Not intended, still embarrassed: Social anxiety is related to increased levels of embarrassment in response to unintentional social norm violations

Altered Putamen Activation for Social Comparison-Related Feedback in Social Anxiety Disorder: A Pilot Study

INTRODUCTION

Social anxiety disorder (SAD) is characterized by abnormal processing of performance-related social stimuli. Previous studies have shown altered emotional experiences and activations of different sub-regions of the striatum during processing of social stimuli in patients with SAD. However, whether and to what extent social comparisons affect behavioural and neural responses to feedback stimuli in patients with SAD is unknown.

MATERIALS AND METHODS

To address this issue, emotional ratings and functional magnetic resonance imaging (fMRI) responses were assessed while patients suffering from SAD and healthy controls (HC) were required to perform a choice task and received performance feedback (correct, incorrect, non-informative) that varied in relation to the performance of fictitious other participants (a few, half, or most of others had the same outcome).

RESULTS

Across all performance feedback conditions, fMRI analyses revealed reduced activations in bilateral putamen when feedback was assumed to be received by only a few compared to half of the other participants in patients with SAD. Nevertheless, analysis of rating data showed a similar modulation of valence and arousal ratings in patients with SAD and HC depending on social comparison-related feedback.

CONCLUSIONS

This suggests altered neural processing of performance feedback depending on social comparisons in patients with SAD.

Emotions in social anxiety disorder: A review

Extant cognitive behavioral models of social anxiety disorder (SAD) have primarily focused on cognitions and behaviors that maintain the disorder. Emotional aspects of SAD have been investigated but have not been sufficiently integrated into current models. To facilitate such integration, we reviewed the literature on emotional constructs (emotional intelligence, emotional knowledge, emotional clarity, emotion differentiation, and emotion regulation), and discrete emotions (anger, shame, embarrassment, loneliness, guilt, pride, and envy) in SAD and social anxiety. We present the studies conducted on these constructs, summarize the main findings, suggest areas for future research, discuss the findings in the context of existing models of SAD and attempt to integrate the findings into these existing models of the disorder. Clinical implications of our findings are also discussed.

РОЛЬ СОЦІАЛЬНОГО ВІДСТОРОНЕННЯ ТА ВІДКИНЕННЯ У ПАТОГЕНЕЗІ СОЦІАЛЬНОГО ТРИВОЖНОГО РОЗЛАДУ: ОГЛЯД ЗАКОРДОННОЇ ЛІТЕРАТУРИ

Мета: теоретично  проаналізувати роль соціального відсторонення та відкинення у патогенезі соціального тривожного розладу як модифікуючих факторів вразливості. Методи. Пошук попередніх досліджень здійснювався за допомогою сервісів  PubMed, Web-of-Science та Research Gate за наступними критеріями: дослідження стосувалися осіб, які мали встановлений діагноз соціальний тривожний розлад або належали до субклінічної групи; була проведена первинна оцінка чи аналіз впливу соціального відсторонення та відкинення; фокусом уваги досліджень соціальна фобія та/чи соціальне відсторонення/відкинення. Результати. Опрацьовуючи дану проблематику було проаналізовано понад 214 наукових статей, з яких  переважна частина опубліковані після 2017 року. У відповідності до критеріїв було обрано 30 статей. За результатами аналізу даних встановлено, що засвоєння соціального травматичного досвіду та підвищений рівень нейротизму сприяють формуванню непродуктивних когнітивних стратегій оцінювання («передбачення катастрофи») соціальних ситуацій й себе в них та відповідних їх змісту поведінкових стратегій уникнення через страх соціального відкинення, що безпосередньо знижує соціальну ефективність особи. Недостатня усвідомленість власних емоцій та викривлені переконання навколо них, стимулюючи уникнення й соціальне відсторонення як запобіжний засіб, обумовлюють високі показники соціальної тривожності, посилюють сприйняття соціальної загрози й зменшують сприйняття контролю над нею, та як наслідок актуалізують патерни травматичного досвіду, який особа намагалася уникнути. Опанування суб’єктивного емоційного досвіду за умов обмежених ресурсів життєвих обставин (як пандемія, проблемні стосунки, тривала ситуація невизначеності тощо) підсилюють вразливість до соціального тривожного розладу як непродуктивної копінг стратегії. Висновки. Уникнення емоційного досвіду та підтримання не коригуючого досвіду стосунків через страх бути відкинутим може закріплювати дисфункційний цикл когнітивних переконань щодо себе й світу у патогенезі соціальної фобії й знаходити свій прояв у соціальній відстороненості.  Ключові слова: уникаюча поведінка, соціальна травма, ранні дисфункційні схеми, стигма, COVID-19.

