an embarrassing experience and then, without knowing it prior, had to read it out loud to the conductor. Embarrassment was then examined using two different approaches: Firstly, from a subjective view, with self-report measures from the participants. Secondly, from an objective, machine-learning approach, in which trained models tested the robustness of our embarrassment data set (i.e., prediction accuracy), and then described embarrassment in a dimensional (i.e., dimension: valence, arousal, dominance; VAD) and categorical (i.e., comparing embarrassment to other emotional states) way. The subjective rating of embarrassment was increased after participants read their stories out loud, and participants with higher SA scores experienced higher embarrassment than participants with lower SA scores. The state of embarrassment was predicted with 86.4% as the best of the unweighted average recall rates. While the simple VAD dimensional analyses did not differentiate between the state of embarrassment and the references, the complex emotional category analyses characterized embarrassment as closer to boredom, a neutral state, and less of sadness. Combining an effective behavioral paradigm and advanced acoustic modeling, we characterized the emotional state of embarrassment, and the identified characteristics could be used as a biomarker to assess SA.

Emotional Granularity and Cognitive Reappraisal Affect Social Anxiety and Interpersonal Relationships in Adolescents: A Bayesian Network Analysis

Background: Emotional granularity (EG), the ability to finely distinguish emotional experiences, plays a crucial role in emotion regulation and social interactions. This study measures EG using a standardized experimental procedure and assesses related variables through questionnaires. We employ both undirected graphical Gaussian models (GGM) and directed Bayesian network analysis (NA) to investigate how positive EG (PEG) and negative EG (NEG), in conjunction with emotion regulation, uniquely influences social anxiety and interpersonal relationships. Methods: The sample comprised 407 junior high school students from China, aged 13-14 years old. We utilized the Photo Emotion Differentiation Task (PED task), Emotion Regulation Scale (ERS), Interpersonal Relationship Comprehensive Diagnostic Scale (IRCDS), and Adolescent Social Anxiety Scale (SAS-A) to measure emotional differentiation, emotion regulation, interpersonal relationships, and social anxiety, respectively. Results: The undirected network highlights a pronounced relationship between interpersonal relationships and social anxiety. "Socialization and Friendship Distress" shows the highest expected influence, followed by "Social Avoidance and Distress in General Situations", and "Conversational Distress". Bayesian NA indicates that both PEG and NEG, along with cognitive reappraisal (CR), influence social anxiety and interpersonal relationships. PEG directly affects social anxiety features, whereas NEG is influenced by them. Additionally, females experience more severe issues with interpersonal relationships and social anxiety than males. Conclusion: The study revealed that individuals with lower positive EG directly impact social anxiety and interpersonal issues, and indirectly affect CR. Conversely, negative EG is mainly influenced by social anxiety symptoms and directly affects CR strategies. These findings highlight the importance of EG in adolescent mental health, suggesting that enhancing emotional differentiation could effectively address social anxiety and foster healthier interpersonal relationships.

Social anxiety among young adults in Switzerland: a cross-sectional study on associations with sports and social support

BACKGROUND

This cross-sectional study examined the relationship of sports and perceived social support with social anxiety in young adults. We aimed to find out whether participation in sports and good social support were associated with lower social anxiety symptoms in individuals aged 18-40 years in Switzerland.

METHODS

Participants aged 18-40 years were recruited through an online panel, which included company data pools, mail/email invitations, and social media. The survey included validated instruments: the Social Phobia and Anxiety Inventory (SPAI) for social anxiety, the Physical Activity and Sports Questionnaire (BSA-F) for sports participation, and the German Questionnaire for Social Support (F-SozU). Sociodemographic data and sports duration were also collected, with sports classified by type and duration. We fitted linear regression models to explore associations between social anxiety, sports type, duration, and perceived social support. Analyses were adjusted for sociodemographic characteristics.

RESULTS

A total of 104 participants (51% female; mean age = 30.2 years, SD = 6.2) completed the survey, with 65.4% reporting recent sports participation, averaging 4.5 h/week. Social anxiety scores did not differ significantly across no sport, individual sport, or group sport participants. However, longer sports duration was associated with lower social anxiety scores, even after adjusting for perceived social support and sociodemographic factors. Social support was independently and negatively associated with social anxiety, highlighting its protective role regardless of sport type or duration.

