Social anxiety is associated with general but not specific biases in emotion recognition

Let's face it! The role of social anxiety and executive functions in recognizing others' emotions from faces: Evidence from autism and specific learning disorders

Youth with different developmental disorders might experience challenges when dealing with facial emotion recognition (FER). By comparing FER and related emotional and cognitive factors across developmental disorders, researchers can gain a better understanding of challenges and strengths associated with each condition. The aim of the present study was to investigate how social anxiety and executive functioning might underlie FER in youth with and without autism spectrum disorders (ASD) and specific learning disorders (SLD). The study involved 263 children and adolescents between 8 and 16 years old divided into three groups matched for age, sex, and IQ: 60 (52 M) with ASD without intellectual disability, 63 (44 M) with SLD, and 140 (105 M) non-diagnosed. Participants completed an FER test, three executive functions' tasks (inhibition, updating, and set-shifting), and parents filled in a questionnaire reporting their children's social anxiety. Our results suggest that better FER was consistent with higher social anxiety and better updating skills in ASD, while with lower social anxiety in SLD. Clinical practice should focus on coping strategies in autistic youth who could feel anxiety when facing social cues, and on self-efficacy and social worries in SLD. Executive functioning should also be addressed to support social learning in autism.

Facial Emotion Recognition and its Associations With Psychological Well-Being Across Four Schizotypal Dimensions: a Cross-Sectional Study

OBJECTIVE

The present study aimed to examine facial emotion recognition in a sample from the general population with elevated schizotypal traits, as defined by the four-factor model of schizotypy, and the association of facial emotion recognition and the schizotypal dimensions with psychological well-being.

METHOD

Two hundred and thirty-eight participants were allocated into four schizotypal groups and one control group. Following a cross-sectional study design, facial emotion recognition was assessed with a computerized task that included images from the Radboud Faces Database, schizotypal traits were measured with the Schizotypal Personality Questionnaire, and psychological well-being was evaluated with the Flourishing scale.

RESULTS

The results revealed distinct patterns of performance across the schizotypal groups and the application of a dimensional approach that included all participants as one group indicated specific associations between the four schizotypal dimensions and psychological well-being. Specifically, (a) negative schizotypes showed poor identification of sadness and fear potentially due to the activation of coping mechanisms, (b) disorganized schizotypes inaccurately recognized surprise, possibly reflecting the effects of disorganized thought on distinguishing this ambiguous emotion, and (c) psychological well-being was predicted by high cognitive-perceptual along with low negative and disorganized schizotypy as well as the accurate recognition of specific emotional states that are common in daily social interactions.

CONCLUSIONS

In conclusion, the study findings further advance the identification of emotion-processing difficulties in schizophrenia-vulnerable individuals and further highlight the need for highly personalized early intervention strategies.

Role of Emotion Reactivity to Predict Facial Emotion Recognition Changes with Aging

Emotional intelligence includes an assortment of factors related to emotion function. Such factors involve emotion recognition (in this case via facial expression), emotion trait, reactivity, and regulation. We aimed to investigate how the subjective appraisals of emotional intelligence (i.e. trait, reactivity, and regulation) are associated with objective emotion recognition accuracy, and how these associations differ between young and older adults. Data were extracted from the CamCAN dataset (189 adults: 57 young/118 older) from assessments measuring these emotion constructs. Using linear regression models, we found that greater negative reactivity was associated with better emotion recognition accuracy among older adults, though the pattern was opposite for young adults with the greatest difference in disgust and surprise recognition. Positive reactivity and depression level predicted surprise recognition, with the associations significantly differing between the age groups. The present findings suggest the level to which older and young adults react to emotional stimuli differentially predicts their ability to correctly identify facial emotion expressions. Older adults with higher negative reactivity may be able to integrate their negative emotions effectively in order to recognize other's negative emotions more accurately. Alternatively, young adults may experience interference from negative reactivity, lowering their ability to recognize other's negative emotions.

Altered mechanisms of adaptation in social anxiety: differences in adapting to positive versus negative emotional faces

Social anxiety is characterised by fear of negative evaluation and negative perceptual biases; however, the cognitive mechanisms underlying these negative biases are not well understood. We investigated a possible mechanism which could maintain negative biases: altered adaptation to emotional faces. Heightened sensitivity to negative emotions could result from weakened adaptation to negative emotions, strengthened adaptation to positive emotions, or both mechanisms. We measured adaptation from repeated exposure to either positive or negative emotional faces, in individuals high versus low in social anxiety. We quantified adaptation strength by calculating the point of subjective equality (PSE) before and after adaptation for each participant. We hypothesised: (1) weaker adaptation to angry vs happy faces in individuals high in social anxiety, (2) no difference in adaptation to angry vs happy faces in individuals low in social anxiety, and (3) no difference in adaptation to sad vs happy faces in individuals high in social anxiety. Our results revealed a weaker adaptation to angry compared to happy faces in individuals high in social anxiety (Experiment 1), with no such difference in individuals low in social anxiety (Experiment 1), and no difference in adaptation strength to sad vs happy faces in individuals high in social anxiety (Experiment 2).