Situational Embarrassment and Its Relationship to Social Anxiety in Adults Who Stutter

Purpose Adults who stutter (AWS) have increased risk of comorbid social anxiety about speaking in social contexts. AWS also report experiencing embarrassment in different social situations; however, research has rarely been conducted on embarrassment and its relationship to social anxiety in AWS. Method AWS (N = 200) reported their level of embarrassment on four 10-point Likert items when speaking in four situational contexts: at home, to an individual important to them, in social groups, and at work. Participants were also assessed for sociodemographic, stuttering, and anxiety variables. Construct validity for the four embarrassment items was examined, the extent of embarrassment established in the four contexts as a function of age and sex, and the relationship of embarrassment to social anxiety evaluated. Results Evidence of acceptable construct validity and reliability is presented for the four embarrassment Likert items. Sixty-five percent of the sample experienced high levels of embarrassment when speaking in groups or at work, while 35.5% experienced high levels when speaking at home or to an individual important to them. Participants were significantly more embarrassed (p < .01) when speaking at work or when socializing in groups. Embarrassment was lowest when speaking in the home. Younger females were significantly more embarrassed when speaking at work or when socializing in groups. Those with high embarrassment scores on all four items were more likely to have elevated social anxiety scores (p < .001). Conclusion These preliminary results suggest that the assessment of situational embarrassment could be an important clinical measure that may help improve stuttering treatment outcomes that also target social anxiety.

Effects of mask-wearing on social anxiety: an exploratory review

BACKGROUND

A unique feature of the global coronavirus pandemic has been the widespread adoption of mask-wearing as a public health measure to minimize the risk of contagion. Little is known about the effects of increased mask-wearing on social interactions, social anxiety, or overall mental health.

OBJECTIVES

Explore the potential effects of mask-wearing on social anxiety.

DESIGN

We review existing literatures to highlight three preselected sets of factors that may be important in shaping the effects of mask-wearing on social anxiety. These are: (a) people's perceptions of the social norms associated with wearing masks; (b) people's experiences of the degree to which masks prevent accurate interpretation of social and emotional cues; and (c) people's use of masks as a type of safety behavior that enables self-concealment.

METHODS

APA PsycNet and PubMed were searched principally between September and November 2020 for articles describing the relationship between social anxiety, intolerance of uncertainty, ambiguous feedback, and safety behavior use and for research on the relationship between mask-wearing and social norms and social interactions. Information identified as relevant from articles of interest was extracted and included in our review.

RESULTS & CONCLUSIONS

The effects of mask-wearing on social anxiety are likely to be substantial and clinically relevant.

A study on the embarrassment of senders who missend emojis with opposite meanings on social apps: taking WeChat as an example

With the increasing popularity of social apps, sending emojis has become a very common way of expressing one’s emotions. However, situations often arise when people send the wrong emoji by mistake, or sometimes even an emoji with an opposite meaning, which can cause embarrassment to the sender. Taking WeChat as an example, which is widely used in Chinese communities, this study summarizes 10 types of dialogue situations in which the meaning of an emoji is wrongly sent and 12 types of emotional components that are related to embarrassment. The purpose of this study was to analyze the extent to which the 12 emotional components that are associated with embarrassment actually explain what embarrassment is, as well as the different degrees of embarrassment among the different genders and age groups. The results showed that (1) among the emotional components of embarrassment, shame has the highest explanation degree for embarrassment; (2) males are more likely to be affected by embarrassment than females; and (3) users aged 18–25 and 26–30 years are more likely to be affected by embarrassment than those aged between 31 and 40 when they mistakenly send WeChat emojis. This study provides a reference value for their sustainable psychological impact on social app users.