CONCLUSION

Our findings suggest that sports involvement and supportive social networks are associated with lower social anxiety. Sports and social support should be considered to treat social anxiety, along with primary treatments such as psychotherapy and pharmacotherapy.

Screening social anxiety with the Social Artificial Intelligence Picture System

Social anxiety disorder (SAD) is a prevalent anxiety disorder marked by strong fear and avoidance of social scenarios. Early detection of SAD lays the foundation for the introduction of early interventions. However, due to the nature of social avoidance in social anxiety, the screening is challenging in the clinical setting. Classic questionnaires also bear the limitations of subjectivity, memory biases under repeated measures, and cultural influence. Thus, there exists an urgent need to develop a reliable and easily accessible tool to be widely used for social anxiety screening. Here, we developed the Social Artificial Intelligence Picture System (SAIPS) based on generative multi-modal foundation artificial intelligence (AI) models, containing a total of 279 social pictures and 118 control pictures. Social scenarios were constructed to represent core SAD triggers such as fear of negative evaluation, social interactions, and performance anxiety, mapping to specific dimensions of social anxiety to capture its multifaceted nature. Pictures devoid of social interactions were included as a control, aiming to reveal response patterns specific to social scenarios and to improve the system's precision in predicting social anxiety traits. Through laboratory and online experiments, we collected ratings on SAIPS from five dimensions. Machine learning results showed that ratings on SAIPS robustly reflected and predicted an individual's trait of social anxiety, especially social anxiety and arousal ratings. The prediction was reliable, even based on a short version with less than 30 pictures. Together, SAIPS may serve as a promising tool to support social anxiety screening and longitudinal predictions.

Emotion Regulation Under Stress: A Social Processing and Memory Perspective

Research on emotion regulation often focuses on cognitively effortful self-regulation strategies, but exposure to stress has been shown to interfere with the underlying mechanisms supporting such processes. Understanding alternative strategies that potentially bolster emotion regulation under stress is an important topic of investigation. Two potential alternatives involve everyday occurrences of social processing and memory recall. Social support and past emotional experiences may help in guiding us toward appropriate neurophysiological responses through overlapping circuitry with stress and reward systems, while also buttressing cognitive regulation strategies by expanding one's perspective and allowing multiple opportunities to regulate retrospectively. In recognition that ongoing social and emotional events are often at the beginning of a cascade of both emotion regulation and memory processes, this chapter focuses on the emerging role of social relationships and autobiographical memory recall in regulating emotions under stress, highlighting opportunities and challenges associated with this process.

Dating in social anxiety disorder: A daily diary study

Romantic relationships are vital for health, well-being and quality of life, and an increasing percentage of romantic relations begin via use of dating apps and subsequently progress to dates. In the present study we examined dating application use and dates among individuals with SAD (n = 54) and without SAD (n = 54). Our sample included young adults (age range 18 to 33) who were not in a romantic relationship at the time of the study. For both individuals with SAD and without SAD, half of the participants were men, and half were women. We used a daily diary measurement in which participants reported on their dating application use and dates, as well as on concomitant emotions and perceptions for 21 consecutive days. We found that individuals with and without SAD did not differ in the frequency/duration of application use nor in the number of dates attended. However, individuals with SAD experienced dates as more negative compared to individuals without SAD (Cohen's d = 0.65). Interestingly, individuals with SAD did not significantly differ in their experience of dates as positive compared to individuals without SAD. Moreover, use of dating applications/going on dates were associated with increases in shame (Cohen's d = 0.59) and embarrassment (Cohen's d = 0.45) and this was found to a greater extent among individuals with SAD compared to individuals without SAD (Cohen's d = 0.50, 0.39 for shame and embarrassment respectively). Findings are discussed in the context of cognitive behavioral models of SAD and implications for treatment are considered.

