Neural bases of social anxiety disorder: emotional reactivity and cognitive regulation during social and physical threat

Neural mechanisms and predictors of SSRI and CBT treatment of anxiety: A randomized trial focused on emotion and cognitive processing

Anxiety disorders (ADs) are common and difficult to treat. While research suggests ADs are characterized by an imbalance between bottom-up and top-down attention processes and that effective treatments work by correcting this dysfunction, there is insufficient data to explain how and for whom treatments work. The late positive potential (LPP), an event-related potential reflecting elaborative processing of motivationally salient stimuli, is sensitive to both bottom-up and top-down processes. The present study examines the LPP in healthy controls (HC) and patients with ADs under low and high working memory (WM) load to assess its utility as a predictor and index of symptom reduction in patients who underwent cognitive behavioral therapy (CBT) or selective serotonin reuptake inhibitor (SSRI) treatment. The LPP when viewing negative and neutral distractor images and WM performance were assessed in 96 participants (40 HC, 32 CBT, 24 SSRI) during a letter recall task at Week 0 and in a subset of the study sample (23 CBT, 16 SSRI) at Week 12. Patients were randomly assigned to twelve weeks of CBT or SSRI treatment. Participants completed self-reported symptom measures at each time point. Greater Week 0 LPP to negative images under low WM load predicted greater symptom reduction in the SSRI, but not the CBT, group. Regression analyses examining the LPP to negative images as an index of symptom reduction revealed a smaller decrease in the LPP to negative images under low WM load was associated with less anxiety reduction across treatment modalities. Findings suggest the LPP during low WM load may serve as a cost-effective predictor and index of treatment outcome in ADs. Clinical Trials Registration: ClinicalTrials.gov (Identifier: NCT01903447).

Neurophysiological Responses to Interpersonal Emotional Images: Associations with Symptoms of Depression and Social Anxiety

Affective neuroscience research using electrocortical event-related potentials has provided valuable insights on alterations in emotion processing in internalizing disorders. However, internalizing disorders are accompanied by additional impairments in social cognition and functioning, and most extant research examines neural responses to broad categories of emotional scenes or faces presented irrespective of context. Examining neural reactivity specifically to interpersonal emotional scenes may more precisely capture and disentangle processes involved in depression and social anxiety, two highly comorbid forms of psychopathology. The current study validated a novel set of positive and threatening interpersonal emotional stimuli in a sample of emerging adults (N = 114) who completed a modified emotional interrupt paradigm while electroencephalogram and behavioral data were recorded. Participant ratings of valence and arousal supported the validity of the emotional images. Consistent with prior research, sustained neurophysiological processing indexed by the late positive potential (LPP) was observed for interpersonal emotional images, especially positive, compared with neutral images. Elevated LPP reactivity to both positive and threatening interpersonal images moderated the effects of chronic interpersonal stress on social anxiety symptoms, such that enhanced LPP reactivity in conjunction with higher levels of chronic interpersonal stress was associated with elevated social anxiety symptoms. These results were unique to social anxiety symptoms and not symptoms of depression, suggesting sustained neural processing of interpersonal stimuli may differentiate social anxiety from depression. Future research on emotional reactivity specifically within the interpersonal domain is needed to inform our understanding of developmental pathways to internalizing psychopathology.

Altered gray matter volume and structural co-variance in adolescents with social anxiety disorder: evidence for a delayed and unsynchronized development of the fronto-limbic system

BACKGROUND

Social anxiety disorder (SAD) is a prevalent mental disorder diagnosed in childhood and adolescence. Theories regarding brain development and SAD suggest a close link between neurodevelopmental dysfunction at the adolescent juncture and SAD, but direct evidence is rare. This study aims to examine brain structural abnormalities in adolescents with SAD.

METHODS

High-resolution T1-weighted images were obtained from 31 adolescents with SAD (15-17 years) and 42 matching healthy controls (HC). We evaluated symptom severity with the Social Anxiety Scale for Children (SASC) and the Screen for Child Anxiety Related Emotional Disorders (SCARED). We used voxel-based morphometry analysis to detect regional gray matter volume abnormalities and structural co-variance analysis to investigate inter-regional coordination patterns.

RESULTS

We found significantly higher gray matter volume in the orbitofrontal cortex (OFC) and the insula in adolescents with SAD compared to HC. We also observed significant co-variance of the gray matter volume between the OFC and amygdala, and the OFC and insula in HC, but these co-variance relationships diminished in SAD.

CONCLUSIONS

These findings provide the first evidence that the brain structural deficits in adolescents with SAD are not only in the core regions of the fronto-limbic system, but also represented by the diminished coordination in the development of these regions. The delayed and unsynchronized development pattern of the fronto-limbic system supports SAD as an adolescent-sensitive developmental mental disorder.

Intrinsic functional connectivity in families genetically enriched for social anxiety disorder - an endophenotype study

BACKGROUND

Social anxiety disorder (SAD) is a serious psychiatric condition with a high prevalence, and a typical onset during childhood/adolescence. The condition runs in families, but it is largely unknown which neurobiological characteristics transfer this genetic vulnerability ('endophenotypes'). Using data from the Leiden Family Lab study on SAD, including two generations of families genetically enriched for SAD, we investigated whether social anxiety (SA) co-segregated with changes in intrinsic functional connectivity (iFC), and examined heritability.

METHODS

Functional MRI data were acquired during resting-state in 109 individuals (56 males; mean age: 31·5, range 9·2-61·5 years). FSL's tool MELODIC was used to perform independent component analysis. Six networks of interest (default mode, dorsal attention, executive control, frontoparietal, limbic and salience) were identified at the group-level and used to generate subject-specific spatial maps. Voxel-wise regression models, with SA-level as predictor and voxel-wise iFC as candidate endophenotypes, were performed to investigate the association with SA, within masks of the networks of interest. Subsequently, heritability was estimated.

FINDINGS

SA co-segregated with iFC within the dorsal attention network (positive association in left middle frontal gyrus and right postcentral gyrus) and frontoparietal network (positive association within left middle temporal gyrus) (cluster-forming-threshold z>2·3, cluster-corrected extent-threshold p<0·05). Furthermore, iFC of multiple voxels within these clusters was at least moderately heritable.

INTERPRETATION

These findings provide initial evidence for increased iFC as candidate endophenotype of SAD, particularly within networks involved in attention. These changes might underlie attentional biases commonly present in SAD.

FUNDING

Leiden University Research Profile 'Health, Prevention and the Human Lifecycle'.

Cognitive Neural Mechanism of Social Anxiety Disorder: A Meta-Analysis Based on fMRI Studies

Objective: The present meta-analysis aimed to explore the cognitive and neural mechanism of social anxiety disorder (SAD) from a whole-brain view, and compare the differences in brain activations under different task paradigms. Methods: We searched Web of Science Core Collection and other databases with the keywords related to social anxiety, social phobia, and functional magnetic resonance imaging (fMRI) for comparing persons with SAD to healthy controls and used the activation likelihood estimation method. Thirty-seven papers met the inclusion criteria, including 15 with emotional faces as stimuli, 8 presenting specific situations as stimuli, and 14 using other types of tasks as stimuli. Among these papers, 654 participants were in the SAD group and 594 participants were in the control group with 335 activation increase points and 115 activation decrease points. Results: Whole-brain analysis showed that compared with healthy controls, persons with SAD showed significantly lower activation of the left anterior cingulate gyrus (MNI coordinate: x = −6, y = 22, z = 38; p 0.001). Sub-group analysis based on task indicated that when performing tasks with emotional faces as stimuli, persons with SAD showed significantly lower activation of the left cerebellar slope and fusiform gyrus (MNI coordinate: x = −26, y = −68, z = −12; p 0.001), and significantly higher activation of the right supramarginal gyrus and angular gyrus, than healthy controls (MNI coordinate: x = 58, y = −52, z = 30; p 0.001). Conclusion: Individuals with social anxiety disorder show abnormal activation in the cingulate gyrus, which is responsible for the process of attention control, and task type can influence the activation pattern.

