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

Emotion regulation difficulties, youth-adult relationships, and suicide attempts among high school students in underserved communities

To develop and refine interventions to prevent youth suicide, knowledge is needed about specific processes that reduce risk at a population level. Using a cross-sectional design, the present study tested hypotheses regarding associations between self-reported suicide attempts, emotion regulation difficulties, and positive youth-adult relationships among 7,978 high-school students (48.6% male, 49.9% female) in 30 high schools from predominantly rural, low-income communities. 683 students (8.6%) reported a past-year suicide attempt. Emotion regulation difficulties and a lack of trusted adults at home and school were associated with increased risk for making a past-year suicide attempt, above and beyond the effects of depressive symptoms and demographic factors. The association between emotion regulation difficulties and suicide attempts was modestly lower among students who perceived themselves as having higher levels of trusted adults in the family, consistent with a protective effect. Having a trusted adult in the community (outside of school and family) was associated with fewer suicide attempts in models that controlled only for demographic covariates, but not when taking symptoms of depression into account. These findings point to adolescent emotion regulation and relationships with trusted adults as complementary targets for suicide prevention that merit further intervention studies. Reaching these targets in a broad population of adolescents will require new delivery systems and "option rich" (OR) intervention designs.

General emotion processing in social anxiety disorder: neural issues of cognitive control

Anxiety disorders are characterized by deficient emotion regulation prior to and in anxiety-evoking situations. Patients with social anxiety disorder (SAD) have increased brain activation also during the anticipation and perception of non-specific emotional stimuli pointing to biased general emotion processing. In the current study we addressed the neural correlates of emotion regulation by cognitive control during the anticipation and perception of non-specific emotional stimuli in patients with SAD. Thirty-two patients with SAD underwent functional magnetic resonance imaging during the announced anticipation and perception of emotional stimuli. Half of them were trained and instructed to apply reality-checking as a control strategy, the others anticipated and perceived the stimuli. Reality checking significantly (p<0.01) reduced activity in insular, amygdalar and medial thalamic areas during the anticipation and perception of negative emotional stimuli. The medial prefrontal cortex was comparably active in both groups (p>0.50). The results suggest that cognitive control in patients with SAD influences emotion processing structures, supporting the usefulness of emotion regulation training in the psychotherapy of SAD. In contrast to studies in healthy subjects, cognitive control was not associated with increased activation of prefrontal regions in SAD. This points to possibly disturbed general emotion regulating circuits in SAD.

Automatic neural processing of disorder-related stimuli in social anxiety disorder: faces and more

It has been proposed that social anxiety disorder (SAD) is associated with automatic information processing biases resulting in hypersensitivity to signals of social threat such as negative facial expressions. However, the nature and extent of automatic processes in SAD on the behavioral and neural level is not entirely clear yet. The present review summarizes neuroscientific findings on automatic processing of facial threat but also other disorder-related stimuli such as emotional prosody or negative words in SAD. We review initial evidence for automatic activation of the amygdala, insula, and sensory cortices as well as for automatic early electrophysiological components. However, findings vary depending on tasks, stimuli, and neuroscientific methods. Only few studies set out to examine automatic neural processes directly and systematic attempts are as yet lacking. We suggest that future studies should: (1) use different stimulus modalities, (2) examine different emotional expressions, (3) compare findings in SAD with other anxiety disorders, (4) use more sophisticated experimental designs to investigate features of automaticity systematically, and (5) combine different neuroscientific methods (such as functional neuroimaging and electrophysiology). Finally, the understanding of neural automatic processes could also provide hints for therapeutic approaches.

Neural response to the observable self in social anxiety disorder

BACKGROUND

Distorted images of the observable self are considered crucial in the development and maintenance of social anxiety. We generated an experimental situation in which participants viewed themselves from an observer's perspective when exposed to scrutiny and evaluation by others. Method Twenty patients with social anxiety disorder (SAD) and 20 control subjects were assessed using functional magnetic resonance imaging (fMRI) during the public exposure of pre-recorded videos in which they were each shown performing a verbal task. The examiners acted as the audience in the experiment and rated performance. Whole-brain functional maps were computed using Statistical Parametric Mapping.

RESULTS

Robust activation was observed in regions related to self-face recognition, emotional response and general arousal in both study groups. Patients showed significantly greater activation only in the primary visual cortex. By contrast, they showed significant deactivation or smaller activation in dorsal frontoparietal and anterior cingulate cortices relevant to the cognitive control of negative emotion. Task-related anxiety ratings revealed a pattern of negative correlation with activation in this frontoparietal/cingulate network. Importantly, the relationship between social anxiety scores and neural response showed an inverted-U function with positive correlations in the lower score range and negative correlations in the higher range.

CONCLUSIONS

Our findings suggest that exposure to scrutiny and evaluation in SAD may be associated with changes in cortical systems mediating the cognitive components of anxiety. Disorder severity seems to be relevant in shaping the neural response pattern, which is distinctively characterized by a reduced cortical response in the most severe cases.

Brain areas controlling heart rate variability in tinnitus and tinnitus-related distress

BACKGROUND

Tinnitus is defined as an intrinsic sound perception that cannot be attributed to an external sound source. Distress in tinnitus patients is related to increased beta activity in the dorsal part of the anterior cingulate and the amount of distress correlates with network activity consisting of the amygdala-anterior cingulate cortex-insula-parahippocampus. Previous research also revealed that distress is associated to a higher sympathetic (OS) tone in tinnitus patients and tinnitus suppression to increased parasympathetic (PS) tone.

METHODOLOGY

The aim of the present study is to investigate the relationship between tinnitus distress and the autonomic nervous system and find out which cortical areas are involved in the autonomic nervous system influences in tinnitus distress by the use of source localized resting state electroencephalogram (EEG) recordings and electrocardiogram (ECG). Twenty-one tinnitus patients were included in this study.

CONCLUSIONS

The results indicate that the dorsal and subgenual anterior cingulate, as well as the left and right insula are important in the central control of heart rate variability in tinnitus patients. Whereas the sympathovagal balance is controlled by the subgenual and pregenual anterior cingulate cortex, the right insula controls sympathetic activity and the left insula the parasympathetic activity. The perceived distress in tinnitus patients seems to be sympathetically mediated.