Deficits in Emotional Perception-Related Motor Cortical Excitability in Individuals With Trait Anxiety: A Transcranial Magnetic Stimulation Study

Abnormal emotional perception may contribute to emotional dysfunction in individuals with anxiety. This study explored the progression of impaired emotional perception with the deepening of anxiety in individuals with nonclinical trait anxiety, by measuring the motor cortical excitability associated with emotional perception. In total, 87 participants were assigned to a high trait anxiety (n = 27), moderate trait anxiety (n = 30), or low trait anxiety (n = 30) group. Transcranial magnetic stimulation was applied to the right primary motor cortex at 150 ms or 300 ms after the onset of positive, negative, or neutral images, while participants performed an emotion recognition task, and motor-evoked potentials (MEPs) were collected. For participants with low trait anxiety, MEP amplitudes were significantly higher for both negative and positive stimuli than for neutral stimuli. Participants with moderate trait anxiety showed significantly higher MEP amplitudes only for negative stimuli. Participants with high trait anxiety showed no significant difference in MEP amplitudes for positive, negative, and neutral stimuli. Trait anxiety score was negatively correlated with MEP amplitude: For higher trait anxiety scores, MEP amplitudes were correlated with lower emotional perception of positive and negative stimuli. Findings suggest that anxiety impairs emotional perception-related motor cortical excitability, starting with decreased motor cortical excitability responses to positive information and progressing to negative information as anxiety levels increase.

Specificity of cost and probability biases in social anxiety: Comparing status and belongingness threats

BACKGROUND

Social anxiety (SA) is characterized by concerns about the expected occurrence (probability) and anticipated distress (cost) of social threats. Unclear is whether SA correlates specifically with biased expectations of belongingness or status threats.

AIMS

We aimed to discern if SA is uniquely tied to biased expectancies of either belongingness or status threats.

MATERIALS AND METHODS

We assessed 757 participants' perceptions of exclusion and put-down scenarios, analysing associations between SA and threat perceptions.

DISCUSSION

Our findings support the status-sensitivity hypothesis, suggesting individuals with high SA are particularly attuned to the perceived cost of status threats, potentially informing treatment approaches.

CONCLUSION

Understanding SA's link to status concerns enhances therapeutic strategies, emphasizing the need to address status-related situations, cognitions, and emotions in interventions.

Distinct patterns of monocular advantage for facial emotions in social anxiety

Individuals with social anxiety often exhibit atypical processing of facial expressions. Previous research in social anxiety has primarily emphasized cognitive bias associated with face processing and the corresponding abnormalities in cortico-limbic circuitry, yet whether social anxiety influences early perceptual processing of emotional faces remains largely unknown. We used a psychophysical method to investigate the monocular advantage for face perception (i.e., face stimuli are better recognized when presented to the same eye compared to different eyes), an effect that is indicative of early, subcortical processing of face stimuli. We compared the monocular advantage for different emotional expressions (neutral, angry and sad) in three groups (N = 24 per group): individuals clinically diagnosed with social anxiety disorder (SAD), individuals with high social anxiety in subclinical populations (SSA), and a healthy control (HC) group of individuals matched for age and gender. Compared to SSA and HC groups, we found that individuals with SAD exhibited a greater monocular advantage when processing neutral and sad faces. While the magnitudes of monocular advantages were similar across three groups when processing angry faces, individuals with SAD performed better in this condition when the faces were presented to different eye. The former findings suggest that social anxiety leads to an enhanced role of subcortical structures in processing nonthreatening expressions. The latter findings, on the other hand, likely reflect an enhanced cortical processing of threatening expressions in SAD group. These distinct patterns of monocular advantage indicate that social anxiety altered representation of emotional faces at various stages of information processing, starting at an early stage of the visual system.

Altered States and Social Bonds: Effects of MDMA and Serotonergic Psychedelics on Social Behavior as a Mechanism Underlying Substance-Assisted Therapy

There has been renewed interest in the use of 3,4-methylenedioxy-methamphetamine (MDMA) and serotonergic psychedelics in the treatment of multiple psychiatric disorders. Many of these compounds are known to produce prosocial effects, but how these effects relate to therapeutic efficacy and the extent to which prosocial effects are unique to a particular drug class is unknown. In this article, we present a narrative overview and compare evidence for the prosocial effects of MDMA and serotonergic psychedelics to elucidate shared mechanisms that may underlie the therapeutic process. We discuss 4 categories of prosocial effects: altered self-image, responses to social reward, responses to negative social input, and social neuroplasticity. While both categories of drugs alter self-perception, MDMA may do so in a way that is less related to the experience of mystical-type states than serotonergic psychedelics. In the case of social reward, evidence supports the ability of MDMA to enhance responses and suggests that serotonergic psychedelics may also do so, but more research is needed in this area. Both drug classes consistently dampen reactivity to negative social stimuli. Finally, preclinical evidence supports the ability of both drug classes to induce social neuroplasticity, promoting adaptive rewiring of neural circuits, which may be helpful in trauma processing. While both MDMA and serotonergic psychedelics produce prosocial effects, they differ in the mechanisms through which they do this. These differences affect the types of psychosocial interventions that may work best with each compound.