Virtual Reality-Based Psychotherapy in Social Anxiety Disorder: fMRI Study Using a Self-Referential Task

BACKGROUND

Although it has been well demonstrated that the efficacy of virtual reality therapy for social anxiety disorder is comparable to that of traditional cognitive behavioral therapy, little is known about the effect of virtual reality on pathological self-referential processes in individuals with social anxiety disorder.

OBJECTIVE

We aimed to determine changes in self-referential processing and their neural mechanisms following virtual reality treatment.

METHODS

We recruited participants with and without a primary diagnosis of social anxiety disorder to undergo clinical assessments (Social Phobia Scale and Post-Event Rumination Scale) and functional magnetic resonance imaging (fMRI) scans. Participants with social anxiety disorder received virtual reality-based exposure treatment for 6 sessions starting immediately after baseline testing. After the sixth session, participants with social anxiety disorder completed follow-up scans during which they were asked to judge whether a series of words (positive, negative, neutral) was relevant to them.

RESULTS

Of 25 individuals with social anxiety disorder who participated in the study, 21 completed the sessions and follow-up; 22 control individuals also participated. There were no significant differences in age (P=.36), sex (P=.71), or handedness (P=.51) between the groups. Whole-brain analysis revealed that participants in the social anxiety disorder group had increased neural responses during positive self-referential processing in the medial temporal and frontal cortexes compared with those in the control group. Participants in the social anxiety disorder group also showed increased left insular activation and decreased right middle frontal gyrus activation during negative self-referential processing. After undergoing virtual reality-based therapy, overall symptoms of the participants with social anxiety disorder were reduced, and these participants exhibited greater activity in a brain regions responsible for self-referential and autobiographical memory processes while viewing positive words during postintervention fMRI scans. Interestingly, the greater the blood oxygen level dependent changes related to positive self-referential processing, the lower the tendency to ruminate on the negative events and the lower the social anxiety following the virtual reality session. Compared with that at baseline, higher activation was also found within broad somatosensory areas in individuals with social anxiety disorder during negative self-referential processing following virtual reality therapy.

CONCLUSIONS

These fMRI findings might reflect the enhanced physiological and cognitive processing in individuals with social anxiety disorder in response to self-referential information. They also provide neural evidence of the effect of virtual reality exposure therapy on social anxiety and self-derogation.

Anticipated Attack Slows Responses in a Cued Virtual Attack Emotional Sternberg Task

Threatening stimuli have varying effects, including reaction time (RT) increase in working memory tasks. This could reflect disruption of working memory or, alternatively, a reversible state of freezing. In the current series of experiments, reversible slowing due to anticipated threat was studied using the cued Virtual Attack Emotional Sternberg Task (cVAEST). In this task visually neutral cues indicate whether a future virtual attack could or could not occur during the maintenance period of a Sternberg task. Three studies (N = 47, 40, and 40, respectively) were performed by healthy adult participants online. The primary hypothesis was that the cVAEST would evoke anticipatory slowing. Further, the studies aimed to explore details of this novel task, in particular the interval between the cue and probe stimuli and the memory set size. In all studies it was found that threat anticipation slowed RTs on the working memory task. Further, Study 1 (memory set size 3) showed a decrease in RT when the attack occurred over all Cue Stimulus Intervals (CSIs). In Study 2 a minimal memory set of one item was used, under which circumstances RTs following attacks were only faster shortly after cue presentation (CSI 200 and 500 ms), when RTs were high for both threat and safe cues. Study 3 replicated results of Study 2 with more fine-grained time intervals. The results confirm that anticipation of attack stimuli can reversibly slow responses on an independent working memory task. The cVAEST may provide a useful method to study such threat-induced response slowing.

Simulating thoughts to measure and study internal attention in mental health

Our mind's eye and the role of internal attention in mental life and suffering has intrigued scholars for centuries. Yet, experimental study of internal attention has been elusive due to our limited capacity to control the timing and content of internal stimuli. We thus developed the Simulated Thoughts Paradigm (STP) to experimentally deliver own-voice thought stimuli that simulate the content and experience of thinking and thereby experimental study of internal attentional processes. In independent experiments (N = 122) integrating STP into established cognitive-experimental tasks, we found and replicated evidence that emotional reactivity to negative thoughts predicts difficulty disengaging internal attention from, as well as biased selective internal attention of, those thoughts; these internal attention processes predict cognitive vulnerability (e.g., negative repetitive thinking) which thereby predict anxiety and depression. Proposed methods and findings may have implications for the study of information processing and attention in mental health broadly and models of internal attentional (dys)control in cognitive vulnerability and mental health more specifically.

The role of expressive suppression and cognitive reappraisal in cognitive behavioral therapy for social anxiety disorder: A study of self-report, subjective, and electrocortical measures

BACKGROUND

Contemporary models of cognitive behavioral therapy (CBT) for social anxiety disorder (SAD) emphasize emotion dysregulation as a core impairment whose reduction may play a causal role in psychotherapy. The current study examined changes in use of emotion regulation strategies as possible mechanisms of change in CBT for SAD. Specifically, we examined changes in expressive suppression and cognitive reappraisal during CBT and whether these changes predict treatment outcome.

METHODS

Patients (n = 34; 13 females; Mean age = 28.36 (6.97)) were allocated to 16-20 sessions of CBT. An electrocortical measure of emotion regulation and a clinician-rated measure of SAD were administered monthly. Self-report measures of emotion regulation and social anxiety were administered weekly. Multilevel models were used to examine changes in emotion regulation during treatment and cross-lagged associations between emotion regulation and anxiety.

RESULTS

CBT led to decreased suppression frequency, increased reappraisal self-efficacy, and decreased unpleasantness for SAD-related pictures (ps < .05). At post-treatment, patients were equivalent to healthy controls in terms of suppression frequency and subjective reactivity to SAD-related stimuli. Gains were maintained at 3-months follow-up. Decreases in suppression frequency and electrocortical reactivity to SAD-related pictures predicted lower subsequent anxiety but not the other way around (ps < .05). Lower anxiety predicted greater subsequent increases in reappraisal self-efficacy.

LIMITATIONS

The lack of a control group precludes conclusions regarding mechanisms specificity.

CONCLUSIONS

Decreased frequency of suppression is a potential mechanism of change in CBT for SAD.

How is psychological stress linked to sleep quality? The mediating role of functional connectivity between the sensory/somatomotor network and the cingulo-opercular control network

How the functional connectivity of brain networks affects the relationship between psychological stress and sleep quality remains unclear. To better understand the associations between psychological stress, resting-state functional connectivity (RSFC), and sleep quality, we used the RSFC, Pittsburgh Sleep Quality Index (PSQI), and Psychosomatic Tension Relaxation Inventory (PSTRI) to investigate the relationship between psychological stress, sleep quality, and RSFC in four brain networks, the sensory/somatomotor (SM) network, cigulo-opercular control (CO) network, default mode (DM) network, and dorsal attention (DA) network, in a large healthy sample of 315 college students from Southwest University. Results showed that the brain functional connectivity in the SM, CO, DM, and DA networks was significantly correlated to sleep quality. Meanwhile, we also found that the brain functional connectivity between the SM and CO networks partially mediated the relationship between psychological stress and sleep quality, suggesting that psychological stress has an important effect on individuals' sleep quality, and increased functional connectivity between the SM and CO networks provides a neural basis for the association between psychological stress and poor sleep quality.