Aberrant amygdala-frontal cortex connectivity during perception of fearful faces and at rest in generalized social anxiety disorder

BACKGROUND

Generalized social anxiety disorder (gSAD) is characterized by exaggerated amygdala reactivity to social signals of threat, but if and how the amygdala interacts with functionally and anatomically connected prefrontal cortex (PFC) remains largely unknown. Recent evidence points to aberrant amygdala connectivity to medial PFC in gSAD at rest, but it is difficult to attribute functional relevance without the context of threat processing. Here, we address this by studying amygdala-frontal cortex connectivity during viewing of fearful faces and at rest in gSAD patients.

METHODS

Twenty patients with gSAD and 17 matched healthy controls (HCs) participated in functional magnetic resonance imaging of an emotional face matching task and a resting state task. Functional connectivity and psychophysiological interaction analysis were used to assess amygdala connectivity.

RESULTS

Compared to HCs, gSAD patients exhibited less connectivity between amygdala and the rostral anterior cingulate cortex (ACC) and dorsolateral prefrontal cortex (DLPFC) while viewing fearful faces. gSAD patients also showed less connectivity between amygdala and rostral ACC at rest in the absence of fearful faces. DLPFC connectivity was negatively correlated with LSASFear (where LSAS is Liebowitz Social Anxiety Scale).

CONCLUSIONS

Task and rest paradigms provide unique and important information about discrete and overlapping functional networks. In particular, amygdala coupling to DLPFC may be a phasic abnormality, emerging only in the presence of a social predictor of threat, whereas amygdala coupling to the rostral ACC may reflect both phasic and tonic abnormalities. These findings prompt further studies to better delineate intrinsic and externally evoked brain connectivity in anxiety and depression in relation to amygdala dysfunction.

Corticolimbic brain reactivity to social signals of threat before and after sertraline treatment in generalized social phobia

BACKGROUND

Generalized social phobia (gSP), also known as generalized social anxiety disorder, is characterized by excessive fear of scrutiny by others and pervasive avoidance of social interactions. Pathophysiologic models of gSP implicate exaggerated reactivity of the amygdala and insula in response to social evaluative threat, making them plausible targets for treatment. Although selective serotonin reuptake inhibitor (SSRI) treatment is known to be an effective treatment, little is known about the mechanism through which these agents exert their anxiolytic effects at a brain level in gSP.

METHODS

We acquired functional magnetic resonance imaging data of brain response to social signals of threat (fearful/angry faces) in 21 gSP patients before and after they completed 12 weeks of open-label treatment with the SSRI sertraline. For comparison, 19 healthy control (HC) subjects also underwent two functional magnetic resonance imaging scans, 12 weeks apart.

RESULTS

Whole-brain voxelwise analysis of variance revealed significant Group×Time interactions in the amygdala and the ventral medial prefrontal cortex. Follow-up analyses showed that treatment in gSP subjects reduced amygdala reactivity to fearful faces (which was exaggerated relative to HCs before treatment) and enhanced ventral medial prefrontal cortex activation to angry faces (which was attenuated relative to HCs before treatment). However, these brain changes were not significantly related to social anxiety symptom improvement.

CONCLUSIONS

SSRI treatment response in gSP is associated with changes in a discrete limbic-paralimbic brain network, representing a neural mechanism through which SSRIs may exert their actions.

Fearful face detection sensitivity in healthy adults correlates with anxiety-related traits

Threatening faces have a privileged status in the brain, which can be reflected in a processing advantage. However, this effect varies among individuals, even healthy adults. For example, one recent study showed that fearful face detection sensitivity correlated with trait anxiety in healthy adults (S. Japee, L. Crocker, F. Carver, L. Pessoa, & L. G. Ungerleider, 2009. Individual differences in valence modulation of face-selective M170 response. Emotion, 9, 59-69). Here, we expanded on those findings by investigating whether intersubject variability in fearful face detection is also associated with state anxiety, as well as more broadly with other traits related to anxiety. To measure fearful face detection sensitivity, we used a masked face paradigm where the target face was presented for only 33 ms and was immediately followed by a neutral face mask. Subjects then rated their confidence in detecting either fear or no fear in the target face. Fearful face detection sensitivity was calculated for each subject using signal detection theory. Replicating previous results, we found a significant positive correlation between trait anxiety and fearful face detection sensitivity. However, this behavioral advantage did not correlate with state anxiety. We also found that fearful face detection sensitivity correlated with other personality measures, including neuroticism and harm avoidance. Our data suggest that fearful face detection sensitivity varies parametrically across the healthy population, is associated broadly with personality traits related to anxiety, but remains largely unaffected by situational fluctuations in anxiety. These results underscore the important contribution of anxiety-related personality traits to threat processing in healthy adults.

Functional magnetic resonance imaging during emotion recognition in social anxiety disorder: an activation likelihood meta-analysis

Background: Social anxiety disorder (SAD) is characterized by abnormal fear and anxiety in social situations. Functional magnetic resonance imaging (fMRI) is a brain imaging technique that can be used to demonstrate neural activation to emotionally salient stimuli. However, no attempt has yet been made to statistically collate fMRI studies of brain activation, using the activation likelihood-estimate (ALE) technique, in response to emotion recognition tasks in individuals with SAD. Methods: A systematic search of fMRI studies of neural responses to socially emotive cues in SAD was undertaken. ALE meta-analysis, a voxel-based meta-analytic technique, was used to estimate the most significant activations during emotional recognition. Results: Seven studies were eligible for inclusion in the meta-analysis, constituting a total of 91 subjects with SAD, and 93 healthy controls. The most significant areas of activation during emotional vs. neutral stimuli in individuals with SAD compared to controls were: bilateral amygdala, left medial temporal lobe encompassing the entorhinal cortex, left medial aspect of the inferior temporal lobe encompassing perirhinal cortex and parahippocampus, right anterior cingulate, right globus pallidus, and distal tip of right postcentral gyrus. Conclusion: The results are consistent with neuroanatomic models of the role of the amygdala in fear conditioning, and the importance of the limbic circuitry in mediating anxiety symptoms.

Cortical thickness alterations in social anxiety disorder

Social anxiety disorder (SAD) has been associated with aberrant processing of socio-emotional stimuli and failure to adaptively regulate emotion, corroborated by functional neuroimaging studies. However, only a few studies of structural brain abnormalities in SAD have been reported, and among these only one investigated cortical thickness. In the present study we used magnetic resonance imaging (MRI) in conjunction with an automated method to measure cortical thickness in patients with SAD (n=14) and healthy controls (n=12). Results showed significantly increased thickness of the left inferior temporal cortex in SAD patients relative to controls. Within the patient group, a negative association was found between social anxiety symptom severity and thickness of the right rostral anterior cingulate cortex. The observed alterations in brain structure may help explain previous findings of dysfunctional regulation and processing of emotion in SAD.