Trial protocol for the Building Resilience through Socio-Emotional Training (ReSET) programme: a cluster randomised controlled trial of a new transdiagnostic preventative intervention for adolescents

BACKGROUND

Adolescence is a period of heightened vulnerability to developing mental health problems, and rates of mental health disorder in this age group have increased in the last decade. Preventing mental health problems developing before they become entrenched, particularly in adolescents who are at high risk, is an important research and clinical target. Here, we report the protocol for the trial of the 'Building Resilience through Socioemotional Training' (ReSET) intervention. ReSET is a new, preventative intervention that incorporates individual-based emotional training techniques and group-based social and communication skills training. We take a transdiagnostic approach, focusing on emotion processing and social mechanisms implicated in the onset and maintenance of various forms of psychopathology.

METHODS

A cluster randomised allocation design is adopted with randomisation at the school year level. Five-hundred and forty adolescents (aged 12-14) will be randomised to either receive the intervention or not (passive control). The intervention is comprised of weekly sessions over an 8-week period, supplemented by two individual sessions. The primary outcomes, psychopathology symptoms and mental wellbeing, will be assessed pre- and post-intervention, and at a 1-year follow-up. Secondary outcomes are task-based assessments of emotion processing, social network data based on peer nominations, and subjective ratings of social relationships. These measures will be taken at baseline, post-intervention and 1-year follow-up. A subgroup of participants and stakeholders will be invited to take part in focus groups to assess the acceptability of the intervention.

DISCUSSION

This project adopts a theory-based approach to the development of a new intervention designed to target the close connections between young people's emotions and their interpersonal relationships. By embedding the intervention within a school setting and using a cluster-randomised design, we aim to develop and test a feasible, scalable intervention to prevent the onset of psychopathology in adolescence.

TRIAL REGISTRATION

ISRCTN88585916. Trial registration date: 20/04/2023.

Social anxiety is associated with personal distress and disrupted recognition of negative emotions

Past research investigating the relation between social anxiety (SA), empathy and emotion recognition is marked by conceptual and methodological issues. In the present study, we aim to overcome these limitations by examining whether individuals with high (n = 40) vs. low (n = 43) social anxiety differed across these two facets of empathy and whether this could be related to their recognition of emotions. We employed a naturalistic emotion recognition paradigm in which participants watched short videos of individuals (targets) sharing authentic emotional experiences. After each video, we measured self-reported empathic concern and distress, as well as their ability to recognize the emotions expressed by the targets in the videos. Our results show that individuals with high social anxiety recognized the targets' emotions less accurately. Furthermore, high socially anxious individuals reported more personal distress than low socially anxious individuals, whereas no significant difference was found for empathic concern. The findings suggest that reduced recognition of emotions among SA individuals can be better explained by the negative effects of social stress than by a general deficit in empathy.

Neural evidence of face processing in social anxiety disorder: A systematic review with meta-analysis

Numerous previous studies have used event-related potentials (ERPs) to examine facial processing deficits in individuals with social anxiety disorder (SAD). However, researchers still need to determine whether the deficits are general or specific and what the dominant factors are behind different cognitive stages. Meta-analysis was performed to quantitatively identify face processing deficits in individuals with SAD. Ninety-seven results in 27 publications involving 1032 subjects were calculated using Hedges' g. The results suggest that the face itself elicits enlarged P1 amplitudes, threat-related facial expressions induce larger P2 amplitudes, and negative facial expressions lead to enhanced P3/LPP amplitudes in SAD individuals compared with controls. That is, there is face perception attentional bias in the early phase (P1), threat attentional bias in the mid-term phase (P2), and negative emotion attentional bias in the late phase (P3/LPP), which can be summarized into a three-phase SAD face processing deficit model. These findings provide an essential theoretical basis for cognitive behavioral therapy and have significant application value for the initial screening, intervention, and treatment of social anxiety.

Social anxiety and behavioral assessments of social cognition: A systematic review

BACKGROUND

Social anxiety is highly prevalent and has increased in young adults during the COVID-19 pandemic. Since social anxiety negatively impacts interpersonal functioning, identifying aspects of social cognition that may be impaired can increase our understanding of the development and maintenance of social anxiety disorder. However, to date, studies examining associations between social anxiety and social cognition have resulted in mixed findings.

METHODS

The aim of this systematic review was to summarize the literature on the association between social anxiety and social cognition, while also considering several potential moderators and covariates that may influence findings.

RESULTS

A systematic search identified 52 studies. Results showed mixed evidence for the association between social anxiety and lower-level social cognitive processes (emotion recognition and affect sharing) and a trend for a negative association with higher-level social cognitive processes (theory of mind and empathic accuracy). Most studies examining valence-specific effects found a significant negative association for positive and neutral stimuli.

LIMITATIONS

Not all aspects of social cognition were included (e.g., attributional bias) and we focused on adults and not children, limiting the scope of the review.

CONCLUSIONS

Future studies would benefit from the inclusion of relevant moderators and covariates, multiple well-validated measures within the same domain of social cognition, and assessments of interpersonal functioning outside of the laboratory. Additional research examining the moderating role of attention or interpretation biases on social cognitive performance, and the potential benefit of social cognitive skills training for social anxiety, could inform and improve existing cognitive behavioral interventions.

