Neural correlates of anticipation and processing of performance feedback in social anxiety

Fear of negative evaluation, such as negative social performance feedback, is the core symptom of social anxiety. The present study investigated the neural correlates of anticipation and perception of social performance feedback in social anxiety. High (HSA) and low (LSA) socially anxious individuals were asked to give a speech on a personally relevant topic and received standardized but appropriate expert performance feedback in a succeeding experimental session in which neural activity was measured during anticipation and presentation of negative and positive performance feedback concerning the speech performance, or a neutral feedback‐unrelated control condition. HSA compared to LSA subjects reported greater anxiety during anticipation of negative feedback. Functional magnetic resonance imaging results showed deactivation of medial prefrontal brain areas during anticipation of negative feedback relative to the control and the positive condition, and medial prefrontal and insular hyperactivation during presentation of negative as well as positive feedback in HSA compared to LSA subjects. The results indicate distinct processes underlying feedback processing during anticipation and presentation of feedback in HSA as compared to LSA individuals. In line with the role of the medial prefrontal cortex in self‐referential information processing and the insula in interoception, social anxiety seems to be associated with lower self‐monitoring during feedback anticipation, and an increased self‐focus and interoception during feedback presentation, regardless of feedback valence. Hum Brain Mapp 35:6023–6031, 2014. © 2014 Wiley Periodicals, Inc.     

Taking a closer look: autonomic dysregulation in socially anxious children

Previous research on autonomic characteristics of social anxiety in children and adolescents has produced highly inconsistent results which may partially be due to task differences and a limited breadth of autonomic measurement. Here we investigated a sample of high (HSA) and low socially anxious (LSA) children, aged 10–12 years before, during and after a standardized evaluated speech task while acquiring a broad set of autonomic and experiential measures. During baseline, we found evidence for tonically higher sympathetic autonomic activity in HSA children, indicated by higher low frequency heart rate variability (LF) and a trend for higher LF to high frequency heart rate variability ratios (LF/HF). In response to the speech task, HSA children showed blunted cardiac responding evidenced by slower increase and delayed recovery of heart rate and a similar significant trend on LF/HF values. Self-reported anxiety, by contrast, showed enhanced reactivity from baseline to anticipation in the HSA compared to the LSA group. The results suggest a restricted cardiac flexibility in HSA children and illustrate that broad autonomic assessment during a well-structured, naturalistic task may improve our understanding of the autonomic physiology of socially anxious children. The results have implications for current theories of social anxiety.     

Social anxiety and ruminative self-focus

Studies of rumination have supported the differentiation of self-focus into distinct modes of self-attention with distinct functional effects. Given that self-focused attention and rumination have been implicated in the maintenance of social anxiety, the present study investigated the effects of these two distinct forms of self-focused attention on mood and cognition in social anxiety. High and low socially anxious individuals (n=29 in each group) either thought analytically about, or focused on their momentary experience of, identical symptom-focused induction items from [Nolen-Hoeksema, S., & Morrow, J. (1993). Effects of rumination and distraction on naturally occurring depressed mood. Cognition and Emotion, 7, 561-570] rumination task. As predicted, in high socially anxious individuals, the experiential (low analysis) self-focus condition decreased ratings of anxious mood pre- to post-manipulation and was associated with more positive thoughts on a thought-listing exercise, whereas the analytical (high analysis) self-focus condition resulted in no significant effects on mood and cognition. Theoretical and clinical implications of these findings are discussed.     

Is eye to eye contact really threatening and avoided in social anxiety?—An eye-tracking and psychophysiology study

The effects of direct and averted gaze on autonomic arousal and gaze behavior in social anxiety were investigated using a new paradigm including animated movie stimuli and eye-tracking methodology. While high, medium, and low socially anxious (HSA vs. MSA vs. LSA) women watched animated movie clips, in which faces responded to the gaze of the participants with either direct or averted gaze, their eye movements, heart rate (HR) and skin conductance responses (SCR) were continuously recorded. Groups did not differ in their gaze behavior concerning direct vs. averted gaze, but high socially anxious women tended to fixate the eye region of the presented face longer than MSA and LSA, respectively. Furthermore, they responded to direct gaze with more pronounced cardiac acceleration. This physiological finding indicates that direct gaze may be a fear-relevant feature for socially anxious individuals in social interaction. However, this seems not to result in gaze avoidance. Future studies should examine the role of gaze direction and its interaction with facial expressions in social anxiety and its consequences for avoidance behavior and fear responses. Additionally, further research is needed to clarify the role of gaze perception in social anxiety.     