MBSR vs aerobic exercise in social anxiety: fMRI of emotion regulation of negative self-beliefs

Mindfulness-based stress reduction (MBSR) is thought to reduce emotional reactivity and enhance emotion regulation in patients with social anxiety disorder (SAD). The goal of this study was to examine the neural correlates of deploying attention to regulate responses to negative self-beliefs using functional magnetic resonance imaging. Participants were 56 patients with generalized SAD in a randomized controlled trial who were assigned to MBSR or a comparison aerobic exercise (AE) stress reduction program. Compared to AE, MBSR yielded greater (i) reductions in negative emotion when implementing regulation and (ii) increases in attention-related parietal cortical regions. Meditation practice was associated with decreases in negative emotion and social anxiety symptom severity, and increases in attention-related parietal cortex neural responses when implementing attention regulation of negative self-beliefs. Changes in attention regulation during MBSR may be an important psychological factor that helps to explain how mindfulness meditation training benefits patients with anxiety disorders.

Gray matter abnormalities in social anxiety disorder: primary, replication, and specificity studies

BACKGROUND

Despite increasing evidence that neuroanatomical abnormalities underlie pathological anxiety, social anxiety disorder (SAD)-although among the most common of anxiety disorders-has received little attention. With magnetic resonance imaging, we: 1) examined gray matter (GM) differences between generalized SAD and healthy control groups; 2) retested the findings in an independent clinical sample; and 3) tested for specificity by contrasting the SAD group to a separate group of panic disorder (PD) subjects.

METHODS

The primary SAD group (n = 16) was required to meet DSM-IV criteria for SAD, with onset by age 30 years; control subjects (n = 20) had no lifetime history of anxiety. The replication sample included 17 generalized SAD and 17 control subjects. The PD comparison group (n = 16) was required to have no lifetime SAD. Images were acquired on a 1.5-Tesla GE Signa magnetic resonance imaging scanner with a three-dimensional T1-weighted spoiled gradient recalled pulse sequence. Morphological differences were determined with voxel-based morphometry, in SPM8.

RESULTS

After adjusting for age, gender, and total intracranial volume, SAD (as compared with control) subjects had greater GM in the left parahippocampal and middle occipital, and bilateral supramarginal and angular cortices, and left cerebellum; and lower GM in bilateral temporal poles and left lateral orbitofrontal cortex. Cerebellar, parahippocampal, and temporal pole differences were observed in both samples, survived whole brain corrections, and were not observed in the PD group, pointing to relative specificity to SAD.

CONCLUSIONS

These findings parallel the functional literature on SAD and suggest structural abnormalities underlying the functional disturbances.

Predicting treatment response in social anxiety disorder from functional magnetic resonance imaging

CONTEXT

Current behavioral measures poorly predict treatment outcome in social anxiety disorder (SAD). To our knowledge, this is the first study to examine neuroimaging-based treatment prediction in SAD.

OBJECTIVE

To measure brain activation in patients with SAD as a biomarker to predict subsequent response to cognitive behavioral therapy (CBT).

DESIGN

Functional magnetic resonance imaging (fMRI) data were collected prior to CBT intervention. Changes in clinical status were regressed on brain responses and tested for selectivity for social stimuli.

SETTING

Patients were treated with protocol-based CBT at anxiety disorder programs at Boston University or Massachusetts General Hospital and underwent neuroimaging data collection at Massachusetts Institute of Technology.

PATIENTS

Thirty-nine medication-free patients meeting DSM-IV criteria for the generalized subtype of SAD.

INTERVENTIONS

Brain responses to angry vs neutral faces or emotional vs neutral scenes were examined with fMRI prior to initiation of CBT.

MAIN OUTCOME MEASURES

Whole-brain regression analyses with differential fMRI responses for angry vs neutral faces and changes in Liebowitz Social Anxiety Scale score as the treatment outcome measure.

RESULTS

Pretreatment responses significantly predicted subsequent treatment outcome of patients selectively for social stimuli and particularly in regions of higher-order visual cortex. Combining the brain measures with information on clinical severity accounted for more than 40% of the variance in treatment response and substantially exceeded predictions based on clinical measures at baseline. Prediction success was unaffected by testing for potential confounding factors such as depression severity at baseline.

CONCLUSIONS

The results suggest that brain imaging can provide biomarkers that substantially improve predictions for the success of cognitive behavioral interventions and more generally suggest that such biomarkers may offer evidence-based, personalized medicine approaches for optimally selecting among treatment options for a patient.

Functional imaging studies of emotion regulation: a synthetic review and evolving model of the cognitive control of emotion

This paper reviews and synthesizes functional imaging research that over the past decade has begun to offer new insights into the brain mechanisms underlying emotion regulation. Toward that end, the first section of the paper outlines a model of the processes and neural systems involved in emotion generation and regulation. The second section surveys recent research supporting and elaborating the model, focusing primarily on studies of the most commonly investigated strategy, which is known as reappraisal. At its core, the model specifies how prefrontal and cingulate control systems modulate activity in perceptual, semantic, and affect systems as a function of one's regulatory goals, tactics, and the nature of the stimuli and emotions being regulated. This section also shows how the model can be generalized to understand the brain mechanisms underlying other emotion regulation strategies as well as a range of other allied phenomena. The third and last section considers directions for future research, including how basic models of emotion regulation can be translated to understand changes in emotion across the life span and in clinical disorders.

Nonlinear relationships between anxiety and visual processing of own and others' faces in body dysmorphic disorder

Individuals with body dysmorphic disorder (BDD) often experience anxiety, as well as perceptual distortions of appearance. Anxiety has previously been found to impact visual processing. This study therefore tested the relationship between anxiety and visual processing of faces in BDD. Medication-free participants with BDD (N=17) and healthy controls (N=16) viewed photographs of their face and a familiar face during functional magnetic resonance imaging. Blood-oxygen-level dependent signal changes in regions involved in anxiety (amygdala) and detailed visual processing (ventral visual stream-VVS) were regressed on anxiety scores. Significant linear relationships between activity in the amygdala and VVS were found in both healthy controls and individuals with BDD. There was a trend of a quadratic relationship between anxiety and activity in the right VVS and a linear relationship between anxiety and activity in the left VVS for the BDD sample, and this was stronger for own-face stimuli versus familiar-face. Results suggest that anxiety symptoms in BDD may be associated with activity in systems responsible for detailed visual processing. This may have clinical implications related to heightened perceptual distortions associated with anxiety.