The Relationship Between Attention, Interpretation, and Memory Bias During Facial Perception in Social Anxiety

Although cognitive theories suggest the interactive nature of information processing biases in contributing to social anxiety, most studies to date have investigated these biases in isolation. This study aimed at (a) testing the association between social anxiety and each of the threat-related cognitive biases: attention, interpretation, and memory bias; and (b) examining the relationship between these cognitive biases in facial perception. We recruited an unselected sample of 188 adult participants and measured their level of social anxiety and cognitive biases using faces displaying angry, disgusted, happy, and ambiguous versions of these expressions. All bias tasks were assessed with the same set of facial stimuli. Regression analyses showed that social anxiety symptoms significantly predicted attention avoidance and poorer sensitivity in recognizing threatening faces. Social anxiety was, however, unrelated to interpretation bias in our sample. Results of path analysis suggested that attention bias influenced memory bias indirectly through interpretation bias for angry but not disgusted faces. Our findings suggest that, regardless of social anxiety level, when individuals selectively oriented to faces displaying anger, the faces were interpreted to be more negative. This, in turn, predicted better memory for the angry faces. The results provided further empirical support for the combined cognitive bias hypothesis.

Perceptions towards an interaction partner predict social anxiety: an ecological momentary assessment study

Social anxiety occurs in everyday social interactions, yet the real-world factors that shape the moment-to-moment experience of social anxiety have not been fully explored. Using ecological momentary assessments (smartphone-based, five signals a day for 21 days), the present study examined the associations between state social anxiety (SSA) and characteristics of interaction partners in varied contexts, and how these momentary associations differed with trait social anxiety (TSA). Ninety-two participants (54% female, age from 18 to 34) completed 4185 momentary reports. Results from multilevel models showed that perceived judgmentalness and unfamiliarity of interaction partners were positively associated with SSA, and the associations were stronger for the high TSA group (n = 30) compared to a control group (n = 62). Exploratory analyses with various types of interaction partners and social settings revealed noticeable group differences in how the types were associated with SSA (e.g. acquaintance, close friend/romantic partner) and how they influenced the effect of judgmentalness and unfamiliarity on SSA (e.g. authority, work/school). Overall, the findings highlight the role of contextual associations in social anxiety, and the benefits and the need for more comprehensive approaches with EMA in studying social anxiety, particularly its contextual aspects.

Visual attention toward emotional stimuli: Anxiety symptoms correspond to distinct gaze patterns

Decades of research have established a link between emotional disorders and attentional biases for emotional stimuli, but the relationship between symptom severity and visual attention is still not fully understood. Depression has been associated with increased attention towards dysphoric stimuli and decreased attention on positive stimuli (“negativity bias”), and some studies have also shown this trend in anxiety disorders. We examined eye fixation variables in 47 participants with emotional disorders completing an emotion recognition task. Results showed that depression severity was not associated with increased fixations on dysphoric stimuli, however, higher levels of generalized anxiety predicted increased fixations in the mouth region of sad and happy faces. Higher levels of social interaction anxiety predicted reduced fixations in the eye region of happy faces. While we did not replicate the negativity bias that has been shown in prior studies, our sample was highly comorbid, indicating the need to consider comorbidity, disorder severity, and the task itself when conducting research on visual attention in clinical samples. Additionally, more attention should be paid to the mouth region of emotional faces, as it may provide more specific information regarding the visual processing of emotions.

Social Anxiety and Empathy: A Systematic Review and Meta-analysis

OBJECTIVE

This systematic review and meta-analysis aimed to clarify the association between social anxiety and affective (AE) and cognitive empathy (CE).

METHODS

1442 studies from PsycINFO, Medline, and EMBASE (inception-January 2020) were systematically reviewed. Included studies (N = 48) either predicted variance in empathy using social anxiety scores or compared empathy scores between socially anxious individuals and a control group.

RESULTS

Social anxiety and AE were statistically significantly positively associated, k = 14, r = .103 (95%CI [.003, .203]), z = 2.03, p = .043. Sex (Q_M (2) = 18.79, p <  .0001), and type of measures (Q_M (1 = 7.34, p = .007) moderated the association. Correlations were significant for male samples (r_male = .316, (95%CI [.200, .432])) and studies using self-report measures (r_self-report = .162 (95%CI [.070, .254])). Overall, social anxiety and CE were not significantly associated, k = 52, r =-.021 (95%CI [-.075, .034]), z= -0.74, p = .459. Sample type moderated the association (Q_M (1) = 5.03, p < .0001). For clinical samples the association was negative (r_clinical= -.112, (95%CI [-.201, -.017]).

CONCLUSION

There was evidence for a positive association between social anxiety and AE, but future studies are needed to verify the moderating roles of sex and type of measure. Besides, low CE might only hold for patients with SAD.

ERP evidence for emotional sensitivity in social anxiety

BACKGROUND

Emotional sensitivity involves the ability to recognize and interpret facial expressions. This is very important for interpersonal communication. Previous studies found differences in emotional sensitivity between high social anxiety (HSA) individuals and low social anxiety (LSA) individuals. However, the underlying neural mechanisms are still unclear. The present study explored the effects of expression intensity and social anxiety on emotional sensitivity and their neural mechanisms.

METHODS

The HSA group (n = 20) and the LSA group (n = 20) were asked to recognize anger expressions with different intensities in an emotion recognition task. The hit rate, reaction time, early time window (P1, N170), and late time window (LPP) were recorded.

RESULTS

The results showed that individuals with HSA had a significantly higher hit rate and shorter reaction time than individuals with LSA (p < 0.01). Event-related potential (ERP) results showed that, compared to the LSA group, the HSA group exhibited significantly enhanced N170 and LPP amplitude (p < 0.01). However, the difference in P1 amplitude was not significant (p > 0.05).

LIMITATIONS

The participants in this study were a subclinical social anxiety sample, and the effects of other mood disorders were not excluded, partially limiting the generalizability of the results.