White matter structural network disturbances in first-episode, drug-naïve adolescents with generalized anxiety disorder

BACKGROUND

Previous studies have suggested that individuals with generalized anxiety disorder (GAD) would show inefficient whole-brain communication and dysconnectivity in the fronto-parietal-subcortical sub-networks in the white matter (WM) structural network. However, these hypotheses have yet to be tested.

METHODS

Individual WM structural networks were constructed based on diffusion MRI data and deterministic tractography in 34 first-episode, medication-naïve adolescents with GAD and 27 healthy controls (HCs). Graph theory was applied to investigate the topological organization alterations of the structural network.

RESULTS

GAD patients showed disrupted small-world configurations (i.e., increased path length and decreased clustering coefficient) and hub organization (i.e., less connection strength in the feeder and local connections). A decreased connection strength was found in a GAD-related sub-network (mainly involving the frontal-subcortical circuits), which was able to distinguish GAD patients from HCs with higher accuracy (area under the curve of 0.96, sensitivity of 94%, specificity of 89%) than clinical scores and other topological alternations.

LIMITATIONS

The current study just compared GAD patients with HCs based on a small sample, leaving whether the alternations found here are specific to GAD still an open question. Future studies are recommended to recruit patients with other anxiety disorders (e.g., social anxiety disorder) and/or comorbid mood disorders to identify the GAD-specific WM alterations using a larger sample.

CONCLUSIONS

Our findings highlight the disruption of the topological organization of the whole-brain WM structural network (especially the frontal-subcortical circuits) in GAD, and suggest the potential of using structural connectivity of the GAD-related sub-network as a biomarker for GAD patients.

Anxiety and Stress Alter Decision-Making Dynamics and Causal Amygdala-Dorsolateral Prefrontal Cortex Circuits During Emotion Regulation in Children

BACKGROUND

Anxiety and stress reactivity are risk factors for the development of affective disorders. However, the behavioral and neurocircuit mechanisms that potentiate maladaptive emotion regulation are poorly understood. Neuroimaging studies have implicated the amygdala and dorsolateral prefrontal cortex (DLPFC) in emotion regulation, but how anxiety and stress alter their context-specific causal circuit interactions is not known. Here, we use computational modeling to inform affective pathophysiology, etiology, and neurocircuit targets for early intervention.

METHODS

Forty-five children (10-11 years of age; 25 boys) reappraised aversive stimuli during functional magnetic resonance imaging scanning. Clinical measures of anxiety and stress were acquired for each child. Drift-diffusion modeling of behavioral data and causal circuit analysis of functional magnetic resonance imaging data, with a National Institute of Mental Health Research Domain Criteria approach, were used to characterize latent behavioral and neurocircuit decision-making dynamics driving emotion regulation.

RESULTS

Children successfully reappraised negative responses to aversive stimuli. Drift-diffusion modeling revealed that emotion regulation was characterized by increased initial bias toward positive reactivity during viewing of aversive stimuli and increased drift rate, which captured evidence accumulation during emotion evaluation. Crucially, anxiety and stress reactivity impaired latent behavioral dynamics associated with reappraisal and decision making. Anxiety and stress increased dynamic casual influences from the right amygdala to DLPFC. In contrast, DLPFC, but not amygdala, reactivity was correlated with evidence accumulation and decision making during emotion reappraisal.

CONCLUSIONS

Our findings provide new insights into how anxiety and stress in children impact decision making and amygdala-DLPFC signaling during emotion regulation, and uncover latent behavioral and neurocircuit mechanisms of early risk for psychopathology.

Reappraisal of Interpersonal Criticism in Social Anxiety Disorder: A Brain Network Hierarchy Perspective

Emotion regulation is thought to involve communication between and within large-scale brain networks that underlie emotion reactivity and cognitive control. Aberrant network interaction might therefore be a key neural feature of mental disorders that involve emotion dysregulation. Here we tested whether connectivity hierarchies within and between emotion reactivity and cognitive reappraisal networks distinguishes social anxiety disorder (SAD) patients (n = 70) from healthy controls (HC) (n = 25). To investigate network organization, we implemented a graph-theory method called Dependency Network Analysis. Participants underwent fMRI while watching or reappraising video clips involving interpersonal verbal criticism. During reappraisal, the reappraisal network exerted less influence on the reactivity network in SAD participants. Specifically, the influence of the right inferior frontal gyrus on both reappraisal and reactivity networks was significantly reduced in SAD compared with HC, and correlated negatively with negative emotion ratings among SAD participants. Surprisingly, the amygdala exhibited reduced influence on the reappraisal network in SAD relative to HC. Yet, during the watch condition, the left amygdala's influence on the reactivity network increased with greater social anxiety symptoms among SAD participants. These findings refine our understanding of network organization that contributes to efficient reappraisal or to disturbances in applying this strategy in SAD.

Dissociations in cortical thickness and surface area in non-comorbid never-treated patients with social anxiety disorder

BACKGROUND

Abnormalities of functional activation and cortical volume in brain regions involved in the neurobiology of fear and anxiety have been implicated in the pathophysiology of social anxiety disorder (SAD). However, few studies have performed separate measurements of cortical thickness (CT) and cortical surface area (CSA) which reflect different neurobiological processes. Thus, we aimed to explore the cortical morphological anomaly separately in SAD using FreeSurfer.

METHODS

High-resolution structural magnetic resonance images were obtained from 32 non-comorbid never-treated adult SAD patients and 32 demography-matched healthy controls. Cortical morphometry indices including CT and CSA were separately determined by FreeSurfer and compared between the two groups via whole-brain vertex-wise analysis, while partial correlation analysis using age and gender as covariates were conducted.

FINDINGS

The patients with SAD showed decreased CT but increased CSA near-symmetrically in the bilateral prefrontal cortex (PFC) of the dorsolateral, dorsomedial, and ventromedial subdivisions, as well as the right lateral orbitofrontal cortex; increased CSA in the left superior temporal gyrus (STG) was also observed in SAD. The CSA in the left PFC was negatively correlated with the disease duration.

INTERPRETATION

As the balloon model hypothesis suggests that the tangentially stretched cortex may cause dissociations in cortical morphometry and affect the cortical capacity for information processing, our findings of dissociated morphological alterations in the PFC and cortical expansion in the STG may reflect the morphological alterations of the functional reorganization in those regions, and highlight the important role of those structures in the pathophysiology and neurobiology of SAD.

FUNDING

This study was funded by the National Natural Science Foundation of China (Grant Nos. 31700964, 31800963, 81621003, and 81820108018).

Variants of Children with Psychopathic Tendencies in a Community Sample

To investigate the heterogeneity of children with psychopathic tendencies, this study identified heterogenous subgroups among a community sample of children based on their callous-unemotional (CU) traits, conduct problems (CP), and anxiety. A latent profile analysis classified 1861 primary school students (age 6-14) into four subgroups based on parent-report CU traits, CP and anxiety: low-risk children (i.e., low in CU traits, CP, and anxiety), anxious children (i.e., high in anxiety, low in CU traits and CP), primary variants of children with psychopathic tendencies (i.e., high in CU traits and CP, low in anxiety), and secondary variants of children with psychopathic tendencies (i.e., high in CU traits, CP, and anxiety). In particular, the secondary variants evidenced higher levels of CU traits, CP, and anxiety than the primary variants. Our findings extend the heterogeneity of psychopathy to childhood and encourage future research to examine the developmental trajectories of psychopathy.