Mindfulness: top-down or bottom-up emotion regulation strategy?

The beneficial clinical effects of mindfulness practices are receiving increasing support from empirical studies. However, the functional neural mechanisms underlying these benefits have not been thoroughly investigated. Some authors suggest that mindfulness should be described as a 'top-down' emotion regulation strategy, while others suggest that mindfulness should be described as a 'bottom-up' emotion regulation strategy. Current discrepancies might derive from the many different descriptions and applications of mindfulness. The present review aims to discuss current descriptions of mindfulness and the relationship existing between mindfulness practice and most commonly investigated emotion regulation strategies. Recent results from functional neuro-imaging studies investigating mindfulness training within the context of emotion regulation are presented. We suggest that mindfulness training is associated with 'top-down' emotion regulation in short-term practitioners and with 'bottom-up' emotion regulation in long-term practitioners. Limitations of current evidence and suggestions for future research on this topic are discussed.

Through the eyes of anxiety: Dissecting threat bias via emotional-binocular rivalry

An extensive body of research has demonstrated that anxious individuals abnormally process threat-related content. Yet, the manner in which clinical anxiety affects the selection of threatening signals and their maintenance within consciousness is yet to be explored. The present study used an emotional binocular rivalry (e-BR) procedure, in which pictures of faces depicting either fearful or neutral expressions competed with pictures of a house for conscious perception. We assumed that first- or cumulative-preferred perception of faces with fearful over neutral expression (i.e., initial or sustained threat bias, respectively) stand for preferential selection or maintenance of fear content in awareness, correspondingly. Unmedicated patients with social anxiety disorder (SAD) and panic disorder (PAD) were compared to healthy controls for threat-related perceptual biases in the e-BR. At first perception of face, both SAD and PAD patients showed a greater initial threat bias than healthy controls. In contrast, at cumulative dwell-time of face, patient groups demonstrated a diminished sustained threat bias relative to healthy controls, yet in a different manner. SAD patients showed a sustained threat bias, though it was smaller than in healthy controls. Furthermore, increased levels of reported anxiety among SAD patients were associated with enhanced sustained perception of neutral faces. PAD patients, on the other hand, showed no sustained threat bias and a diminished cumulative perception of fearful faces with increased levels of anxiety traits. These findings indicate that anxiety disorders commonly involve an initially enhanced selection of threat signals into awareness, followed by disorder-specific manifestation of diminished preferred maintenance of threat in awareness.

Why do anxious children become depressed teenagers? The role of social evaluative threat and reward processing

BACKGROUND

Depression is a leading cause of worldwide disability. Adolescence represents a key developmental window in which rates of this disorder increase markedly. Children with an anxiety disorder show a particular risk of developing depression during adolescence.

METHOD

We present and review evidence for a developmental model that considers the intersection of two vulnerabilities relevant to the trajectory from anxiety to depression: difficulties in response to potential social evaluation and changes in reward processing at puberty.

RESULTS

Evidence suggests that these vulnerabilities (a) have been associated with depression, (b) are likely to be problematic in many, but not all, anxious youth, and (c) may be exacerbated by maturational processes that occur around pubertal development in ways that can create a negative spiral into a depressive disorder.

CONCLUSIONS

We discuss the possibility that early intervention strategies targeting key aspects of these vulnerabilities could alter the trajectory away from depression for many anxious youth.

Reduced dorsal anterior cingulate cortical activity during emotional regulation and top-down attentional control in generalized social phobia, generalized anxiety disorder, and comorbid generalized social phobia/generalized anxiety disorder

BACKGROUND

Generalized social phobia (GSP) and generalized anxiety disorder (GAD) are both associated with emotion dysregulation. Research implicates dorsal anterior cingulate cortex in both explicit emotion regulation (EER) and top-down attentional control (TAC). Although studies have examined these processes in GSP or GAD, no work compares findings across the two disorders or examines functioning in cases comorbid for both disorders (GSP/GAD). Here we compare the neural correlates of EER and TAC in GSP, GAD, and GSP/GAD.

METHODS

Medication-free adults with GSP (EER n = 19; TAC n = 18), GAD (EER n = 17; TAC n = 17), GSP/GAD (EER n = 17; TAC n = 15), and no psychopathology (EER n = 18; TAC n = 18) participated. During EER, individuals alternatively viewed and upregulated and downregulated responses to emotional pictures. During TAC, they performed an emotional Stroop task.

RESULTS

For both tasks, significant group × condition interactions emerged in dorsal anterior cingulate cortex and parietal cortices. Healthy adults showed significantly increased recruitment during emotion regulation, relative to emotion-picture viewing. GAD, GSP, and GSP/GAD subjects showed no such increases, with all groups differing from healthy adults but not from each other. Evidence of emotion-related disorder-specificity emerged in medial prefrontal cortex and amygdala. This disorder-specific responding varied as a function of emotion content but not emotion-regulatory demands.

CONCLUSIONS

GSP and GAD both involve reduced capacity for engaging emotion-regulation brain networks, whether explicitly or via TAC. A reduced ability to recruit regions implicated in top-down attention might represent a general risk factor for anxiety disorders.

Grey matter abnormalities in social anxiety disorder: a pilot study

While a number of studies have explored the functional neuroanatomy of social anxiety disorder (SAD), data on grey matter integrity are lacking. We conducted structural MRI scans to examine the cortical thickness of grey matter in individuals with SAD. 13 unmedicated adult patients with a primary diagnosis of generalized social anxiety disorder and 13 demographically (age, gender and education) matched healthy controls underwent 3T structural magnetic resonance imaging. Cortical thickness and subcortical volumes were estimated using an automated algorithm (Freesurfer Version 4.5). Compared to controls, social anxiety disorder patients showed significant bilateral cortical thinning in the fusiform and post central regions. Additionally, right hemisphere specific thinning was found in the frontal, temporal, parietal and insular cortices of individuals with social anxiety disorder. Although uncorrected cortical grey matter volumes were significantly lower in individuals with SAD, we did not detect volumetric differences in corrected amygdala, hippocampal or cortical grey matter volumes across study groups. Structural differences in grey matter thickness between SAD patients and controls highlight the diffuse neuroanatomical networks involved in both social anxiety and social behavior. Additional work is needed to investigate the causal mechanisms involved in such structural abnormalities in SAD.