CONCLUSIONS

Our findings suggest that, compared to LSA individuals, HSA individuals are more sensitive to all presented faces. The ERP results indicated that HSA individuals' high sensitivity to threatening expressions is related to stronger structural encoding and fine processing.

From structure to concepts: The two stages of facial expression recognition

Facial expressions are the dominant way of human emotional and social communications. However, it remains unclear that how can perceivers extract emotion from the face. In the present study, we adopted a repetition-priming paradigm in combine with event-related potentials (ERP) to examine neurocognitive processing stages of facial expression perception. Results showed that emotional words were recognized faster than emotional faces, when both of which were primed by emotional faces, indicating the involvement of concepts processes in facial expression recognition. ERP results showed that all emotional faces could evoke responses of N170, while there was no significant difference between positive and negative emotional faces, suggesting that geometrical configurations of faces rather than emotional concepts of faces are processed at the stage of N170. In contrast, both emotional words and faces showed larger P2 in response to anger than happiness, which suggests that emotional concepts are extracted from faces at the stage of P2. To examine the underlying dynamic causal connectivity between facial structure and emotional conception, we conducted information flow analysis, which showed significant decreases of information flow from the fusiform gyrus to dorsal anterior cingulate cortex/dorsal medial prefrontal cortex and increases of information flow from the fusiform gyrus to posterior insula. These results revealed neural mechanisms underlying processes from physical structure to emotional concepts. Our findings suggest that facial expression recognition consists of two stages from geometrical structure of faces to emotional concepts of facial expressions, which provides evidence for facial expression processing and has important implications in the diagnosis and treatment of emotion recognition related disorders.

Social anxiety and the interpretation of morphed facial expressions following exclusion and inclusion

BACKGROUND AND OBJECTIVES

Negative interpretation biases are postulated to play etiological and maintaining roles in social anxiety (SA). However, empirical support for interpretation biases of facial expression in SA is inconsistent. Given the importance of signals of (dis)approval in SA, our objective was to examine whether SA is associated with enhanced sensitivity to such signals especially following exclusion.

METHODS

In Study 1, participants (N = 139) underwent an exclusion/inclusion manipulation and were then presented with video clips of smiles gradually changing into disgust expressions (smile-to-disgust). In Study 2 (N = 203), participants saw smile-to-disgust as well as disgust-to-smile clips following an exclusion/inclusion manipulation. Participants' task in both studies was to detect the offset of the initial expression.

RESULTS

Results of Study 1 show that detection latency of smiles' disappearance is negatively associated with SA severity. The results of Study 2 suggest that this association is stronger following exclusion, and specific to the smile-to-disgust as opposed to the disgust-to-smile, transitions.

LIMITATIONS

Our studies did not examine whether the observed interpretation bias was specific to SA.

CONCLUSIONS

Our findings support and refine cognitive theories of SA, suggesting that interpretation biases for facial information in SA may be especially pronounced following exclusion.

Psychological Science Needs a Standard Practice of Reporting the Reliability of Cognitive-Behavioral Measurements

Psychological science relies on behavioral measures to assess cognitive processing; however, the field has not yet developed a tradition of routinely examining the reliability of these behavioral measures. Reliable measures are essential to draw robust inferences from statistical analyses, and subpar reliability has severe implications for measures’ validity and interpretation. Without examining and reporting the reliability of measurements used in an analysis, it is nearly impossible to ascertain whether results are robust or have arisen largely from measurement error. In this article, we propose that researchers adopt a standard practice of estimating and reporting the reliability of behavioral assessments of cognitive processing. We illustrate the need for this practice using an example from experimental psychopathology, the dot-probe task, although we argue that reporting reliability is relevant across fields (e.g., social cognition and cognitive psychology). We explore several implications of low measurement reliability and the detrimental impact that failure to assess measurement reliability has on interpretability and comparison of results and therefore research quality. We argue that researchers in the field of cognition need to report measurement reliability as routine practice so that more reliable assessment tools can be developed. To provide some guidance on estimating and reporting reliability, we describe the use of bootstrapped split-half estimation and intraclass correlation coefficients to estimate internal consistency and test-retest reliability, respectively. For future researchers to build upon current results, it is imperative that all researchers provide psychometric information sufficient for estimating the accuracy of inferences and informing further development of cognitive-behavioral assessments.

Variation in recognition of happy and sad facial expressions and self-reported depressive symptom severity: A prospective cohort study

OBJECTIVE

Cognitive theories suggest people with depression interpret self-referential social information negatively. However, it is unclear whether these biases precede or follow depression. We investigated whether facial expression recognition was associated with depressive symptoms cross-sectionally and longitudinally.

METHODS

Prospective cohort study of people who had visited UK primary care in the past year reporting depressive symptoms (n = 509). Depressive symptoms were measured using the Patient Health Questionnaire (PHQ-9) at four time-points, 2 weeks apart. A computerised task assessed happy and sad facial expression recognition at three time-points (n = 505 at time 1). The unbiased hit rate measured ability to recognise emotions accounting for any general tendency to identify the emotion when it was not present.

RESULTS

The sample included the full range of depressive symptom severity, with 45% meeting diagnostic criteria for depression. There was no evidence that happy or sad unbiased hit rates were associated with concurrent or subsequent depressive symptoms. There was weak evidence that, for every additional face incorrectly classified as happy, concurrent PHQ-9 scores reduced by 0.05 of a point (95% CI = -0.10 to 0.002, p = 0.06 after adjustment for confounders). This association was strongest for more ambiguous facial expressions (interaction term p<0.001).