Multiple large-scale neural networks underlying emotion regulation

Recent models suggest emotion generation, perception, and regulation rely on multiple, interacting large-scale brain networks. Despite the wealth of research in this field, the exact functional nature and different topological features of these neural networks remain elusive. Here, we addressed both using a well-established data-driven meta-analytic grouping approach. We applied k-means clustering to a large set of previously published experiments investigating emotion regulation (independent of strategy, goal and stimulus type) to segregate the results of these experiments into large-scale networks. To elucidate the functional nature of these distinct networks, we used functional decoding of metadata terms (i.e. task-level descriptions and behavioral domains). We identified four large-scale brain networks. The first two were related to regulation and functionally characterized by a stronger focus on response inhibition or executive control versus appraisal or language processing. In contrast, the second two networks were primarily related to emotion generation, appraisal, and physiological processes. We discuss how our findings corroborate and inform contemporary models of emotion regulation and thereby significantly add to the literature.

OFC and its connectivity with amygdala as predictors for future social anxiety in adolescents

Social anxiety is a common problem that usually emerges at puberty, during which great developmental changes occur both in the brain and mental state. However, little is known about the influence of social anxiety on adolescents’ brain and behavior. The present study investigated the neural basis of social anxiety using voxel-based morphometry (VBM) and functional connectivity analysis. Then we investigated whether social anxiety is associated with attention bias. Furthermore, we investigated the neural basis of this association. Finally, longitudinal data was used to test if these biomarkers could predict social anxiety. The results indicated that social anxiety is positively associated with the grey matter volume (GMV) of orbital-frontal cortex (OFC), and the functional connectivity (FC) of OFC-amygdala. Mediation analysis revealed that the relationship between social anxiety and attention avoidance is partly mediated by the FC of OFC-amygdala. Finally, the present study demonstrated a close relationship between FC of the OFC-amygdala, the GMV of the OFC and the individual’s social anxiety one year later. The present study suggested the aberrant structure of OFC and its connectivity with amygdala as the neural underpinning of social anxiety, which might serve as a compensatory mechanism to decrease attention avoidance and promote effective emotion regulation.

The Role of Childhood Maltreatment in The Relationship Between Social Anxiety and Dissociation: A Novel Link

Children that have been maltreated may experience manifold negative effects later in life. Two such sequelae are social anxiety and dissociation. Recent studies have noted their frequent co-occurrence, but no hypothesis has yet been offered explaining how they interact. College undergraduates (N = 198) completed the Child Trauma Questionnaire, Liebowitz Social Anxiety Scale, and Cambridge Depersonalization Scale. Social anxiety significantly predicted severity of dissociation, and self-reported childhood maltreatment (CM) significantly predicted both social anxiety and dissociation. Notably, emotional abuse was the only significant subtype of CM to predict social anxiety. Furthermore, CM moderated the relationship between social anxiety and dissociation, such that the presence of CM strengthened the predictive effect of social anxiety on dissociation. This study was the first to implicate CM as a mechanism in the social anxiety-dissociation relationship. This study was also the first to note a social anxiety-dissociation link in a non-clinical sample, thus demonstrating the existence of this relationship along a continuum of severity - not solely for those with extreme disturbances.

Assessment of the Emotional Reactivity Through the Positive and Negative Emotions: The Psychometric Properties of the Persian Version of the Perth Emotional Reactivity Scale

Background: Emotional reactivity is a key construct for understanding psychopathology. Examining the psychometric properties of the instruments in societies with different cultures can help with their external validity. Objectives: The current study aimed at standardization and validation of the Perth emotional reactivity scale (PERS) in Iranian university students. Methods: The Persian version of the PERS was produced through forward translation, reconciliation, and back-translation. A total of 302 (169 males and 133 females) nonclinical students were selected by convenience sampling method, and completed a set of questionnaires, including the PERS, weight efficacy lifestyle questionnaire-short form (WEL-SF), eating attitude test-16 (EAT-16), self-esteem scale (SES), difficulties in emotion regulation scale-16 (DERS-16), and self-compassion scale (SCS) short-form. The construct validity of the PERS was assessed using confirmatory factor analysis and divergent and convergent validity. Internal consistency and test-retest reliability (a 2-weeks interval) were used to evaluate the reliability. Data analysis was performed using LISREL (version 8.8) and SSPS (version 22) software. Results: All PERS scales and subscales were found with good internal consistency and test-retest reliability in a nonclinical population. The convergent validity and divergent validity were also found good. The results of this study provides the support for the applicability of the six-factor (RMSEA = 0.06, NFI = 0.94, NNFI = 0.96, and CFI = 0.97) and two-factor (RMSEA = 0.07, NFI = 0.94, NNFI = 0.96, and CFI = 0.96) models of the PERS. Conclusions: The PERS showed good validity and reliability and can be useful in assessing emotional reactivity in the Iranian population. The PERS can be promising as a measure to use in emotional-based studies and clinical settings.

Regulation of negative emotions through positive reappraisal and distancing in high-trait-anxious women

BACKGROUND

Positive reappraisal and distancing are two distinct cognitive reappraisal strategies for emotion regulation. Critically however, research examining the impact of elevated trait anxiety on cognitive reappraisal has often conflated these strategies. Thus, the present study investigated whether high-trait-anxious (HTA) women can effectively utilize positive reappraisal and distancing to regulate emotional responses to negative stimuli.

METHODS

Twenty-six HTA women and twenty-seven low-trait-anxious (LTA) women were investigated in a self-generated reappraisal paradigm. Subjective measures of emotional regulation and event-related potentials (ERPs) were recorded while participants were instructed to passively view neutral or negative pictures, or to reinterpret negative pictures in a positive way (positive reappraisal) or a detached and unemotional way (distancing).

RESULTS

HTA women, as compared to LTA women, reported smaller reductions in negative affect after positive reappraisal and smaller reductions in emotional arousal after distancing. Though ERP data did not reveal corresponding differences in the centro-parietal late positive potential during emotion regulation, data did reveal HTA women exhibited enhanced recruitment of cognitive control during positive reappraisal and greater preparatory processing before engaging in distancing.

LIMITATIONS

Future research should examine the generalizability of the present results in clinical anxiety individuals, male sample and other reappraisal strategies.

CONCLUSIONS

Overall, HTA women appeared to recruit more cortical resources, suggestive of compensatory mechanisms, to achieve a similar performance as LTA women when engaging in positive reappraisal and distancing strategies to regulate negative emotions. Therefore, the findings demonstrate that HTA women are characterized by the inefficient implementation of positive reappraisal and distancing strategies.

Changes in functional connectivity with cognitive behavioral therapy for social anxiety disorder predict outcomes at follow-up

Approximately half of individuals with Social Anxiety Disorder (SAD) treated with psychological intervention do not achieve clinically significant improvement or retain long-term gains. Neurobiological models of SAD propose that disruptions in functioning of amygdala-prefrontal circuitry is implicated in short-term treatment response. However, whether treatment-related changes in functional connectivity predict long-term well-being after psychotherapy is unknown. Patients with SAD completed an incidental emotion regulation task during fMRI before and after treatment with cognitive behavioral therapy or acceptance and commitment therapy (n = 23, collapsed across groups). Psychophysiological interaction analyses using amygdala seed regions were conducted to assess changes in functional connectivity from pre-to post-treatment that predicted symptom change from 6 to 12-month follow-up. Negative change (i.e., greater inverse/weaker positive) in amygdala connectivity with the dorsomedial prefrontal cortex (dmPFC) and dorsal anterior cingulate cortex (dACC) predicted greater symptom reduction during follow-up. Positive change in amygdala connectivity with the cerebellum, fusiform gyrus, and pre-central and post-central gyri predicted less symptom reduction (e.g., no change or worsening). Results suggest that strengthened amygdala connectivity with regulatory regions may promote better long-term outcomes, whereas changes with visual and sensorimotor regions may represent sensitization to emotion-related cues, conferring poorer outcomes. Clinical implications for treatment personalization are discussed, should effects replicate in larger samples.