Medial frontal hyperactivity to sad faces in generalized social anxiety disorder and modulation by oxytocin

Generalized social anxiety disorder (GSAD) is associated with heightened limbic and prefrontal activation to negative social cues conveying threat (e.g. fearful faces), but less is known about brain response to negative non-threatening social stimuli. The neuropeptide oxytocin (Oxt) has been shown to attenuate (and normalize) fear-related brain activation and reactivity to emotionally negative cues. Here, we examined the effects of intranasal Oxt on cortical activation to non-threatening sad faces in patients with GSAD and matched controls (Con). In a double-blind placebo-controlled within-subjects design, the cortical activation to sad and happy (vs. neutral) faces was examined using functional magnetic resonance imaging following acute intranasal administration of 24 IU Oxt and placebo. Relative to the Con group, GSAD patients exhibited heightened activity to sad faces in the medial prefrontal cortex (mPFC/BA 10) extending into anterior cingulate cortex (ACC/BA 32). Oxt significantly reduced this heightened activation in the mPFC/ACC regions to levels similar to that of controls. These findings suggest that GSAD is associated with cortical hyperactivity to non-threatening negative but not positive social cues and that Oxt attenuates this exaggerated cortical activity. The modulation of cortical activity by Oxt highlights a broader mechanistic role of this neuropeptide in modulating socially negative cues in GSAD.

Performance monitoring and the medial prefrontal cortex: a review of individual differences and context effects as a window on self-regulation

The medial prefrontal cortex (MPFC) is central to self-regulation and has been implicated in generating a cluster of event-related potential components, collectively referred to as medial frontal negativities (MFNs). These MFNs are elicited while individuals monitor behavioral and environmental consequences, and include the error-related negativity, Nogo N2, and the feedback-related negativity. A growing cognitive and affective neuroscience literature indicates that the activation of the anterior cingulate cortex (ACC) and surrounding medial prefrontal regions during performance monitoring is not only influenced by task context, but that these patterns of activity also vary as a function of individual differences (e.g., personality, temperament, clinical and non-clinical symptomatology, socio-political orientation, and genetic polymorphisms), as well as interactions between individual differences and task context. In this review we survey the neuroscience literature on the relations between performance monitoring, personality, task context, and brain functioning with a focus on the MPFC. We relate these issues to the role of affect in the paradigms used to elicit performance-monitoring neural responses and highlight some of the theoretical and clinical implications of this research. We conclude with a discussion of the complexity of these issues and how some of the basic assumptions required for their interpretation may be clarified with future research.

Functional network dysfunction in anxiety and anxiety disorders

A recent paradigm shift in systems neuroscience is the division of the human brain into functional networks. Functional networks are collections of brain regions with strongly correlated activity both at rest and during cognitive tasks, and each network is believed to implement a different aspect of cognition. We propose here that anxiety disorders and high trait anxiety are associated with a particular pattern of functional network dysfunction: increased functioning of the cingulo-opercular and ventral attention networks as well as decreased functioning of the fronto-parietal and default mode networks. This functional network model can be used to differentiate the pathology of anxiety disorders from other psychiatric illnesses such as major depression and provides targets for novel treatment strategies.

Imaging trait anxiety in high anxiety F344 rats: Focus on the dorsomedial prefrontal cortex

Functional magnetic resonance imaging (fMRI) has become an important method in clinical psychiatry research whereas there are still only few comparable preclinical investigations. Herein, we report that fMRI in rats can provide key information regarding brain areas underlying anxiety behavior. Perfusion as surrogate for neuronal activity was measured by means of arterial spin labeling-based fMRI in various brain areas of high anxiety F344 rats and control Sprague-Dawley rats. In one of these areas, the dorsomedial prefrontal cortex (dmPFC), c-Fos labeling was compared between these two strains with immunolabeling. The effects of a neurotoxic ibotenic acid lesion of the dmPFC in F344 rats were examined in a social approach-avoidance anxiety procedure and fMRI. Regional brain activity of high anxiety F344 rats was different in selective cortical and subcortical areas as compared to that of low anxiety Sprague-Dawley rats; the largest difference (i.e. hyperactivity) was measured in the dmPFC. Independently, c-Fos labeling confirmed that F344 rats show increased dmPFC activity. The functional role was confirmed by neurotoxic lesion of the dmPFC that reversed the high anxiety-like behavior and partially normalized the brain activity pattern of F344 rats. The current findings may have translational value as increased activity is reported in an equivalent cortical area in patients with social anxiety, suggesting that pharmacological or functional inhibition of activity in this brain area should be explored to alleviate social anxiety in patients.

Mood dysregulation and stabilization: perspectives from emotional cognitive neuroscience

Mood is conceptualized as a long-lasting emotional state, which can have profound implications for mental and physical health. The development of neuroimaging methods has enabled significant advances towards elucidating the mechanisms underlying regulation of mood and emotion; however, our understanding of mood and emotion dysregulation in stress-related psychiatric disorders is still largely lacking. From the cognitive-affective neuroscience perspective, achieving deeper, more mechanistic understanding of mood disorders necessitates detailed understanding of specific components of neural systems involved in mood dysregulation and stabilization. In this review, we provide an overview of neural systems implicated in the development of a long-term negative mood state, as well as those related to emotion and emotion regulation, and discuss their proposed involvement in mood and anxiety disorders.

Cognitive reappraisal self-efficacy mediates the effects of individual cognitive-behavioral therapy for social anxiety disorder

OBJECTIVE

To examine whether changes in cognitive reappraisal self-efficacy (CR-SE) mediate the effects of individually administered cognitive-behavioral therapy (I-CBT) for social anxiety disorder (SAD) on severity of social anxiety symptoms.

METHOD

A randomized controlled trial in which 75 adult patients (21-55 years of age; 53% male; 57% Caucasian) with a principal diagnosis of generalized SAD were randomly assigned to 16 sessions of I-CBT (n = 38) or a wait-list control (WL) group (n = 37). All patients completed self-report inventories measuring CR-SE and social anxiety symptoms at baseline and post-I-CBT/post-WL, and I-CBT completers were also assessed at 1-year posttreatment.

RESULTS

Compared with WL, I-CBT resulted in greater increases in CR-SE and greater decreases in social anxiety. Increases in CR-SE during I-CBT mediated the effect of I-CBT on social anxiety. Gains achieved by patients receiving I-CBT were maintained 1-year posttreatment, and I-CBT-related increases in CR-SE were also associated with reduction in social anxiety at the 1-year follow-up.