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.

Altered Neurobiological Processing of Unintentional Social Norm Violations: A Multiplex, Multigenerational Functional Magnetic Resonance Imaging Study on Social Anxiety Endophenotypes

BACKGROUND

Patients with social anxiety disorder (SAD) fear negative evaluation in social situations. Specifically, previous work indicated that social anxiety is associated with increased medial prefrontal cortex activation in response to unintentional social norm (SN) transgressions, accompanied by increased embarrassment ratings for such SN violations. Here, we used data from the multiplex, multigenerational LFLSAD (Leiden Family Lab study on Social Anxiety Disorder), which involved two generations of families genetically enriched for SAD, and investigated whether these neurobiological and behavioral correlates of unintentional SN processing are SAD endophenotypes. Of four endophenotype criteria, we examined two: first, the cosegregation of these characteristics with social anxiety (SA) within families of SAD probands (criterion 4), and second, the heritability of the candidate endophenotypes (criterion 3).

METHODS

Participants (n = 110, age range 9.0-61.5 years, eight families) performed the revised Social Norm Processing Task; functional magnetic resonance imaging data and behavioral ratings related to this paradigm were used to examine whether brain activation in response to processing unintentional SN violations and ratings of embarrassment were associated with SA levels. Next, heritability of these measurements was estimated.

RESULTS

As expected, voxelwise functional magnetic resonance imaging analyses revealed positive associations between SA levels and brain activation in the medial prefrontal cortex and medial temporal gyrus, superior temporal gyrus, and superior temporal sulcus, and these brain activation levels displayed moderate to moderately high heritability. Furthermore, although SA levels correlated positively with behavioral ratings of embarrassment for SN transgressions, these behavioral characteristics were not heritable.

CONCLUSIONS

These results show, for the first time, that brain responses in the medial prefrontal cortex and medial temporal gyrus, superior temporal gyrus, and superior temporal sulcus, related to processing unintentional SN violations, provide a neurobiological candidate endophenotype of SAD.

The Leiden Family Lab study on Social Anxiety Disorder: A multiplex, multigenerational family study on neurocognitive endophenotypes

OBJECTIVES

Social anxiety disorder (SAD) is a serious and prevalent psychiatric condition, with a heritable component. However, little is known about the characteristics that are associated with the genetic component of SAD, the so-called "endophenotypes". These endophenotypes could advance our insight in the genetic susceptibility to SAD, as they are on the pathway from genotype to phenotype. The Leiden Family Lab study on Social Anxiety Disorder (LFLSAD) is the first multiplex, multigenerational study aimed to identify neurocognitive endophenotypes of social anxiety.

METHODS

The LFLSAD is characterized by a multidisciplinary approach and encompasses a variety of measurements, including a clinical interview, functional and structural magnetic resonance imaging and an electroencephalography experiment. Participants are family members from 2 generations, from families genetically enriched for SAD.

RESULTS

The sample (n = 132 participants, from 9 families) was characterized by a high prevalence of SAD, in both generations (prevalence (sub)clinical SAD: 38.3%). Furthermore, (sub)clinical SAD was positively related to self-reported social anxiety, fear of negative evaluation, trait anxiety, behavioral inhibition, negative affect, and the level of depressive symptoms.

CONCLUSIONS

By the multidimensional character of the measurements and thorough characterization of the sample, the LFLSAD offers unique opportunities to investigate candidate neurocognitive endophenotypes of SAD.