Amygdala hyperreactivity to faces conditioned with a social-evaluative meaning- a multiplex, multigenerational fMRI study on social anxiety endophenotypes

Social anxiety disorder (SAD) runs in families, but the neurobiological pathways underlying the genetic susceptibility towards SAD are largely unknown. Here, we employed an endophenotype approach, and tested the hypothesis that amygdala hyperreactivity to faces conditioned with a social-evaluative meaning is a candidate SAD endophenotype. We used data from the multiplex, multigenerational Leiden Family Lab study on Social Anxiety Disorder (eight families, n = 105) and investigated amygdala activation during a social-evaluative conditioning paradigm with high ecological validity in the context of SAD. Three neutral faces were repeatedly presented in combination with socially negative, positive or neutral sentences. We focused on two endophenotype criteria: co-segregation of the candidate endophenotype with the disorder within families, and heritability. Analyses of the fMRI data were restricted to the amygdala as a region of interest, and association analyses revealed that bilateral amygdala hyperreactivity in response to the conditioned faces co-segregated with social anxiety (SA; continuous measure) within the families; we found, however, no relationship between SA and brain activation in response to more specific fMRI contrasts. Furthermore, brain activation in a small subset of voxels within these amygdala clusters was at least moderately heritable. Taken together, these findings show that amygdala engagement in response to conditioned faces with a social-evaluative meaning qualifies as a neurobiological candidate endophenotype of social anxiety. Thereby, these data shed light on the genetic vulnerability to develop SAD.

The Efficacy of Intensive Short-Term Dynamic Psychotherapy for Social Anxiety Disorder: Randomized Trial and Substudy of Emphasizing Feeling Versus Defense Work

This research examined the efficacy of intensive short-term dynamic psychotherapy (ISTDP) in the treatment of social anxiety disorder (SAD) and compared the therapeutic outcomes of ISTDP when feeling focus or defense work is emphasized. A three-group randomized design with 6-month follow-up was used. Forty-one subjects were selected among volunteer college students diagnosed with SAD. They were assigned randomly into three groups; 14 cases to feeling-focused ISTDP (FF-ISTDP) group, 14 cases to defense-focused ISTDP (DF-ISTDP) group, and 13 cases to a control group. All subjects were evaluated at pretest, posttest, and six-month follow-up through clinical interviewing using DSM-5 criteria for SAD along with the Liebowitz Social Anxiety Scale. Each experimental group had a course of 8 to 10 sessions of ISTDP treatment. Analysis of variance showed that ISTDP is an effective treatment for SAD compared with a control group. No outcome differences were found between FF-ISTDP and DF-ISTDP in treating SAD.

Brain and behavioral alterations in subjects with social anxiety dominated by empathic embarrassment

People are increasingly affected by social anxiety that includes emotional hypersensitivity and inaccurate interpretation of social encounters, and varies markedly in its subjective manifestations. We searched for insights into the underlying neurocognitive mechanisms of Taijin-kyofusho (TKS), a specific subtype of social-anxiety disorder common in East Asia and dominated by empathic or other-oriented embarrassment. We found TKS to be characterized by enhanced affective and reduced cognitive empathy. Moreover, analysis of functional MRI data—collected while subjects viewed videos of badly singing people—revealed disruption of the cognitive–empathy network, possibly obstructing flexible inference of others’ perspective or augmenting maladaptive feelings of embarrassment. Our findings shed light on how altered affective and cognitive processing can contribute to the development of imaginary fears.

Social-anxiety disorder involves a fear of embarrassing oneself in the presence of others. Taijin-kyofusho (TKS), a subtype common in East Asia, additionally includes a fear of embarrassing others. TKS individuals are hypersensitive to others’ feelings and worry that their physical or behavioral defects humiliate others. To explore the underlying neurocognitive mechanisms, we compared TKS ratings with questionnaire-based empathic disposition, cognitive flexibility (set-shifting), and empathy-associated brain activity in 23 Japanese adults. During 3-tesla functional MRI, subjects watched video clips of badly singing people who expressed either authentic embarrassment (EMBAR) or hubristic pride (PRIDE). We expected the EMBAR singers to embarrass the viewers via emotion-sharing involving affective empathy (affEMP), and the PRIDE singers to embarrass via perspective-taking involving cognitive empathy (cogEMP). During affEMP (EMBAR > PRIDE), TKS scores correlated positively with dispositional affEMP (personal-distress dimension) and with amygdala activity. During cogEMP (EMBAR < PRIDE), TKS scores correlated negatively with cognitive flexibility and with activity of the posterior superior temporal sulcus/temporoparietal junction (pSTS/TPJ). Intersubject correlation analysis implied stronger involvement of the anterior insula, inferior frontal gyrus, and premotor cortex during affEMP than cogEMP and stronger involvement of the medial prefrontal cortex, posterior cingulate cortex, and pSTS/TPJ during cogEMP than affEMP. During cogEMP, the whole-brain functional connectivity was weaker the higher the TKS scores. The observed imbalance between affEMP and cogEMP, and the disruption of functional brain connectivity, likely deteriorate cognitive processing during embarrassing situations in persons who suffer from other-oriented social anxiety dominated by empathic embarrassment.

Neuroticism and Its Associated Brain Activation in Women With PTSD

Previous research suggests a diathesis-stress model of posttraumatic stress disorder (PTSD), wherein individuals with high levels of neuroticism who are exposed to traumatic events subsequently develop PTSD. Although studies have established relationships between neuroticism and neurological functioning in various brain regions for healthy and depressed individuals, the specific neural correlates of neuroticism for individuals with PTSD are yet unknown. This relationship is particularly relevant for women, given that their increased risk for PTSD is partially accounted for by their higher baseline levels of neuroticism. The current study examined previously established neural correlates of neuroticism in 61 women (48 women with interpersonal violence [IPV]/PTSD and 13 healthy controls). A specific region of interest map, including the amygdala, hippocampus, parahippocampus, anterior cingulate cortex (ACC), and dorsal medial prefrontal cortex (dmPFC), was examined while participants completed an emotional conflict task. Results showed that the PTSD group had significantly higher neuroticism scores than the healthy control group (t = 6.90, p < .001). Higher neuroticism scores were associated with increased neural activity in the right dmPFC when participants were instructed to directly attend to faces with negative emotional valences. Significant trends between higher neuroticism scores and greater right amygdala and right ACC activation also emerged for this condition. Finally, neuroticism was found to be associated with right amygdala and right parahippocampal activity when participants were instructed to ignore faces with negative emotional valences. The results of this study lend further evidence to the proposed diathesis-stress model of neuroticism and PTSD. Moreover, findings suggest a significant association between neuroticism and neural activity in brain regions associated with fear and emotion regulation for women with IPV and subsequent PTSD.