CONCLUSIONS

Increasing CR-SE may be an important mechanism by which I-CBT for SAD produces both immediate and long-term reductions in social anxiety.

Changes in dopamine D2-receptor binding are associated to symptom reduction after psychotherapy in social anxiety disorder

The dopamine system has been suggested to play a role in social anxiety disorder (SAD), partly based on molecular imaging studies showing reduced levels of striatal dopaminergic markers in patients compared with control subjects. However, the dopamine system has not been examined in frontal and limbic brain regions proposed to be central in the pathophysiology of SAD. In the present study, we hypothesized that extrastriatal dopamine D2-receptor (D2-R) levels measured using positron emission tomography (PET) would predict symptom reduction after cognitive behavior therapy (CBT). Nine SAD patients were examined using high-resolution PET and the high-affinity D2-R antagonist radioligand [(11)C]FLB 457, before and after 15 weeks of CBT. Symptom levels were assessed using the anxiety subscale of Liebowitz Social Anxiety Scale (LSAS(anx)). At posttreatment, there was a statistically significant reduction of social anxiety symptoms (P<0.005). Using a repeated measures analysis of covariance, significant effects for time and time × LSAS(anx) change on D2-R-binding potential (BP(ND)) were shown (P<0.05). In a subsequent region-by-region analysis, negative correlations between change in D2-R BP(ND) and LSAS(anx) change were found for medial prefrontal cortex and hippocampus (P<0.05). This is the first study to report a direct relationship between symptom change after psychological treatment and a marker of brain neurotransmission. Using an intra-individual comparison design, the study supports a role for the dopamine system in cortical and limbic brain regions in the pathophysiology of SAD.

A Cognitive Neuroscience Approach to Generalized Anxiety Disorder and Social Phobia

Generalized anxiety disorder (GAD) and social phobia (SP) are major anxiety disorders identified by the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV). They are comorbid, overlap in symptoms, yet present with distinct features (worry in GAD and fear of embarrassment in SP). Both have also been explained in terms of conditioning-based models. However, there is little reasoning currently to believe that GAD in adulthood reflects heightened conditionability or heightened threat processing—though patients with SP may show heightened processing of social threat stimuli. Moreover, the computational architectures that maintain these disorders in adulthood are different. For GAD this may reflect the development of an inefficient “worrying” strategy of emotional regulation. For SP this appears to reflect the atypical processing of self-referential information.

Ansiedade social e atribuição de emoções a faces neutras

Trabalhos anteriores têm revelado vieses no reconhecimento de emoções e padrões diferenciais de ativação cerebral no transtorno de ansiedade social. No presente estudo, foi investigada a atribuição de emoções a faces neutras em 22 indivíduos com ansiedade social e 20 voluntários controles. Através do método da escolha forçada, participantes atribuíram emoções de alegria, medo, raiva ou tristeza a faces neutras. Verificou-se que homens e mulheres com ansiedade social atribuíram mais frequentemente emoções de raiva e tristeza às faces neutras, respectivamente. A atribuição de raiva por homens pode estar associada à tendência masculina em detectar sinais de hostilidade no ambiente social, enquanto que o aumento na atribuição de tristeza pelas mulheres pode estar associado à facilitação na identificação de emoções negativas. Os resultados sugerem que a ansiedade social afeta diferentemente os sexos e têm implicações importantes sobre o uso da face neutra como condição de base ou controle nas neurociências comportamentais.

Emotionsregulation und Psychopathologie

Zusammenfassung. Eine Vielzahl psychischer Störungen im DSM-IV und ICD-10 beinhalten Symptome einer maladaptiven Emotionsregulation. Der folgende Beitrag beinhaltet einen Überblick zu Definition und Funktion von Emotionsregulation (ER). Danach werden neurowissenschaftliche Modellvorstellungen der ER und empirische Befunde zu neuronalen Korrelaten von ER-Prozessen vorgestellt. Anschließend dokumentiere ich überblicksartig Studienbefunde zur Bedeutung von ER-Prozessen für internalisierende und externalisierende Störungen. Der Beitrag schließt mit Anregungen bezüglich zukünftiger Forschungsansätze und Integration in die Psychotherapieforschung.

Mood regulation and quality of life in social anxiety disorder: an examination of generalized expectancies for negative mood regulation

The present study examined negative mood regulation expectancies, anxiety symptom severity, and quality of life in a sample of 167 patients with social anxiety disorder (SAD) and 165 healthy controls with no DSM-IV Axis I disorders. Participants completed the Generalized Expectancies for Negative Mood Regulation Scale (NMR), the Beck Anxiety Inventory, and the Quality of Life Enjoyment and Satisfaction Questionnaire. SAD symptom severity was assessed using the Liebowitz Social Anxiety Scale. Individuals with SAD scored significantly lower than controls on the NMR. Among SAD participants, NMR scores were negatively correlated with anxiety symptoms and SAD severity, and positively correlated with quality of life. NMR expectancies positively predicted quality of life even after controlling for demographic variables, comorbid diagnoses, anxiety symptoms, and SAD severity. Individuals with SAD may be less likely to engage in emotion regulating strategies due to negative beliefs regarding their effectiveness, thereby contributing to poorer quality of life.

Social anxiety and emotion regulation in daily life: spillover effects on positive and negative social events

To minimize the possibility of scrutiny, people with social anxiety difficulties exert great effort to manage their emotions, particularly during social interactions. We examined how the use of two emotion regulation strategies, emotion suppression and cognitive reappraisal, predict the generation of emotions and social events in daily life. Over 14 consecutive days, 89 participants completed daily diary entries on emotions, positive and negative social events, and their regulation of emotions. Using multilevel modeling, we found that when people high in social anxiety relied more on positive emotion suppression, they reported fewer positive social events and less positive emotion on the subsequent day. In contrast, people low in social anxiety reported fewer negative social events on days subsequent to using cognitive reappraisal to reduce distress; the use of cognitive reappraisal did not influence the daily lives of people high in social anxiety. Our findings support theories of emotion regulation difficulties associated with social anxiety. In particular, for people high in social anxiety, maladaptive strategy use contributed to diminished reward responsiveness.