Impaired visuocortical discrimination learning of socially conditioned stimuli in social anxiety

In search of causative factors of social anxiety disorder (SAD), classical conditioning has been discussed as a potential trigger mechanism for many years. Recent findings suggest that the social relevance of the unconditioned stimulus (US) might play a major role in learning theories of SAD. Thus, this study applied a social conditioning paradigm with disorder-relevant US to examine the electrocortical correlates of affective learning. Twenty-four high socially anxious (HSA) and 23 age- and gender-matched low socially anxious (LSA) subjects were conditioned to 3 different faces flickering at a frequency of 15 Hz which were paired with auditory insults, compliments or neutral comments (US). The face-evoked electrocortical response was measured via steady-state visually evoked potentials and subjective measures of valence and arousal were obtained. Results revealed a significant interaction of social anxiety and conditioning, with LSA showing highest cortical activity to faces paired with insults and lowest activity to faces paired with compliments, while HSA did not differentiate between faces. No group differences were discovered in the affective ratings. The findings indicate a potentially impaired ability of HSA to discriminate between relevant and irrelevant social stimuli, which may constitute a perpetuating factor of SAD.     

The relationship between dorsolateral prefrontal activation and speech performance-based social anxiety using functional near infrared spectroscopy

Functional near-infrared (fNIR) spectroscopy is a promising new technology that has demonstrated utility in the study of normal human cognition. We utilized fNIR spectroscopy to examine the effect of social anxiety and performance on hemodynamic activity in the dorsolateral prefrontal cortex (DLPFC). Socially phobic participants and non-clinical participants with varying levels of social anxiety completed a public speaking task in front of a small virtual audience while the DLPFC was being monitored by the fNIR device. The relationship between anxiety and both blood volume (BV) and deoxygenated hemoglobin (Hb) varied significantly as a function of speech performance, such that individuals with low social anxiety who performed well showed an increase in DLPFC activation relative to those who did not perform well. This result suggests that effortful thinking and/or efficient top-down inhibitory control may have been required to complete an impromptu speech task with good performance. In contrast, good performers who were highly socially anxious showed lower DLPFC activation relative to good performers who were low in social anxiety, suggesting autopilot thinking or less-effortful thinking. In poor performers, slight increases in DLPFC activation were observed from low to highly anxious individuals, which may reflect a shift from effortless thinking to heightened self-focused attention. Heightened self-focused attention, poor inhibitory control resulting in excessive fear or anxiety, or low motivation may lower performance. These results suggest that there can be different underlying mechanisms in the brain that affect the level of speech performance in individuals with varying degrees of social anxiety. This study highlights the utility of the fNIR device in the assessment of changes in DLPFC in response to exposure to realistic phobic stimuli, and further supports the potential utility of this technology in the study of the neurophysiology of anxiety disorders.     

Why social anxiety persists: an experimental investigation of the role of safety behaviours as a maintaining factor

Study one used a semi-structured interview to assess the use of safety behaviours in high and low socially anxious participants. As predicted from cognitive models, the high social anxiety group reported using a greater number of safety behaviours, more frequently, in a greater number of situations. Both the high and low social anxiety groups perceived their safety behaviours to be helpful. Study two involved experimentally manipulating the use of safety behaviours and self-focus and demonstrated the use of safety behaviours and self-focused attention to be unhelpful in a number of ways. Results support the role of safety behaviours and self-focused attention in the cognitive model of social phobia, and the value of dropping safety behaviours and reducing self-focus as therapeutic strategies in social phobia.     