Thalamocortical dysconnectivity in premenstrual syndrome

Premenstrual syndrome (PMS) is a menstrual cycle-related disorder. Although the precise pathophysiology is not fully understood, it is increasingly believed that the central nervous system plays a vital role in the development of PMS. The aim of this study is to elucidate specific functional connectivity between the thalamus and cerebral cortex. Resting-state functional magnetic resonance imaging (fMRI) data were obtained from 20 PMS patients and 21 healthy controls (HCs). Seed-based functional connectivity between the thalamus and six cortical regions of interest, including the prefrontal cortex (PFC), posterior parietal cortex, somatosensory cortex, motor cortex/supplementary motor area, temporal and occipital lobe, was adopted to identify specific thalamocortical connectivity in the two groups. Correlation analysis was then used to examine relationships between the neuroimaging findings and clinical symptoms. Activity in distinct cortical regions correlated with specific sub-regions of the thalamus in the two groups. Comparison between groups exhibited decreased prefrontal-thalamic connectivity and increased posterior parietal-thalamic connectivity in the PMS patients. Within the PMS group, the daily record of severity of problems (DRSP) score negatively correlated with the prefrontal-thalamic connectivity. Our findings may provide preliminary evidence for abnormal thalamocortical connectivity in PMS patients and may contribute to a better understanding of the pathophysiology of PMS.

Overanxious and underslept

Are you feeling anxious? Did you sleep poorly last night? Sleep disruption is a recognized feature of all anxiety disorders. Here, we investigate the basic brain mechanisms underlying the anxiogenic impact of sleep loss. Additionally, we explore whether subtle, societally common reductions in sleep trigger elevated next-day anxiety. Finally, we examine what it is about sleep, physiologically, that provides such an overnight anxiety-reduction benefit. We demonstrate that the anxiogenic impact of sleep loss is linked to impaired medial prefrontal cortex activity and associated connectivity with extended limbic regions. In contrast, non-rapid eye movement (NREM) slow-wave oscillations offer an ameliorating, anxiolytic benefit on these brain networks following sleep. Of societal relevance, we establish that even modest night-to-night reductions in sleep across the population predict consequential day-to-day increases in anxiety. These findings help contribute to an emerging framework explaining the intimate link between sleep and anxiety and further highlight the prospect of non-rapid eye movement sleep as a therapeutic target for meaningfully reducing anxiety.

Social Anxiety, Loneliness, and the Moderating Role of Emotion Regulation

Background: Loneliness is a universal experience that is particularly relevant to social anxiety. However, research has not examined loneliness among treatment-seeking individuals with social anxiety disorder (SAD) or assessed whether mal-adaptive or adaptive emotion regulation strategies moderate the relationship between social anxiety and loneliness.

Methods: We examined the baseline scores of individuals with SAD (n = 121) who sought treatment as part of a waitlist-controlled trial of cognitive behavioral group therapy versus mindfulness-based stress reduction. Healthy controls (n = 38) were also examined.

Results: Individuals with SAD exhibited greater social anxiety (SA), greater loneliness, more frequent expressive suppression (ES), and less frequent cognitive reappraisal (CR) than controls. Hierarchical multiple regressions indicated that emotion regulation variables moderated the relationship between social anxiety and loneliness. At lower CR and higher ES, there was a positive relationship between social anxiety and loneliness. At higher CR and lower ES, there was unexpectedly a stronger positive relationship between social anxiety and loneliness. Higher SA was associated with higher loneliness regardless of emotion regulation strategy, whereas lower SA was associated with more moderate and lower levels of loneliness dependent on level of ER strategy.

Discussion: Implications for understanding the prevalence and burden of loneliness among individuals with SAD, the role of emotion regulation in the relationship between social anxiety and loneliness, and directions for future research are discussed.

Modeling anxiety in healthy humans: a key intermediate bridge between basic and clinical sciences

Animal models of anxiety disorders are important for elucidating neurobiological defense mechanisms. However, animal models are limited when it comes to understanding the more complex processes of anxiety that are unique to humans (e.g., worry) and to screen new treatments. In this review, we outline how the Experimental Psychopathology approach, based on experimental models of anxiety in healthy subjects, can mitigate these limitations and complement research in animals. Experimental psychopathology can bridge basic research in animals and clinical studies, as well as guide and constrain hypotheses about the nature of psychopathology, treatment mechanisms, and treatment targets. This review begins with a brief review of the strengths and limitations of animal models before discussing the need for human models of anxiety, which are especially necessary to probe higher-order cognitive processes. This can be accomplished by combining anxiety-induction procedures with tasks that probe clinically relevant processes to identify neurocircuits that are potentially altered by anxiety. The review then discusses the validity of experimental psychopathology and introduces a methodological approach consisting of five steps: (1) select anxiety-relevant cognitive or behavioral operations and associated tasks, (2) identify the underlying neurocircuits supporting these operations in healthy controls, 3) examine the impact of experimental anxiety on the targeted operations in healthy controls, (4) utilize findings from step 3 to generate hypotheses about neurocircuit dysfunction in anxious patients, and 5) evaluate treatment mechanisms and screen novel treatments. This is followed by two concrete illustrations of this approach and suggestions for future studies.

Principal component analysis and brain-based predictors of emotion regulation in anxiety and depression

BACKGROUND

Reappraisal, an adaptive emotion regulation strategy, is associated with frontal engagement. In internalizing psychopathologies (IPs) such as anxiety and depression frontal activity is atypically reduced suggesting impaired regulation capacity. Yet, successful reappraisal is often demonstrated at the behavioral level. A data-driven approach was used to clarify brain and behavioral relationships in IPs.

METHODS

During functional magnetic resonance imaging, anxious [general anxiety disorder (n = 43), social anxiety disorder (n = 72)] and depressed (n = 47) patients reappraised negative images to reduce negative affect ('ReappNeg') and viewed negative images ('LookNeg'). After each trial, the affective state was reported. A cut-point (i.e. values <0 based on ΔReappNeg-LookNeg) demarcated successful reappraisers. Neural activity for ReappNeg-LookNeg, derived from 37 regions of interest, was submitted to Principal Component Analysis (PCA) to identify unique components of reappraisal-related brain response. PCA factors, symptom severity, and self-reported habitual reappraisal were submitted to discriminant function analysis and linear regression to examine whether these data predicted successful reappraisal (yes/no) and variance in reappraisal ability.

RESULTS

Most patients (63%) were successful reappraisers according to the behavioral criterion (values<0; ΔReappNeg-LookNeg). Discriminant function analysis was not significant for PCA factors, symptoms, or habitual reappraisal. For regression, more activation in a factor with high loadings for frontal regions predicted better reappraisal facility. Results were not significant for other variables.

CONCLUSIONS

At the individual level, more activation in a 'frontal' factor corresponded with better reappraisal facility. However, neither brain nor behavioral variables classified successful reappraisal (yes/no). Findings suggest individual differences in regions strongly implicated in reappraisal play a role in on-line reappraisal capability.

Neurobiological Markers of Resilience to Depression Following Childhood Maltreatment: The Role of Neural Circuits Supporting the Cognitive Control of Emotion

BACKGROUND

Childhood adversity is strongly linked to negative mental health outcomes, including depression and anxiety. Leveraging cognitive neuroscience to identify mechanisms that contribute to resilience in children with a history of maltreatment may provide viable intervention targets for the treatment or prevention of psychopathology. We present a conceptual model of a potential neurobiological mechanism of resilience to depression and anxiety following childhood adversity. Specifically, we argue that neural circuits underlying the cognitive control of emotion may promote resilience, wherein a child's ability to recruit the frontoparietal control network to modulate amygdala reactivity to negative emotional cues-such as during cognitive reappraisal-buffers risk for internalizing symptoms following exposure to adversity.

METHODS

We provide preliminary support for this model of resilience in a longitudinal sample of 151 participants 8 to 17 years of age with (n = 79) and without (n = 72) a history of childhood maltreatment who completed a cognitive reappraisal task while undergoing functional magnetic resonance imaging.