See what you think: reappraisal modulates behavioral and neural responses to social stimuli

The social environment requires people to quickly form contextually appropriate social evaluations. Models of social cognition suggest that this ability depends on the interaction of automatic and controlled evaluative systems. However, controlled processes, such as reappraisal of an initial response, have rarely been studied in the context of social evaluation. In the two studies reported here, participants reappraised or simply observed angry or neutral faces. In Study 1, reappraisal modulated evaluations of angry faces on explicit as well as implicit behavioral levels. In Study 2, reappraisal altered both early and late phases of evaluative electrocortical processing. These studies suggest that controlled processes, such as reappraisal, can quickly and substantially modulate early evaluative processes in the context of biologically significant social stimuli.

Competition effects of threatening faces in social anxiety

Threatening faces involuntarily grab attention in socially anxious individuals. It is unclear, however, whether attention capture is at the expense of concurrent visual processing. The current study examined the perceptual cost effects of viewing fear-relevant stimuli (threatening faces) relative to a concurrent change-detection task. Steady-state visual evoked potentials (ssVEPs) were used to separate the neural response to 2 fully overlapping types of stimuli flickering at different frequencies: Task-irrelevant facial expressions (angry, neutral, happy) were overlaid with a task-relevant Gabor patch stream, which required a response to rare phase reversals. Groups of 17 high and 17 low socially anxious observers were recruited through online prescreening of 849 students. A prominent competition effect of threatening faces was observed solely in elevated social anxiety: When an angry face, relative to a neutral or happy face, served as a distractor, heightened ssVEP amplitudes were seen at the tagging frequency of that facial expression. Simultaneously, the ssVEP evoked by the task-relevant Gabor grating was reliably diminished compared with conditions with neutral or happy distractor faces. Thus, threatening faces capture and hold low-level perceptual resources in viewers symptomatic for social anxiety at the cost of a concurrent primary task. It is important to note that this competition in lower tier visual cortex was maintained throughout the viewing period and was unaccompanied by competition effects on behavioral performance.

The role of maladaptive beliefs in cognitive-behavioral therapy: Evidence from social anxiety disorder

Beliefs that are negatively biased, inaccurate, and rigid are thought to play a key role in the mood and anxiety disorders. Our goal in this study was to examine whether a change in maladaptive beliefs mediated the outcome of individual cognitive-behavioral therapy (CBT) for social anxiety disorder (SAD). In a sample of 47 individuals with SAD receiving CBT, we measured maladaptive interpersonal beliefs as well as emotional and behavioral components of social anxiety, both at baseline and after treatment completion. We found that (a) maladaptive interpersonal beliefs were associated with social anxiety at baseline and treatment completion; (b) maladaptive interpersonal beliefs were significantly reduced from baseline to treatment completion; and (c) treatment-related reductions in maladaptive interpersonal beliefs fully accounted for reductions in social anxiety after CBT. These results extend the literature by providing support for cognitive models of mental disorders, broadly, and SAD, specifically.

Evidence of frontotemporal structural hypoconnectivity in social anxiety disorder: A quantitative fiber tractography study

Investigation of the brain's white matter fiber tracts in social anxiety disorder (SAD) may provide insight into the underlying pathophysiology. Because models of pathological anxiety posit altered frontolimbic interactions, the uncinate fasciculus (UF) connecting (orbito-) frontal and temporal areas including the amygdala is of particular interest. Microstructural alterations in parts of the UF have been reported previously, whereas examination of the UF as discrete fiber tract with regard to more large-scale properties is still lacking. Diffusion tensor imaging was applied in 25 patients with generalized SAD and 25 healthy control subjects matched by age and gender. By means of fiber tractography, the UF was reconstructed for each participant. The inferior fronto-occipital fasciculus (IFOF), originating from the frontal cortex similarly to the UF, was additionally included as control tract. Volume and fractional anisotropy (FA) were compared between the groups for both tracts. Volume of left and right UF was reduced in patients with SAD, reaching statistical significance for the left UF. Bilateral IFOF volume was not different between groups. A similar pattern was observed for FA. Reduced volume of the left UF in SAD fits well into pathophysiological models of anxiety, as it suggests deficient structural connectivity between higher-level control areas in the orbitofrontal cortex and more basal limbic areas like the amygdala. The results point to a specific role of the left UF with regard to altered white matter volume in SAD. However, results should be replicated and functional correlates of altered UF volume be determined in future studies.

Regional homogeneity changes in social anxiety disorder: a resting-state fMRI study

The previous task-based or resting perfusion studies in social anxiety disorder (SAD) patients have highlighted specific differences in brain response. Little is known about the changes in the local synchronization of spontaneous functional magnetic resonance imaging (fMRI) blood oxygen level-dependent (BOLD) signals that occur in SAD during the resting state. We investigated altered neural activity in the resting state using a regional homogeneity (ReHo) analysis on 20 SAD and 20 healthy controls (HC). Compared with HC, SAD patients exhibited decreased coherence (ReHo) in the bilateral angular gyrus and the left medial prefrontal cortex within the default mode network (DMN), suggesting functional impairment of the perception of socially relevant emotional state and self-related mental representations; and also in the right dorsolateral prefrontal cortex and right inferior parietal gyrus within the central-executive network (CEN), reflecting the deficit of cognitive control of social anxiety. Significantly increased coherence (ReHo) was found in the left middle occipital gyrus, which would be consistent with their hypervigilance and hyperprosexia to the social communication even in the resting state. Our results might supply a novel way to look into neuro-pathophysiological mechanisms in SAD patients.

Selective influences of oxytocin on the evaluative processing of social stimuli

The neuropeptide oxytocin has been implicated in a wide range of social processes, such as pair bonding, affiliation, and social judgments that may contribute to normal adjustment and psychiatric states. The present experimental study sought to elucidate potential underlying mechanisms by which oxytocin may impact social processes by examining the effects of intranasal oxytocin on basic evaluative processes. Subjects rated slide stimuli from the International Affective Picture System, varying across multiple categories (pleasant, neutral, unpleasant) and social content. Separate ratings for arousal and for the positive and negative components of valence were obtained in the context of a bivariate evaluative space model. Oxytocin did not have an independent significant effect on positivity or negativity ratings, but instead oxytocin treatment altered the interaction between these component processes for social, relative to non-social stimuli regardless of valence conditions. Specifically, oxytocin, relative to vehicle, significantly decreased arousal ratings to threatening human stimuli without altering ratings of threatening animal stimuli. These results indicate that oxytocin may exert its effects through dynamic alterations in the partially separable neural substrates mediating arousal as well as positive and negative evaluations of social stimuli.