LIMITATIONS

This was an observational study with relatively short follow-up (6 weeks) and small changes in depressive symptoms and emotion recognition. Only 7% of invited patients consented to participate.

CONCLUSIONS

Reduced misclassifications of ambiguous faces as happy could be a state marker of depression, but was not associated with subsequent depressive symptoms. Future research should focus on the interpretation of ambiguous social information.

Facial Emotion Recognition and Social-Cognitive Correlates of Narcissistic Features

Narcissistic personality disorder (NPD) is associated with both seeming indifference and hypersensitivity to social feedback. This study evaluated whether rejection sensitivity and empathic difficulties in NPD are accounted for by altered facial emotion recognition (FER). Two-hundred non-clinical individuals self-reported NPD features, rejection sensitivity, and empathy and performed an FER task assessing the ability to determine the presence or absence of an emotion when viewing neutral and negative facial stimuli presented at varying emotional intensities (25%, 50%, 75%). Those with higher NPD features were faster at accurately recognizing neutral and low, 25%-intensity emotional stimuli. This response pattern mediated the association between NPD features and increased anger about rejection. Thus, individuals with high NPD traits are hypervigilant toward subtle negative emotions and neutral expressions; this may explain their tendency to experience intense angry feelings when facing the possibility that the others would not meet their need for acceptance.

A randomised controlled trial assessing the use of citalopram, sertraline, fluoxetine and mirtazapine in preventing relapse in primary care patients who are taking long-term maintenance antidepressants (ANTLER: ANTidepressants to prevent reLapse in dEpRession): study protocol for a randomised controlled trial

Background

Antidepressants are used both for treating acute episodes and for prophylaxis to prevent future episodes of depression, also called maintenance treatment. This article describes the protocol for a randomised controlled trial (ANTLER: ANTidepressants to prevent reLapse in dEpRession) to investigate the clinical effectiveness and cost-effectiveness in UK primary care of continuing on long-term maintenance antidepressants compared with a placebo in preventing relapse of depression in those who have taken antidepressants for more than 9 months and who are currently well enough to consider stopping maintenance treatment.

Methods/design

The ANTLER trial is an individually randomised, double-blind, placebo-controlled trial in which participants are randomised to remain on active medication or to take an identical placebo after a tapering period of 2 months. Eligible participants are those who: are between the ages of 18 and 74 years; have had at least two episodes of depression; and have been taking antidepressants for 9 months or more and are currently taking citalopram 20 mg, sertraline 100 mg, fluoxetine 20 mg or mirtazapine 30 mg but are well enough to consider stopping their medication. The participants will be followed up at 6, 12, 26, 39 and 52 weeks.

The primary outcome will be the time in weeks to the beginning of the first episode of depression after randomisation. This will be measured using a retrospective version of the Clinical Interview Schedule—Revised administered at 12, 26, 39 and 52 weeks.

Secondary outcomes will include depressive and anxiety symptoms, adverse effects, withdrawal symptoms, emotional processing tasks, quality of life and the resources and costs used. We will also perform a cost-effectiveness analysis based on results of the trial.

Discussion

The ANTLER trial findings will inform primary care prescribing practice by providing a valid and generalisable estimate of the clinical effectiveness and cost-effectiveness of long-term maintenance treatment with antidepressants in UK primary care.

Trial registration

Controlled Trials ISRCTN Registry, ISRCTN15969819. Registered on 21 September 2015.

Electronic supplementary material

The online version of this article (10.1186/s13063-019-3390-8) contains supplementary material, which is available to authorized users.

State anxiety and information processing: A 7.5% carbon dioxide challenge study

We used the 7.5% carbon dioxide model of anxiety induction to investigate the effects of state anxiety on simple information processing. In both high- and low-anxious states, participants (n = 36) completed an auditory–visual matching task and a visual binary categorization task. The stimuli were either degraded or clear, so as to investigate whether the effects of anxiety are greater when signal clarity is compromised. Accuracy in the matching task was lower during CO₂ inhalation and for degraded stimuli. In the categorization task, response times and indecision (measured using mouse trajectories) were greater during CO₂ inhalation and for degraded stimuli. For most measures, we found no evidence of Gas × Clarity interactions. These data indicate that state anxiety negatively impacts simple information processing and do not support claims that anxiety may benefit performance in low-cognitively-demanding tasks. These findings have important implications for understanding the impact of state anxiety in real-world situations.

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

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

Exposure to childhood adversity and deficits in emotion recognition: results from a large, population-based sample

BACKGROUND

Emotion recognition skills are essential for social communication. Deficits in these skills have been implicated in mental disorders. Prior studies of clinical and high-risk samples have consistently shown that children exposed to adversity are more likely than their unexposed peers to have emotion recognition skills deficits. However, only one population-based study has examined this association.

METHODS

We analyzed data from children participating in the Avon Longitudinal Study of Parents and Children, a prospective birth cohort (n = 6,506). We examined the association between eight adversities, assessed repeatedly from birth to age 8 (caregiver physical or emotional abuse; sexual or physical abuse; maternal psychopathology; one adult in the household; family instability; financial stress; parent legal problems; neighborhood disadvantage) and the ability to recognize facial displays of emotion measured using the faces subtest of the Diagnostic Assessment of Non-Verbal Accuracy (DANVA) at age 8.5 years. In addition to examining the role of exposure (vs. nonexposure) to each type of adversity, we also evaluated the role of the timing, duration, and recency of each adversity using a Least Angle Regression variable selection procedure.