Safety behaviors, self-focused attention and negative thinking in children with social anxiety disorder, socially anxious and non-anxious children

Background and objectivesCognitive behavioral models of social anxiety disorder (SAD) in adults suggest several mechanisms that maintain social anxiety. So far, little is known about the role of these processes in childhood social anxiety.MethodsIn this study, 21 children with SAD, 21 children with high social anxiety and 21 non-anxious controls (age between 8 and 13 years) were asked about their use of safety behavior in anxiety producing situations. Furthermore, children were asked to indicate their levels of anxiety, self-focused attention and frequency of positive and negative cognitions while engaging in a performance task in front of two adults.ResultsAs expected, a significant group effect was found for all dependent variables, with children suffering from SAD reporting the most frequent use of safety behavior and highest levels of anxiety, self-focused attention and negative cognitions during the task, followed by socially anxious children and controls. Unexpectedly, only self-focused attention mediated the relationship between general social anxiety and state anxiety in response to the task.LimitationsWe assessed only the general use of safety behavior in social threatening situations and not with respect to the performance task.ConclusionsThe results provide important preliminary evidence for differences between clinical and non-clinical groups in childhood anxiety in maintaining variables as proposed from cognitive models in adults. In particular, self-focused attention seems to be relevant. Targeting the change of inappropriate attentional focus could be promising for treatment improvement in childhood social anxiety.     

Private and public self-awareness in social anxiety

Clark and Wells' [(1995). A cognitive model of social phobia. In R.G. Heimberg, M. Liebowitz, D.A. Hope, & F. Schneier (Eds.). Social phobia: Diagnosis, assessment and treatment. New York: Guildford Press] cognitive model of social phobia proposes that self-focused attention and construction of the self as a social object maintain anxiety. This study examines the effect of two different self-focus manipulations (mirror and video) on public and private self-awareness, perspective taking, anxiety, and attributions. Thirty one high socially anxious participants (26 female, 5 male) with a mean age of 19.58 (SD=1.89) and 32 low socially anxious participants (21 female, 11 male) with a mean age of 20.47 (SD=3.69) took part in a conversation with a stooge. Public self-awareness increased in both groups but was higher overall in the high socially anxious group. Private self-awareness decreased for the low socially anxious group, but did not change for the high socially anxious group. High socially anxious participants were also more aware of their surroundings than low socially anxious participants. High socially anxious participants used the field perspective less, and experienced more anxiety. High socially anxious participants also made fewer internal attributions for the conversation going well and more for the conversation going badly than low socially anxious participants who did the opposite. The implications of the results for the cognitive model are discussed.     

Sociocultural patterning of neural activity during self-reflection

Western cultures encourage self-construals independent of social contexts, whereas East Asian cultures foster interdependent self-construals that rely on how others perceive the self. How are culturally specific self-construals mediated by the human brain? Using functional magnetic resonance imaging, we monitored neural responses from adults in East Asian (Chinese) and Western (Danish) cultural contexts during judgments of social, mental and physical attributes of themselves and public figures to assess cultural influences on self-referential processing of personal attributes in different dimensions. We found that judgments of self vs a public figure elicited greater activation in the medial prefrontal cortex (mPFC) in Danish than in Chinese participants regardless of attribute dimensions for judgments. However, self-judgments of social attributes induced greater activity in the temporoparietal junction (TPJ) in Chinese than in Danish participants. Moreover, the group difference in TPJ activity was mediated by a measure of a cultural value (i.e. interdependence of self-construal). Our findings suggest that individuals in different sociocultural contexts may learn and/or adopt distinct strategies for self-reflection by changing the weight of the mPFC and TPJ in the social brain network.     

Social anxiety and cognitive biases in non-referred children: The interaction of self-focused attention and threat interpretation biases

Cognitive-behavioral models of social phobia emphasize the combined effects of cognitive biases in the maintenance of the condition, and recent findings in adults implicate self-focused attention as one such bias. However, research examining self-focus in youth is limited. This investigation examined the causal role of self-focused attention on threat interpretation biases in a community sample of 175 socially anxious children. Self-focused attention was experimentally induced via a mirror manipulation procedure and self-focused attention was assessed before and after mirror exposure. Social interpretation biases were examined via an ambiguous stories task with half of the children completing the task in front of a mirror and the other half without a mirror. Social anxiety predicted self-focus and threat interpretation bias. The mirror manipulation did not have an effect on focus of attention or on threat interpretation bias, nor did it interact with social anxiety. Implications and future research directions are discussed.     