Magnitude and chronometry of neural mechanisms of emotion regulation in subtypes of aggressive children

Emotion regulation is a key social skill and children who fail to master it are at risk for clinical disorders. Specific styles of emotion regulation have been associated with particular patterns of prefrontal activation. We investigated whether anxious aggressive children would reveal a different pattern of cortical activation than non-anxious aggressive children and normally-developing children. We examined the magnitude and timing of source activation underlying the N2-an ERP associated with inhibitory control-during a go/nogo task with a negative emotion induction component (loss of earned points). We estimated cortical activation for two regions of interest-a ventral prefrontal and a dorsomedial prefrontal region-for three 100-ms windows over the range of the N2 (200-500 ms). Anxious aggressive children showed high ventral prefrontal activation in the early window; non-anxious aggressive children showed high ventral prefrontal activation in the late window, but only for the duration of the emotion induction; and normally-developing children showed low ventral prefrontal activation throughout. There were no group differences in dorsomedial prefrontal activation. These results suggest that anxious aggressive children recruit ventral prefrontal activation quickly and indiscriminately, possibly giving rise to their rigid, threat-oriented approach to conflict. The late ventral prefrontal activation seen for non-anxious aggressive children may underlie a more delayed, situation-specific, but ineffective response to frustration.

Evoked facial emotional expression and emotional experience in people with anorexia nervosa

OBJECTIVE

To use an experimental paradigm to assess facial expression, subjective experience of emotion and the relationship between them in people with anorexia nervosa (AN).

METHOD

Film clips are used to elicit emotion and participants' facial expression and subjective experience are recorded. Thirty inpatients with AN and 34 healthy control (HC) women are included in the study.

RESULTS

People with AN are less facially expressive than HC while watching positive and negative film clips and report feeling less positive emotion than HC but not less negative emotion. People with AN look away significantly more than HC during the negative film clip. Duration of illness and depression relate to attenuated positive facial expression and eating pathology to attenuated negative facial expression.

DISCUSSION

This experimental study supports self report studies showing people with AN attenuate emotional expression and avoid negative affect. Such behavior may affect social interaction and contribute to the maintenance of the disorder.

Amygdala hyperactivation and prefrontal hypoactivation in subjects with cognitive vulnerability to depression

The hopelessness theory (HT) of depression is a diathesis-stress theory which construes cognitive vulnerability (CV) to depression. Neuroimaging studies examining depression have implicated the amygdala as an important potential locus of dysfunction in the processing of salient threatening stimuli. However, little is known about neural activation in the brain of subjects with CV to depression. Medication-free major depressive disorder (MDD) subjects (N=29), never depressed subjects with CV (N=26), and demographically matched never depressed healthy control (HC) subjects (N=31) were scanned using functional magnetic resonance imaging (fMRI) while performing an emotional matching task. The MDD subjects showed elevated left amygdala responses and reduced left dorsolateral prefrontal cortex (dlPFC) activation levels relative to HC subjects. Similarly, CV subjects had greater activity in the amygdala bilaterally and lesser activation in the dlPFC bilaterally, relative to HC subjects. The present findings raise the possibility that cognitive vulnerability to depression might be characterized by hypoactivation of the prefrontal cortex and hyperactivation of the amygdala in response to emotional stimuli; our observations might provide a potential interpretation to explain the abnormalities in neural networks mediating cognitive modulation of emotions in individuals with cognitive vulnerability to depression.

Preliminary findings: neural responses to feedback regarding betrayal and cooperation in adolescent anxiety disorders

We compared neural and behavioral responses to feedback received during interpersonal interactions within the Prisoner's Dilemma game between adolescents with anxiety disorders (n = 12) and healthy peers (n = 17). Groups differed significantly in neural activation in the medial prefrontal cortex (mPFC), anterior cingulate cortex (ACC), precuneus, insula, and temporoparietal junction (TPJ). Anxious adolescents were also more likely than controls to cooperate after co-player betrayal. Our findings provide evidence that social behavior and related neural activity differs between anxious and healthy adolescents. These findings constitute a step toward elucidating neural correlates of social impairment in anxious youths.

Social and non-social behavioral inhibition in preschool-age children: differential associations with parent-reports of temperament and anxiety

Behavioral inhibition (BI) has generally been treated as a unitary construct and assessed by combining ratings of fear, vigilance, and avoidance to both novel social and non-social stimuli. However, there is evidence suggesting that BI in social contexts is not correlated with BI in non-social contexts. The present study examined the distinction between social and non-social BI in a community sample of 559 preschool-age children using a laboratory assessment of child temperament, a diagnostic interview, and parent-completed questionnaires. Social and non-social BI were not significantly correlated and exhibited distinct patterns of associations with parent reports of temperament and anxiety symptoms. This study suggests that BI is heterogeneous, and that distinguishing between different forms of BI may help account for the variation in trajectories and outcomes exhibited by high BI children.

Neurobiological correlates of cognitions in fear and anxiety: a cognitive-neurobiological information-processing model

We review likely neurobiological substrates of cognitions related to fear and anxiety. Cognitive processes are linked to abnormal early activity reflecting hypervigilance in subcortical networks involving the amygdala, hippocampus, and insular cortex, and later recruitment of cortical regulatory resources, including activation of the anterior cingulate cortex and prefrontal cortex to implement avoidant response strategies. Based on this evidence, we present a cognitive-neurobiological information-processing model of fear and anxiety, linking distinct brain structures to specific stages of information processing of perceived threat.

Defining reactivity: how several methodological decisions can affect conclusions about emotional reactivity in psychopathology

There are many important methodological decisions that need to be made when examining emotional reactivity in psychopathology. In the present study, we examined the effects of two such decisions in an investigation of emotional reactivity in depression: (1) which (if any) comparison condition to employ; and (2) how to define change. Depressed (N = 69) and control (N = 37) participants viewed emotion-inducing film clips while subjective and facial responses were measured. Emotional reactivity was defined using no comparison condition (i.e., raw scores), baseline comparison condition (i.e., no stimulus presented), and neutral comparison condition (i.e., neutral stimulus presented). Change in emotional reactivity was assessed using four analytic approaches: difference scores, percentage change, residualised change, and ANCOVA. Results differed among the three comparison conditions and among several of the analytic approaches. Overall, our investigation suggests that choosing a comparison condition and the definition of change can significantly influence the presence of group differences in emotional reactivity. Recommendations for studies of emotional reactivity in psychopathology are discussed.