RESULTS

Over three-quarters of the sample experienced at least one adversity. We found no evidence to support an association between emotion recognition deficits and previous exposure to adversity, either in terms of total lifetime exposure, timing, duration, or recency, or when stratifying by sex.

CONCLUSIONS

Results from the largest population-based sample suggest that even extreme forms of adversity are unrelated to emotion recognition deficits as measured by the DANVA, suggesting the possible immutability of emotion recognition in the general population. These findings emphasize the importance of population-based studies to generate generalizable results.

An investigation of emotion recognition training to reduce symptoms of social anxiety in adolescence

This study aimed to examine the effect of emotion recognition training on social anxiety symptoms among adolescents, aged 15-18 years. The study included a screening session, which identified participants who scored above a cut-off on a self-report measure of social anxiety for enrolment into a randomized controlled trial (Clinical Trials ID: NCT02550379). Participants were randomized to an intervention condition designed to increase the perception of happiness over disgust in ambiguous facial expressions or a sham intervention control condition, and completed self-report measures of social anxiety, fear of negative evaluation, anxiety-related disorders, and depressive symptoms. The intervention group demonstrated a strong shift in the balance point at which they perceived happiness over disgust in ambiguous facial expressions. This increase in positive perception was not associated with any changes in the primary outcome of social anxiety; however, some evidence of improvement in symptomatology was observed on one of a number of secondary outcomes. Those in the intervention group had lower depression symptoms at 2-week follow-up, compared to those in the control group who received the sham intervention training. Potential reasons for why the shift in balance point measurement was not associated with a concurrent shift in symptoms of social anxiety are discussed.

Social anxiety and detection of facial untrustworthiness: Spatio-temporal oculomotor profiles

Cognitive models posit that social anxiety is associated with biased attention to and interpretation of ambiguous social cues as threatening. We investigated attentional bias (selective early fixation on the eye region) to account for the tendency to distrust ambiguous smiling faces with non-happy eyes (interpretative bias). Eye movements and fixations were recorded while observers viewed video-clips displaying dynamic facial expressions. Low (LSA) and high (HSA) socially anxious undergraduates with clinical levels of anxiety judged expressers' trustworthiness. Social anxiety was unrelated to trustworthiness ratings for faces with congruent happy eyes and a smile, and for neutral expressions. However, social anxiety was associated with reduced trustworthiness rating for faces with an ambiguous smile, when the eyes slightly changed to neutrality, surprise, fear, or anger. Importantly, HSA observers looked earlier and longer at the eye region, whereas LSA observers preferentially looked at the smiling mouth region. This attentional bias in social anxiety generalizes to all the facial expressions, while the interpretative bias is specific for ambiguous faces. Such biases are adaptive, as they facilitate an early detection of expressive incongruences and the recognition of untrustworthy expressers (e.g., with fake smiles), with no false alarms when judging truly happy or neutral faces.

Categorical perception of facial expressions in individuals with non-clinical social anxiety

BACKGROUND AND OBJECTIVES

According to the well-established categorical perception (CP) of facial expressions, we decode complicated expression signals into simplified categories to facilitate expression processing. Expression processing deficits have been widely described in social anxiety (SA), but it remains to be investigated whether CP of expressions are affected by SA. The present study examined whether individuals with SA had an interpretation bias when processing ambiguous expressions and whether the sensitivity of their CP was affected by their SA.

METHODS

Sixty-four participants (high SA, 30; low SA, 34) were selected from 658 undergraduates using the Interaction Anxiousness Scale (IAS). With the CP paradigm, specifically with the analysis method of the logistic function model, we derived the categorical boundaries (reflecting interpretation bias) and slopes (reflecting sensitivity of CP) of both high- and low-SA groups while recognizing angry-fearful, happy-angry, and happy-fearful expression continua.

RESULTS

Based on a comparison of the categorical boundaries and slopes between the high- and low-SA groups, the results showed that the categorical boundaries between the two groups were not different for any of the three continua, which means that the SA does not affect the interpretation bias for any of the three continua. The slopes for the high-SA group were flatter than those for the low-SA group for both the angry-fearful and happy-angry continua, indicating that the high-SA group is insensitive to the subtle changes that occur from angry to fearful faces and from happy to angry faces.

LIMITATIONS

Since participants were selected from a sample of undergraduates based on their IAS scores, the results cannot be directly generalized to individuals with clinical SA disorder.

CONCLUSIONS

The study indicates that SA does not affect interpretation biases in the processing of anger, fear, and happiness, but does modulate the sensitivity of individuals' CP when anger appears. High-SA individuals perceive angry expressions in a less categorical manner than the low-SA group, but no such difference was found in the perception of happy or fearful expressions.

Extraction of mean emotional tone from face arrays in social anxiety disorder

BACKGROUND

Social anxiety disorder (SAD) is characterized by intense fear when facing a crowd. Processing biases of crowd-related information have been suggested as contributing to the etiology and maintenance of the disorder. Here we tested whether patients with SAD display aberrant patterns of extracting the mean emotional tone from sets of faces.

METHODS

Twenty-one participants with SAD and 24 unanxious control participants had to determine the average emotion expression of sets of six different morphed faces ranging from happy to angry. In 20% of trials the six faces were randomly sampled from the entire happy-angry range. The remaining 80% of trials, considered the critical trials, had an emotional outlier: five faces were sampled from one-half of the emotional range, whereas the sixth face was sampled from the opposite emotional range.