RESULTS

Among maltreated youths, those who were better able to recruit prefrontal control regions and modulate amygdala reactivity during reappraisal exhibited lower risk for depression over time. By contrast, no association was observed between neural functioning during reappraisal and depression among youths without a history of maltreatment.

CONCLUSIONS

These preliminary findings support the hypothesis that children who are better able to regulate emotion through recruitment of the frontoparietal network exhibit greater resilience to depression following childhood maltreatment. Interventions targeting cognitive reappraisal and other cognitive emotion regulation strategies may have potential for reducing vulnerability to depression among children exposed to adversity.

The importance of avoidant personality in social anxiety disorder with and without attention-deficit/hyperactivity disorder

In the present study, our primary aim was to compare the generalized social anxiety (GSAD) patients with and without attention-deficit/hyperactivity disorder (ADHD) in terms of avoidant personality disorder (AVPD), and some clinical variables. We also investigated the relationship of AVPD and depression with ADHD and GSAD. We hypothesized that ADHD may be associated with AVPD in patients with GSAD. Seventy-six patients with GSAD were evaluated for depression, AVPD, and childhood and adulthood diagnoses of ADHD. The GSAD patients with (n = 34) and without adulthood ADHD (n = 30) were compared with respect to some sociodemographic and clinical variables. GSAD patients with adulthood ADHD had significantly higher comorbid diagnosis of AVPD, more avoidant personality and depression symptoms than those without ADHD. Pearson's correlation coefficient in total sample (n = 76) showed that the mean number of AVPD criteria was significantly associated with the severity of Beck Depression Inventory, Wender Utah Rating Scale (WURS), and inattention symptoms of ADHD. There were no correlations between the total and subscale scores of Liebowitz Social Anxiety Scale and the mean number of AVPD criteria. The scores of WURS significantly predicted the mean number of AVPD criteria (β = 0.305, p= 0.007). The severity of current depression (β = 0.143, p = 0.30) and inattention symptoms of adulthood ADHD (β = 0.112, p = 0.46) were not associated with the severity of AVPD symptoms. These results might demonstrate that comorbid AVPD in adult SAD patients was related to a childhood ADHD independent from depression, and inattention symptoms of ADHD in adulthood.

The characteristics of the comorbidity between social anxiety and separation anxiety disorders in adult patients

Objective: In the present study, we compared social anxiety disorder (SAD) patients with (n = 31) and without childhood and adulthood separation anxiety disorder (SeAD) (n = 50) with respect to suicidal behavior, avoidant personality disorder (AvPD), other anxiety disorders (ADs), and major depression as well as some sociodemographic variables. Methods: In assessment of patients, we used Structured Clinical Interview for Separation Anxiety Symptoms, childhood and adulthood Separation Anxiety Symptom Inventories, Liebowitz Social Anxiety Scale, The SCID-II Avoidant Personality Disorder Module, Beck Depression Inventory, and Beck Scale for Suicidal Ideation. Results: SAD patients with SeAD had higher comorbidity rates of AvPD, other lifetime ADs and panic disorder, and current major depression than those without SeAD. The current scores of SAD, depression, and suicide ideation and the mean number of AvPD symptoms were significantly higher in comorbid group compared to pure SAD subjects. The SAD and SeAD scores had significant associations with current depression, suicide ideations, and AvPD. The mean number of AvPD criteria and the current severity of depression were significantly associated with the comorbidity between SAD and SeAD. Conclusion: Our findings might indicate that the comorbidity of SeAD with SAD may increase the risk of the severity of AvPD and current depression.

Limbic and prefrontal neural volume modulate social anxiety in children at temperamental risk

BACKGROUND

Clinical levels of a social anxiety disorder (SAD) often appear during childhood and rise to a peak during late adolescence. The temperament trait behavioral inhibition (BI), evident early in childhood, has been linked to increased risk for SAD. Functional and structural variations in brain regions associated with the identification of, and response to, fear may support the BI-SAD relation. Whereas relevant functional studies are emerging, the few extant structural studies have focused on adult samples with mixed findings.

METHODS

A moderated-mediation model was used to examine the relations between BI, SAD symptoms, and brain-volume individual differences in a sample of children at risk for anxiety (ages 9-12; N = 130, 52 BI).

RESULTS

Our findings indicate that at higher levels of BI, children with smaller anterior insula volumes showed stronger correlations between BI and SAD. In addition, larger ventrolateral prefrontal cortex (vlPFC) volumes were associated with fewer SAD symptoms.

CONCLUSIONS

These findings support previous reports linking SAD levels with variations in volume and reactivity in both limbic (insula) and prefrontal (vlPFC) regions. These findings set the foundation for further examination of networks of neural structures that influence the transition from BI to SAD across development, helping further clarify mechanisms of risk and resilience.

Neural evidence for persistent attentional bias to threats in patients with social anxiety disorder

Does the biased attention toward social threats dwells on or disappears in patients with social anxiety disorder (SAD)? We investigated the neural mechanism of attentional bias in terms of attentional capture and holding in SAD. A total of 31 SAD patients and 30 healthy controls performed a continuous performance task detecting the orientation of a red letter 'T' while angry or neutral face distractors appeared or disappeared at the center of the screen. Behaviorally, typical attentional capture effects were found in response to abruptly appearing distractors in both groups. The patient group showed significant attentional dwelling effects in response to the angry face distractor only. Patients showed increased neural activity in the amygdala, insula/inferior frontal gyrus (IFG) and temporo-parietal junction (TPJ) compared with those of controls for the abruptly appearing angry distractor. Patients also maintained increased activities in brain regions related to attentional reorienting to distractor, namely the TPJ and IFG in line with their behavioral results of attentional holding effects. Our results indicate that patients with SAD showed prolonged attentional bias to task-irrelevant social threats. The underlying mechanism of prolonged attentional bias in SAD was indicated with amygdala hyperactivity and continued activity of the bottom-up attention network including the TPJ and IFG.

The interactive effect of emotional reactivity and maladaptive metacognitive beliefs on anxiety

Emotional reactivity has been implicated in the development and maintenance of anxiety. The metacognitive model suggests that maladaptive metacognitive beliefs (i.e. beliefs about thinking) may increase the impact of emotional reactivity on anxiety. As such, the purpose of the present study was to examine maladaptive metacognitive beliefs as a moderator of the relationship between emotional reactivity and anxiety in an undergraduate student sample (N = 78). Participants completed a battery of self-report measures and a negative emotion induction procedure during a single laboratory session. As predicted, higher levels of maladaptive metacognitive beliefs strengthened the relationship between emotional reactivity and anxiety. This effect was found in relation to negative (e.g. "My thoughts are uncontrollable"), but not positive (e.g. "Worrying will keep me safe"), metacognitive beliefs. Study results support the proposal that maladaptive metacognitive beliefs potentiate the effect of emotional reactivity on anxiety and suggest that preemptive efforts to reduce negative metacognitive beliefs may be beneficial among individuals prone to emotional reactivity.

Transdiagnostic neural correlates of volitional emotion regulation in anxiety and depression

BACKGROUND

Individuals who suffer from anxiety and/or depression face difficulty in adaptively managing emotional responses, while accumulating evidence suggests impaired emotion regulation is a transdiagnostic feature of psychopathology. Effectual regulation in the context of negative stimuli is characterized by engagement of the prefrontal cortex (PFC) coupled with reduced amygdala reactivity. In anxiety disorders and major depression, PFC underengagement and atypical PFC-amygdala connectivity has been observed, although patient findings based on case-control studies have been mixed with regard to magnitude, locality, and extent of dysfunction. As anxiety disorders and major depression are heterogeneous disorders and frequently comorbid with one another, delineating relationships between reappraise-related substrates and symptoms may advance our understanding of emotion dysregulation in these populations.