Anticipatory processing in social anxiety: two pilot studies

Two studies investigating the cognitive processes associated with anticipatory social anxiety are reported. Study 1 used a semi-structured interview to compare high and low socially anxious individuals (n=20 per group) in terms of their reported mental processes during periods of anticipatory social anxiety. Study 2 investigated the anxiety inducing effects of the mental processes that were shown to be characteristic of high socially anxious individuals in Study 1. Prior to giving a speech, high and low socially anxious individuals (n=20 per group) either engaged in these processes or performed a distraction task. The results of Study 1 were broadly consistent with Clark and Wells’ (In: R.G. Heimberg, M. Liebowitz, D.A. Hope, F.R. Schneier (Eds.), Social phobia: Diagnosis, Assessment and Treatment (pp. 69–93). New York: Guilford Press, 1995) hypotheses about the nature of anticipatory processing in social anxiety. Study 2 showed that, compared to distraction, engaging in the mental processes characteristic of high socially anxious individuals was associated with sustained elevations of anticipatory anxiety in both high and low socially anxious individuals, and led to higher levels of peak anxiety during the speech. The findings suggest that high and low socially anxious individuals show systematic differences in their mental processes prior to a stressful social event, and are consistent with the suggestion that these differences play an important role in sustaining anticipatory anxiety.     

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

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

The effect of positive and negative evaluation on state anxiety and repetitive negative thinking in social evaluative situations: An experimental study

The Bivalent Fear of Evaluation (BFOE) Model suggests that fears of negative and positive evaluation are core cognitive vulnerability and maintenance factors for social anxiety disorder The aim of this study was to experimentally assess cognitive and emotional effects of positive and negative feedback in social anxiety. False positive or negative feedback (vs no feedback) was provided following a speech task to high and low socially anxious individuals to investigate impacts on state anxiety and repetitive negative thinking (N = 152, M_age = 22.13, 69 % female). Measures were completed prior to the speech and after the false feedback but prior to an anticipated discussion with the group about participants’ feedback and performance. High socially anxious participants reporting higher state anxiety and repetitive negative thinking than low socially anxious participants. There were no feedback type by group interactions, indicating that high socially anxious individuals experienced heightened social anxiety and repetitive negative thinking regardless of feedback type (or the absence of feedback). Exploratory analyses revealed that state fear of negative evaluation but not state fear of positive evaluation uniquely predicted both outcomes. Implications for theory and clinical practice are discussed.     

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

Misreading facial expressions as signals of social disapproval, such as anger and disgust, may maintain social anxiety. If so, manipulating face processing could be therapeutic. It remains unclear, however, whether socially anxious individuals are in fact more sensitive to disapproving emotions. We assessed decoding of, and cost attributions to, emotional expressions in high and low socially anxious females (n=102) using five emotions (anger, disgust, fear, happiness, and sadness) expressed at 15 intensities (9–65%), providing 75 stimuli (see Supplementary Material). The decoding task briefly presented the stimuli and participants identified the emotion. The cost attribution task asked individuals to rate each stimulus for how costly it would be for them to interact with the person. Random effects regression indicated that social anxiety was not associated with overall decoding accuracy but was associated with a response bias. High socially anxious individuals had a lower threshold for decoding emotions but also more frequently classified low intensity emotions incorrectly. These effects were not emotion-specific. Socially anxious individuals also attributed excessive social cost to expressions of negative valence. Our results provide a novel conceptual framework for understanding emotion decoding in social anxiety, indicating the importance of considering both accuracy and response bias.     