RESULTS

Participants with SAD were less accurate than controls in extracting the mean emotional tone from sets of faces. Unanxious participants underweighted negative outliers and overweighed positive outliers when extracting the mean, whereas participants with SAD exhibited no such biases.

CONCLUSIONS

Results suggest a possible mechanism associated with the anxiety experienced by socially anxious individuals when facing a crowd.

Effects of Social Anxiety on Emotional Mimicry and Contagion: Feeling Negative, but Smiling Politely

Socially anxiety may be related to a different pattern of facial mimicry and contagion of others' emotions. We report two studies in which participants with different levels of social anxiety reacted to others' emotional displays, either shown on a computer screen (Study 1) or in an actual social interaction (Study 2). Study 1 examined facial mimicry and emotional contagion in response to displays of happiness, anger, fear, and contempt. Participants mimicked negative and positive emotions to some extent, but we found no relation between mimicry and the social anxiety level of the participants. Furthermore, socially anxious individuals were more prone to experience negative emotions and felt more irritated in response to negative emotion displays. In Study 2, we found that social anxiety was related to enhanced mimicry of smiling, but this was only the case for polite smiles and not for enjoyment smiles. These results suggest that socially anxious individuals tend to catch negative emotions from others, but suppress their expression by mimicking positive displays. This may be explained by the tendency of socially anxious individuals to avoid conflict or rejection.

Effects of psychotropic drugs used in the treatment of anxiety disorders on the recognition of facial expressions of emotion: Critical analysis of literature

Deficits in recognition of facial expressions of emotion (RFEE) play a central role in the manifestation of anxiety disorders (AD). We systematically reviewed the literature to determine effects of drugs used in AD treatment on RFEE, based on outcomes of accuracy rate, reaction time, and intensity. Electronic databases, including Pubmed, PsycINFO, and Scielo, were used without time constraints. Twenty-six clinical/experimental studies on healthy subjects, focusing on 11 drugs, published in English, Portuguese, and Spanish, were selected. We found that increased recognition of happiness was associated with acute use of citalopram, fluoxetine, duloxetine, and reboxetine. Increased and decreased recognition of negative emotions were associated with the use of selective serotonin and/or norepinephrine reuptake inhibitors, respectively. Benzodiazepine favored recognition of negative emotions. Differences in reaction time were rarely observed. Stimuli with distinct emotion intensities produced similar effects. Specific changes occurred in RFEE depending on the drug, its administration route and dose, and emotion valence. Evidences indicate significant effects on emotional processing relevant to clinical practice, particularly in treating patients with emotional disorders.

Social anxiety and perception of (un)trustworthiness in smiling faces

In social environments the smile can be driven by different motives and convey different emotions. This makes a smiling face ambiguous and amenable to alternative interpretations. We investigated how social anxiety is related to trustworthiness evaluation of morphed dynamic smiling faces depending on changes in the eye expression. Socially anxious and non-anxious participants judged the un/trustworthiness of people with different smiles. Social anxiety was related to reduced trustworthiness of (a) faces with a neutral mouth unfolding to a smile when the eyes were neutral at the beginning or end of the dynamic sequence, and (b) faces with a smiling mouth when happy eyes slightly changed towards neutrality, surprise, fear, sadness, disgust, or anger. In contrast, social anxiety was not related to trustworthiness judgments for non-ambiguous expressions unfolding from neutral (eyes and mouth) to happy (eyes and mouth) or from happy to neutral. Socially anxious individuals are characterized by an interpretation bias towards mistrusting any ambiguous smile due to the presence of non-happy eyes.

Social anxiety and trustworthiness judgments of dynamic facial expressions of emotion

BACKGROUND AND OBJECTIVES

Perception of trustworthiness in other people is essential for successful social interaction. Facial expressions-as conveyers of feelings and intentions-are an important source of this information. We investigated how social anxiety is related to biases in the judgment of faces towards un/trustworthiness depending on type of emotional expression and expressive intensity.

METHODS

Undergraduates with clinical levels of social anxiety and low-anxiety controls were presented with 1-s video-clips displaying facial happiness, anger, fear, sadness, disgust, surprise, or neutrality, at various levels of emotional intensity. Participants judged how trustworthy the expressers looked like.

RESULTS

Social anxiety was associated with enhanced distrust towards angry and disgusted expressions, and this occurred at lower intensity thresholds, relative to non-anxious controls. There was no effect for other negative expressions (sadness and fear), basically ambiguous expressions (surprise and neutral), or happy faces.

LIMITATIONS

The social anxiety and the control groups consisted of more females than males, although this gender disproportion was the same in both groups. Also, the expressive speed rate was different for the various intensity conditions, although such differences were equated for all the expressions and for both groups.

CONCLUSIONS

Individuals with high social anxiety overestimate perceived social danger even from subtle facial cues, thus exhibiting a threat-related interpretative bias in the form of untrustworthiness judgments. Such a bias is, nevertheless, limited to facial expressions conveying direct threat such as hostility and rejection.