METHODS

We examined PFC activation and its functional connectivity (FC) to the amygdala using functional magnetic resonance imaging in a large sample of patients (N = 174) with primary generalized anxiety disorder (n = 47), social anxiety disorder (n = 78), or major depressive disorder (n = 49) during a reappraisal-based emotion regulation task. Comorbidity was permitted and the majority of participants had a concurrent psychiatric illnesses.

RESULTS

Across participants, whole-brain results showed that (1) greater anxiety and depression symptom severity was related to less engagement of the dorsal anterior cingulate cortex (ACC) and (2) less FC between the amygdala and ventrolateral PFC. Results were driven by anxiety, while depression symptoms were not significant.

CONCLUSION

These findings demonstrate that individual differences in anxiety and depression may help explain ACC and PFC dysfunction during emotion regulation observed across anxiety and depressive disorders.

The Hippocampus and Social Impairment in Psychiatric Disorders

Social deficits, such as poor social skills (i.e., the inability to engage in appropriate and effective social interactions) and social withdrawal, are prevalent across psychiatric disorders and often co-occur with hippocampal structural and functional abnormalities. The centrality of both social and hippocampal dysfunction in psychiatric research prompts the question: Are they linked? The social cognitive map framework provides a clue: The hippocampus tracks social information in the physical environment, maps others along social dimensions, and supports social memory and decision-making. Hippocampal dysfunction might disrupt social map representation and contribute to commonly seen social behavioral symptoms. This review summarizes evidence for the role of the hippocampus in social cognitive mapping, followed by evidence that hippocampal dysfunction and social dysfunction co-occur in psychiatric disorders. We argue that the co-occurrence of hippocampal and social impairment may be related via hippocampal social cognitive mapping.

Parental touch reduces social vigilance in children

The sense of touch develops in utero and enables parent-child communication from the earliest moments of life. Research shows that parental touch (e.g., licking and grooming in rats, skin-to-skin care in humans) has organizing effects on the offspring's stress system. Little is known, however, about the psychological effects of parental touch. Building on findings from ethology and psychology, we propose that parental touch-even as subtle as a touch on the shoulder-tells children that their environment is safe for exploration, thus reducing their social vigilance. We tested this hypothesis in late childhood (ages 8-10) and early adolescence (ages 11-14) in 138 parent-child dyads. Parents were randomly assigned to touch or not touch their child briefly and gently on the shoulder, right below the deltoid. Parental touch lowered children's implicit attention to social threat. While parental touch lowered trust among socially non-anxious children, it raised trust among those who needed it the most: socially anxious children. The effects were observed only in late childhood, suggesting that parental touch loses its safety-signaling meaning upon the transition to adolescence. Our findings underscore the power of parental touch in childhood, especially for children who suffer from social anxiety.

Neural bases underlying the association between balanced time perspective and trait anxiety

The aims of present study were to investigate the association between balanced time perspective (BTP) and trait anxiety, and the neural substrates underlying this association using voxel-based morphometry (VBM) and resting-state functional connectivity (RSFC) methods. 140 college students (83 females) ranging in age from 17 to 25 years were assessed on deviation from the balanced time perspective (DBTP) and trait anxiety. Behavioral analyses found BTP could significantly predict trait anxiety after controlling age and gender. Whole-brain VBM analyses found that DBTP was positively correlated with gray matter volume (GMV) in the parahippocampal gyrus (PHG) and precuneus, while trait anxiety positively correlated with GMV in the PHG. Considering the overlapping region in the PHG, we further defined the overlapping region as the seed, and calculated seed-to-voxel-based functional connectivity in resting-state. RSFC results showed that DBTP was positively associated with the RSFC between the PHG and medial prefrontal cortex (mPFC), posterior cingulate cortex (PCC), and precuneus, whereas negatively correlated with the RSFC between the PHG and cuneus. Trait anxiety was also positively correlated with the RSFC between the PHG and PCC while negatively correlated with the RSFC between the PHG and cuneus. Mediation analysis further found GMV in the overlapping PHG and PHG-PCC, PHG-cuneus functional connectivity played significantly mediating roles in the relation between DBTP and trait anxiety. In sum, our research suggests the structural features of the PHG and its connectivity with PCC and cuneus may be the neural bases underlying the association between BTP and trait anxiety.

Intrinsic functional and structural connectivity of emotion regulation networks in obsessive-compulsive disorder

Despite emotion regulation being altered in patients with obsessive-compulsive disorder (OCD), no studies have investigated its relation to multimodal amygdala connectivity. We compared corticolimbic functional and structural connectivity between OCD patients and healthy controls (HCs), and correlated this with the dispositional use of emotion regulation strategies and with OCD severity. OCD patients (n = 73) and HCs (n = 42) were assessed for suppression and reappraisal strategies using the Emotion Regulation Questionnaire (ERQ) and for OCD severity using the Yale-Brown Obsessive-Compulsive Scale. Resting-state functional magnetic resonance imaging (rs-fMRI) connectivity maps were generated using subject-specific left amygdala (LA) and right amygdala (RA) masks. We identified between-group differences in amygdala whole-brain connectivity, and evaluated the moderating effect of ERQ strategies. Significant regions and amygdala seeds were used as targets in probabilistic tractography analysis. Patients scored higher in suppression and lower in reappraisal. We observed higher rs-fMRI RA-right postcentral gyrus (PCG) connectivity in HC, and in patients this was correlated with symptom severity. Reappraisal scores were associated with higher negative LA-left insula connectivity in HC, and suppression scores were negatively associated with LA-precuneus and angular gyri connectivity in OCD. Structurally, patients showed higher mean diffusivity in tracts connecting the amygdala with the other targets. RA-PCG connectivity is diminished in patients, while disrupted emotion regulation is related to altered amygdala connectivity with the insula and posterior brain regions. Our results are the first showing, from a multimodal perspective, the association between amygdala connectivity and specific emotional processing domains, emphasizing the importance of amygdala connectivity in OCD pathophysiology.

Decreased Intrinsic Functional Connectivity in First-Episode, Drug-Naive Adolescents With Generalized Anxiety Disorder

Generalized anxiety disorder (GAD) is characterized by excessive and uncontrollable worry about everyday life. Prior neuroimaging studies have demonstrated that GAD is associated with disruptions in specific brain regions; however, little is known about the global functional connectivity maps in adolescents with GAD. Here, first-episode, medication-naive, adolescent GAD patients (N = 36) and healthy controls (N = 28) (HCs) underwent resting-state functional MRI (R-fMRI) and completed a package of questionnaires to assess clinical symptoms. Functional connectivity strength and seed-based functional connectivity were employed to investigate the functional connectivity architecture. GAD patients showed reduced functional connectivity strength in right supramarginal gyrus (SMG) and right superior parietal gyrus (SPG) compared with HCs. Further seed-based functional connectivity analysis revealed that GAD patients displayed decreased functional connectivity between right SMG and left fusiform gyrus, inferior temporal gyrus, parahippocampal gyrus, bilateral precuneus and cuneus, and between right SPG and bilateral supplementary motor area and middle cingulate gyrus, as well as between the SMG-based network and the SPG-based network. Moreover, the disrupted intra-network connectivity (i.e., the SMG-based network and the SPG-based network) and inter-network connectivity between the SMG-based network and the SPG-based network accounted for 25.5% variance of the State and Trait Anxiety Inventory (STAI) and 39.5% variance of the trait subscale of STAI. Our findings highlight the abnormal functional architecture in the SMG-based network and the SPG-based network in GAD, providing novel insights into the pathological mechanisms of this disorder.