Post-event processing and the retrieval of autobiographical memories in socially anxious individuals

Individuals with social anxiety often report considerable ruminative thoughts following ambiguous social events (post-event processing). The purpose of this study was to determine whether post-event processing affects retrieval of autobiographical memories rated as negative, anxious and shameful in a sample of socially anxious individuals and controls. Results indicated that, compared to controls, socially anxious individuals recalled memories that were rated as significantly more negative and shameful regardless of the type of post-event processing engaged in. Unexpectedly, after negative post-event processing socially anxious individuals recalled memories that although anxious and shameful, were rated as significantly more calming than after other types of post-event processing. The results imply that post-event processing may have some adaptive benefit that could explain why it persists in socially anxious individuals.     

The effect of single-session interpretation modification on attention bias in socially anxious individuals

Research suggests that individuals with social anxiety interpret ambiguous social information negatively (e.g., Amir, Foa, & Coles, 1998) and that much negative interpretation bias may share a common mechanism with other information processing biases (e.g., Mathews, Mackintosh, & Fulcher, 1997). In the current study, we examined effectiveness of an Interpretation Modification Program in changing attention biases in socially anxious individuals. Participants were randomly assigned to either an Interpretation Modification Program (IMP) that guided them to make benign interpretations of ambiguous social scenarios or an Interpretation Control Condition (ICC) that did not guide participants’ interpretation in either direction. Results revealed that individuals in the IMP group demonstrated greater ability to disengage attention from threat stimuli after completing the program, while individuals in the ICC did not. These results are consistent with the hypothesis that information processing biases in anxious individuals may share a common mechanism that may contribute to the maintenance of anxiety.     

Beyond the average brain: individual differences in social brain development are associated with friendship quality

We tested whether adolescents differ from each other in the structural development of the social brain and whether individual differences in social brain development predicted variability in friendship quality development. Adolescents (N = 299, M_age T1 =13.98 years) were followed across three biannual waves. We analysed self-reported friendship quality with the best friend at T1 and T3, and bilateral measures of surface area and cortical thickness of the medial prefrontal cortex (mPFC), posterior superior temporal sulcus (pSTS), temporoparietal junction (TPJ) and precuneus across all waves. At the group level, growth curve models confirmed non-linear decreases of surface area and cortical thickness in social brain regions. We identified substantial individual differences in levels and change rates of social brain regions, especially for surface area of the mPFC, pSTS and TPJ. Change rates of cortical thickness varied less between persons. Higher levels of mPFC surface area and cortical thickness predicted stronger increases in friendship quality over time. Moreover, faster cortical thinning of mPFC surface area predicted a stronger increase in friendship quality. Higher levels of TPJ cortical thickness predicted lower friendship quality. Together, our results indicate heterogeneity in social brain development and how this variability uniquely predicts friendship quality development.     

Direct replication of task‐dependent neural activation patterns during sadness introspection in two independent adolescent samples

Functional neuroimaging results need to replicate to inform sound models of human social cognition and its neural correlates. Introspection, the capacity to reflect on one's thoughts and feelings, is one process required for normative social cognition and emotional functioning. Engaging in introspection draws on a network of brain regions including medial prefrontal cortex (mPFC), posterior cingulate cortex (PCC), middle temporal gyri (MTG), and temporoparietal junction (TPJ). Maturation of these regions during adolescence mirrors the behavioral advances seen in adolescent social cognition, but the neural correlates of introspection in adolescence need to replicate to confirm their generalizability and role as a possible mechanism. The current study investigated whether reflecting upon one's own feelings of sadness would activate and replicate similar brain regions in two independent samples of adolescents. Participants included 156 adolescents (50% female) from the California Families Project and 119 adolescent girls from the Pittsburgh Girls Study of Emotion. All participants completed the Emotion Regulation Questionnaire (ERQ) and underwent a functional magnetic resonance imaging scan while completing the same facial emotion‐processing task at age 16–17 years. Both samples showed similar whole‐brain activation patterns when engaged in sadness introspection and when judging a nonemotional facial feature. Whole‐brain activation was unrelated to ERQ scores in both samples. Neural responsivity to task manipulations replicated in regions recruited for socio‐emotional (mPFC, PCC, MTG, TPJ) and attention (dorsolateral PFC, precentral gyri, superior occipital gyrus, superior parietal lobule) processing. These findings demonstrate robust replication of neural engagement during sadness introspection in two independent adolescent samples.