Studies of Social Anxiety Using Ambulatory Assessment: Systematic Review

BACKGROUND

There has been an increased interest in understanding social anxiety (SA) and SA disorder (SAD) antecedents and consequences as they occur in real time, resulting in a proliferation of studies using ambulatory assessment (AA). Despite the exponential growth of research in this area, these studies have not been synthesized yet.

OBJECTIVE

This review aimed to identify and describe the latest advances in the understanding of SA and SAD through the use of AA.

METHODS

Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a systematic literature search was conducted in Scopus, PubMed, and Web of Science.

RESULTS

A total of 70 articles met the inclusion criteria. The qualitative synthesis of these studies showed that AA permitted the exploration of the emotional, cognitive, and behavioral dynamics associated with the experience of SA and SAD. In line with the available models of SA and SAD, emotion regulation, perseverative cognition, cognitive factors, substance use, and interactional patterns were the principal topics of the included studies. In addition, the incorporation of AA to study psychological interventions, multimodal assessment using sensors and biosensors, and transcultural differences were some of the identified emerging topics.

CONCLUSIONS

AA constitutes a very powerful methodology to grasp SA from a complementary perspective to laboratory experiments and usual self-report measures, shedding light on the cognitive, emotional, and behavioral antecedents and consequences of SA and the development and maintenance of SAD as a mental disorder.

A study on the impact of mental health problems on the academic buoyancy of medical students and the mechanisms

Objective

To analyze the effects of different family environmental backgrounds and mental health problems on academic buoyancy and to explore the potential mechanisms of their effects, using a sample of 2085 medical students in Jiangsu province.

Methods

Using the multiple linear regression to analyze the impact of mental health problems on academic buoyancy in different family environment contexts.

Results

(1) Higher family income and parental literacy implied higher levels of academic buoyancy in children; (2) mental health problems and academic buoyancy were negatively related, and generalized anxiety and uncertainty stress negatively predicted academic buoyancy levels; (3) uncertainty stress may have an indirect effect on academic buoyancy levels through a partially mediating effect of generalized anxiety.

Mediating effect of social interaction anxiety between emotional intelligence and life satisfaction in physical education students: post-COVID-19 study

The aim of this research is to analyze the effect of social interaction anxiety on satisfaction with life mediated by emotional intelligence. The research design was descriptive, cross-sectional, and non-randomized. In total, 1,164 Mexican physical education students participated (Mage = 21.21; SD = 3.26; 30.0% female; 69.6% male; 0.4% other). The scales used were the Social Interaction Anxiety Scale, Trait Meta-Mood Scale and Satisfaction with Life and a structural equation analysis with latent variables was conducted. The results highlight that it can be asserted that emotional clarity and repair had a mediating effect between social interaction anxiety and satisfaction with life, as they did decrease the negative effects of social interaction anxiety on satisfaction with life. In addition, social interaction anxiety had a direct and positive effect on emotional attention and a negative effect on emotional clarity and repair.

Breaking the cycle of emotional flooding: the protective role of women's emotional intelligence in couple's conflict

INTRODUCTION

One of the most damaging aspects, both for people's well-being and for close relationships, is conflict. Beyond different stressors, the emotions evoked, their regulation and an appropriate conflict resolution strategy will reduce negative consequences. Emotional Intelligence facilitates social relationships, but little applied research has been done on the relationship with couple conflict and emotional flooding, particularly from the perspective of women. Therefore, the present study analyzes the role of Perceived Emotional Intelligence (PEI) and the mediating effect of Positive Conflict Resolution strategies (PCR) in couples' conflicts from women's perspective, examining its effect on Emotional Flooding (EF) and Satisfaction.

METHODS

Through a cross-sectional design, the relationships between variables were analyzed using group comparisons and means of a structural equation model (SEM) in a sample of 692 women.

RESULTS

Significant differences were found between the groups by age, length of relationship, and motherhood. The SEM revealed a good fit. PEI predicted 71.8% of the variance in EF and 35% in Satisfaction through PCR and Conflict.