Impaired face recognition is associated with social inhibition

Face recognition is fundamental to successful social interaction. Individuals with deficits in face recognition are likely to have social functioning impairments that may lead to heightened risk for social anxiety. A critical component of social interaction is how quickly a face is learned during initial exposure to a new individual. Here, we used a novel Repeated Faces task to assess how quickly memory for faces is established. Face recognition was measured over multiple exposures in 52 young adults ranging from low to high in social inhibition, a core dimension of social anxiety. High social inhibition was associated with a smaller slope of change in recognition memory over repeated face exposure, indicating participants with higher social inhibition showed smaller improvements in recognition memory after seeing faces multiple times. We propose that impaired face learning is an important mechanism underlying social inhibition and may contribute to, or maintain, social anxiety.

Early effects of duloxetine on emotion recognition in healthy volunteers

The serotonin-noradrenaline reuptake inhibitor (SNRI) duloxetine is an effective treatment for major depression and generalised anxiety disorder. Neuropsychological models of antidepressant drug action suggest therapeutic effects might be mediated by the early correction of maladaptive biases in emotion processing, including the recognition of emotional expressions. Sub-chronic administration of duloxetine (for two weeks) produces adaptive changes in neural circuitry implicated in emotion processing; however, its effects on emotional expression recognition are unknown. Forty healthy participants were randomised to receive either 14 days of duloxetine (60 mg/day, titrated from 30 mg after three days) or matched placebo (with sham titration) in a double-blind, between-groups, repeated-measures design. On day 0 and day 14 participants completed a computerised emotional expression recognition task that measured sensitivity to the six primary emotions. Thirty-eight participants (19 per group) completed their course of tablets and were included in the analysis. Results provide evidence that duloxetine, compared to placebo, may reduce the accurate recognition of sadness. Drug effects were driven by changes in participants' ability to correctly detect subtle expressions of sadness, with greater change observed in the placebo relative to the duloxetine group. These effects occurred in the absence of changes in mood. Our preliminary findings require replication, but complement recent evidence that sadness recognition is a therapeutic target in major depression, and a mechanism through which SNRIs could resolve negative biases in emotion processing to achieve therapeutic effects.

Meta-analysis of emotion recognition deficits in major depressive disorder

BACKGROUND

Many studies have explored associations between depression and facial emotion recognition (ER). However, these studies have used various paradigms and multiple stimulus sets, rendering comparisons difficult. Few studies have attempted to determine the magnitude of any effect and whether studies are properly powered to detect it. We conducted a meta-analysis to synthesize the findings across studies on ER in depressed individuals compared to controls.

METHOD

Studies of ER that included depressed and control samples and published before June 2013 were identified in PubMed and Web of Science. Studies using schematic faces, neuroimaging studies and drug treatment studies were excluded.

RESULTS

Meta-analysis of k = 22 independent samples indicated impaired recognition of emotion [k = 22, g = -0.16, 95% confidence interval (CI) -0.25 to -0.07, p < 0.001]. Critically, this was observed for anger, disgust, fear, happiness and surprise (k's = 7-22, g's = -0.42 to -0.17, p's < 0.08), but not sadness (k = 21, g = -0.09, 95% CI -0.23 to +0.06, p = 0.23). Study-level characteristics did not appear to be associated with the observed effect. Power analysis indicated that a sample of approximately 615 cases and 615 controls would be required to detect this association with 80% power at an alpha level of 0.05.

CONCLUSIONS

These findings suggest that the ER impairment reported in the depression literature exists across all basic emotions except sadness. The effect size, however, is small, and previous studies have been underpowered.

The role of emotion and emotion regulation in social anxiety disorder

Many psychiatric disorders involve problematic patterns of emotional reactivity and regulation. In this review, we consider recent findings regarding emotion and emotion regulation in the context of social anxiety disorder (SAD). We first describe key features of SAD which suggest altered emotional and self-related processing difficulties. Next, we lay the conceptual foundation for a discussion of emotion and emotion regulation and present a common framework for understanding emotion regulation, the process model of emotion regulation. Using the process model, we evaluate the recent empirical literature spanning self-report, observational, behavioral, and physiological methods across five specific families of emotion regulation processes-situation selection, situation modification, attentional deployment, cognitive change, and response modulation. Next, we examine the empirical evidence behind two psychosocial interventions for SAD: cognitive behavioral therapy (CBT) and mindfulness-based stress reduction (MBSR). Throughout, we present suggestions for future directions in the continued examination of emotion and emotion regulation in SAD.

Effects of oxytocin on attention to emotional faces in healthy volunteers and highly socially anxious males

BACKGROUND

Evidence suggests that individuals with social anxiety demonstrate vigilance to social threat, whilst the peptide hormone oxytocin is widely accepted as supporting affiliative behaviour in humans.

METHODS

This study investigated whether oxytocin can affect attentional bias in social anxiety. In a double-blind, randomized, placebo-controlled, within-group study design, 26 healthy and 16 highly socially anxious (HSA) male volunteers (within the HSA group, 10 were diagnosed with generalized social anxiety disorder) were administered 24 IU of oxytocin or placebo to investigate attentional processing in social anxiety. Attentional bias was assessed using the dot-probe paradigm with angry, fearful, happy and neutral face stimuli.

RESULTS

In the baseline placebo condition, the HSA group showed greater attentional bias for emotional faces than healthy individuals. Oxytocin reduced the difference between HSA and non-socially anxious individuals in attentional bias for emotional faces. Moreover, it appeared to normalize attentional bias in HSA individuals to levels seen in the healthy population in the baseline condition. The biological mechanisms by which oxytocin may be exerting these effects are discussed.

CONCLUSIONS

These results, coupled with previous research, could indicate a potential therapeutic use of this hormone in treatment for social anxiety.